IV Therapies in Oncology CME Exam

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Which is true about bone marrow response to Chemo therapeutic drugs?

An RDW of Normal or High is a good marker for bone marrow response. It means that marrow is producing immature erythroblasts, triggering marrow response- This is GOOD!!

An RDW of Normal or High is a good marker for bone marrow response. It means that marrow is producing immature erythroblasts, triggering marrow response- This is BAD!!

RDW only gives a functional marker of oxidative status in the patient. The RBC is the only marker that gives a measurement of marrow response.

Marrow response can only be assessed by the RBC and WBC, showing Normal to pancytopenia.

What is true about the measurement of kidney function?

The eGFR is a good way to measure kidney function but the 24hr-creatinine clearance test is the best

The most accurate measurement of kidney function is the 24hr renal clearance of 125I-iothalamate.

Serum Cystatin C is better than Levy calculation, serum creatinine clearance or 24hr urine creatinine clearance for the measurement of kidney function.

Levy is the most accurate measurement of kidney function.

How long after an IV should you wait to draw blood for liver and renal function?

24 hours only

48 hours, but better taken after 72 hours.

Best taken 24-48 hours after IV.

There is no immediate effect of Liver or Renal function on blood work

Will Normal Saline effect blood lab results? Electrolytes for 24 hours

No, Normal Saline is given all the time without any effect on blood lab results

Yes, blood lab results are effected by certain carrier fluids like Lactated Ringers, but not Normal Saline.

Yes, the RBC will be abnormal for 24 hours

Yes, the CMP electrolytes will be abnormal on lab blood work for 24 hours.

What is a way to assess and monitor hypoxia and pro-oxidant therapies in your patient?

The decrease of GGT correlates with high levels of Glutathione and anti-oxidants

The decrease in ALT/AST shows the increased use of and increased levels of Glutathione and anti-oxidants.

The increase of GGT enzymes correlates with the increased use of Glutathione and antioxidants, leading to the decreased levels of glutathione and antioxidants in the body.

The low ALT/AST levels correspond with high levels of hypoxia in the body and can indicate your therapy is working well in the patient.

Match which of these statements are correct about measuring inflammation with blood markers.

Marker of tissue damage in the body
Marker of oxidative damage in the body
Highly sensitive marker of inflammation in the body
Marker shows the presence of plasma proteins from increased inflammation
Marker associated with poor outcome in malignancies.

GGT

(Use list from above)

CRP-hs

(Use list from above)

LDH

(Use list from above)

ESR

(Use list from above)

Fibrinogen

(Use list from above)

D-Dimer

(Use list from above)

Which statement is true about high fibrinogen levels?

There is a higher risk of clot for a peripheral stick

There is a higher risk of clot and therefore you should only use a central line

Serum Iodine and B12 will increase due to an increase or reoccurrence in cancer.

True

False

What is the function of NLR (Lymphocyte-Neutrophil Ratios)?

Neutral Liver Reticulocytes is used to assess the progression of cancer

Is used to assess the probability of a viral vs bacterial infection

NLR is used to assess the function of the immune system.

This is not really a thing

What is the definition of Pseudo-Progression?

Appearance of disease progression on scans without disease progression by symptoms and/or labs.

No Appearance of disease progression on scans with no disease progression by symptoms and/or labs.

Appearance of disease improvement on scans without disease progression by symptoms and/or labs.

Appearance of disease improvement on scans with disease progression by symptoms and/or labs.

What are 2 lab values that can be used to assess immune function and activity?

WBC and RBC are lab values to check for immune function.

RDW and LDH are the first markers to check for immune dysfunction

NK cell function and N:L are lab values to check and/or calculate for immune activity.

CRP and Fibrinogen are 2 labs are accurately evaluate the immune response to cancer.

The functions of the Liver are:

Glutathione Recycling, Methylation, activates Vitamin D

Sulfation, Detoxification, RBC synthesis

Erythrocytes, Protein Synthesis, Detoxification

Glutathione recycling, Methylation, Protein synthesis

Which minerals are involved in Glutathione recycling?

Magnesium, Selenium

Molybdenum, Iodine

Molybdenum, Selenium

Magnesium, Molybdenum

Studies show that after cancer treatments,

All nutrients in the body are decreased

Glutathione levels in the body are decreased

Mental help is needed to deal with the cause

The immune system will resume normal function

Methylation is both pro or anti-cancer in most cancers.

True

False

When optimizing methylation pathways,

we never stimulate just one methyl pathway. All methyl pathways need to be stimulated.

we activate the least active methyl pathway to prime the pump.

we use specific methyl nutrients to obtain balance within the methyl pathways.

all methyl nutrients should be supplemented for essential optimization of all methyl pathways.

Glutamine is stimulatory to most cancer from a supplementary source.

True

False

Does Glutathione and Glutamine supplementation feed most cancers?

Cancer makes its own Glutathione and Glutamine and does not use supplemental Glutathione and Glutamine to feed its cancer

Glutathione is required for life and we must get it from a food or supplemental source sine we do not make our own.

Only in the presence of Vitamin C

Supplementation only makes expensive urine since supplements are not utilized by the body, therefore they cannot be utilized by cancer

Do we need to supplement with B12 or Iodine if the labs are high?

No supplementation is needed. Serum levels or B12 and Iodine are high

When there is an increase or reoccurrence in cancer, the liver dumps B12 and Iodine, leading to a supplemental need from an immediate deficiency

B12 supplementation is needed but we never supplement with Iodine unless there is a thyroid condition

We need to supplement with B12 and Folic Acid to make up for the transient deficiency made by the increased utilization by the cancer

HDIVC and nutrients should be given on same day to stimulate all the co-factor associated with the oxidative process.

True

False

Which oxidative therapy releases cytokines intracellularly?

Ozone

H2O2

Ozone with Glutathione

High Dose Vitamin C

Which statement is true?

High Dose Vitamin C produces H2O2 intracellularly and has the potential for cell damage by this mechanism.

H2O2 infusion gets intracellularly when using DMSO to drive it into the cell. Providing the mechanism for H2O2 mediated cell damage.

High Dose Vitamin C produces H2O2 extracellularly and in the plasma.

Ozone is the only oxidative therapy that can produce H2O2 intracellularly

What shifts in electrolytes are seen when infusing High Dose Vitamin C and must be accounted for with your Vitamin C infusion to reduce side effects?

Hypocalcemia, Hypokalemia, Hyponatremia, Hypochloremia

Hypercalcemia, Hyperkalemia, Hyponatremia, Hyperchloremia

Hypocalcemia, Hypokalemia, Hypernatremia, Hypermagnesemia

Hypocalcemia, Hypokalemia, Hypernatremia, Hypochloremia

Zinc Cl can be added to HDIVC.

True

False

Which additives can be added to High Dose Vitamin C?

Amino Acids

B Vitamins

Minerals

Glutathione

Which is true when administering HDIVC:

If watching kidney/liver functions closely, do labs every week when doing HDIVC

It is ok to do a series of 10-15 IV’s. Check kidney or liver function when the series of all IV’s are completed.

Hydration does not matter as much as the speed of dosage

B Vitamins complete the biochemistry of the oxidative process and better outcomes are seen.

How long do you typically continue HDIVC protocols?

One and done!

Make sure your patient knows this is a long-term therapy and 12-15 IVs are typical protocol

Until normal cancer marker levels are achieved, then protocol can be terminated

For 4 months, every year for the rest of the patients life.

Dietary changes make a difference in cancer treatment outcomes.

True

False

If oral Vitamin A is tolerated well, but levels are exceptionally low, it is ok to start with IV Vitamin A to eliminate absorption challenges.

True

False

Which B Vitamin, diluated and given IV, can mimic some of the effects of DCA?

1000 mg Thiamine HCl diluted in 250 mL normal saline

5000mg Pyridoxine diluted in 250mL ½ normal saline

500mg Dexpanthenol diluted in 250 mL normal saline

5000mcg Methylcobalamin diluted in 250 mL normal saline

Is synergistic with oxidative therapies?

No, and should never be given on the same day

Yes, it can be given on the same day but should not be combined with other therapies at time of administration.

Yes, it can be given on the same day and can be administered at the same time with HDIVC

No, it is not to be while a course of oxidative therapies are being given.

Since Iron is used in the metabolism of Artesunate, should we give Iron with Art?

No, it is not necessary. This reaction will happen despite Iron levels being low.

No, not enough is used to create an Iron deficiency

Yes, this keeps further symptoms and exacerbation of iron anemia

Yes, it is a good idea despite patient’s iron status since it is used in the metabolism of Artesunate.

Which therapies can be used on closed brain tumors?

Mistletoe, H2O2

Nutrients only

None, pack your bags and go to Hawaii

HBOT and Artesunate

What are some serious side effects of Artemisia? Neutropenia, anemia

B12 deficiency, usually only seen with oral use

Iron deficiency anemia, usually only seen with IV use

Neutropenia and anemia, usually only seen with oral use

Thalassemia, usually only seen with oral use

Artemisia and its various types are all synergistic with chemotherapy.

True

False

Which of these statements about Artesunate is FALSE?

ART and HDIVC have a synergistic relationship

Start at low dose, can be given rapidly

Not to be given in the same bag as HDIVC. Give ART, clear the line, then HDIVC

This is a good therapy to give continuously while doing other therapies. It does not need to be pulsed- done on and off every so often.

Which statements are TRUE about Artesunate?

Only compatible with IV nutrient therapies, not oxidative therapies

It must be given slow enough to tolerance due to the bitter quality which can stimulate vomiting.

Resistance does not develop to Artesunate

Must be given very slow at higher doses

Apoptosis is initiated by which cell structure?

RBC

Erythrocyte

Cell Membrane

Mitochondria

What are 3 strong eliminators of glyphosates?

Fulvic acid, Humic acid, Glycine

Glutathione, Mud, NAC

EDTA, DMSO, DMPS

Magnesium, Water, Fiber

What is the most common preservative used with IV Curcumin products?

Sodium Bicarb- check for patient intolerances

Sodium Hydroxide- check for patient intolerances

ETOH- check for patient intolerances

Potassium Sorbate- check for patient intolerances

Lipocurc, at high doses, can cause what as a side effect?

RBC damage

Liver damage

Kidney damage

Musculoskeletal Pain

Which statement is FALSE about IV Curcumin?

Safe at doses used in common protocols

Start low and titrate up to dose needed

IV form is a lipid

The water soluble form is safe and comfortable for IV administration.

Quercetin can be used orally, nebulized, intravenous, and topically.

True

False

Quercetin cannot be nebulized with NAC for lung conditions.

True

False

What is the function of Quercetin?

Mast cell destabilizer

An oxidative therapy

Tyrosine Kinase inhibition and tumor growth suppression

Inflammatory agent, used to modulate the immune system

Which statement is FALSE about Quercetin?

IV Quercetin is well tolerated and safe

Dosed to patient tolerance, not just by protocol

Incompatible with other IV nutrients

Mixed in the same bag as Vitamin C

What are some side effects of Ozone?

Oxidative- can cause hemolysis at >80mcg/ml

Immune Inhibitory at high doses

Contraindicated use with Heparin when Heparin allergies present

All of the above

What can Ozone be used for in Cancer?

Can be used as a single stand-alone therapy

Tumor hypoxia, cancer related fatigue, rashes and burns

Immune suppressive

Anti-chemotherapy agent

Which of these statements are true regarding Ozone therapy?

A regular IV line can be used and will not clot due to filter size

Cannot be used topically

Lab work of a G6PD must be obtain before initiating treatment

It’s ok to use Heparin even when there is a Heparin allergy, to make sure the ozonated blood won’t clot.

Normal tissue and wounded tissue respond the same to HBOT

True

False

Increasing the intake of antioxidants just before pro-oxidant therapies will enhance the benefits.

True

False

For the safest delivery of HDIVC, only ascorbic acid should be added to the base solution?

True

False

Any antitumor immune response can cause the appearance of disease progression, either as tumor growth or appearance of new lesions. This can be caused by:

immune cells infiltrate the tumor site

disease progression

All the above

None of the above

Would these labs CBC, CMP and G6PD be required for delivering ozone systemically?

True

False

What IV adjuvant would be avoided in the recommendations directly for treatment: after oxidative treatments such as H202, Ozone, HDIVC, Artesunate?

Zinc

Alpha Lipoic acid

Magnesium

Glutathione

Which treatment therapies cause H2O2 surges?

Methylene Blue and Ozone, B-complex

Not Methylene Blue

Vitamin C (HDIVC), Ozone, Methylene Blue

Only Vitamin C and Ozone

Which of these treatment option work as great treatments for oral mucositis?

Methylene Blue, Photo Bio-Modulation (PBM)

Ozone, H2O2, Vitamin C

Vitamin C (HDIVC) only

GSH only

NAD and Methylene Blue increase Oxidative Phosphorylation surges and triggers Mitochondrial activity.

True

False

Giving NAD and Methylene Blue together may have a side effect of too much mitochondrial excitability.

True

False

When considering Methylene Blue toxicity:

There is no toxicity

Toxicity is at very high doses that we don’t use

When given with Vitamin C (HDIVC)

When given with NAD

Which statements are true about Methylene Blue?

Only given for IV in D5W

Toxicity at high doses

Pulse Ox is inaccurate for 10-14 hours

All of the above

Which treatments depletes Glutathione:

Selenium

NAD

Vitamin C (HDIVC) and Chemotherapy

Methylcobalamin

Cancer cells produce more exogenous Glutathione than healthy cells.

True

False

Which statement is true about NAD?

NAD does not trigger mitochondrial excitability

Not enough is known about how NAD is used by cancer cells

NAD cannot be combined with other IV nutrients

NAD cannot be used for cell reparation after Chemotherapy

Regarding Methylation Support in Cancer patients:

Healthy cells need continued methylation support.

Cancer patients need increased methylation support in recovery phase

Cancer patients need punctuated methylation support

All of the above

Restrict methyl support in Cancer patients

True

False

Statistically there are equal cases of cancer patient in both over and under methylators, making both conditions a risk for cancer developement

True

False

These nutrient markers are used to monitor reoccurrence of cancer

CA125, diluted Vit C

ANA

Magnesium

Iodine and B12

Does B12 cause cancer?

No, B12 does not cause Cancer but is a marker of reoccurrence or mets

No, but it may trigger cancer growth

Yes, long term and high dose B12 causes and feeds cancer growth

Yes, B12 causes cancer

When drawing a serum B12 level

Serum B12 blood draw measures the total cobalamin- only useful if deficient

Patient must be off Biotin for 72 hours prior to blood draw

Patient must be off B12 supplement for 1 month for most accuracy

All of the above

Which important mineral nutrients are required for H2O2 production in Vitamin C (HDIVC)?

Iron

Iron and Copper

Manganese

Zinc

In general, Cancer management includes supporting healthy cells while destroying cancer cells

True

False

Regarding Photo BioModulation (PBM)

The longer the treatment, the better the outcome

Cannot be given with any other mitochondrial treatment- too excitatory

Is a targeted mitochondrial therapy

Should be used during active cancer treatments

Photo BioModulation (PBM) is dose and frequency dependent

True

False

PEMP uses magnetic pulses to change cell signaling

True

False

Regarding Radio Shockwave Therapy

Considered “supportive” cancer care

There is a caution while on anti-coagulant medication

Do NOT treat directly over tumor site

All of the above are true

Radio Shockwave Therapy can be used:

Contraindicated in lymphedema

To increased circulation and reduce pain in a non-invasive manner

Contraindicated in pain management

With anticoagulants without caution

Which of these statements is true about administering DCA and LAMC (Lipoic Acid Mineral Complex)?

LAMC and DCA shouldn’t be given on the same day.

LAMC protects against the DCA neurotoxicity and side effects and should always be given before DCA

LAMC and DCA don’t have an influence on each other

There is no toxicity to DCA and DCA should always be given first

Hyperbaric Oxygen Therapy (HBOT) modulates the signaling mechanisms of cancer cells

True

False

Hyperbaric Oxygen Therapy (HBOT) is synergistic with any cancer treatment

True

False

Which of these statements are FALSE about Hyperbaric Oxygen Therapy (HBOT)?

Decreases pro-cancer signaling

Increases Apoptosis

Changes the tumor environment/Stroma to an anti-tumor environment/Stroma

Is NOT Contraindicated with any pharmaceutics drugs

CBD is considered “supportive care” which is considered care that is supportive of improving quality of life

True

False

Which of the statements is FALSE regarding CBD

CBD interacts with Adenosine rectors, up regulating pain and irritation

It should never be smoked due to the irritation and infection risk

CBD interacts with non-Cannabinoid receptors

There are anti-cancer mechanisms to CBD

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