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Board Study Topics > 00 Chemotherapy > Flashcards

00 Chemotherapy Flashcards

1
Q

What is the generic name of Cytoxan?

A

Cyclophosphamide (Alkylating agent)

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2
Q

What are the ADRs associated with Cytoxan (Cyclophosphamide)?

A

DLT: Myelosuppression. High dose: cardiotoxicity, hemorrhagic cystitis

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3
Q

What is a common class side effect/warning with alkylating agents?

A

Myelosuppression

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4
Q

What is the generic name of Ifex?

A

Ifosfamide (Alkylating agent)

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5
Q

What can be used to prevent hemorrhagic cystitis (with ifosfamide and cyclophosphamide)?

A

Hyper-hydration with NS to flush out ACROLEIN. The use of Mesna (Mesnex), continue a few hours after end of chemo

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6
Q

What is the generic name of Busulfex?

A

Busulfan (Alkylating agent)

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7
Q

What is a unique side effect of Busulfan?

A

“Busulfan tan”, “Busulfan lung”, seizures

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8
Q

What should be used with high dose Busulfan?

A

Antiepileptic prophylaxis (commonly with Keppra)

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9
Q

What is the generic name of Trexall, Rheumatrax?

A

Methotrexate (antimetabolite)

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10
Q

What are some common side effects with Methotrexate?

A

Myelosuppression, hepatotoxic, nephrotoxic

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11
Q

What are the contraindications to MTX use?

A

Severe renal/hepatic dysfunction. Pregnancy (Category X)

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12
Q

What are some more common DDIs with MTX to keep an eye out for?

A

NSAID/Probenecid (increases [MTX] by competing for renal clearance)

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13
Q

What is one way to increase the excretion of MTX?

A

Urine alkalinization with NaHCO3 can increase renal clearance (especially w/ high dose)

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14
Q

What can be used for MTX-induced myelosuppression?

A

Leucovorin, start 24 hours after MTX administration

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15
Q

What is the generic name of Voraxaze?

A

Glucarpidase (used for MTX toxicity)

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16
Q

What is the generic name of Alimta?

A

Pemetrexed (antimetabolite)

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17
Q

What needs to be done before starting Alimta (Premetrexed)?

A

Daily folic acid and Q9 weeks of Vitamin B12 starting 1 week prior to reduce heme/GI toxicities

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18
Q

What is the generic name of Adrucil?

A

5-FU

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19
Q

What are the side effects associated with 5-FU?

A

Myelosuppression (Bolus > IV), Hand-foot syndrome (IV > bolus), Diarrhea/mucositis (IV > Bolus)

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20
Q

What is the generic name of Xeloda?

A

Capecitabine (oral pro-drug of 5-FU)

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21
Q

How do the side effects of Xeloda compare to 5-FU?

A

Similar, except more GI SEs (diarrhea, N/V, mucositis)

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22
Q

What is the generic name of Kepivance?

A

Palifermin (IV drug to help manage Mucositis)

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23
Q

What is the generic name of Gemzar?

A

Gemcitabine

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24
Q

What is the generic name of Ara-C?

A

Cytarabine

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25
Q

What are some toxicities with Ara-C (Cytarabine) to look out for?

A

High dose: Cerebullar toxicity (trouble walking straight, sitting up, writing), Conjuntivitis, N/V/mucositis

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26
Q

How is Purinethol (Mercaptopurine) metabolized?

A

By Xanthine oxidase (w/ allopurinol decrease dose by 50-75%)

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27
Q

What are the boxed warnings for Taxanes?

A

Myelosuppression, Hypersensitivity (w/i 2-3 mins, pre-med w/ steroids, H1RA, H2RA)

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28
Q

What is the generic name of Taxol?

A

Paclitaxel (Taxane) - contains Cremophor in formulation, this causes the hypersensitivity reactions

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29
Q

What is the generic name of Abraxane?

A

Paclitaxel Albumin-bound (Taxane) - no need for premeds, doesn’t contain Cremophor

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30
Q

What is the generic name of Taxotere?

A

Docetaxel (Taxane) - Contains Polysorbate 80 instead of Cremophor, still causes hypersensitivity reactions

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31
Q

How does Paclitaxel compare to Albumin-bound Paclitaxel?

A

Paclitaxel has more hypersensitivity reactions and neutropenia, but albumin bound paclitaxel has more neuropathy

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32
Q

Whats important to remember about the Vinca Alkaloids?

A

Lethal if given intrathecally - Vesicant

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33
Q

How do the side effects of Vincristine and Vinblastine compare?

A

Vincristine causes more Neurotoxicity (peripheral and central) which causes constipation. Vinblastine causes more Myelosuppression

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34
Q

What is the generic name of Camptosar?

A

Irinotecan (Topoisomerase Inhibitor)

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35
Q

What is the DLT of Camptosar (Irinotecan)?

A

“I ran to the can”: SEVERE diarrhea

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36
Q

What genetic test can help with Irinotecan?

A

UGT1A1 mutation increases toxicity

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37
Q

What pre-med if often given before Irinotecan?

A

Atropine to help with diarrhea. Once symptoms occur, other agents can be used (Loperamide, Lomitil, Octreotide)

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38
Q

What is the generic name of Toposar?

A

Etoposide (Topoisomerase II inhibitor)

39
Q

What is a common ADR with Etoposide?

A

Infusion-related reaction (contains Polysorbate 80)

40
Q

What is a warning associated with Cisplatin?

A

Nephrotoxicity!!! Anaphylaxis, Ototoxicity

41
Q

What are the ADRs associated with Cisplatin?

A

N/V (acute and delayed). Myelosuppression

42
Q

What can be done to help with the severe N/V caused by Cisplatin?

A

Antiemetics for highly emetogenic therapy (eg., Aprepitant + 5HT3 antagonist + Steroid)

43
Q

What is the DLT with Paraplatin (Carboplatin)?

A

Myelosuppression

44
Q

How do the toxicities of Carboplatin and Cisplatin compare?

A

Carboplatin has less Nephrotoxicity but greater Myelosuppression

45
Q

What is the major ADR seen with Eloxatin (Oxaliplatin)?

A

Peripheral neuropathy (exacerbated by cold temperature)

46
Q

What is a common class side effect of Anthracyclines?

A

Cardiotoxicity (max cumulative dose for all agents ~500mg/m2), vesicants, myelosuppression, cause urine to be red

47
Q

What is the generic name of Adriamycin?

A

Doxorubicin (anthracycline)

48
Q

What is the generic name of Doxil?

A

Liposomal Doxorubicin (slightly less cardiotoxicity than Doxorubicin, but more HFS and stomatitis)

49
Q

What is the generic name of Cerubidine?

A

Daunorubicin

50
Q

What is the generic name of Zinecard?

A

Dexrazoxane (free-radical scavenger) - used to help prevent cardiotoxicity caused by anthracyclines

51
Q

What is the generic name of Totect?

A

Dexrazoxane - indicated for the treatment of anthracycline-induced extravasation

52
Q

What are some warnings with the use of Blenoxane (Bleomycin)?

A

Pulmonary fibrosis (esp. > 400 units), oxygen treatment (> 25%) can increase pulmonary toxicity

53
Q

What are some warnings with the use of Nolvadex (Tamoxifen)?

A

(Anti-estrogen: SERM): Stroke, PE, uterine malignancy

54
Q

What is a common ADR seen with anti-estrogen type chemotherapy treatments?

A

Menopausal symptoms (hot flashes), fluid retention, tumor flare, osteoporosis

55
Q

What is the generic name of Arimidex?

A

Anastrozole (selective aromatase inhibitor): osteoporosis risk > than with Tamoxifen

56
Q

What is the generic name of Gleevec?

A

Imatinib mesylate (TKI)

57
Q

What are the ADRs associated with Gleevec (Imatinib mesylate)?

A

Myelosuppression. Fluid retention (CHF, LVEF)

58
Q

What is the generic name of Tarceva?

A

Erlotinib

59
Q

What are the ADRs associated with Tarceva (Erlotinib)?

A

Acneiform rash, Diarrhea

60
Q

What is the generic name of Nexavar?

A

Sorafenib (multi-kinases)

61
Q

What is the generic name of Sutent?

A

Sunitinib (multi-kinases)

62
Q

How do the ADRs of Sorafenib and Sunitinib compare?

A

Sunitinib has more HTN and stomatitis, but less HFS. Sorafenib also causes diarrhea

63
Q

What is the generic name of Rituxan?

A

Rituximab (Anti-CD20)

64
Q

What are the warnings associated with Rituxan?

A

1st dose infusion reaction. PML

65
Q

What is the generic name of Herceptin?

A

Trastuzumab (Anti-HER-2)

66
Q

What are the warnings associated with Herceptin?

A

Cardiotoxicity. Pulmonary toxicity. Infusion-related reaction

67
Q

What is the generic name of Erbitux?

A

Cetuximab (Anti-EGFR)

68
Q

What is the generic name of Avastin?

A

Bevacizumab (Anti-VEGF)

69
Q

What are the warnings associated with Avastin?

A

Wound dehiscence (be careful if patients needs surgery)

70
Q

What is the class warning for Immunomodulator Antiangiogenesis drugs?

A

Thromboembolism, recommend patients be on an anti-coagulant. Required to be in REMS program

71
Q

What are the Immunomodulator Antiangiogenesis drugs?

A

Thalomid (Thalidomide), Revlimid (Lenalidomide)

72
Q

What is the generic name of Velcade?

A

Bortezomib (Protease inhibitor)

73
Q

What is a common ADR with Velcade (Bortezomib)?

A

Peripheral neuropathy

74
Q

What cancer type is Hydroxyurea (Hydrea) used for?

A

Heme, Solid tumors (also for SICKLE CELL)

75
Q

What is the generic name of Torisel?

A

Temsirolimus (mTOR kinase inhibitor: only chemo for kidney cancer)

76
Q

What is the generic name of Afinitor?

A

Everolimus (mTOR kinase inhibitor: also used for GVHD prophylaxis)

77
Q

What is the generic name of Zofran?

A

Ondansetron (5HT3 Receptor Antagonist)

78
Q

What is the generic name of Kytril?

A

Granisetron (5HT3 Receptor Antagonist)

79
Q

What is the generic name of Sancuso?

A

Granisetron Patch (5HT3 Receptor Antagonist)

80
Q

What is the generic name of Anzemet?

A

Dolasetron (5HT3 Receptor Antagonist) - least potent

81
Q

What is the generic name of Aloxi?

A

Palonosetron (5HT3 Receptor Antagonist) - most potent

82
Q

What is a common side effect of the 5HT3 receptor antagonists?

A

Constipation, QT prolongation

83
Q

Which chemotherapy drugs have high emetic risk?

A

Cisplatin, Cyclophosphamide (these are the most common)

84
Q

Which chemotherapy drugs have delayed onset of emesis?

A

Cisplatin, Carboplatin, Cyclophosphamide, and Doxorubicin

85
Q

What is the generic name of Emend?

A

Aprepitant (NK-1 Receptor Antagonist)

86
Q

How is Emend (Aprepitant) dosed?

A

3 days only! PO: 125mg day 1, 80mg day 2 and 3. OR given IV 150mg and nothing day 2 and 3

87
Q

What is the generic name of Decadron?

A

Dexamethasone

88
Q

How is Decadron (Dexamethasone) dosed?

A

With Aprepitant: 12mg day 1, 8mg day 2-4

W/o Aprepitant: 10-20mg day 1, 8mg day 2-4

89
Q

What is the generic name of Reglan?

A

Metoclopramide

90
Q

What is a side effect to look out for with Reglan (Metoclopramide)?

A

EPS

91
Q

How are anti-emetic drugs usually dosed for a highly emetogenic chemotherapy regimen?

A

Day 1: Dexamethasone + Aprepitant (or Olanzapine) + 5HT3 antagonist (Palonosetron preferred). Day 2-3: Dexamethasone + Aprepitant (or Olanzapine). Day 4: Dexamethasone (+ Olanzapine)

92
Q

How are anti-emetic drugs usually dosed for a moderately emetogenic chemotherapy regimen?

A

Day 1: Dexamethasone + 5HT3 antagonist. Days 2-4: Dexamethasone

93
Q

What is the generic of Mozobil?

A

Plerixafor (use with filgastrim for hematopoietic stem cell mobilization)

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