11 Oral Chemotherapy Kam

Question 1

What is Hand-Foot syndrome most common with?

Answer 1

Capecitabine and TKIs

Question 2

What are nonpharmacological management options for Hand-Foot syndrome?

Answer 2

Keep skin moist. Reduce friction and pressure. Wear sunscreen, avoid exposure to heat. Shower in lukewarm water. Use mild soap to bathe pat dry. War loose-fitting cotton gloves. Avoid walking barefoot. Put hands in cool water to relieve symptoms

Question 3

What pharmacologic agent can be used for Hand-Foot syndrome?

Answer 3

Pyridoxine 50-100mg PO BID (may help with tingling/numbness)

Question 4

What is Acneiform Rash most common with?

Answer 4

TKIs

Question 5

What is Grade 1 Acneiform Rash?

Answer 5

Macular or papular eruption or erythema. NO associated symptoms

Question 6

What is Grade 2 Acneiform Rash?

Answer 6

Macular or papular eruption or erythema. Pruritus or other symptoms

Question 7

What is Grade 3 Acneiform Rash?

Answer 7

Severe, generalized erythroderma or macular, papular or vesicular eruption

Question 8

What is Grade 4 Acneiform Rash?

Answer 8

Generalized exfoliative, ulcerative or blistering skin toxicity

Question 9

What is often used for Mild Acneiform Rash?

Answer 9

Topical antibiotics

Question 10

What is often used for severe Acneiform Rash?

Answer 10

Systemic antibiotics

Question 11

What is Diarrhea most common with?

Answer 11

Capecitabine and TKIs

Question 12

What is the management of Diarrhea like?

Answer 12

HOLD oral chemotherapy if increase of 4 or more stools per day over baseline until symptoms resolve and notify MD. Increase fluid intake

Question 13

How is Loperamide dosed for cancer treatment-induced diarrhea?

Answer 13

4mg followed by 2mg Q4h or after each loose stool, max 16mg/day

Question 14

Which medications must be taken WITH food?

Answer 14

(RIBCC). Cyclophosphamide. Capecitabine. Bosutinib. Imatinib. Regorafenib

Question 15

Which medications must be taken WITHOUT food?

Answer 15

(SLERPN). Erlotinib. Lapatinib. Nilotinib. Pazopanib. Ruxolitinib. Sorafenib

Question 16

What are the major drawbacks to oral chemotherapy?

Answer 16

Decrease in doctor visits. Responsibility of managing chemotherapy shifts more directly to the patient

Question 17

What are the main CYP 3A4 Inhibitors to look out for with cancer drugs?

Answer 17

(G-PACMAN). Grapefruit. Protease inhibitor. Azoles. Cimetidine. Macrolides. Amiodarone. Non-DHPs CCBs (Verapamil, Diltiazem)

Question 18

What are the main CYP 3A4 Inducers to look out for with cancer drugs?

Answer 18

(PS PORCS). Phenytoin. Smoking. Phenobarbital. Oxcarbazepine. Rifampin. Carbamazepine. St. Johns Wort

Question 19

What are some Direct Measures that can be taken to assess medication adherence?

Answer 19

Biologic assays: measure plasma levels of drug or metabolites. This is an accurate method

Question 20

What is the disadvantage of Biologic Assays?

Answer 20

Medications with short plasma half-lives (only identify the most recent doses). Costs. Time consuming

Question 21

What does REMS stand for?

Answer 21

Risk Evaluation and Mitigation Strategy. From manufacturers to ensure that the benefits of a drug or biological product outweigh its risks

Question 22

What are the 3 components to a REMS program?

Answer 22

A medication guide or patient PI. A communication plan for healthcare providers. Elements to assure safe use (ETASU)