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General Pharmacy > 50, 51. Oncology > Flashcards

50, 51. Oncology Flashcards

1
Q

Choose the correct statement/s concerning Zometa: (Select ALL that apply.)

A. It starts working within minutes.
B. It is a bisphosphonate.
C. The dose is 4 mg IV yearly.
D. It is used for hypercalcemia of malignancy.
E. The generic name is zoledronic acid.

A

B, D, E. IV bisphosphonates take at least 24 hours to start working and are combined with other treatments (e.g., fluid and diuretics).

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2
Q

Which of the following classes of drugs is used to treat hypercalcemia of malignancy?

A. Selective estrogen receptor modulators, Oral
B. Parathyroid hormone, SC injection
C. Estrogen, Oral
D. Bisphosphonates, IV
E. Thiazides, Oral

A

D. The IV bisphosphonates indicated for hypercalcemia of malignancy include zoledronic acid (Zometa) and pamidronate (Aredia).

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3
Q

A female patient, 61 years old, 5 foot 4 inches tall, 135 pounds, will receive oral capecitabine therapy as a component of the chemotherapeutic regimen to treat breast cancer. The initial dose is 250 mg/m2 twice daily for 2 weeks. What is the daily dose, in milligrams, during the initial treatment period using the DuBois and DuBois formula?

A. 415
B. 830
C. 1111
D. 1115
E. 3712

A

B. Caution: 415 mg is dosed twice daily; the question asked for the daily dose, which is 830 mg.

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4
Q

Carmen is receiving Zofran for nausea. Choose the mechanism of action for this agent:

A. Serotonin (5-HT3) receptor agonist
B. Dopamine blocker
C. Neurokinin-1 receptor blocker
D. Substance P inhibitor
E. Serotonin (5-HT3) receptor antagonist

A

E. Ondansetron is a 5-HT3 antagonist.

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5
Q

The following may be warning signs of cancer; if present, the patient should be referred to a physician: (Select ALL that apply.)

A. Nagging, chronic cough or hoarseness
B. Chronic congestion
C. Vaginal candida infection
D. Depression
E. Thickening or lump in breast or elsewhere

A

A, E. “CAUTION” signs of possible cancer:

Change in bowel or bladder habits
A sore that does not heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

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6
Q

A patient is receiving cisplatin therapy. She may receive the following agent to reduce the risk of renal damage:

A. Mesnex
B. Zinecard
C. Procrit
D. Totect
E. Ethyol

A

E. Amifostine (Ethyol) may be used prophylactically to reduce the risk of renal toxicity.

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7
Q

In cancer patients, anemia is being treated less commonly with erythropoietin than in previous years due to the following reasons: (Select ALL that apply.)

A. Neutropenia
B. Shortened survival
C. Severe nausea and vomiting
D. Increased tumor progression in some cancers
E. Drug shortages of iron products

A

B, D. Shortened survival and increased tumor progression have limited the use of ESAs recently.

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8
Q

What is the advantage in using darbepoetin over epoetin alfa?

A. Less frequent dosing
B. Decreased side effects
C. Faster response time
D. Oral route of administration
E. No need for iron supplementation

A

A. Darbepoetin can be given less frequently than epoetin alfa.

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9
Q

Which drug is likely to cause symptoms of heart failure?

A. Vincristine
B. Bleomycin
C. Doxorubicin
D. Cisplatin
E. Fluorouracil

A

C. Doxorubicin can cause free radicals that damage cardiac tissue. A lifetime cumulative dose of doxorubicin is well established.

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10
Q

A pharmacist received a prescription to fill for a patient receiving emetogenic chemotherapy for Sancuso to help with side effect management. Which drug should be dispensed? Choose the generic name for this branded drug:

A. Ondansetron
B. Granisetron
C. Dolasetron
D. Palonosetron
E. Netupitant

A

B. This is the patch formulation for granisetron.

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11
Q

Which of the following statements are true regarding extravasation of chemotherapy? (Select ALL that apply.)

A. Cold compresses should be used for all agents except vinca alkaloids and etoposide.
B. Warm compresses should be used for all agents except vinca alkaloids and etoposide.
C. DMSO or dexrazoxane can be used for the anthracyclines.
D. Extravasation is the leakage of the drug from a vein into the extravascular space.
E. Extravasation is rare; thus, protocols for management are typically not necessary.

A

A, C, D.

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12
Q

Choose the correct name for the test/s used to screen for prostate cancer: (Select ALL that apply.)

A. Prostate Specific Antigen
B. Digital Rectal Exam
C. FOBT
D. Colonoscopy
E. FIT

A

A, B. PSA and DRE are the tests used to screen for prostate cancer.

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13
Q

Which of the following chemotherapeutic medications is associated with a higher incidence of hand-foot syndrome?

A. Doxil
B. Ellence
C. Avastin
D. Adriamycin
E. Camptosar

A

A. Doxil (doxorubicin) and DaunoXome (daunorubicin) are liposomal formulations. These liposomal formulations are associated with more hand-foot syndrome than the non-liposomal formulations.

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14
Q

Jan has been using prochlorperazine for nausea several times daily. She is 82 years old and frail. Which of the following statements are correct regarding prochlorperazine? (Select ALL that apply.)

A. This drug can cause pseudo-parkinsonism.
B. This drug can cause significant QT prolongation.
C. This drug is a member of the ethanolamines.
D. This drug can cause strong anticholinergic side effects.
E. This drug can be given IV or SC.

A

A, B, D. Never give prochlorperazine via the SC route as this can cause gangrene.

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15
Q

A patient with cancer has developed anemia. If treated, which of the following agents could be used to increase the hemoglobin level? (Select ALL that apply.)

A. Neulasta
B. Procrit
C. Aranesp
D. Omontys
E. Leukine

A

B, C. Epoetin alfa and darbepoetin are used to treat anemia in cancer patients.

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16
Q

Which of the following drugs have high emetogenic risk? (Select ALL that apply.)

A. Cisplatin
B. Rituximab
C. Thalidomide
D. Vincristine
E. High dose cyclophosphamide

A

A, E. Cisplatin and high-dose cyclophosphamide are highly-emetogenic.

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17
Q

Choose the correct statement concerning dronabinol:

A. Appetite will likely decrease.
B. Unlike nabilone, dronabinol is no longer controlled by the DEA.
C. The capsules must be refrigerated.
D. The brand name is Cesamet.
E. It frequently causes insomnia.

A

C. Appetite will increase. Euphoria, drowsiness and orthostasis are other likely side effects. Dronabinol is C III. Nabilone is C II. Nabilone does not require refrigeration.

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18
Q

A patient will receive a chemotherapeutic regimen that includes cisplatin. Choose the correct agents given prophylactically to reduce the risk of nausea and vomiting: (Select ALL that apply.)

A. Promethazine
B. Ondansetron
C. Aprepitant
D. Droperidol
E. Dexamethasone

A

B, C, E. This three drug regimen is required for highly emetogenic regimens.

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19
Q

Which agent/s are effective in treating neutropenia? (Select ALL that apply.)

A. Filgrastim
B. Pegfilgrastim
C. Darbepoetin
D. Epoetin alfa
E. Sargramostim

A

A, B, E. These agents reduce infectious mortality when given prophylactically in patients at a high risk of febrile neutropenia. They are expensive.

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20
Q

What conditions need to be met for the addition of epoetin alfa to be appropriate to stimulate red blood cell production in a patient with cancer? (Select ALL that apply.)

A. The provider must be enrolled in the APPRISE program.
B. The baseline hemoglobin should be at least 12 g/dL.
C. A MedGuide must be dispensed to the patient.
D. The cancer must be curable.
E. Iron stores must be adequate.

A

A, C, E. If used in patients with cancer, the provider must be enrolled in the ESA APPRISE program and the hemoglobin should be < 10 g/dL. In addition, the patient should be symptomatic and iron stores adequate.

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21
Q

A pharmacist received a prescription to fill for a patient receiving emetogenic chemotherapy for Aloxi, to help with side effect management. Which drug should be dispensed? Choose the generic name for this branded drug:

A. Ondansetron
B. Granisetron
C. Dolasetron
D. Palonosetron
E. Netupitant

A

D.

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22
Q

Choose the correct name for the test used to screen for cervical cancer:

A. Pap test
B. Breast self-exam
C. Digital Rectal Exam
D. Colonoscopy
E. FOBT

A

A. A pap smear is performed to screen for cervical cancer.

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23
Q

A pharmacist received a prescription to fill for a patient receiving emetogenic chemotherapy for Zuplenz to help with side effect management. Which drug should be dispensed? Choose the generic name for this branded drug:

A. Ondansetron
B. Granisetron
C. Dolasetron
D. Palonosetron
E. Netupitant

A

A. This is the patch formulation for the ondansetron film formulation.

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24
Q

A 25 year old woman states she is concerned about developing breast cancer. She states she is “doomed” since her mother had cancer. She should be counseled to pursue the following recommended screening:

A. Yearly mammograms beginning at age 30 years old
B. Breast self-exam
C. Prostate Specific Antigen test
D. HER2/neu antigen testing
E. Clinical breast exam beginning at age 60 years old

A

B. Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health, clinical breast exam (CBE) are recommended about every 3 years for women in their 20s and 30s and every year for women 40 and over. Breast self-exam (BSE) is an option for women starting in their 20s.

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25
Q

Choose the correct name for the test/s used to screen for colon cancer: (Select ALL that apply.)

A. Sigmoidoscopy or colonoscopy
B. Digital Rectal Exam
C. Pap test
D. Fecal immunochemical test
E. Fecal occult blood test

A

A, D, E. Beginning at age 50, both men and women should follow a schedule that includes various combinations of: sigmoidoscopy, colonoscopy, barium enema or CT scan and a yearly fecal occult blood test (FOBT), or fecal immunochemical test (FIT).

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26
Q

Charlene is a 44 year old female with a history of motion sickness who has experienced debilitating nausea and vomiting with her last chemotherapy round. She is due to receive the same regimen again. Choose the risk factors present in this patient that put her at high emetogenic risk: (Select ALL that apply.)

A. Female gender
B. Poor control of nausea and vomiting with prior chemotherapy
C. Age less than 50 years
D. History of motion sickness
E. Overhydration

A

A, B, C, D. Female, age < 50 years, history of motion sickness, and poor control with previous chemotherapy are risk factors for CINV.

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27
Q

A patient presents with an acneiform rash. Which of the following oral chemotherapy agents can cause this dermatologic condition?

A. Temodar
B. Tarceva
C. Thalomid
D. Nolvadex
E. Trexall

A

B. Tarceva (erlotinib) is an EGFR (epidermal growth factor receptor) inhibitor. Acneiform rash is a side effect that has been correlated to a response to therapy.

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28
Q

A patient is beginning erythropoietin therapy for anemia. Choose the side effects that can occur with the use of this therapy: (Select ALL that apply.)

A. Arthralgias/myalgias/back pain
B. Thrombosis
C. Weight gain
D. Bleeding
E. Hypertension

A

A, B, E. Arthralgias/myalgias, thrombosis, and hypertension are significant side effects associated with ESAs.

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29
Q

Patsy has breast cancer. She is receiving tamoxifen therapy. Choose the mechanism of action for tamoxifen:

A. Selective norepinephrine receptor modulator
B. Nonselective norepinephrine receptor modulator
C. Selective estrogen receptor modulator
D. Nonselective estrogen receptor modulator
E. Selective herceptin receptor modulator

A

C. Selective estrogen receptor modulators, or SERMs, such as tamoxifen block estrogen in breast tissue and at other tissues, but can act as estrogen agonists elsewhere. They are used if the tumor is estrogen-receptor positive.

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30
Q

What is the maximum single dose of vincristine?

A. 1 mg
B. 2 mg
C. 5 mg
D. 10 mg
E. 20 mg

A

B. Due to the risk of neuropathy, the maximum single dose of vincristine is 2 mg.

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31
Q

Rituximab carries a high risk of the following severe adverse reaction:

A. Nerve damage
B. Severe infusion reactions
C. Cardiotoxicity
D. Hepatotoxicity
E. Pulmonary toxicity

A

B. Infusion reactions from rituximab can be fatal; therefore, it is administered only in a medical setting.

rituximab (Rituxan): targets CD20 antigen on B lymphocytes

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32
Q

A pharmacist has a prescription for Tarceva. Which of the following is an appropriate generic substitution for Tarceva?

A. Crizotinib
B. Capecitabine
C. Cetuximab
D. Dasatinib
E. Erlotinib

A

E. The generic name of Tarceva is erlotinib.

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33
Q

A pharmacist has filled a prescription for Femara. She should include the following points in her counseling to the patient: (Select ALL that apply.)

A. Ensure adequate calcium intake.
B. Ensure adequate vitamin D supplementation.
C. Ensure adequate iron intake.
D. Report any chest pain, jaw, neck or back pain immediately to your physician.
E. You may experience weakness, extreme fatigue and a desire to eat non-food substances such as paper. If this happens, report these symptoms immediately to your doctor.

A

A, B, D. Letrozole decreased bone mineral density and has increased risk for cardiac events.

34
Q

A patient is receiving doxorubicin chemotherapy. The patient has received a cumulative dose greater than 300 mg/m2. The patient should be receiving the following agent to reduce the risk of heart damage:

A. Mesna
B. Amifostine
C. Dexrazoxane
D. Lisinopril
E. Filgrastim

A

C. With doxorubicin, dexrazoxane (Zinecard) can be used to help reduce the risk of cardiotoxicity. It is used when the cumulative dose is greater than 300 mg/m2.

35
Q

A 62 year old patient with lymphoma (and an extensive cardiac history) is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m2 PO on days 1-5. Patient weighs 175 pounds and is 6’1” tall. What is the most appropriate dose of cyclophosphamide for this patient?

A. 950 mg
B. 1390 mg
C. 1515 mg
D. 2055 mg
E. 2250 mg

A

C. Using the BSA of 2.02, the dose of cyclophosphamide would be 1,515 mg.

36
Q

A pharmacist has a prescription for Gleevec. Which of the following is an appropriate generic substitution for Gleevec?

A. Sunitinib
B. Erlotinib
C. Nilotinib
D. Dasatinib
E. Imatinib

A

E. The generic name of Gleevec is imatinib.

37
Q

A pharmacist has a prescription for Revlimid. Which of the following is an appropriate generic substitution for Revlimid?

A. Gemcitabine
B. Docetaxel
C. Rituximab
D. Lenalidomide
E. Carboplatin

A

D. The generic name of Revlimid is lenalidomide.

38
Q

Which of the following medications contains a boxed warning that it can be fatal if given intrathecally?

A. Methotrexate
B. Vincristine
C. Cytarabine
D. Liposomal cytarabine
E. Ironotecan

A

B. Vicristine can be fatal if given intrathecally.

39
Q

Which of the following represents the principal toxicities of cisplatin? (Select ALL that apply.)

A. Ototoxicity
B. Cardiotoxicity
C. Severe nausea and vomiting
D. Nephrotoxicity
E. Pulmonary toxicity

A

A, C, D. Ototoxicity, nephrotoxicity, and nausea/vomiting are key toxicities associated with cisplatin.

40
Q

A pharmacist has a prescription for Rituxan. Which of the following is an appropriate generic substitution for Rituxan?

A. Rituximab
B. Capecitabine
C. Etoposide
D. Oxaliplatin
E. Irinotecan

A

A. The generic name of Rituxan is rituximab.

41
Q

A patient is receiving chemotherapy and her urine turns red. Which of the following chemotherapeutic agents can cause red urine?

A. Doxorubicin
B. Paclitaxel
C. Cytarabine
D. Fluorouracil
E. Mitoxantrone

A

A. Doxorubicin, idarubicin, daunorubicin, and epirubicin are all reddish-orange in color and can discolor the urine with a pink-reddish tint up to 48 hours after treatment.

42
Q

A patient has rheumatoid arthritis and will begin therapy with methotrexate. Choose the correct starting dose for this condition:

A. Starting dose is 7.5 mg po weekly
B. Starting dose is 125 mg po weekly
C. Starting dose is 250 mg po weekly
D. 2.5 mg/kg IV daily
E. 3.3 g/m2 IV per cycle

A

A. Doses of methotrexate used for rheumatoid arthritis are much lower than chemotherapeutic dosing. It is critical that patients understand that the dose is not daily, and that the correct (lower) dose is used.

43
Q

Which of the following oral medications needs to be refrigerated?

A. Erlotinib
B. Sunitinib
C. Etoposide
D. Imatinib
E. Nilotinib

A

C. When a capsule requires refrigeration (such as etoposide VePesid capsules), it is important to know. We do not regularly refrigerate capsules and therefore it is easy for pharmacy staff to leave the product out of the refrigerator; this will ruin valuable medication.

44
Q

A pre-menopausal woman with breast cancer (ER/PR+ and HER-2+) has a prescription for Arimidex 1 mg PO daily. Which of the following is the correct action to be taken by the pharmacist?

A. Fill the prescription with anastrozole.
B. Fill the prescription with tamoxifen.
C. Do not fill since the patient is HER-2+.
D. Do not fill since the patient is pre-menopausal.
E. Do not fill as this is the wrong dose.

A

D. Do not fill since the patient is pre-menopausal. Aromatase inhibitors are only approved for post-menopausal women.

45
Q

A patient is receiving trastuzumab therapy. Choose the description that describes the patient’s tumor:

A. Estrogen-receptor positive
B. ALK positive
C. Over-expresses HER2/neu
D. No K-ras mutations
E. EGRF positive

A

C. Trastuzumab should only be used if the tumor over-expresses HER2/neu.

46
Q

What is the maximum lifetime dose of bleomycin?

A. 200 units
B. 400 units
C. 550 units
D. 450 mg/m2
E. 550 mg/m2

A

B. Bleomycin has a maximum lifetime dose due to risk of pulmonary toxicity.

47
Q

A patient gave the pharmacist a prescription for Femara. Which of the following is an appropriate generic substitution forFemara?

A. Letrozole
B. Flutamide
C. Bicalutamide
D. Anastrozole
E. Exemestane

A

A. The generic name of Femara is letrozole.

48
Q

Which of the following represents the principal toxicity of vincristine therapy?

A. Progressive multifocal leukoencephalopathy
B. Nephrotoxicity
C. Cardiotoxicity
D. Nerve damage
E. Pulmonary toxicity

A

D. Cumulative (dose-dependent) nerve damage can occur with the vinca alkaloids (parathesias, gastroparesis, paralytic ileus, risk of falls, etc.)

49
Q

What FDA Pregnancy Category do thalidomide and lenalidomide belong?

A. A
B. B
C. C
D. D
E. X

A

E. There may be other options to use if the mother needs treatment or she may decide to delay treatment until the pregnancy is completed, but pregnancy category X drugs are not options as these drugs cause severe birth defects.

50
Q

A 62 year old patient with lymphoma (and an extensive cardiac history) is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m2 PO on days 1-5. Patient weighs 175 pounds and is 6’1” tall. What is the most appropriate dose of prednisone for this patient?

A. 50 mg
B. 74 mg
C. 80 mg
D. 110 mg
E. 120 mg

A

C. Using the BSA of 2.02, the dose of prednisone would calculate out to 80.8 mg. However, it’s acceptable to round to the nearest whole tablet, so 80 mg would be the correct answer.

51
Q

Choose the correct mechanism of action for the aromatase inhibitors:

A. Blocks conversion of aroma enzyme to aromatase
B. Blocks conversion to active estrogen
C. Acts as an estrogen agonist in breast tissue
D. Acts as an estrogen antagonist in breast tissue
E. Blocks androgen receptors

A

B. Aromatase inhibitors block conversion to active estrogen.

52
Q

A patient gave the pharmacist a prescription for Adriamycin. Which of the following is an appropriate generic substitution forAdriamycin?

A. Doxorubicin
B. Idarubicin
C. Epirubicin
D. Daunorubicin
E. Docetaxel

A

A. The generic name of Adriamycin is doxorubicin.

53
Q

A 62 year old patient with lymphoma (and an extensive cardiac history) is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m2 PO on days 1-5. Patient weighs 175 pounds and is 6’1” tall. Calculate the patient’s BSA using the Mosteller Formula.

A. 1.27
B. 1.85
C. 2.02
D. 2.74
E. 3

A

C. The Mosteller Formula = BSA (m2)= SQR RT ([Height(cm) x Weight(kg)]/ 3600). Wt= 175# = 79.5kg. Ht=6’1”=73”=185.4cm. BSA = 2.02

54
Q

Which of the following medications needs to be taken with food?

A. Erlotinib
B. Abiraterone
C. Capecitabine
D. Nilotinib
E. Mercaptopurine

A

C. Capecitabine needs to be taken with a meal. Erlotinib, abiraterone, nilotinib, and mercaptopurine should all be taken on an empty stomach.

55
Q

A patient gave the pharmacist a prescription for Ellence. Which of the following is an appropriate generic substitution for Ellence?

A. Idarubicin
B. Epirubicin
C. Doxorubicin
D. Daunorubicin
E. Docetaxel

A

B. The generic name of Ellence is epirubicin.

56
Q

A patient is using IV methotrexate for cancer treatment. Choose possible adverse effects: (Select ALL that apply.)

A. Pancreatitis
B. Myelosuppression
C. Red-tender palms and feet
D. Mucositis
E. Pulmonary, hepatic and renal toxicity

A

B, C, D, E. Myelosuppression, mucositis, hand-foot syndrome, and lung/liver/kidney toxicity are all serious side effects associated with methotrexate.

57
Q

A patient is receiving ifosfamide therapy. The patient should receive the following agent(s) to reduce the risk of hemorrhagic cystitis: (Select ALL that apply.)

A. Mesna
B. Loop diuretics
C. Dexrazoxane
D. Hydration
E. Dimethyl sulfoxide

A

A, D. Mesna (Mesnex) is given with all doses of ifosfamide. Aggressive hydration with fluids to flush the drug out of the bladder is also recommended to reduce the risk of this toxicity.

58
Q

A patient is going to be started on a chemotherapeutic regimen. She is prescribed dexamethasone 8 mg PO BID for 3 days. This regimen is required to prevent fluid retention associated with which of the following medications?

A. Cabazitaxel
B. Docetaxel
C. Paclitaxel
D. Irinotecan
E. Topotecan

A

B. Fluid retention is a common side effect of docetaxel. Corticosteroid treatment is required (started the day before chemotherapy) for prevention.

59
Q

Which of the following medications can cause pneumonitis and pulmonary fibrosis? (Select ALL that apply.)

A. Busulfan
B. Bleomycin
C. Cisplatin
D. Doxorubicin
E. Methotrexate

A

A, B, E. Busulfan, bleomycin and methotrexate can cause pulmonary toxicity.

60
Q

Which of the following chemotherapeutic agents have maximum lifetime doses? (Select ALL that apply.)

A. Idarubicin
B. Epirubicin
C. Daunorubicin
D. Doxorubicin
E. Methotrexate

A

A, B, C, D. The anthracyclines have maximum lifetime doses due to cardiotoxicity.

61
Q

A patient gave the pharmacist a prescription for Avastin. Which of the following is an appropriate generic substitution forAvastin?

A. Goserelin
B. Bicalutamide
C. Epirubicin
D. Bevacizumab
E. Trastuzumab

A

D. The generic name of Avastin is bevacizumab.

62
Q

A pharmacist has a prescription for Aromasin. Which of the following is an appropriate generic substitution for Aromasin?

A. Anastrozole
B. Fluvestrant
C. Exemestane
D. Leuprolide
E. Goserelin

A

C. The generic name of Aromasin is exemestane.

63
Q

A patient gave the pharmacist a prescription for Thalomid. Which of the following is an appropriate generic substitution forThalomid?

A. Erlotinib
B. Thalidomide
C. Temozolomide
D. Busulfan
E. Tositumomab

A

B. The generic name of Thalomid is thalidomide.

64
Q

What is the rationale in using leucovorin? (Select ALL that apply.)

A. To increase the clearance of doxorubicin.
B. To decrease the toxicity of methotrexate.
C. As an enzyme inhibitor to raise the concentration of drugs such as docetaxel.
D. To decrease the toxicity of cisplatin.
E. To increase the efficacy of drugs such as fluorouracil.

A

B, E. Leucovorin (or levoleucovorin) is an adjunct used in combination with other chemotherapy drugs to either enhance effectiveness, such as with flourouracil, or as a chemo-protectant/antidote to reduce the toxicity of methotrexate.

65
Q

Which of the following agents is not an alkylating agent?

A. Cyclophosphamide
B. Fluorouracil
C. Melphalan
D. Temozolomide
E. Ifosfamide

A

B. Fluorouracil is an anti-metabolite.

66
Q

A patient is receiving single agent oral capecitabine chemotherapy. Her dose is 1000 mg/m2 PO BID x 14 days every 21 days. She weighs 128 pounds and is 5’5” tall. What is her BSA (using the Mosteller Formula)?

A. 1.5
B. 1.63
C. 1.93
D. 2.23
E. 2.42

A

B. The Mosteller Formula = BSA (m2)= SQR RT ([Height(cm) x Weight(kg)]/ 3600). Wt= 128# = 58.2 kg. Ht=5’5”=65”=165.1cm. BSA = 1.63

67
Q

A pharmacist has a prescription for Ifex. Which of the following is an appropriate generic substitution for Ifex?

A. Ifosfamide
B. Cyclophosphamide
C. Erlotinib
D. Imatinib
E. Cetuximab

A

A. The generic name of Ifex is ifosfamide.

68
Q

A pharmacist has a prescription for Cytoxan. Which of the following is an appropriate generic substitution for Cytoxan?

A. Ifosfamide
B. Cyclophosphamide
C. Temozolomide
D. Bevacizumab
E. Cisplatin

A

B. The generic name of Cytoxan is cyclophosphamide.

69
Q

A 62 year old patient with lymphoma (and an extensive cardiac history) is scheduled to receive the CVP chemotherapy regimen today. The CVP regimen includes cyclophosphamide 750 mg/m2 IV on day 1, vincristine 1.4 mg/m2 IV on day 1 and prednisone 40 mg/m2 PO on days 1-5. Patient weighs 175 pounds and is 6’1” tall. What is the most appropriate dose of vincristine for this patient?

A. 1.5 mg
B. 2 mg
C. 2.5 mg
D. 3 mg
E. 4 mg

A

B. Using the BSA of 2.02, the dose would calculate out to 2.8 mg. However, the max single dose of vincristine is 2 mg (due to the risk of neuropathy).

70
Q

Which of the following represents the most significant clinical risk of ifosfamide therapy?

A. Pulmonary toxicity
B. Bladder toxicity
C. Cardiotoxicity
D. Pancreatitis
E. Fatal rash

A

B. Bladder toxicity (with high-dose cyclophosphamide and all doses of ifosfamide) can occur.

71
Q

A patient is receiving single agent oral capecitabine chemotherapy. Her dose is 1000 mg/m2 po BID x 14 days every 21 days. She weighs 128 pounds and is 5’5” tall. What is the most appropriate dose of capecitabine for this patient?

A. 1500 mg
B. 1600 mg
C. 1650 mg
D. 2200 mg
E. 2000 mg

A

C. Using the BSA of 1.63, the dose of capecitabine would calculate out to 1630 mg. However, capecitabine only comes in 50-mg and 500-mg tablets. So, rounding to the nearest full tablet is acceptable. Dose will be 1650 mg (3 x 500 mg tablets + 1 x 150 mg tablet) orally BID x 14 days and 1 week off.

72
Q

Which of the following tests should be performed prior to cisplatin therapy?

A. Audiogram
B. Echocardiogram
C. Vision test
D. Pulmonary function tests
E. Liver function tests

A

A. Cisplatin can cause ototoxicity. Baseline and frequent audiograms are recommended.

73
Q

Aromatase inhibitors are used to prevent breast cancer recurrence, but are poorly tolerated in many women. Choose the likely side effects from the use of aromatase inhibitors. (Select ALL that apply.)

A. Feeling weak and tired
B. Thrombocytopenia
C.. Nausea
D. Leukopenia
E. Hot flashes

A

A, C, E. These drugs cause significant lethargy and fatigue, hot flashes, nausea and can cause a rash and vomiting.

74
Q

Your patient complains of dry, red hands after starting Xeloda. What can you recommend to alleviate the early stages of hand-foot syndrome?

A. Folic acid
B. Vitamin B6
C. Vitamin B12
D. Emollient
E. Aspirin

A

D. Emollients to moisturize the hands have shown benefit in alleviating hand-foot syndrome. Vitamin B6, vitamin B12 and folic acid have not been proven to be beneficial for this condition.

75
Q

Candace is concerned about getting breast cancer. She is receiving raloxifene therapy. Choose the possible adverse effects from the use of raloxifene: (Select ALL that apply.)

A. Hot flashes
B. Hypotension
C. Osteoporosis
D. DVT or PE
E. Hyperglycemia

A

A, D. In the class of SERMs, only fulvestrant increases the risk of low bone density. The other SERMs improve bone density. Hot flashes can be very bothersome. Clotting risk is high so patients should not be bed-bound and should use extreme caution on long plane trips, or any situation where they are not up and moving for a long period.

76
Q

What can be given to a patient as primary prophylaxis to boost the patient’s WBC count to keep her on a scheduled chemotherapeutic regimen of doxorubicin and cyclophosphamide?

A. Filgrastim only
B. Filgrastim or pegfilgrastim
C. Filgrastim or pegfilgrastim or oprelvekin
D. Filgrastim or pegfilgrastim or oprelvekin or sargramostim
E. Pegfilgrastim only

A

B. Filgrastim or pegfilgrastim can be used for neutropenia.

77
Q

A patient gave the pharmacist a prescription for Trexall. Which of the following is an appropriate generic substitution forTrexall?

A. Cetuximab
B. Trastuzumab
C. Thalidomide
D. Lenalidomide
E. Methotrexate

A

E. The generic name of Trexall is methotrexate.

78
Q

A pharmacist has a prescription for Xeloda. Which of the following is an appropriate generic substitution for Xeloda?

A. Etoposide
B. Capecitabine
C. Cabazitaxel
D. Erlotinib
E. Oxaliplatin

A

B. The generic name of Xeloda is capecitabine.

79
Q

A patient gave the pharmacist a prescription for Erbitux. Which of the following is an appropriate generic substitution forErbitux?

A. Cetuximab
B. Trastuzumab
C. Lapatinib
D. Dasatinib
E. Erlotinib

A

A. The generic name of Erbitux is cetuximab.

80
Q

A patient is receiving chemotherapy and her urine turns blue. Which of the following chemotherapeutic agents can cause blue urine?

A. Doxorubicin
B. Fulvestrant
C. Mitoxantrone
D. Etoposide
E. Dasatinib

A

C. Mitoxantrone is an anthracycline-like agent that is blue in color and may discolor the urine to a bluish color.

81
Q

A patient gave the pharmacist a prescription for Evista 60 mg daily #30. Which of the following is an appropriate generic substitution for Evista?

A. Tamoxifen
B. Raloxifene
C. Bicalutamide
D. Anastrazole
E. Exemestane

A

B. The generic name of Evista is raloxifene.

General Pharmacy (61 decks)

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