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NAPLEX 2024 > 61. Oncology I: Overview + Side Effect Management > Flashcards

61. Oncology I: Overview + Side Effect Management Flashcards

1
Q

Types of skin cancers and differences

A

Basal cell and squamous cell carcinoma - common, unlikely to metastasize, simple to remove surgically or with topical treatment

Melanoma - skin cancer that forms in the melanocytes, least prevalent type of skin cancer (2%) but most deadly

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2
Q

Define adjuvant

A

Treatment given AFTER primary therapy (usually surgery) or CONCURRENT with other therapy (usually radiation) to eradicate residual disease and decrease recurrence

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3
Q

___ results are used to make a definitive cancer diagnosis

A

Biopsy

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4
Q

Define metastatic

A

Term for cancer that has spread to a different part of body from primary (starting) location

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5
Q

Define neoadjuvant

A

Treatment given BEFORE primary therapy (usually surgery) to shrink size of tumor and make surgery more effective

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6
Q

Radiation therapy uses high-energy ___ or other particles to destroy cancer cells

A

X-rays

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7
Q

Define remission

A

Disappearance of s/sx of cancer but not necessarily the presence of the disease (cancer could be undetectable but still present)

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8
Q

What does T, N, and M stand for in the TNM staging

A

T - tumor size and extent
N - spread of cancer to lymph notes
M - whether cancer has metastasized

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9
Q

____ test is one type of tumor marker common in colon cancer

A

Carcinoembryonic antigen (CEA)

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10
Q

Metastases form when malignant cells from the primary cancer (original site) travel through the ___ or ___ to form new tumors in other parts of the body

A

Lymphatic system or blood

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11
Q

The American Cancer Society (ACS) lists 7 warning signs (CAUTION). What are they?

A

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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12
Q

____ is recommended for prevention of colorectal cancer

A

Low-dose aspirin

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13
Q

To lower skin cancer risk, use a broad-spectrum sunscreen, at least SPF ___, and reapply every ___ hours

A

SPF 30, every 2 hrs

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14
Q

Breast cancer screening recommendations

A

40-44yo: optional annual mammograms
45-54yo: begin yearly mammograms
≥55yo: mammograms every 2 years or continue yearly

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15
Q

Cervical cancer screening recommendations

A

25-65yo
Pap smear every 3 years
HPV testing every 5 years
PAP smear + HPV testing every 5 years

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16
Q

Colorectal cancer screening recommendations

A

≥45 yo
Stool-based test (fecal occult blood test (gFOBT) yearly // stool DNA test (MT-sDNA) every 3 years)
Colonoscopy every 10 years
Sigmoidoscopy (FSIG) every 5 years

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17
Q

Lung cancer screening recommendations

A

≥50yo
Annual CT scan of chest if smoking hx + still smoking or quit smoking within past 15 years

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18
Q

Prostate cancer screening recommendations

A

If patient chooses to be tested:
Prostate-specific antigen (PSA) blood test ± digital rectal exam (DRE)

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19
Q

T/F: Female pts on chemotherapy should avoid pregnancy during treatment, no teratogenic concern in male pts

A

False - all pts regardless of gender must avoid conceiving during treatment

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20
Q

T/F: Pregnant females should not handle chemotherapy drugs

A

True

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21
Q

Max dose and reason: Bleomycin

A

Lifetime cumulative dose: 400 units
Pulmonary toxicity

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22
Q

Max dose and reason: Doxorubicin

A

Lifetime cumulative dose: 450-550 mg/m2
Cardiotoxicity

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23
Q

Max dose and reason: Cisplatin

A

Dose per cycle not to exceed 100 mg/m2
Nephrotoxicity

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24
Q

Max dose and reason: Vincristine

A

Single dose “capped” at 2 mg
Neuropathy

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25
Q

An IV room pharmacist might dispense a drug that requires a chemoprotectant (i.e., a medication to limit toxicity, such as ___ to prevent cardiac damage from ____)

A

Dextrazoxane
Doxorubicin

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26
Q

Almost all chemotherapy drugs cause myelosuppression except ____

A

Asparaginase, belomycin, vincristine, most monoclonal antibodies (MAbs)

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27
Q

Management of chemotherapy-associated neutropenia

A

Colony-stimulating factors (CSFs)

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28
Q

Management of chemotherapy-associated anemia

A

RBC transfusions, and (in palliation only) erythropoiesis-stimulating agents (ESAs)

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29
Q

Management of chemotherapy-associated thrombocytopenia

A

Platelet transfusion (when very low, especially if bleeding)

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30
Q

Chemotherapy drugs that cause N/V

A

Cisplatin, cyclophosphamide, ifosfamide
Others: doxorubicin, epirubicin

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31
Q

Management of chemotherapy-associated N/V

A

NK1-RA, 5HT3-RA, dexamethasone, IV/PO fluid hydration
Others: olanzapine, metoclopramide, prochlorperazine

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32
Q

Chemotherapy drugs that cause mucositis

A

Flurouracil, methotrexate
Others: capecitabine, irinotecan, many TKIs

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33
Q

Management of chemotherapy-associated mucositis

A

Symptomatic treatment (e.g. mucosal coating agents, topical local anesthetics (such as viscous lidocaine)) and analgesics for pain

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34
Q

Chemotherapy drugs that cause diarrhea

A

Irinotecan, capecitabine, fluorouracil, methotrexate, many TKIs

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35
Q

Management of chemotherapy-associated diarrhea

A

IV/PO fluid hydration, antimotility medications (e.g. loperamide)
Irinotecan: atropine for early-onset diarrhea

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36
Q

Chemotherapy drugs that cause constipation

A

Vincristine
Others: pomalidomide, thalidomide

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37
Q

Management of chemotherapy-associated constipation

A

Stimulant laxatives, PEG (PEG3350, Miralax)

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38
Q

Management of chemotherapy-associated xerostomia

A

Artificial saliva substitutes, pilocarpine, amifostine

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39
Q

Chemotherapy drugs that cause cardiomyopathy

A

Anthracyclines
Others: HER2 inhibitors (adotrastuzumab, trastuzumab, pertuzumab, lapatinib), fluorouracil

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40
Q

Management of chemotherapy-associated cardiomyopathy

A

Do not exceed lifetime cumulative dose of 450-550 mg/m2 for doxoruicin; give dextrazoxane ppx in select pts receiving doxorubicin

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41
Q

Chemotherapy drugs that cause QT prolongation

A

Arsenic trioxide, many TKIs, leuprolide

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42
Q

Chemotherapy drugs that cause pulmonary fibrosis

A

Bleomycin, busulfan, carmustine, lomustine

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43
Q

Chemotherapy drugs that cause pneumonitis

A

MAbs targeting CTLA-4 or PD-1/PD-L1, methotrexate

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44
Q

Management of chemotherapy-associated pulmonary toxicity (pulmonary fibrosis or pneumonitis)

A

Steroid for immunotherapy agents
Do not exceed lifetime cumulative dose of 400 units for bleomycin
Symptomatic management
Stop therapy

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45
Q

Chemotherapy drugs that cause hepatotoxicity

A

Antiandrogens (bicalutamide, flutamide, nilutamide)
Others: folate antimetabolites (e.g. methotrexate), pyrimidine analog antimetabolites (e.g. cytarabine), many TKIs, some MAbs

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46
Q

Management of chemotherapy-associated hepatotoxicity

A

Steroids for immunotherapy agents (e.g. CTLA-4 or PD-1/PD-L1 immune therapy MAbs - atezolizumab, durvalumab, ipilimumab, nivolumab, and pembrolizumab)
Consider stopping therapy
Symptomatic management

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47
Q

Chemotherapy drugs that cause nephrotoxicity

A

Cisplatin, methotrexate (high doses)
Others: memtrexed, pralatrexate, some MAbs)

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48
Q

Management of chemotherapy-associated nephrotoxicity

A

Amifostine (Ethyol) can be given ppx with cisplatin to reduce risk of nephrotoxicity
Ensure adequate hydration
Do not exceed max dose 100mg/m2/cycle for cisplatin

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49
Q

Chemotherapy drugs that cause hemorrhagic cystitis

A

Ifosfamide (all doses), cyclophosphamide (higher doses > 1g/m2)

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50
Q

Management of chemotherapy-associated hemorrhagic cystitis

A

Mesna (Mesnex) is ALWAYS given ppx with ifosfamide (and sometimes with cyclophosphamide) to reduce risk of hemorrhagic cystitis
Ensure adequate hydration

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51
Q

Chemotherapy drugs that cause peripheral neuropathy

A

Vinca alkaloids (vincristine, vinblastine, vinorelbine)
Platinums (cisplatin, oxaliplatin)
Taxanes (paciltaxel, docetaxel, cabazitaxel)

Others: proteasone inhibitors (bortezomib, carfilzomib), thalidomide, ado-trastuzumab emtansine, cytarabine (high doses, brentuximab)

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52
Q

Management of vincristine-associated neuropathy

A

Limit dose of vincristine to 2 mg per dose (Regardless of BSA calculated dose)

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53
Q

Management of oxaliplatin-associated neuropathy

A

Causes an acute cold-mediated sensory neuropathy; instruct pts to avoid cold temps and avoid drinking cold beverages

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54
Q

Chemotherapy drugs that cause thromboembolic risk (clotting)

A

Aromatase inhbitors (e..g anastrozole, letrozole), SERMs (e.g. tamoxifen, raloxifene)
Others: immunomodulators (thalidomide, lenalidomide, pomalidomide)

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55
Q

Treatment and Indication for adjunctive therapy for cisplatin

A

Amifostine (Ethyol) and hydration
Ppx to prevent nephrotoxicity

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56
Q

Treatment and Indication for adjunctive therapy for doxorubicin

A

Dexrazoxane (Totect, Zinecard)
Ppx to prevent cardiomyopathy

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57
Q

Treatment and Indication for adjunctive therapy for fluorouracil

A

Leucovorin or levoleucovorin
To enhance efficacy (as a cofactor)

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58
Q

Treatment and Indication for adjunctive therapy for fluorouacil or capecitabine

A

Uridine triacetate
Antidote: use within 96 hrs for an overdose or to treat severe, life-threatening or early-onset toxicity

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59
Q

Treatment and Indication for adjunctive therapy for ifosfamide

A

Mensa (Mesnex) and hydration
Ppx to prevent hemorrhagic cystitis

60
Q

Treatment and Indication for adjunctive therapy for irinotecan

A

Atropine - prevent or treat acute diarrhea
Loperamide - to treat delayed diarrhea

61
Q

Treatment and Indication for adjunctive therapy for methotrexate

A

Leucovorin or levoleucovorin - ppx to protect cells from toxicity (e.g. myelosuppression, mucositis) after high-dose methotrexate
Glucarpidase - antidote; use within 48-60 hrs for pts with methotrexate induced AKI and delayed methotrexate clearance

62
Q

S/sx and treatment of chemotherapy-associated anemia

A

decreased RBCs (Hgb/Hct)
Weakness/fatigue
Can resolve on its own or with RBC transfusion
ESA (Epotein alfa (Epogen, Procrit) or Darboepoetin alfa (Aranesp)

63
Q

S/sx and treatment of chemotherapy-associated thrombocytopenia

A

Decreased platelets
Bleeding
Platelet transfusion if platelets very low <10,000 cells/mm3

64
Q

S/sx and treatment of chemotherapy-associated leukopenia

A

Decreased WBC (immune response)
Fever/infection
Colony-stimulating factor (CSF): filgastrin (Neupogen), pegfilgrastim (Neulasta)

65
Q

The lowest point that WBCs and platelets reach is called the ___ which occurs (With most drugs) about 7-14 days after chemotherapy

A

nadir

66
Q

The RBC nadir is much later than WBC/platelet nadir, about ___ days, d/t long lifespan of RBCs

A

120 days

67
Q

WBCs and platelets generally recover ___ weeks post treatment. The next dose of chemotherapy is given after WBCs and platelets have returned to a safe level (may be delayed for more time to recover).

A

3-4 weeks

68
Q

T/F: WBCs and platelets recovery should be done naturally. Use of drugs or transfusions is not recommended.

A

False - Drugs that hasten recover can be needed. Severe cases can require a transfusion (e.g. giving RBCs for severe anemia)

69
Q

Neutropenia is defined as ANC < ____ while severe neutropenia is ANC < ____

A

Neutropenia = ANC <1000
Severe neutropenia = ANC <500

70
Q

Role of growth colony-stimulating factors in myelosuppression

A

Stimulate production of WBCs, given ppx after chemotherapy to shorten time that a pt is at risk for infection d/t neutropenia and reduce mortality from infections
Prevent neutropenia

71
Q

Filgrastim (Neupogen) vs Pegfilgrastim (Neulasta) dosing schedule

A

Filgrastim = daily
Pegfilgrastim = once per chemo cycle (longer half-life); must document when given, should have at least 14 days before next chemotherapy cycle

72
Q

____ is the colony-stimulating factors med used most commonly for stem cell transplants

A

Sargramostim (Leukine)

73
Q

Side effects of Filgrastim/pegfilgrastim

A

Bone pain
Others: fever, glomerulonephritis, generalized rash, injection site reaction

74
Q

Side effects of sargramostim

A

Fever, bone pain, arthralgias, myalgias, rash
Others: dyspnea, peripheral edema, pericardial effusion, HTN, chest pain

75
Q

Storage for Colony-stimulating factors

A

Store in refrigerators, protect vials and syringes from light

76
Q

When using colony-stimulating factors, pts should report any signs of _____

A

enlarged spleen (pain in left upper abdomen or respiratory distress syndrome)

77
Q

Febrile neutropenia diagnosis requirements

A

Fever: oral temp ≥ 38.3ºC (101ºF) x1 reading (or ≥ 38ºC (100.4ºF) sustained for >1 hr)
Neutropenia: ANC < 500 (or ANC <1000 and expected to drop to ≤500 during next 48 hrs)

78
Q

Both GP and GN bacteria cause infections in febrile neutropenia but ___ bacteria have highest risk of causing sepsis

A

Gram negative

79
Q

T/F: In neutropenia, empiric abx are started immediately if a fever occurs

A

True

80
Q

Initial empiric abx for febrile neutropenia should include coverage for _____

A

GN bacteria, including pseudomonas

81
Q

Empiric abx regimen for febrile neutropenia low risk (expected ANC ≤100 for <7 days, no comorbidities)

A

PO anti-pseudomonal abx:
Ciprofloxacin or levofloxacin PLUS amox/clav (for adequate GP coverage) or clindamycin (if PCN allergy)

82
Q

Empiric abx regimen for febrile neutropenia high risk (expected ANC ≤100 for ≥7 days, comorbidities, renal/hepatic impairment)

A

IV anti-pseudomonal beta-lactams:
Cefepime or
Ceftazidime or
Meropenem
Imipenem/cilastatin or
Pip/tazo

83
Q

Why are erythropoiesis-stimulating agent (ESAs) only used palliatively and not recommended in pts receiving chemotherapy with curative intent?

A

Can shorten survival and increase tumor progression

84
Q

What are 4 important things to consider before using ESA in a chemo patient?

A

Use is only for pts with non-myeloid malignancies where anemia is d/t chemotherapy
Upon initiation, there must be a minimum of 2 additional months of planned therapy
Initiate only when Hgb <10
Use lowest dose to avoid RBC transfusions

85
Q

____ must be assess since ESAs will not work well to correct anemia if iron levels are inadequate

A

Serum ferritin, transferrin saturation (TSAT) and total iron-binding capacity (TIBC)

86
Q

For chemotherapy-induced N/V (CINV), administer antiemetics at least ___ prior to chemotherapy and provide antiemetic medication for breakthrough N/V

A

30 min

87
Q

What are the 3 subtypes of chemotherapy-induced N/V (CINV)?

A

Acute, delayed, and anticipatory

88
Q

Compare onset of CINV subtypes acute, delayed, and anticipatory

A

Acute - within 24 hrs after chemotherapy
Delayed - > 24 hrs after chemotherapy
Anticipatory - before chemotherapy

89
Q

Patient factors that increase risk of chemotherapy-induced N/V (CINV)

A

Hx of N/V with prior regimens
Female gender, age <50yo, anxiety, depression, dehydration, hx of motion sickness

90
Q

Drug therapy for acute chemotherapy-induced N/V (CINV)

A

5HT-3 receptor antgonists (5HT3-RAs)
Others: NK1 receptor antagonist (NK1-RAs), dexamethasone, olanzapine

91
Q

Drug therapy for delayed chemotherapy-induced N/V (CINV)

A

NK1-RA, corticosteroids, palonosetron, olanzapine
Others: granisetron ER SC

92
Q

Drug therapy for anticipatory chemotherapy-induced N/V (CINV)

A

BZD - start the evening prior to chemotherapy to alleviate anxiety and N/V

93
Q

Chemo regimens with high emetic risk cause emesis at a frequency > 90%. What is an example of a high emetic risk drug?

A

Cisplatin
Others: clycophosphamide, ifosfamide

94
Q

5HT3-RA examples for chemotherapy-induced N/V (CINV)

A

Dolasetron
Ondansetron
Granisetron
Palonosetron

95
Q

NK1-RA examples for chemotherapy-induced N/V (CINV)

A

Aprepitant PO
Aprepitant injectable emulsion IV
Fosaprepitant IV
Rolapitant

96
Q

Combination antiemetic drug examples for chemotherapy-induced N/V (CINV)

A

Netupitant/palonosetron PO (Akynzeo)
Fosnetupitant/palonosetrone IV (Akynzeo)

97
Q

Corticosteroid drug examples for chemotherapy-induced N/V (CINV)

A

Dexamethasone

98
Q

For high emetic risk drugs, what antiemetic regimen do you recommend?

A

3 or 4 drugs:
NK1-RA + 5HT3-RA + olanzapine + dexamethasone (preferred)
Palonosetron + olanzapine + dexamethasone
NK1-RA +5HT3-RA + dexamethasone

99
Q

Antiemetics for breakthrough chemotherapy-induced N/V (CINV)

A

5HT3-RAs, dopamine receptors antagonists, cannabinoids, olanzapine
Others: lorazepam, dexamethasone, scopolamine

100
Q

5HT3-RAs are usually well-tolerated by most pts, with ____ being common side effects

A

Migraine-like HA and constipation

101
Q

5HT3-RAs cause minimal sedation compared to ____ and ____

A

Dopamine receptor antagonists and cannabinoids

102
Q

Dopamine receptor antagonists such as ____ commonly cause sedation and some anticholinergic side effects. ___ such as acute dystonic reactions can occur, especially in younger patients.

A

Prochlorperazine, promethazine, and metoclopramide

103
Q

Acute dystonic reactions should be treated with ___

A

anticholinergics (benztropine, diphenhydramine)

104
Q

____ is an antiemetic in the same class as haloperidol (i.e., butyrophenones) but has restricted use (or removed entirely) in most hospitals d/t ____. It used to be commonly used for postoperative N/V (not for CINV)

A

Droperidol
QT-prolongation (TdP risk)

105
Q

Cannabinoids such as ___ can be used for refractory N/V. They may cause similar

A

Dronabinol and nabilone

106
Q

Side effects of Cannabinoids (dronabinol, nabilone)

A

Similar to Cannabis - increased appetite, sedation, dysphoria, or euphoria

107
Q

NK-1RA (aprepitant, fosaprepitant) are CYP___ inhibitors. What changes to dexamethasone dose may needed when used concurrently as an antiemetic?

A

CYP3A4
Decrease dexamethasone dose (CYP3A4 substrate)

108
Q

Formulation Aprepitant (Emend) vs fosaprepitant (Emend)

A

Aprepitant = PO, injection
Fosaprepitant = injection

109
Q

Contraindications 5HT-3 RA (ondansetron, granisetron, palonosetron)

A

Do NOT use with apomorphine (Apokyn) d/t severe hypotension and loss of consciousness

110
Q

Warnings 5HT-3 RA (ondansetron, granisetron, palonosetron)

A

Dose-dependent prolonged QTc interval (more common with IV)
Serotonin syndrome when sued with other serotonergic agents

111
Q

Side effects 5HT-3 RA (ondansetron (Zofran, Zuplenz film), granisetron (Sancuso), palonosetron(Aloxi))

A

HA, constipation
Others: fatigue, dizziness, injection site reactions (Sustol)

112
Q

Side effects corticosteroids (dexamethasone (Decadron))

A

Short-term: increased appetite, weight gain, fluid retention, insomnia
Others: emotional instability (euphoria, mood swings, irritability, acute psychosis), GI upset

Long-term: increased BP and blood glucose (esp in pts with DM)

113
Q

Side effects dopamine receptor antagonists (Prochlorperazine, promethazine (Phenergan), metoclopramide (Reglan), olanzapine (Zyprexa), haloperidol (Haldol)

A

Sedation, lethargy, acute EPS (common in children; antidote is diphenhydramine or benztropine), can decrease seizure threshold
Others: hypotension, neuroleptic malignant syndrome (NMS), QT prolongation

114
Q

Boxed warnings for promethazine

A

Do not use in children < 2yo (risk of respiratory depression)
Do not given via intra-arterial or SC administration, IV route can cause serious tissue injury if extravasation occurs (deep IM injection preferred)

115
Q

Boxed warnings for metoclopramide

A

Tardive dyskinesia (TD) that can be irreversible (d/c if occurs)
Decrease dose with renal impairment

116
Q

Boxed warnings for haloperidol/droperidol

A

QT prolongation and serious arrhythmias

117
Q

Warnings for dopamine receptor antagonists (prochlorperazne, promethazine, metoclopramide, olanzapine, haloperidol)

A

Symptoms of Parkinson disease may be exacerbated - avoid use in Parkinson disease pts

118
Q

Control schedule of dronabinol capsules vs solution

A

Capsules = C-III
Solution = C-II

119
Q

Side effects Cannabinoids (Dronabinol (Marinol), nabilone (Cesamat))

A

Somnolence, euphoria, increased appetite
Others: orthostatic hypotension, dysphoria, lowering seizure threshold, use with caution in pts with hx of substance abuse or psychiatric disorders

120
Q

Dronabinol solution contains ___% alcohol

A

50%

121
Q

Dronabinol ____ has higher bioavailability than dronabinol ____

A

oral solution > capsules
2.1 mg solution = 2.5mg capsules

122
Q

Benzodiazepine MOA in CINV

A

Enhance GABA (inhibitory NT) to decrease neuronal excitability&raquo_space; alleviation of anxiety and suppression of anticipatory N/V

123
Q

Antimotility agents such as __ and ___ may be prescribed to treat chemotherapy-induced diarrhea

A

Loperamide
Diphenoxylate/atropine

124
Q

The maximum dose of loperamide is ___ /day when treating diarrhea under medical supervision

A

15mg/day

125
Q

___ also causes early-onset diarrhea that occurs during infusion of chemo drug and is often accompanied by symptoms of cholinergic excess such as ____. Treatment of cholinergic excess is ___

A

Irinotecan (I run to the can)
Abdominal cramping, rhinitis, lacrimation, and salivation
Anticholinergic drug atropine

126
Q

Oral mucositis increases risk of ___

A

oral Candida infection (thrush)

127
Q

Hand-food syndrome (aka ___ or PPE) frequently occurs following treatment with ___ and ____

A

palmar-plantar erythrodysesthesia
capecitabine, fluorouracil
Others: cytarabine, liposomal doxorubicin, and tyrosine kinase inhibitors (TKIs) sorafenib and sunitinib

128
Q

What changes in electrolytes can tumor lysis syndrome (TLS) cause?

A

hyperkalemia (can cause arrhythmias), hyperphosphatemia, hypocalcemia (can cause seizure, anorexia, nausea), and hyperuricemia

129
Q

Allopurinol is a ___ inhibitor that blocks the conversion of purines into uric acid. Treatment for TLS requires higher doses than gout.

A

xanthine oxidase

130
Q

If allopurinol is not reasonable option (e.g. risk of allopurinol-induced rash/severe skin reactions), ___ can be used as alternative

A

febuxostat

131
Q

___ is used for initial management of TLS for patients at high risk (e.g. WBC >100,000, Burkitt Lymphoma). Converts uric acid to more water-soluble metabolite which is easily secreted

A

Rasburicase

132
Q

Rasburicase (used in TLS management for pts at high risk) is contraindicated in ___ deficiency

A

G6PD

133
Q

Certain cancers cause calcium to leach from bone and into the blood cause ____ which can lead to weak bones (fractures)

A

hypercalcemia

134
Q

Pts with mild hypercalcemia (corrected calcium < ___) do not require immediate treatment though ___ can be considered

A

<12
hydration

135
Q

___ is generally considered first-line for hypercalcemia of malignancy. In severe cases, ___ may be added (for up to 48 hrs, d/t tachyphylaxis (tolerance)).
___ may be used for hypercalcemia refractory to first line therapy

A

IV bisphosphonate (e.g. pamidronate, zoledronic acid)
Calcitonin
Denosumab

136
Q

Zoledronic acid: Zometa vs Reclast

A

Reclast - IV yearly for osteoprorosis
Zometa - IV once, may repeat in 7 days if needed for hypercalcemia of malignancy

137
Q

Denosumab: Xgeva vs Prolia

A

Prolia - SC every 6 months for osteoporosis
Xgeva - SC on days 1, 8, 15 of first month, then monthly for hypercalcemia of malignancy

138
Q

MOA of denosumab (Xgeva)

A

Monoclonal antibody that blocks interaction between RANKL and RANK (a receptor on osteoclasts), preventing osteoclast formation

139
Q

______ commonly occur with virtually every monoclonal antibody (MAb). ___ can be used to prevent it

A

Immunologic reactions
Premedication - APAP and diphenhydramine ± steroids

140
Q

T/F: many chemotherapy agents are vesicants

A

True

141
Q

Major chemotherapy vesicants include ___ and ___

A

anthracyclines
Vinca alkaloids

142
Q

If extravasation occurs, apply (warm/cold) compresses
Exception: with vinca alkaloids and etoposide use (warm/cold) compresses

A

cold
warm

143
Q

Antidote of Drug extravasated: anthracyclines

A

dexrazoxan or dimethyl sulfoxide

144
Q

Antidote of Drug extravasated: vinca alkaloids and etoposide

A

Hyaluronidase

145
Q

Which chemotherapy drugs can be given intrathecally (into CSF)?

A

Cytarabine, methotrexate, hydrocortisone and thiotepa
Must be preservative-free

146
Q

T/F: pts currently on chemotherapy should receive vaccinations

A

False- should avoid during chemotherapy
Vaccination should precede chemotherapy by ≥ 2 weeks

NAPLEX 2024 (74 decks)

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