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NAPLEX > Chapter 61: Oncology I: Overview and Side Effect Management > Flashcards

Chapter 61: Oncology I: Overview and Side Effect Management Flashcards

1
Q

What is an adjuvant

A

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

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2
Q

A tumor that is not cancerous is also called

A

benign

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3
Q

What is used to make a definitive diagnosis of cancer

A

Biopsy

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4
Q

What is a neoadjuvant

A

Treatment given before the primary therapy to shrink the size of the tumor and make surgery more effective

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5
Q

Cancer that has returned after a period during which it could not be detected is called

A

recurrence

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6
Q

The disappearance of the signs and symptoms of cancer, but not necessarily the presence of the disease is called

A

Remission

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7
Q

How is cancer staged

A

T - size and extent
N - spread to lymph nodes
M - whether the cancer has metastasized

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8
Q

Cancer that cannot be cured and leads to death is called

A

Terminal or end-stage

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9
Q

What are the warning signs that warrant referral to a physician (if suspected cancer)

A 
CAUTION:
Change in bowel or bladder habits
A sore throat 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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10
Q

____ is recommended for prevention of colorectal cancer and CVD in patients who are 50-59 years old, have ASCVD risk >/= 10%, have >/= 10-year life expectancy and are at low risk of bleeding

A

Low-dose ASA

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11
Q

To reduce risk of developing skin cancer, you should use a broad-spectrum sunscreen with an SPF of at least ____ and reapply every __ hours

A

15-30

2 hours

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12
Q

Mammograms should begin ____ in women age 45-54

A

Yearly

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13
Q

Mammograms should be done _____ at age 55

A

every 2 years or yearly

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14
Q

Women age 21-29 should have a PAP smear every ___

A

3 years

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15
Q

Women age 30-65 should have a pap smear and ____ every 5 years

A

HPV DNA test

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16
Q

Men and women over 45 years should have stool-based tests done (i.e., fecal occult blood test, stool DNA test) and colonoscopy every ____ & flexible sigmoidoscopy every ___

A

10 years

5 years

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17
Q

Men and women age 55-47 should complete an annual _____ if all of the following:

  • In good health
  • Have at least a 30-pack year ____
  • Still smoking or quit smoking within the past 15 years
A

annual CT scan of the chest

smoking history

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18
Q

If a patient ops to be tested for prostate, it involves:

A 
PSA test (blood test)
\+/- digital rectal exam
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19
Q

Max dose for bleomycin and reason

A

Lifetime cumulative dose: 400 units

Pulmonary toxicity

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20
Q

Max dose for doxorubicin and reason

A

Lifetime cumulative dose: 450-550 mg/m2

Cardiotoxicity

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21
Q

Max dose for Cisplatin and reason

A

Dose per cycle not to exceed 100 mg/m2

Nephrotoxicity

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22
Q

Max dose for Vincristine and reason

A

Single dose “capped” at 2 mg

Neurotoxicity

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23
Q

Almost all classic chemo drugs can cause myelpsuppression EXCEPT:

A

asparginase, bleomycin, vincristine

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24
Q

How to manage neutropenia in myelosuppression:

A

CSFs

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25
Q

How to manage anemia in myelosuppression:

A

RBC transfusions and (in palliation only) ESAs

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26
Q

How to manage thrombocytopenia in myelosuppression:

A

platelet transfusions

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27
Q

Which chemo drugs commonly cause nausea/vomiting

A

Cisplatin, cyclophosphamide, ifosfamide

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28
Q

Management of N/V with chemotherapy

A

NK1-RA
5HT3-RA
dexamethasone
IV/PO fluid hydration

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29
Q

Which chemo drugs commonly cause mucositis

A

Fluorouracil, MTX

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30
Q

Management of mucositis with chemotherapy

A

Symptomatic treatment: mucosal coating agents, topical local anesthetics, antifungals, antivirals

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31
Q

Which chemo drugs commonly cause diarrhea

A

Irinotecan, capecitabine, FU, MTX

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32
Q

Management of diarrhea with chemotherapy

A

IV/PO fluid hydration, antimotility meds (e.g., loperamide)

Irinotecan: atropine for early-onset diarrhea

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33
Q

Which chemo drug commonly causes constipation

A

Vincristine

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34
Q

Management of constipation with chemotherapy

A

Stimulant laxatives, Miralax

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35
Q

Management of xerostomia with radiation

A

artificial saliva substitutes, pilocarpine

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36
Q

Which chemo drug class commonly causes cardiomyopathy

A

Anthracyclines

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37
Q

Which chemo drugs commonly cause QT prolongation

A

Arsenic trioxide, many TKIs

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38
Q

What can be given prophylactically in select patients receiving doxorubicin

A

dexrazoxane (Zinecard) to prevent cardiomyopathy

dexrazoxane (Totect) treatment for extravasation

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39
Q

Which chemo drugs can cause pulmonary fibrosis

A

Bleomycin, busulfan, carmustine, lomustine

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40
Q

Which chemo drugs can cause pneumonitis

A

Immune therapy MABs

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41
Q

Management of pulmonary toxicity

A

Steroids for immune therapy agents

or stop drug

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42
Q

Which chemo drugs can cause hepatotoxicity

A

Antiandrogens (bicalutamide, flutamide, nilutamide)

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43
Q

Management of hepatotoxicity

A

Steroids for immunotherapy agents

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44
Q

Which chemo drugs can cause nephrotoxicity

A

Cisplatin, MTX

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45
Q

What drug can be given prophylactically with cisplatin to reduce the risk of hepatotoxicity

A

Amifostene (Ethyol)

Ensure adequate hydration

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46
Q

Which chemo drugs can cause hemorrhagic cystitis

A

Ifosfamide (all doses), cyclophosphamide (higher doses)

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47
Q

What drug is always given prophylactically with ifosfamide (and sometimes with cyclophosphamide) to reduce risk of hemorrhagic cystitis

A

Mesna (Mesnex)

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48
Q

Which chemo drug classes can cause peripheral neuropathy

A 
Vinca alkaloids (vincristine, vinblastine, vinorelbine)
Platinums (cisplatin, oxaliplatin)
Taxanes (paclitaxed, docetaxel, cabazitaxel)
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49
Q

Which chemo drugs have clotting risk

A

Aromatase inhibitors (i.e., anastrazole, letrozole), SERMs (e.g., tamoxifen, raloxifene)

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50
Q

What adjunctive treatment can be given with fluorouracil to enhance efficacy

A

Leucovorin

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51
Q

What adjunctive treatment can be given with fluorouracil or capecitabine as an antidote within 96 hours for an OD or to treat severe, life-threatening or early-onset toxicity

A

Uridine triacetate (Vistogard)

52
Q

What adjunctive treatment can be given with MTX prophylactically after MTX to decrease myelosuppression and mucositis in high-dose therapy

A

Leucovorin or levoleucovorin (Fusilev)

53
Q

What adjunctive treatment can be given with MTX as an antidote to decrease excessive MTX levels d/t acute renal failure

A

Glucarpidase (Voraxaze)

54
Q

When does nadir occur

A

7-14 days after chemo

55
Q

WBCs and platelets generally recover ____ post treatment

A

3-4 weeks

56
Q

All drugs used for myelosuppression (e.g., EPO, filgrastim) are kept ____ and are given by ____

A

refrigerated

SC injection

57
Q

What ANC is considered neutropenia

A

< 1000 cells/mm3

58
Q

What ANC is considered severe neutropenia

A

< 500 cells/mm3

59
Q

What are G-CSFs used for

A

To prevent neutropenia

60
Q

Filgrastin brand name

A

Neupogen

61
Q

Pegfilgrastim brand name

A

Neulasta

62
Q

How often is filgrastim dosed

A

daily

63
Q

How often is pegfilgrastim dosed

A

1 syringe once per chemo cycle

64
Q

Which is longer acting: filgrastim or pegfilgrastim

A

Pegfilgrastim

65
Q

Side effects of filgrastim & pegfilgrastim

A

Bone pain

66
Q

While using filgrastim or pegfilgrastim, patients should report any signs of ______

A

Enlarged spleen (pain in the left upper abdomen)

67
Q

Which drug has to be documented when it was given since it should have at least 12 days from dose to the next cycle of chemo: filgrastim or pegfilgrastim

A

Pegfilgrastim

68
Q

T/F: empiric antibiotics are started immediately if a fever occurs after chemo

A

True

69
Q

Neutropenia diagnosis requirements

A

Oral temp > 38.3C (101F) x 1 reading

and ANC < 500 cells/mm3

70
Q

Which bacteria have the highest risk for causing sepsis

A

Gram-negative

71
Q

The initial empiric abx must provide adequate ____ coverage, including _____

A

Gram-negative

PSA

72
Q

ESAs should only be initiated when Hgb is

A

< 10 g/dL

73
Q

What needs to be assessed when using ESAs since they will not work well to correct anemia if these levels are inadequate

A

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

74
Q

When are platelet transfusions indicated

A

When platelet count is < 10,000 cells/mm3

75
Q

What patient factors increase the risk of N/V

A 
female
age < 50
anxiety, depression
dehydration
history of motion sickness
history of N/V with prior regimens
76
Q

For CINV, when should antiemetics be administered

A

30 min prior to chemo and provide take-home antiemetic therapy

77
Q

What is the onset of acute and delayed CINV

A

acute - within 24 hrs after chemo

delayed - > 24 hours after chemo

78
Q

Drug therapy for acute CINV

A

5HT3-RA

79
Q

Drug therapy for delayed CINV

A

NK1-RA, corticosteroids, palonosetron, olanzapine

80
Q

Drug therapy for anticipatory CINV

A

BZDs; start evening prior to chemo

81
Q

Which drug has the highest emetic risk

A

Cisplatin

82
Q

Antiemetic regimen for high-emetic risk chemo

A

3 or 4 drugs:

  • NK1RA + 5HT3RA + Olanzapine + Dexamethasone (preferred)
  • Olanzapine + Palonosetron + Dexa
  • NK1RA + 5HT3RA + Dexa
83
Q

What meds can be used for breakthrough CINV

A

5HT3-RA, dopamine RA, cannabinoids, olanzapine

84
Q

Common SE of 5HT3-RAs

A

migraine-like headaches and constipation

minimal sedation

85
Q

Droperidol has restricted use due to

A

QT prolongation

86
Q

Cannabinoids like dronabinol and nabilone can be used as second-line agents and are synthetic analogs of

A

delta-9-THC

87
Q

Aprepitant brand name

A

Emend

88
Q

Fosaprepitant brand name

A

Emend

89
Q

What formulation does fosaprepitant come in

A

Injection

90
Q

Aprepitant/Fosaprepitant/netupitant are CYP3A4 inhibitors; dose of _____ should be decreased

A

Dexamethasone

91
Q

Ondansetron brand name

A

Zofran

92
Q

Granisetron brand name

A

Sancuso

93
Q

Palonosetron brand name

A

Aloxi

94
Q

5HT3-RA should not be used with ____ d/t severe hypotension and loss of consciousness

A

apomorphine

95
Q

5HT3-RA warnings

A

risk of serotonin syndrome when used in combination with other serotonergic agents

96
Q

Short-term SE of dexamethasone

A

increased appetite/weight gain, fluid retention, insomnia

Higher doses increase BP and blood glucose

97
Q

Prochlorperazine brand name

A

Compazine

98
Q

Promethazine brand name

A

Phenergan

99
Q

Metoclopramide brand name

A

Reglan

100
Q

Olanzapine brand name

A

Zyprexa

101
Q

Promethazine should not be used in children < ___ years of age d/t risk of respiratory depression

A

2 years

102
Q

Promethazine given IV route can cause

A

Serious tissue injury if extravasation occurs

103
Q

Boxed warning for metoclopramide

A

tardive dyskinesia that can be irreversible

104
Q

Side effects of dopamine receptor antagonists

A

Sedation, lethargy, acute EPS, can decrease seizure threshold

105
Q

Dronabinol brand name

A

Marinol

106
Q

Dronabinol must be

A

refrigerated

107
Q

Nabilone brand name

A

Cesamet

108
Q

Side effects of cannabinoids

A

Somnolence, euphoria, increased appetite

109
Q

What is the max dose of loperamide when treating chemo induced diarrhea

A

24 mg/day

110
Q

What is the classic med that blocks acute diarrhea

A

Atropine

111
Q

What is the classic med used for xerostomia (dry mouth)

A

Pilocarpine

112
Q

What drugs are used to treat Candida infection with oral mucositis

A

Nystatin oral suspension or clotrimazole troches

113
Q

Which drugs can cause hand-foot syndrome, or PPE

A

Capecitabine and FU

114
Q

How can you treat hand-foot syndrome

A

Cooling with cold compresses
Emollients to retain moisture
Steroids and pain meds to lessen inflammation and pain

115
Q

What medications are used to treat hyperuricemia in tumor lysis syndrome

A

Allopurinol and rasburicase

116
Q

Treatment for mild hypercalcemia of malignancy

A

hydration and loop diuretics

117
Q

Treatment for mod-severe hypercalcemia of malignancy

A

IV hydration with NS
Calcitonin is sometimes used initially for up to 48 hrs
IV bisphosphonate (e.g., pamidronate, zoledronic acid) or denosumab - can build bone density and reduce fraction

118
Q

Calcitonin brand name

A

Miacalcin

119
Q

Zoledronic acid brand name for hypercalcemia of malignancy

brand name for osteoporosis

A

Zometa

Reclast

120
Q

Denosumab brand name for hypercalcemia of malignancy

brand name for osteoporosis

A

Xgeva

Prolia

121
Q

Denosumab brand name

A

Monoclonal antibody that block the interaction between RANKL and RANK

122
Q

To prevent immunologic reactions, most monoclonal antibodies require the following premeds:

A

APAP and diphenhydramine

123
Q

Major chemo vesicants include

A

anthracyclines and vinca alkaloids

124
Q

If extravasation occurs, what can be done

A

apply cold compresses (except with vinca alkaloids and etoposide, use warm compresses)

Antidotes:

  • Anthracyclines: dexrazoxane (Totect) or dimethyl sulfoxide
  • Vinca alkaloids and etoposide: hyaluronidase
125
Q

Drugs that can be given intrathecally include:

and must be ______

A

Cytarabine, MTX, hydrocortisone and thiotepa

Preservative-free

126
Q

Which chemo drug can be fatal if given intrathecally

A

Vincristine

Do not dispense in a syringe

127
Q

When chemo is being planned, vaccination should precede chemo by >/= ____

A

2 weeks

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