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NAPLEX 2023 > 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

At what age should women have a pap smear and HPV DNA test?
How often?

A

age 30-65
every 5 years

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16
Q

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

A

45 years
10 years
5 years

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17
Q

Men and women age 55-74 should complete an annual ____ if all of the following:

  • In good health
  • Have ____
  • Still smoking or quit smoking within the past 15 years
A

annual CT scan of the chest
at least a 30-pack year smoking hx

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18
Q

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

what age?

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

for ≥ 50

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19
Q

Max dose for bleomycin and reason

A

Lifetime cumulative dose: 400 units
Pulmonary toxicity

(Lungs have 4 lobes – 400)

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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
(loperamide for delayed 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

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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 targeting PD-1 and CTLA-4

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41
Q

Management of pulmonary toxicity/ pneumonitis

A

stop drug
Steroids for immune therapy agents

DNE lifetime cumulative dose of 400 units for bleomycin

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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 nephrotoxicity

A

Amifostine (Ethyol)
Ensure adequate hydration

DNE max cycle dose of 100 for cisplatin

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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)
ensure adequate hydration

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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

Management of neuropathy with vincristine and oxaliplatin

A

symptomatic treatment
vincristine: limit dose to 2mg/dose
oxaliplatin: avoid cold temperatures and avoid cold beverages (cold-mediated neuropathy)

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50
Q

Which chemo drugs have clotting risk

A

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

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51
Q

What adjunctive treatment can be given with fluorouracil to enhance efficacy

A

Leucovorin

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52
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)

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53
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)

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54
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)

55
Q

what is nadir?

A

lowest point that WBCs and platelets reach after chemo

56
Q

When does nadir occur

A

7-14 days after chemo

57
Q

WBCs and platelets generally recover ____ post treatment

A

3-4 weeks

58
Q

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

A

refrigerated
SC injection

59
Q

What ANC is considered neutropenia

A

< 1000 cells/mm3

60
Q

What ANC is considered severe neutropenia

profound neutropenia?

A

< 500 cells/mm3

<100

61
Q

What are G-CSFs used for

A

To prevent neutropenia
by stimulating production of WBCs

62
Q

Filgrastin brand name

A

Neupogen

63
Q

Pegfilgrastim brand name

A

Neulasta

64
Q

How often is filgrastim dosed

A

daily

65
Q

How often is pegfilgrastim dosed

A

1 syringe once per chemo cycle

66
Q

Side effects of filgrastim & pegfilgrastim

A

Bone pain

67
Q

SE of sargramostim

A

fever, bone pain, arthralgias, myalgias, rash

68
Q

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

A

Enlarged spleen (pain in the left upper abdomen)

69
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

70
Q

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

A

True

71
Q

Neutropenia diagnosis requirements

A

Oral temp > 38.3C (101F) x 1 reading
and ANC < 500 cells/mm3

72
Q

Which bacteria have the highest risk for causing sepsis

A

Gram-negative

73
Q

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

A

Gram-negative
Pseudomonas aeruginosa

74
Q

Treatment of neutropenia, low risk patients
(expected ANC < 500 for ≤ 7 days, no comorbidities)

A

ORAL
cipro/levo + augmentin

clindamycin can replace augmentin in pcn allergy

75
Q

Treatment of neutropenia, high risk patients
(expected ANC < 500 for > 7 days, comorbidities present, renal or hepatic impairment)

A

INTRAVENOUS anti-pseudomonal beta-lactam

76
Q

ESAs should only be initiated when Hgb is

A

< 10 g/dL

77
Q

ESA’s risk in cancer

A

can shorten survival and increase tumor progression - ONLY for palliation

78
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)

79
Q

When are platelet transfusions indicated

A

When platelet count is < 10,000 cells/mm3

or < 30K with bleeding present

80
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
81
Q

For CINV, when should antiemetics be administered

A

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

82
Q

What is the onset of acute, delayed, and anticipatory CINV

A

acute - within 24 hrs after chemo
delayed - > 24 hours after chemo
anticipatory - before chemo

83
Q

Drug therapy for acute CINV

A

5HT3-RA

84
Q

Drug therapy for delayed CINV

A

NK1-RA, corticosteroids, palonosetron, olanzapine

85
Q

Drug therapy for anticipatory CINV

A

BZDs; start evening prior to chemo

86
Q

Which drug has the highest emetic risk

A

Cisplatin

87
Q

Antiemetic regimen for high-emetic risk chemo

A

3 or 4 drugs:

  • NK1RA + 5HT3RA + Olanzapine + Dexamethasone (preferred)
  • Olanzapine + Palonosetron + Dexa
  • NK1RA + 5HT3RA + Dexa
88
Q

What meds can be used for breakthrough CINV

A

5HT3-RA, dopamine RA, cannabinoids, olanzapine

89
Q

Common SE of 5HT3-RAs

A

migraine-like headaches and constipation

minimal sedation

90
Q

dopamine receptor antagonists common SE

A

sedation
(prochlorperazine, promethazine, metoclopramide)

91
Q

management of extrapyramidal symptoms like acute dystonic reactions should be managed with

A

anticholinergics (benztropine, diphenhydramine)

92
Q

Droperidol has restricted use due to

A

QT prolongation

93
Q

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

A

delta-9-THC

94
Q

Aprepitant brand name

A

(PO) Emend

95
Q

Fosaprepitant brand name

A

(IV) Emend

96
Q

What formulation does fosaprepitant come in

A

Injection

97
Q

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

A

Dexamethasone

98
Q

Ondansetron brand name

A

Zofran, Zuplenz film

99
Q

Granisetron brand name

A

Sancuso

100
Q

Palonosetron brand name

A

Aloxi

101
Q

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

A

apomorphine
hypotension

102
Q

5HT3-RA warnings

A

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

103
Q

Short-term SE of dexamethasone

A

increased appetite/weight gain, fluid retention, insomnia

Higher doses increase BP and blood glucose

104
Q

Prochlorperazine brand name

A

Compazine

105
Q

Promethazine brand name

A

Phenergan

106
Q

Metoclopramide brand name

A

Reglan

107
Q

Olanzapine brand name

A

Zyprexa

108
Q

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

A

2 years
respiratory

109
Q

Promethazine given IV route can cause

A

Serious tissue injury if extravasation occurs

deep IM preferred

110
Q

Boxed warning for metoclopramide

A

tardive dyskinesia that can be irreversible

111
Q

Side effects of dopamine receptor antagonists

A

Sedation, lethargy, acute EPS, can decrease seizure threshold

112
Q

Dronabinol brand name

A

Marinol

113
Q

Dronabinol must be

A

refrigerated

114
Q

Nabilone brand name

A

Cesamet

115
Q

Side effects of cannabinoids

A

Somnolence, euphoria, increased appetite

116
Q

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

A

16 mg/day

117
Q

What is the classic med that blocks acute diarrhea

A

Atropine

118
Q

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

A

Pilocarpine

119
Q

What drugs are used to treat Candida infection with oral mucositis

A

Nystatin oral suspension or clotrimazole troches

120
Q

Which drugs can cause hand-foot syndrome, or PPE

A

Capecitabine and FU

121
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

122
Q

What medications are used to treat hyperuricemia in tumor lysis syndrome

A

Allopurinol and rasburicase

123
Q

Treatment for mild hypercalcemia of malignancy

A

hydration and loop diuretics
IV bisphosphonates

124
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)
  • denosumab - can build bone density and reduce fraction
125
Q

Calcitonin brand name

A

Miacalcin

126
Q

Zoledronic acid brand name for hypercalcemia of malignancy

brand name for osteoporosis

A

Zometa

Reclast

127
Q

Denosumab brand name for hypercalcemia of malignancy

brand name for osteoporosis

A

Xgeva

Prolia

128
Q

Denosumab MOA

A

Monoclonal antibody that block the interaction between RANKL and RANK

129
Q

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

A

APAP and diphenhydramine

130
Q

Major chemo vesicants include

A

anthracyclines and vinca alkaloids

131
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
132
Q

Drugs that can be given intrathecally include:

and must be ______

A

Cytarabine, MTX, hydrocortisone and thiotepa

Preservative-free

133
Q

Which chemo drug can be fatal if given intrathecally

A

Vincristine

Do not dispense in a syringe

134
Q

When chemo is being planned, vaccination should precede chemo by ≥ ____

A

2 weeks

NAPLEX 2023 (88 decks)

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