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NAPLEX 2023 > Chapter 62: Oncology II - Common Cancers & Cancer Treatment > Flashcards

Chapter 62: Oncology II - Common Cancers & Cancer Treatment Flashcards

1
Q

When treatment has destroyed all known tumors

A

Complete response

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2
Q

A partial response in cancer is when

A

at least 30% of the tumor was eliminated

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3
Q

The majority of adverse effects are due to damaging effects on non-cancerous, rapidly-dividing cells in the:

A

GI tract, hair follicles and bone marrow, where the production of blood cells take place

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4
Q

Which drugs can increase the risk of skin cancer

A

Immunosuppressants (including many transplant drugs)

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5
Q

What does each letter stand for in ABCDE for educating patients on suspicious skin spots?

A 
Asymmetry
Border
Color
Diameter
Evolving
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6
Q

What is the top risk factor for breast cancer

A

female gender

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7
Q

What are the modifiable RF for breast cancer

A

Being overweight (in postmenopausal women)
Low physical activity
Poor nutrition
Tobacco use

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8
Q

Which genes normally suppress tumor growth in breast cancer

A

BRCA1 and BRCA2

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9
Q

Inherited mutations in BRCA1 and BRCA2 prevent:

A

cell repair and causes dramatic increase in breast cancer incidence

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10
Q

What is Klinefelter Syndrome?
how does it relate to breast cancer?

A

A congenital condition in which males have one Y chromosome and two or more X chromosomes (normally, they only have one X and one Y)
They produce more estrogen than is typical for males & have higher risk of breast cancer

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11
Q

For breast cancer, hormone sensitive (e.g., ER+) cancer for PREmenopausal women is treated with

A

Tamoxifen

antagonist in breast tissue

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12
Q

For breast cancer, hormone sensitive (e.g., ER+) cancer for POSTmenopausal women is treated with

why?

A

Aromatase Inhibitor

majority of estrogen is produced outside ovaries by AI

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13
Q

What drug class does tamoxifen fall under

A

Selective Estrogen Receptor Modulator (SERM)

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14
Q

Is tamoxifen an estrogen agonist or antagonist in breast cells?

A

Antagonist

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15
Q

MOA of aromatase inhibitors

A

Reduce estrogen production by blocking the aromatase enzyme that catalyzes the conversion of androgens to estrogens

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16
Q

Which SERM is used for breast cancer prevention (NOT treatment)

A

Raloxifene

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17
Q

What is another use of raloxifene (besides breast cancer prevention) & it’s benefit

A

Used for osteoporosis prevention and treatment in postmenopausal women
Increases bone density

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18
Q

Raloxifene is not first-line for osteoporosis because of what SE/risks

A

Hot flashes
Clotting risk

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19
Q

In some circumstances, a premenopausal woman will be put into menopause by taking a GnRH agonist. What is the MOA of GnRH agonists

A

Decrease LH and FSH, which suppresses ovarian estradiol production. This makes aromatase inhibitors a reasonable option

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20
Q

The HER2 oncogene promotes:

A

Breast tumor growth

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21
Q

breast cancer therapy that targets HER2

A

trastuzumab (Herceptin)

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22
Q

What formulation does fulvestrant come in

A

IM injection

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23
Q

Tamoxifen should not be used with

A

2D6 inhibitors, such as fluoxetine and paroxetine

tamoxifen is a prodrug converted via 2D6

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24
Q

What drug can be used with tamoxifen to treat hot flashes

A

Venlafaxine

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25
Q

Tamoxifene boxed warnings

A

Increased risk of uterine or endometrial cancer and thrombotic events (also raloxifene)

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26
Q

Side effects of tamoxifene and fulvestrant

A

hot flashes/night sweats, vaginal bleeding/spotting, vaginal discharge/dryness/pruritis, decreased libido, decreased bone density (premenopausal women) - supplement with calcium/vitamin D

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27
Q

Which SERM drug is teratogenic

A

Tamoxifen

also raloxifene but only used in POST menopausal women

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28
Q

Anastrozole brand name

A

Arimidex

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29
Q

Which drug class has a higher risk of CVD: SERMs or Aromatase Inhibitors

A

AIs

androgens have negative impact on CV health

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30
Q

Which drug class has a higher risk of osteoporosis: SERMs or Aromatase Inhibitors

A

AIs
(tamoxifen decreases bone density in PREmenopausal women, raloxifene incr bone density)

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31
Q

Side effects of aromatase inhibitors

A

Hot flashes/night sweats, arthralgia/myalgia

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32
Q

What drugs are contraindicated with any history of breast cancer

A

Estrogen-containing meds

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33
Q

Androgen deprivation therapy (ADT) for prostate cancer is also called

A

Chemical castration

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34
Q

Androgen deprivation therapy is achieved with either:

A

GnRH antagonist alone or a GnRH agonist (initially taken with an antiandrogen)

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35
Q

Another name for GnRH agonists

A

Luteinizing hormone releasing hormone (LHRH) agonists

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36
Q

The initial surge of testosterone caused by GnRH agonists is called

A

Tumor flare

Symptoms include bone pain and difficulty urinating

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37
Q

To prevent tumor flares with GnRH agonists, what can be given in combination

A

Antiandrogens (“lutamides”) for several weeks at the start of a GnRH agonist

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38
Q

Leuprolide brand name

A

Lupron Depot

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39
Q

Goserelin brand name

A

Zoladex

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40
Q

Concerns with GnRH agonists

A

Decrease bone density; supplement with calcium/vitamin D

Tumor flares

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41
Q

GnRH agonist side effects

A

Hot flashes, impotence, gynecomastia, bone pain
QT prolongation

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42
Q

Name drugs in the following drug classes:
1. GnRH agonists
2. GnRH antagonists
3. antiandrogens (1st or 2nd gen)
4. androgen biosynthesis inhibitor (interferes with CYP17 enzyme)

A
  1. leuprolide, goserelin
  2. degarelix, relugolix (relics are antiques)
  3. bicalutamide, enzalutamide
  4. abiraterone
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43
Q

Degarelix, a GnRH antagonist, has what concerns

A

Osteoporosis risk

No tumor flares

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44
Q

1st antiandrogen SEs

A

hot flashes, gynecomastia

lutamides

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45
Q

How to calculate BSA using Mosteller Equation

A

BSA (m2) = √ Ht (cm) x Wt (kg) / 3600

use acutal BW

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46
Q

Cyclophosphamide and ifosfamide produce a metabolite called ____ that concentrated in the bladder and can cause hemorrhagic cystitis

A

Acrolein

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47
Q

Which chemoprotectant inactivates acrolein in the bladder without interfering with the cyctotoxic efficacy of cyclophosphamide and ifosfamide

48
Q

Between cyclophosphamide and ifosfamide, which drug is ALWAYS given with mesna

A

Ifoafamide

cyclophosphamide is only used with mesna at high doses

49
Q

Busulfan has a side effect of

A

Pulmonary toxicity

50
Q

Mitomycin has a concern for

51
Q

Which platinum chemotherapy is associated with the highest incidence of nephrotoxicity

52
Q

Besides nephrotoxicity and CINV, what other concern does cisplatin have

A

Ototoxicity

53
Q

Which chemoprotectant is given prophylactically to prevent cisplatin-induced nephrotoxicity

A

Amifostene (Ethyol)

54
Q

What formula is used to dose carboplatin in adults?

A

Calvert
Uses target AUC and eGFR

55
Q

Using the Calvert formula to dose carboplatin, what is the GFR usually capped at

A

125 mL/min

56
Q

Doses of cisplatin > ____ mg/m2/cycle must be confirmed with a prescriber

A

100

renal and ototoxicity

57
Q

Which chemoprotectant is indicated for prevention of doxorubicin-induced cardiotoxicity

A

Dexrazoxane (Totect)

58
Q

What is the antidote for accidental doxorubicin extravasation

A

Dexrazoxane (Totect)

59
Q

dexrazoxane may be considered when the doxorubicin cumulative dose > ___ mg/m2

60
Q

What color does doxorubicin turn urine, tears, sweat and saliva

61
Q

T/F: Doxorubicin is a highly emetic drug

A

True - give antiemetics

62
Q

Mitoxantrone is an anthracendione related to the anthracyclines that turns urine, sclera and other body fluids which color

63
Q

Irinotecan causes acute cholinergic symptoms such as diarrhea, which should be treated with ____. Delayed diarrhea should be treated with ___

A

Atropine

Loperamide

64
Q

Etoposide IV causes:

A

Infusion rate-related hypotension: infuse over ≥ 30-60 min

65
Q

Etoposide capsules should be stored

A

in the refrigerated

66
Q

T/F: Bleomycin causes myelosuppression

67
Q

anthracyclines MOA

A

inhibit topoisomerase II and create free radicals

68
Q

ironotecan MOA

A

topoisomerase I inhibitor - block coiling and uncoiling of DNA

69
Q

etoposide and bleomycin MOA

A

inhibit Top II - block coiling and uncoiling of DNA

70
Q

Which vinca alkaloid when given intrathecally will cause progressive paralysis and death

A

Vincristine

do not put in syringe, put in small IV piggyback bag

71
Q

Which two vinca alkaloids are associated with more bone marrow suppression

A

Vinblastine and vinorelbine

both have B for bone marrow suppression

72
Q

vincristine max dose

A

2mg per dose

prevent neuropathies

73
Q

VInca alkaloids are potent vesicants and should be treated with ____ if extravasation occurs

A

Warm compresses and hyaluronidase

74
Q

T/F: vinca alkaloids can be given via IV administration

A

True

only IV

75
Q

What can occur with all taxanes

A

Severe infusion-related hypersensitivity reactions and fatal anaphylaxis: premedicate (steroid, diphenhdyramine, and H2RA)

76
Q

Docetaxel can cause severe ___

A

fluid retention

77
Q

All taxanes except paclitaxel should use ____

A

non-PVC bag and tubing

LATTIN

78
Q

Which taxane does not require premedication

A

Paclitaxel bound to albumin (Abraxane)

79
Q

Paclitaxel and cabazitaxel should use ____

A

0.22-micron filter

GAl, PLAT

80
Q

What is given with fluorouracil to increase its efficacy

A

Leucovorin

helps bind tightly to its target enzymes

81
Q

Capecitabine brand name

82
Q

What increases the risk of severe fluorouracil toxicity

A

DPD deficiency

83
Q

Side effects of 5-FU and capecitabine

A

Hand-foot syndrome, diarrhea, mucositis

84
Q

Methotrexate brand name

85
Q

Methotrexate doses used for RA/psoriasis are given

A

weekly, not daily

86
Q

High-dose MTX requires

A

Leucovorin rescue

87
Q

vinca alkaloids MOA

A

inhibit function of microtubules

88
Q

taxanes MOA

A

inhibit microtubuels during M phase

89
Q

5-FU and capecitabine MOA

A

inhibit pyrimidine synthesis during S phase

90
Q

MTX MOA

A

inhibits purine and pyrimidine biosynthesis during S phase

91
Q

What antidote will rapidly decrease MTX levels that remain high despite hydration and urinary alkalinization

A

Glucarpidase

92
Q

Drug interactions with MTX
+ effect

A

NSAIDs, salicylates
decrease clearance

93
Q

Boxed warnings for MTX

A

Myelosuppression, renal damage, hepatotoxicity, GI toxicity, teratogenicity

94
Q

Side effects of the mTOR inhibitor everolimus

A

Mouth ulcers/stomatitis, rash, interstitial lung disease, peripheral edema, dyslipidemia, increased BP

95
Q

Bevacizumab brand name

96
Q

name the protease inhibitors used as chemo

A

bortezomib - use antiviral to prevent herpes reactivation
carfilzomib - peripheral neuropathy

97
Q

Concern with bevacizumab (VGEF inhibitor)

A

Impairs wound healing: do not administer for 28 days before or after surgery

98
Q

Bevacizumab boxed warnings

A

Severe/fatal bleeding, GI perforation

99
Q

Trastuzumb brand name

100
Q

Monitoring for trastuzumab

A

LVEF (using echo or MUGA scan)

101
Q

Persons using cetuximab need to have what gene

A

KRAS wild type

KRAS mutation will have poor response

102
Q

Side effect of cetuximab

A

Acneiform rash - indicates that a patient is expected to have a better response to the drug.

Advise pts to avoid sunlight, use sunscreen. Topical steroids and antibiotics can be given prophylactically

103
Q

Rituximab brand name

104
Q

Must premedicate with what drugs when using Rituximab

what must be checked prior to use

A

APAP, steroids, diphenhydramine

hep B panel

105
Q

What must be done before giving a patient a TKI

A

PG testing

Oral bioavailability may be altered if taken with food

106
Q

Imatinib brand name

107
Q

Someone using imatinib must be positive for which chromosome

A

Philedelphia chromosome (BCR-ABL)

108
Q

Side effect of imatinib

A

Fluid retention, QT prolongation

109
Q

To use vemurafenic and dabrafenib in melanoma, patients must be positive for what mutations

A

BRAF V600E or V600K mutation

110
Q

To use afatinib, erlotinib and gefitinib for NSCLC, patients must be positive for what mutation

A

EGFR mutation + (exon 19 or 21)

111
Q

Side effect for EGFR inhibitors (afatinib, erlotinib)

A

Aceniform rash, which indicates patient is expected to have a better response to the drug

112
Q

To use alectinib and brigatinib patients must be positive for which mutation

113
Q

common toxicities of TKIs

A

hypothyroidism
QT prolongation
hepatic metabolism/toxicity
diarrhea
skin rash (acneiform, SJS/TEN)
HTN
hand-foot syndrome

114
Q

Which chemo agents must be taken with food

A

Imatinib and capcitabine

115
Q

Which chemo agents can be taken without regard to food

A

Tamoxifen and Anastrozole

116
Q

Which chemo agents are teratogens

A

Thalidomide, pomalidomide, and lenalidomide

NAPLEX 2023 (88 decks)

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