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CSO Exam 2023 > Chapter 9: Medical Oncology & Medications > Flashcards

Chapter 9: Medical Oncology & Medications Flashcards

1
Q

What is MedOnc?

A

Cancer treatment using chemotherapy, targeted therapy, immunotherapy, and hormone therapy

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2
Q

What is chemotherapy?

A

It is the use of chemical agents or drugs to systemically kill cancer cells.

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3
Q

T/F: Chemotherapy has a cytotoxic effect on all cells (both healthy and malignant).

A

TRUE

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4
Q

Which cells have rapid turnover and more more susceptible to the effects of chemotherapy?

A

Bone marrow (blood cells)
Hair follicles
Gonads (ovaries and testes)
Gastrointestinal mucosa (mouth, esophagus, stomach and intestines)

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5
Q

T/F: Slow growing cells are less responsive to the effects of chemo?

A

TRUE

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6
Q

Phases of the Cell Cycle

A

G0: resting phase (cells are not dividing)
G1: postmitotic phase (cells synthesize DNA and protein)
S: synthesis phase (DNA is synthesized)
G2: premitotic phase (cells prepare to divide)
M: mitotic phase (cells divide into 2 daughter cells)

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7
Q

What are cell cycle nonspecific agents?

A

Agents that damage cells in all phases of the cell cycle.

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8
Q

Examples of cell cycle nonspecific agents

A

Alkylating agents
Antitumor metabolites
Hormone therapy
Nitrosoureas

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9
Q

What are cell cycle specific agents?

A

Agents that exert their effect within a specific phase of the cell cycle.

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10
Q

Examples of cell cycle specific agents.

A

Antimetabolites (S phase)
Camptothecins (S phase)
Plant alkaloids and Taxanes (M phase)

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11
Q

T/F: Patients generally recover from chemotherapy quickly once treatment has stopped.

A

FALSE

Can take weeks, months, and even years.

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12
Q

Which organs are most likely to receive permanent damage from chemotherapy?

A

Lungs, heart, liver, kidney, reproductive organs, nerves, bone marrow

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13
Q

What is personalized or precision medicine?

A

Uses a patient’s genetic info to prevent, diagnose or treat cancer.

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14
Q

T/F: Knowing if a person has a genetic mutation helps guide the oncologist in customizing certain treatments that may be more effective.

A

TRUE

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15
Q

What is Targeted Therapy?

A

The use of drugs that are specific to a type of tumor or they concentrate on the genetic change. They target specific genes or proteins found on the cancer cell. Or it acts on the tissue environment related to cancer cell growth/survival (blood supply).

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16
Q

Examples of Targeted Therapy

A

monoclonal antibodies
immune checkpoint inhibitors
small molecule drugs

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17
Q

What do monoclonal antibodies do?

A

Target specific receptors on the cell surface then activate pathways within the tumor cell to disrupt cell function and cause apoptosis.

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18
Q

What are side effects of monoclonal antibodies?

A

Fever, chills, hives, flushing, fatigue, headache, nausea, vomiting, mouth sores, diarrhea, reduced appetite, dyspnea (labored breathing), rash, hand-foot syndrome

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19
Q

What do immune checkpoint inhibitors do?

A

They block pathways and stop / slow cancer growth.

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20
Q

What do small molecule drugs do?

A

Protein-targeted agents that use small molecules use small molecules that penetrate malignant cell membranes to interact with specific areas of the targeted protein. They disrupt cell function and cause apoptosis.

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21
Q

Example of a small molecule drug.

A

Angiogenesis inhibitor - hinders the formation of new blood vessels in primary and metastatic tumors.

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22
Q

What are the side effects of small molecule drugs?

A

skin rash, facial reddening, hand-foot syndrome, cardiotoxicities, hair can turn white, N/V/D, decreased appetite, taste change

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23
Q

What is immunotherapy?

A

Also called “Biological Therapy” uses the body’s immune system to fight cancer.

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24
Q

What are examples of immunotherapy?

A

Nonspecific immunotherapy
Oncolytic viral therapies
T-cell therapies
Cancer vaccines

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25
Q

Which are the only two cancer vaccines that are approved?

A

HPV
Hep B

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26
Q

Which kinds of cancers does hormone therapy treat?

A

Hormone sensitive cancers: breast, ovarian and prostate.

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27
Q

What are examples of hormone therapy?

A

Antiestrogen
Aromatase inhibitor
Progesterones
Antiandrogens
LHRH agonists

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28
Q

How do antiestrogen agents work?

A

They compete with estrogen for binding to estrogen receptors.

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29
Q

What are examples of antiestrogen agents and which cancer does it treat?

A

tamoxifen
toremifene
raloxifene

Treats breast cancer.

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30
Q

Side effects of antiestrogen receptors

A

menstrual symptoms (hot flashes, sweating, nausea, menstrual irregularities, vaginal dryness, reduced libido, fatigue), weight gain, achy joints

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31
Q

How do aromatase inhibitors work?

A

They block the production of estrogen.

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32
Q

What are examples of aromatase inhibitors and which cancer does it treat?

A

anastrozole
letrozole
exemetane
(post-menopausal breast ca)

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33
Q

Side effects of aromatase inhibitors

A

hot flashes, N/V, increased cholesterol

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34
Q

Side effect of Aromatase Inhibitors
Anastrozole
Letrozole
Exemestane

A

Bone pain

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35
Q

How do progesterones work?

A

They inhibit the availability and stability of estrogen receptors.

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36
Q

What is an example of a progesterone and which cancer does it treat?

A

Megasetrol acetate (megace)
(breast, endometrial, renal cell ca)

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37
Q

Side effects of progesterone?

A

weight gain, N/V, hyperglycemia, hot flashes, mood changes

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38
Q

How do antiandrogens work? Which cancer does it work on?

A

They bind to androgen receptors and block the effects of testosterone in androgen-sensitive prostate cancer cells.

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39
Q

How do LHRH agonists work? Which cancers do they work on?

A

They signal the pituitary gland to stop producing LHRH which results in suppression of testosterone. Prostate and ovarian

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40
Q

Notable side effects of Carboplatin (Paraplatin).

A

Low Mg
Taste changes

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41
Q

Notable side effects of cisplatin (Platinol)

A

N/V - acute and delayed vomiting
Metallic taste
Low Mg, Ca, K
Hearing loss

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42
Q

Which medication needs IV fluids to be given before and after its administration?

A

Cisplatin due to renal toxicity

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43
Q

What special side effect does Oxaliplatin (eloxatin) have?

A

Cold sensitivity / neuropathy - avoid cold for 5 days after drug administration

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44
Q

What is one of the major side effects of Irinotecan (camptosar)?

A

Diarrhea - both early diarrhea (within 24 hours) and late diarrhea (>24 hours after receiving drug)
Fluid replacement is important
Can reduce appetite
No St. John’s Wort

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45
Q

Side effect of Azacitidine (vidaza)?

A

Low K

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46
Q

Notable side effect of Capecitabine (xeloda)?

A

Hand foot syndrome

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47
Q

Notable side effects of Fluorouracil (5-FU)?

A

Mucositis (prevent by putting ice chips in mouth during infusion)
Hand-foot syndrome
Taste changes
Photosensitivity

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48
Q

Notable side effect of Methotrexate (MTX)?

A

Oral and GI ulcers
Leucovorin is the rescue drug for MTX toxicity
Avoid alcohol

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49
Q

Pemetrexed (alimta) requires which two vitamins to reduce its side effects?

A

Vitamin B12 (1000 nanograms)
Folic acid (350-1000 nanograms)

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50
Q

What two things should you avoid with Procarbazine?

A

Tyramine-rich foods
Alcohol

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51
Q

What should you avoid when taking vincristine (oncovin)?

A

Alcohol

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52
Q

Notable side effects of Bleomycin (blenoxane)?

A

Pulmonary toxicity (SOB)
Skin / nail changes - hyperpigmentation

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53
Q

Notable side effects of Doxorubicin (adriamycin)?

A

Hand-foot syndrome
Red-orange urine
“The Red Devil” - can cause tissue damage if it leaves the vein.

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54
Q

Notable side effect of Idarubicin (idamycis)?

A

Red urine
Hand foot syndrome

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55
Q

Side effect of Etoposide (vepesid)?

A

Metallic taste during infusion

56
Q

Side effects of Vincristine (oncovin), Vinblastine (velban) and Vinorelbine (navelbine)?

A

Constipation

57
Q

Notable side effect of Erbitux (cetuximab)?

A

Low Mg

58
Q

Notable side effect of Vectibix (panitumumab)?

A

Low Mg

59
Q

Notable side effects of Prolia (denosumab)?

A

hypocalcemia
increased risk for osteoporosis

60
Q

Notable side effects of Nivolumab (opdivo)?

A

Low Na, Mg, K

61
Q

Notable side effects of Pembrolizumab (keytruda)?

A

Elevated BG
Low Na
Low Albumin
Constipation

62
Q

What should you avoid with Bortexomin (Velcade)?

A

Green Tea

63
Q

Many medications use the enzyme Cytochrome P450 (CYP). What common herb stimulates CYP and can cause a reduction in drug availability?

A

St. Johns Wort

64
Q

Many medications use the enzyme Cytochrome P450 (CYP). What common food inhibits CYP and can cause an increase in drug availability?

A

Grapefruit juice

65
Q

What vitamin reduces the incidents of hand-foot syndrome in 5-FU, Oxaliplatin (eloxatin) and Capecitabine (xeloda)? How much should be given?

A

Vitamin B6
Dose: 50-100 mg/day x 2-3 times per day

66
Q

Important consideration for Cyclophosphamide (cytoxan)?

A

vigorous oral hydration (3L fluid per day). Empty bladder every 2-3 hours

67
Q

What should be monitored with Cetuximab (Erbitux)

A

Magnesium, Calcium
Risk of lows

68
Q

What should you avoid when Mercaptomurine (6-MP) is given?

A

DAIRY

69
Q

What vitamin do you need to limit with Bexarotene (targretin)?

A

Vitamin A - limit to 1500 mg per day

70
Q

With Fluorouracil (5-FU) what should be given for 10-15 minutes before and after medication administration?

A

Ice chips

71
Q

Which macronutrient reduces the absorption of Regorafenib (stivarga)

A

Fat
Should be given with low fat meals for better absorption

72
Q

Side effects of Tamoxifen

A

hot flashes / sweating
menstrual irregularities
fluid retention / edema

73
Q

Side effects of Dexamothasone (Decadron)

A

increased blood sugars
increased appetite
muscle weakness
impaired wound healing

74
Q

Side effects of Docetaxel (Taxotere)

A

peripheral neuropathy
mucositis
myleosuppression
N/V
Diarrhea

75
Q

Considerations with Temozolomide (Temodar)

A

Take zofran before
Take on empty stomach
Nausea
Taste changes
reduced appetite

76
Q

Side effects of Paclitaxel (Taxol)

A

peripheral neuropathy
mucositis / mouth sores
may get hypersensitivity reaction after taxol is given

77
Q

What should you avoid with Imatinib (Gleevec)

A

St. Johns Wort

78
Q

What should you take with Deferasiox (Exjade)

A

Lactose enzyme

79
Q

What should you take with Zoledronic Acid (Zometa)?

A

500 mg calcium
400 IU vitamin D

80
Q

When should you recommend Glutamine? When should you avoid it?

A

Give to reduce severity of mouth sores (mucositis).
Avoid with liver cancer.

81
Q

Adriamycine (doxorubicin)

A

Use: breast cancer, RCHOP
Side effects: nausea, mouth sores, dry mouth, taste changes

82
Q

Alimta (pemetrexed)

A

Use: NSCLC, pleural mesothelioma
Side effects: minimal
Supplement: vitamin B12, folic acid

83
Q

Arimidex (anatrozole)

A

Use: breast, hormonal
Side effects: increased appetite, wt gain, fluid retention

84
Q

Aromasin (exemestane)

A

Use: aromatase inhibitor
Side effects: nausea, increased appetite, insomnia
Food interactions: grapefruit

85
Q

ATRA (Vesanoid)

A

Use reintoid to treat leukemia
Avoid vitamin A and Beta Carotene

86
Q

Axitinib (Inlyta)

A

Use: in combination with pembrolizumab as the first-line treatment of patients with advanced renal cell carcinoma (RCC).

Side effects: diarrhea, loss of appetite, nausea, fatigue

Food interaction: grapefruit, St. Johns Wort

87
Q

Azacitidine (Vidaza)

A

Use: myelodysplasia
Side effects: nausea, loss of appetite, stomach pain, fatigue, flu like symptoms, anxiety, insomnia

88
Q

Bendamustine Hcl (Bendeka)

A

Use: CLL, NHL
Side effects: nausea, fatigue
Food interaction: caffeine

89
Q

Bevacizumab (Avastin)

A

Use: glioblastoma, kidney, liver, lung, colorectal, cervical, ovarian, fallopian tube
Side effects: dysgeusia, altered smell

90
Q

Bleomycin (Bleo 15K)

A

Use: SCC
Side effects: mucositis, possible nausea

Fun fact: type of antibiotic that is poisonous to cells.

91
Q

Irinotecan (Onivyde, Camptosar)

A

Use: colorectal, part of FOLFIRINOX
Side effects: cramping, diarrhea, nausea, loss of appetite, taste changes

92
Q

Carboplatin (paraplatin)

A

Use: lung, bladder, breast, and endometrial cancer; head and neck cancer; cancer of the cervix and testicles: Wilms’ tumor, neuroblastoma
Side effects: nausea, taste changes, loss of appetite

93
Q

Carfilzomib (Kyprolis)

A

Use: relapsed MM
Side effects: fatigue, diarrhea

94
Q

Cisplatin (Platinol)

A

Use: testicular, ovarian, bladder, head and neck, lung and cervical cancer
Side effects: nausea, taste changes, loss of appetite, constipation, fatigue
Labs: watch for low Mg, K, Ca, renal function
Rigorous hydration needed

95
Q

Cytarabine (Ara-C)

A

Use: leukemia
Side effects: nausea, loss of appetite

96
Q

Cyclophosphamide (Cytoxan)

A

Use: breast cancer, RCHOP
Side effects: loss of appetite, moutnsores, nausea, diarrhea, dry mouth
Rigorous hydration needed

97
Q

Dacarbizine (DTIC)

A

Use: HD, skin care
Side effects: nausea, metallic taste, reduced appetite

98
Q

Decitabine (Dacogen)

A

Use: myelodysplastic syndrome
Side effects: nausea, loss of appetite, stomach pain, fatigue, flu like symptoms

99
Q

Daratumumab (Darzalex)

A

Use: MM
Anti-cancer monoclonal antibody medication. It binds to CD38, which is overexpressed in multiple myeloma cells.

Side effects: nausea, decreased appetite, diarrhea, constipation

100
Q

Dexamethasone (Decadron)

A

Use: steroid
Side effects: Low K, nausea, vomiting, increased appetite

101
Q

Etoposide (Etopophos, Toposar)

A

Use: testicular, prostate, bladder, stomach, and lung cancer
Side effects: nausea, mouth sores, loss of appetite

102
Q

Fulvestrant (Faslodex)

A

Use: breast cancer (postmenopausal)
Side effects: black/tarry stools, itching, bloating (face, hands, feet, lower legs)

103
Q

Letrozole (Femara)

A

Use: breast cancer
Side effects: increased appetite, weight gain, fluid retention

104
Q

Fluorouracil (5-FU)

A

Use: breast, bowel, skin, stomach, esophageal, and pancreatic
Part of FOLFOX
Side effects: severe mouth sores/mucositis, diarrhea

105
Q

Gemcitabine (Gemzar)

A

Use: pancreatic, breast, ovarian, lung
Side effects: nausea, loss of appetite, diarrhea

106
Q

Herceptin (trastuzumab/Ogivri)

A

Use: HER 2+ breast cancer, stomach, part of TCHP

107
Q

Ifosfamide (Ifex)

A

Use: testicular cancer
Part of RICE
Side effects: bladder issues, hemorrhagic cystitis

108
Q

ADO-trastuzumab (Kadycla)

A

Use: HER2+ breast cancer
Side effects: nausea, constipation

109
Q

Lenalidomide (Revlimid)

A

Use: MM, s/p HCT, anemia
Side effects: constipation

110
Q

Lenvatinib (Lenvima)

A

Use: thyroid, targeted therapy for endometrial ca
Side effects: constipation, diarrhea, nausea, fatigue, loss of appetite, wt loss

111
Q

Leucovorin

A

Part of FOLFOX and FOLFIRINOX
Use: helps 5-FU stay in cells longer, rescue drug for MTX

112
Q

Leuprolide (Lupron Depot)

A

Use: prostate cancer symptoms
Side effects: hyperglycemia

113
Q

Methotrexate/MTX

A

Use: CMF for leukemia
Side effects: nausea, mucositis, diarrhea, decreased absorption of folate and B12 (do not supplement tho)
Food interactions: caffeine

114
Q

Mitomycin (Mitosol)

A

Use: anal, bladder, breast, head and neck, pancreatic, gastrointestinal
Side effects: nausea, mucositis, loss of appetite

115
Q

Pegfilgrastim (Neulasta, Ziextenzo)

A

Use: neutropenia prevention, bone marrow stimulant
Side effects: nothing major

116
Q

Filgrastim (Neupogen)

A

Use: colony stimulating factor
Side effects: nausea

117
Q

Nivolumab (Opdivo)

A

Use: immunotherapy
Side effects: decreased appetite, low Na

118
Q

Oncovin (Vincristine)

A

Part of RCHOP
Side effects: constipation

119
Q

Oxaliplatin

A

Part of FOLFOX & FOLFIRINOX
Side effects: nausea, vomiting, fatigue, loss of appetite, taste changes, cold intolerance

120
Q

Pembrolizumab (Keytruda)

A

Use: immunotherapy for SCC HNC, NSCLC, bladder
Side effects: nausea, fatigue

121
Q

Pertuzumab (Perjeta)

A

Part of TCHP
Use: HER 2+ breast cancer
Side effects: diarrhea

122
Q

Denosumab (Prolia)

A

Can treat osteoporosis and hypercalcemia
Side effects: nothing major

123
Q

Prednisone

A

Steroid
Part of RCHOP
Side effects: hyperglycemia, fluid retention, hyperactivity

124
Q

Procarbazine (Matulane)

A

Use: Hodgkins
Side effects: nausea, loss of appetite
Diet: LOW TYRAMINE (avoid aged cheese, processed meats, alcohol, pickled or fermented foods, dried fruits, soybeans)

125
Q

Rituximab (Rituxan)

A

Part of RCHOP and RICE
Side effects: constipation

126
Q

Osimertinib (Tagrisso)

A

Use: NSCLC
Side effects: mouth sores, low blood cell counts, diarrhea

127
Q

Tamoxifen (Soltamox)

A

Use: breast, hormonal
Side effects: increased appetite, wt gain, fluid retention
Food: no grapefruit, no St. Johns Wort, Soy is FINE
Don’t take antacids 2 hrs before

128
Q

Paclitaxel (Taxol, Abraxane)

A

Use: ovarian, esophageal, breast, lung, cervical, and pancreatic cancers; Kaposi’s sarcoma
Side effects: mouth sores, taste changes, nephrotoxicity, diarrhea
Food: no grapefruit

129
Q

Docetaxel (Taxotere)

A

Use: breast, lung, prostate, stomach, HNC
Part of TCHP
Side effects: nausea, loss of appetite, mouth sores, diarrhea, fluid retention
Food: avoid grapefruit

130
Q

Atezolizumab (Tecentriq)

A

Use: SCLC
Side effects: fatigue, nausea, vomiting, constipation, diarrhea

131
Q

Bortezomib (Velcade)

A

Use: MM, mantle cell lymphoma
Side effects: constipation
Food: avoid green tea, grapefruit, vitamin C supplements

132
Q

Abemaciclib (Verzenio)

A

Use: breast cancer
Side effects: diarrhea, nausea, vomiting, loss of appetite, fatigue
Food: no grapefruit

133
Q

Capecitabine (Xeloda)

A

Use: metastatic cancers
Side effects: diarrhea, loss of appetite, cramping
Food: avoid folic acid
Vitamin B6 can decrease risk of hand foot syndrome

134
Q

FOLFOX

A

Leucovorin calcium
5FU/fluorouracil
Oxaliplatin.

135
Q

FOLFIRINOX

A

Leucovorin calcium
5FU/fluorouracil
Irinotecan

136
Q

RCHOP

A

Rituxan
Cytoxan
Adriamycin
Oncovin
Prednisone

137
Q

TCHP

A

Taxotere
Carboplatin
Herceptin
Perjeta

CSO Exam 2023 (12 decks)

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