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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
Which are the only two cancer vaccines that are approved?
HPV Hep B
26
Which kinds of cancers does hormone therapy treat?
Hormone sensitive cancers: breast, ovarian and prostate.
27
What are examples of hormone therapy?
Antiestrogen Aromatase inhibitor Progesterones Antiandrogens LHRH agonists
28
How do antiestrogen agents work?
They compete with estrogen for binding to estrogen receptors.
29
What are examples of antiestrogen agents and which cancer does it treat?
tamoxifen toremifene raloxifene Treats breast cancer.
30
Side effects of antiestrogen receptors
menstrual symptoms (hot flashes, sweating, nausea, menstrual irregularities, vaginal dryness, reduced libido, fatigue), weight gain, achy joints
31
How do aromatase inhibitors work?
They block the production of estrogen.
32
What are examples of aromatase inhibitors and which cancer does it treat?
anastrozole letrozole exemetane (post-menopausal breast ca)
33
Side effects of aromatase inhibitors
hot flashes, N/V, increased cholesterol
34
Side effect of Aromatase Inhibitors Anastrozole Letrozole Exemestane
Bone pain
35
How do progesterones work?
They inhibit the availability and stability of estrogen receptors.
36
What is an example of a progesterone and which cancer does it treat?
Megasetrol acetate (megace) (breast, endometrial, renal cell ca)
37
Side effects of progesterone?
weight gain, N/V, hyperglycemia, hot flashes, mood changes
38
How do antiandrogens work? Which cancer does it work on?
They bind to androgen receptors and block the effects of testosterone in androgen-sensitive prostate cancer cells.
39
How do LHRH agonists work? Which cancers do they work on?
They signal the pituitary gland to stop producing LHRH which results in suppression of testosterone. Prostate and ovarian
40
Notable side effects of Carboplatin (Paraplatin).
Low Mg Taste changes
41
Notable side effects of cisplatin (Platinol)
N/V - acute and delayed vomiting Metallic taste Low Mg, Ca, K Hearing loss
42
Which medication needs IV fluids to be given before and after its administration?
Cisplatin due to renal toxicity
43
What special side effect does Oxaliplatin (eloxatin) have?
Cold sensitivity / neuropathy - avoid cold for 5 days after drug administration
44
What is one of the major side effects of Irinotecan (camptosar)?
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
45
Side effect of Azacitidine (vidaza)?
Low K
46
Notable side effect of Capecitabine (xeloda)?
Hand foot syndrome
47
Notable side effects of Fluorouracil (5-FU)?
Mucositis (prevent by putting ice chips in mouth during infusion) Hand-foot syndrome Taste changes Photosensitivity
48
Notable side effect of Methotrexate (MTX)?
Oral and GI ulcers Leucovorin is the rescue drug for MTX toxicity Avoid alcohol
49
Pemetrexed (alimta) requires which two vitamins to reduce its side effects?
Vitamin B12 (1000 nanograms) Folic acid (350-1000 nanograms)
50
What two things should you avoid with Procarbazine?
Tyramine-rich foods Alcohol
51
What should you avoid when taking vincristine (oncovin)?
Alcohol
52
Notable side effects of Bleomycin (blenoxane)?
Pulmonary toxicity (SOB) Skin / nail changes - hyperpigmentation
53
Notable side effects of Doxorubicin (adriamycin)?
Hand-foot syndrome Red-orange urine “The Red Devil” - can cause tissue damage if it leaves the vein.
54
Notable side effect of Idarubicin (idamycis)?
Red urine Hand foot syndrome
55
Side effect of Etoposide (vepesid)?
Metallic taste during infusion
56
Side effects of Vincristine (oncovin), Vinblastine (velban) and Vinorelbine (navelbine)?
Constipation
57
Notable side effect of Erbitux (cetuximab)?
Low Mg
58
Notable side effect of Vectibix (panitumumab)?
Low Mg
59
Notable side effects of Prolia (denosumab)?
hypocalcemia increased risk for osteoporosis
60
Notable side effects of Nivolumab (opdivo)?
Low Na, Mg, K
61
Notable side effects of Pembrolizumab (keytruda)?
Elevated BG Low Na Low Albumin Constipation
62
What should you avoid with Bortexomin (Velcade)?
Green Tea
63
Many medications use the enzyme Cytochrome P450 (CYP). What common herb stimulates CYP and can cause a reduction in drug availability?
St. Johns Wort
64
Many medications use the enzyme Cytochrome P450 (CYP). What common food inhibits CYP and can cause an increase in drug availability?
Grapefruit juice
65
What vitamin reduces the incidents of hand-foot syndrome in 5-FU, Oxaliplatin (eloxatin) and Capecitabine (xeloda)? How much should be given?
Vitamin B6 Dose: 50-100 mg/day x 2-3 times per day
66
Important consideration for Cyclophosphamide (cytoxan)?
vigorous oral hydration (3L fluid per day). Empty bladder every 2-3 hours
67
What should be monitored with Cetuximab (Erbitux)
Magnesium, Calcium Risk of lows
68
What should you avoid when Mercaptomurine (6-MP) is given?
DAIRY
69
What vitamin do you need to limit with Bexarotene (targretin)?
Vitamin A - limit to 1500 mg per day
70
With Fluorouracil (5-FU) what should be given for 10-15 minutes before and after medication administration?
Ice chips
71
Which macronutrient reduces the absorption of Regorafenib (stivarga)
Fat Should be given with low fat meals for better absorption
72
Side effects of Tamoxifen
hot flashes / sweating menstrual irregularities fluid retention / edema
73
Side effects of Dexamothasone (Decadron)
increased blood sugars increased appetite muscle weakness impaired wound healing
74
Side effects of Docetaxel (Taxotere)
peripheral neuropathy mucositis myleosuppression N/V Diarrhea
75
Considerations with Temozolomide (Temodar)
Take zofran before Take on empty stomach Nausea Taste changes reduced appetite
76
Side effects of Paclitaxel (Taxol)
peripheral neuropathy mucositis / mouth sores may get hypersensitivity reaction after taxol is given
77
What should you avoid with Imatinib (Gleevec)
St. Johns Wort
78
What should you take with Deferasiox (Exjade)
Lactose enzyme
79
What should you take with Zoledronic Acid (Zometa)?
500 mg calcium 400 IU vitamin D
80
When should you recommend Glutamine? When should you avoid it?
Give to reduce severity of mouth sores (mucositis). Avoid with liver cancer.
81
Adriamycine (doxorubicin)
Use: breast cancer, RCHOP Side effects: nausea, mouth sores, dry mouth, taste changes
82
Alimta (pemetrexed)
Use: NSCLC, pleural mesothelioma Side effects: minimal Supplement: vitamin B12, folic acid
83
Arimidex (anatrozole)
Use: breast, hormonal Side effects: increased appetite, wt gain, fluid retention
84
Aromasin (exemestane)
Use: aromatase inhibitor Side effects: nausea, increased appetite, insomnia Food interactions: grapefruit
85
ATRA (Vesanoid)
Use reintoid to treat leukemia Avoid vitamin A and Beta Carotene
86
Axitinib (Inlyta)
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
Azacitidine (Vidaza)
Use: myelodysplasia Side effects: nausea, loss of appetite, stomach pain, fatigue, flu like symptoms, anxiety, insomnia
88
Bendamustine Hcl (Bendeka)
Use: CLL, NHL Side effects: nausea, fatigue Food interaction: caffeine
89
Bevacizumab (Avastin)
Use: glioblastoma, kidney, liver, lung, colorectal, cervical, ovarian, fallopian tube Side effects: dysgeusia, altered smell
90
Bleomycin (Bleo 15K)
Use: SCC Side effects: mucositis, possible nausea Fun fact: type of antibiotic that is poisonous to cells.
91
Irinotecan (Onivyde, Camptosar)
Use: colorectal, part of FOLFIRINOX Side effects: cramping, diarrhea, nausea, loss of appetite, taste changes
92
Carboplatin (paraplatin)
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
Carfilzomib (Kyprolis)
Use: relapsed MM Side effects: fatigue, diarrhea
94
Cisplatin (Platinol)
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
Cytarabine (Ara-C)
Use: leukemia Side effects: nausea, loss of appetite
96
Cyclophosphamide (Cytoxan)
Use: breast cancer, RCHOP Side effects: loss of appetite, moutnsores, nausea, diarrhea, dry mouth Rigorous hydration needed
97
Dacarbizine (DTIC)
Use: HD, skin care Side effects: nausea, metallic taste, reduced appetite
98
Decitabine (Dacogen)
Use: myelodysplastic syndrome Side effects: nausea, loss of appetite, stomach pain, fatigue, flu like symptoms
99
Daratumumab (Darzalex)
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
Dexamethasone (Decadron)
Use: steroid Side effects: Low K, nausea, vomiting, increased appetite
101
Etoposide (Etopophos, Toposar)
Use: testicular, prostate, bladder, stomach, and lung cancer Side effects: nausea, mouth sores, loss of appetite
102
Fulvestrant (Faslodex)
Use: breast cancer (postmenopausal) Side effects: black/tarry stools, itching, bloating (face, hands, feet, lower legs)
103
Letrozole (Femara)
Use: breast cancer Side effects: increased appetite, weight gain, fluid retention
104
Fluorouracil (5-FU)
Use: breast, bowel, skin, stomach, esophageal, and pancreatic Part of FOLFOX Side effects: severe mouth sores/mucositis, diarrhea
105
Gemcitabine (Gemzar)
Use: pancreatic, breast, ovarian, lung Side effects: nausea, loss of appetite, diarrhea
106
Herceptin (trastuzumab/Ogivri)
Use: HER 2+ breast cancer, stomach, part of TCHP
107
Ifosfamide (Ifex)
Use: testicular cancer Part of RICE Side effects: bladder issues, hemorrhagic cystitis
108
ADO-trastuzumab (Kadycla)
Use: HER2+ breast cancer Side effects: nausea, constipation
109
Lenalidomide (Revlimid)
Use: MM, s/p HCT, anemia Side effects: constipation
110
Lenvatinib (Lenvima)
Use: thyroid, targeted therapy for endometrial ca Side effects: constipation, diarrhea, nausea, fatigue, loss of appetite, wt loss
111
Leucovorin
Part of FOLFOX and FOLFIRINOX Use: helps 5-FU stay in cells longer, rescue drug for MTX
112
Leuprolide (Lupron Depot)
Use: prostate cancer symptoms Side effects: hyperglycemia
113
Methotrexate/MTX
Use: CMF for leukemia Side effects: nausea, mucositis, diarrhea, decreased absorption of folate and B12 (do not supplement tho) Food interactions: caffeine
114
Mitomycin (Mitosol)
Use: anal, bladder, breast, head and neck, pancreatic, gastrointestinal Side effects: nausea, mucositis, loss of appetite
115
Pegfilgrastim (Neulasta, Ziextenzo)
Use: neutropenia prevention, bone marrow stimulant Side effects: nothing major
116
Filgrastim (Neupogen)
Use: colony stimulating factor Side effects: nausea
117
Nivolumab (Opdivo)
Use: immunotherapy Side effects: decreased appetite, low Na
118
Oncovin (Vincristine)
Part of RCHOP Side effects: constipation
119
Oxaliplatin
Part of FOLFOX & FOLFIRINOX Side effects: nausea, vomiting, fatigue, loss of appetite, taste changes, cold intolerance
120
Pembrolizumab (Keytruda)
Use: immunotherapy for SCC HNC, NSCLC, bladder Side effects: nausea, fatigue
121
Pertuzumab (Perjeta)
Part of TCHP Use: HER 2+ breast cancer Side effects: diarrhea
122
Denosumab (Prolia)
Can treat osteoporosis and hypercalcemia Side effects: nothing major
123
Prednisone
Steroid Part of RCHOP Side effects: hyperglycemia, fluid retention, hyperactivity
124
Procarbazine (Matulane)
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
Rituximab (Rituxan)
Part of RCHOP and RICE Side effects: constipation
126
Osimertinib (Tagrisso)
Use: NSCLC Side effects: mouth sores, low blood cell counts, diarrhea
127
Tamoxifen (Soltamox)
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
Paclitaxel (Taxol, Abraxane)
Use: ovarian, esophageal, breast, lung, cervical, and pancreatic cancers; Kaposi's sarcoma Side effects: mouth sores, taste changes, nephrotoxicity, diarrhea Food: no grapefruit
129
Docetaxel (Taxotere)
Use: breast, lung, prostate, stomach, HNC Part of TCHP Side effects: nausea, loss of appetite, mouth sores, diarrhea, fluid retention Food: avoid grapefruit
130
Atezolizumab (Tecentriq)
Use: SCLC Side effects: fatigue, nausea, vomiting, constipation, diarrhea
131
Bortezomib (Velcade)
Use: MM, mantle cell lymphoma Side effects: constipation Food: avoid green tea, grapefruit, vitamin C supplements
132
Abemaciclib (Verzenio)
Use: breast cancer Side effects: diarrhea, nausea, vomiting, loss of appetite, fatigue Food: no grapefruit
133
Capecitabine (Xeloda)
Use: metastatic cancers Side effects: diarrhea, loss of appetite, cramping Food: avoid folic acid Vitamin B6 can decrease risk of hand foot syndrome
134
FOLFOX
Leucovorin calcium 5FU/fluorouracil Oxaliplatin.
135
FOLFIRINOX
Leucovorin calcium 5FU/fluorouracil Irinotecan
136
RCHOP
Rituxan Cytoxan Adriamycin Oncovin Prednisone
137
TCHP
Taxotere Carboplatin Herceptin Perjeta

CSO Exam 2023 (12 decks)

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