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SHPCPJEN2 > ChemoSH3 > Flashcards

ChemoSH3 Flashcards

1
Q

Breast cancer

A

Mammogram to identify lump. Then biopsy to identify if malignant or benign.

Different typers of breast cancers. ER ( estrogen receptors + ) , ( PR ) progesterone receptor + , ( HER2/ ErbB2 ) human epidermal receptor positive. HER2 have a more aggressive disease and higher risk recurrence

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2
Q

Types of Tx for breast cancer

A

Radiation, surgery, mastectomy, chemo, hormone therapy, target therapy

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3
Q

Chemo

A

Taxanes ( most common)
- paclitaxel ( taxol ) and docetaxel ( taxotere )

Anthracyclines
-doxorubicin ( adriamycin ) and epirubicin ( ellence )

Platinum agents
- cisplatin, carboplatin ( paraplatin )

Cyclophosphamide ( cytoxan )
-5FU , capecitabine ( xeloda )

Ixabepilone ( ixempra )

Eribulin ( halaven )

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4
Q

Hormone Therapy

: patients that have sensitivity to estrogen

A

•Tamoxifen , Raloxifene ( SERMS: selective estrogen receptor modulators ; they are sitting on the receptor of estrogen so wont let estrogen sit there. #1 side effect : CLOTS )

•Aromatase inhibitors ( AI ) : used for post menopausal breast cancer
• Fulvestrant ( IM ) : estrogen receptor antagonists : blocks estrogen completely. Increase in bleeding risk

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5
Q

Targeted therapy :

A

Hormone Receptor- positive ( ER + )
- Palbociclib ( Ibrance ) , Ribociclib ( kisqali ) , Everolimus ( Afinitor )

HER2+ breast cancer
- Trastuzumab ( herceptin ) , Pertuzaumab ( Perjeta ) , Ado-trastuzumab emtansine ( Kadcycla, TDM-1 ) , lapatinib ( tykerb) ( TINIB: tyrosine kinase inhibitor : always PO )

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6
Q

Tamoxifen ; raloxifene ( Evista ) are SERMS. You worry about

A

Clots!

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7
Q

Aromatase inhibitors:

A

Hormone therapy
Anastrozole ( armidex)
Letrozole ( Femara )

Stop production of estrogen in ovaries

no clot issues. Dont sit on R of estrogen. If premenopausal then we can only give tamoxifen and if post menopausal then can give evista or Aromatase inhibitors

Faslodex( fulvestrant ) IM estrogen R antagonists

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8
Q

Tamoxifen

A

non steroidal anti estrogen
SERM: selective estrogen receptor modulator. causes side effects of estrogen. Worry about CLOTS!
Endrogmetrial cancer( tamoxifen stimulates uterine estrogen receptor; evista does not ) , hyper calcemia.

Dose: 20 mg daily.

Clots: swelling of right leg? Go to md asap if any signs or sx

Tamoxifen goes through cyp2d6 to become active. Watch out of ddi. Cyp2d6 inhibitors ( Prozac , Paxil , ) weak but still watch out for Wellbutrin / Zoloft, duloxetine
Recommend venlafaxine

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9
Q

Raloxifene

A

Evista

Reduce the risk of breast cancer ( POSTMENOPAUSAL )
Osteoporosis prevention

Worry about clots just like tamoxifen

Tamoxifen vs raloxifene : evista does not causes endometrial cancer.

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10
Q

Aromatase inhibitors
: block production of estrogen

A

It does simulate estrogen so you dont worry about clots, hypercalcemia, or endometrial cancer.
It blocks production of estrogen.
POSTMENOPAUSAL agents.

Anastrozole ( arimidex ) - 1 mg QD
Letrozole ( femara ) - 2.5 mg QD
Exemestane ( aromasin ) - 25 mg QD

Major source of estrogen is derived from peripheral androgen conversion which requires Aromatase

DDI : never give tamoxifen with Aromatase inhibitors. Tamoxifen may decrease serum levels of Aromatase inhibitors

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11
Q

Target therapy for hormone receptor positive breast cancer

A

Palbociclib ( ibrance ) : CDK 4/6 inhibitor : watch for pulmonary embolism
Ribociclib ( kisqali ) : CDK 4/6 inhibitor. DDI 3a4 sub.
Everlimus ( afinitor , zortress )

Used for
- hormone receptor positive
- HER2 negative breast cancer
- they are used along with Aromatase inhibitors

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12
Q

FULVESTRANT

A

Faslodex ( IM )

Blocks estrogen completely. MOA: estrogen R antangoist.

IM once a month.

SE: bleeding, thrombocytopenia. Watch if patient on anticoagulants.

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13
Q

Target therapy for HER2 +

A

Chemo and HER2+ targeted therapy

targeted therapy : trastuzumab ( HERCEPTIN ) 52 weeks 1 year.

Never had herceptin before: give herceptin plus pertuzumab perjeta ( BBW : cardiac failure )

Lapatinib: tyrosine kinase inhibitor

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14
Q

Trastuzumab ( HERCEPTIN )

A

HErCEPTIN

IV
Dont get this alone, get in combination. With concurrent paclitaxel or docetaxel

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15
Q

Ado trastuzumab ( kadcyla) last line therapy for HEr2 +

A

T

Last line IV only therapy

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16
Q

Lapatinib

A

Tykerb

Tyrosine kinase inhibitor ( PO ) - empty stomach

17
Q

Eribulin mesylate

A

Halaven

Can be used for triple negative metastatic breast cancer

18
Q

Megestrol

A

Megace

Progestin : advanced breast and endometrial cancer
Also used to stimulate appetite

SE: weight gain thromboemolism HF

19
Q

Prostate cancer

A

Males only.
Fueled by testosterone

PSA: if high then do biopsy

20
Q

LH-RH or GnRH analogs

Lutenizing hormone - releasing hormone agonist

A

Goseriln ( zoladex )
Leuprolide ( Lupron )
Triptorelin ( Trelstar )

Histrelin ( Vantas )

Not just used for prostate cancer. Used for endometriosis and pre menopausal breast cancer patients

21
Q

LH - RH analogs SEs:

A

Bc increasing testosterone you can get a tumor flare ( bone pain, increase tumor size, )
- so give an antiandrogen med : Flutamide, biclutamide, nilutamide
LUTAMIDE: start 2 to 4 weeks.

SE: If you decrease testosterone you can get gynecomastia

Pulmonary embolism

22
Q

LH-RH analogs

A

Never given daily.

Im q 1 month, q 3 months, or q 4 months

23
Q

Degarelix

A

Firmagon

MOA: LHRH antagonists. ( no neg feedback ). Rapid suppression of testosterone.
SUBQ every 28 days

SE: hot flashes weight gain

24
Q

Ani androgens

A

Block testosterone production.

Used with LHRH / GnRH analogues

SE: gynecomastia

25
Q

Salvage Hormone Therapy

A

Ketoconazole ( nizoral )
Reduces levels of testosterone and cortisol

SE: gynecomastia ( remember sprionlactone, Tagamet and anything that suppress testosterone)

Oral formulation take with food bc want acidic environment to be absorbed

Inhibits cyp3a4

26
Q

Finasteride ( 5m g

Dutasteride ( avodart ) ( 0.5 mg )

A

Proscar ( 5 mg ) : can sub for 1 mg propecia

Prevention of prostate cancer: indication.
MOA: inhibit 5 alpha reductase ( enzyme that converts testosterone to the more potent androgen dihydrotestosterone

Studies: these drugs seem to lower the risk of less aggressive prostate cancers while increasing the risk of more aggressive cancers

27
Q

Provenge

A

Sipulucel - T

Vaccine : treat advance prostate cancer that is no longer responding to hormone therapy

28
Q

Colon Cancer Screening

A

Colonoscopy screen
Start at age 50

29
Q

Immunotherapy

A

makes own immune system fight against the cancer

Keytruda ( Pembrolizumab ) : PD-1 Inhibitor monoclonal AB ( PD-1 acts to prevent immune cells from attacking its own cells. By blocking PD1 keytruda allows immune cells to attack own cells / cancer cells

Indication:
-melanoma IV
- Non - small cell lung cancer : metastatic IV
-head and neck cancer IV

SIDE EFFECTS: more tolerable than conventional chemo. GI toxicity, hepatotoxicity, pulmonary toxicity, thyroid disorders

30
Q

AMES TEST

A

Test to see if chemical is a mutagen or has mutagenic potential.

If it can change bacterial dna it may also turn out to be a carcinogen that is to cause cancer

SHPCPJEN2 (26 decks)

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