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Chemotherapy Flashcards

1
Q

What are two cell-cycle specific and non-specific classes?

A

Cell-cycle specific - Antimetabolites and vinca’s

Non-specific - Alkylating agents and cytotoxic antibiotics

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2
Q

Dolasetron

Brand
Class
ROA

A

Anzemet

5HT3R Blocker

IV and PO but don’t use IV for CINV because of QT prolongation

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3
Q

Granisetron

Class
Brand/ROA

A

5HT3R blocker

IV - Kytil
PO - Granisol
SQ (ER) - Sustol Q7D
Patch - Sancuso every 24-48 hours every 7 days (but they keep patch up on for the whole week)

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4
Q

Ondansetron

Brand
ROA

A

IV/PO/IM/ODT - zofran

Thin strip that melts on tongue - Zuplenz

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5
Q

palonsetron

Brand - ROA

When to recommend

A

Aloxi - IV

Recommend if they have QT prolongation

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6
Q

Akynzeo

Components
ROA

A

Netupitant + palonsetron

PO

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7
Q

Are steroids for CINV supposed to be used alone or with another drug?

A

Can be alone or with a 5HT3R antagonist

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8
Q

Do we use NK1R antagonists alone or with another drug?

A

With another drug

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9
Q

Aprepitant

Brand
ROA
Combo

A

Emend PO

Combo with 5HT3R antagonist and steroid

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10
Q

Fosaprepitant

Brand / ROA

A

Emend IV

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11
Q

Rolapitant

Brand / ROA
PGX

A

Varubi PO

2D6 inhibitor

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12
Q

What cannabinoid is available for CINV and what are the brand names?

A

Dronabinol (marinol/ syndros)

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13
Q

What are two dopaminergic antagonists used in CINV?

A

Metoclopramide (reglan)

Prochlorperazine

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14
Q

Which benzo can be used for CINV?

A

Lorazepam

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15
Q

Erythropoietin

Brand
Dose / ROA / duration

A

Epogen , procrit

150-300U/KG SC/IV 3/week or 40,000-60,000 units weekly

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16
Q

Dabepoetin alfa

Brand
Dose
Storage

A

Aranesp

2.25mcg/kg SC/IV weekly or 500mcg every 3 weeks

Don’t shake, protect from light refrigerate, must be clear and colorless

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17
Q

What is one contraindication for erythropoitin/darbopoetin ?

What is the goal Hgb while on these meds?

A

Uncontrolled HTN

10-11g/dL

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18
Q

At what serum ferritin and transferring level would you start iron?

A

<100mcg/mL and/or serum transferrin saturation <20%

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19
Q

What are two options for chemo-induced leukopenia?

What is a common ADE of both?

A

Filgrastim (granix, neupogen, zarxio)

Pegfilgrastim (neulesta)

Both cause bone pain

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20
Q

What 4 electrolytes change with tumor lysis syndrome?

A

INCREASED K+ , uric acid, phosphate

DECREASE Ca2+

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21
Q

Calcium acetate

Brand
ADE

A

PhosLo

Constipation

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22
Q

Which version of calcium has more elemental calcium?

A

Calcium chloride

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23
Q

Sodium polystyrene sulfonate

Brand
MOA

A

Kayexalate

Exchanges sodium for potassium

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24
Q

Patriomer

Brand
MOA
ROA

A

Veltassa

Binds K+ in colon and exchanges for calcium

Oral suspension

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25
What are three major classes that cause chemo-induced peripheral neuropathy?
Platinum drugs Taxanes Alkaloids
26
Cisplatin Class ADE What to give prior and why?
Alkylating agent Nephrotoxic , ototoxic, peripheral neuropathy , decrease phosphate/potassium/magnesium Give hydration and amifostine to prevent nephrotox
27
Major ADE of amifostine?
severe hypotension so D/C HTN meds at least 2 hours prior
28
Do you throw away the mannitol bags if you see crystals?
No, just warm up, shake, and cool down
29
Carboplatin Brand Oxaliplatin Brand
Paraplatin Eloxatin
30
Busulfan Brand / ROA Class ADE
Busulfex IV Myleran PO Alkylating agent Increase uric acid Pulmonary fibrosis SEIZURES Hyperpigmentation Bone marrow Suppression
31
Cyclophosphamide Brand Class ROA ADE What to give prior and why?
Cytoxan IV Alkylating agent Hemmorhagic cystitis Sterility Hepatotox Renal tubular necrosis Alopecia Give MESNA to prevent hemorhagic cystitis
32
Ifosfamide Brand ROA Alkylating agent Prophylaxis?
Ifex IV Alkylating agent GIve MESNA to protect bladder
33
Carmustine / Lomustine Brand ADE Class
Carmustine - BiCNU Lomustine - Gleostine Pulmonary fibrosis Hepatotox Nephrotox Bone marrow suppression Alkylating agent
34
Streptozocin Brand ROA Indication ADE Class
Zanosar IV Pancreatic cancer Extravasation and nephrotox Alkylating agent
35
Melphalan Brand RIA ADE Stability Class
Alkeran IV/ PO Fertility impairement Use within 60 minutes of reconstitution Alkylating agent
36
Mechlorethamine Brand ROA ADE
Mustargen, valchlor IV Extravasation and fertility impairment
37
Altretamine Brand ROA Indication ADE Class
Hexalen PO Ovarian cancer Neurotoxicity Alkylating agent
38
Procarbazine Brand ROA Class (2) ADE
Matulane PO Alkylating agent AND MAOI Disulfram-like reaction
39
Bendamustine Brand ROA Indication Stabiity/storage Class ADE
Treanda IV Chronic lymphocytic leukemia 24H in fridge or 3 hours at room temp Alkylating agent Myelosuppression, infusion reactions, TLS
40
Methotrexate ROA ADE Class Antidote What can you give to protect the kidneys?
Intrathecal PO/IM/SC Liver/renal/lung tox Photosensitivity Mucositits Anti-metabolite Leucovorin Sodium bicarb and hydration
41
Fluorouracil Brand ROA Class ADE What can you give to increase concentration ?
Adrucil IV Effudex cream Anti-metabolite Increase INR Hand-foot syndrome (turns red/peeling) Give leucovorin
42
Capecitabine Brand ROA Class Box warning
Xeloda PO Anti-metabolite Warfarin interaction
43
Mercaptopurine Brand ROA Class Interactions What drug metabolizes into mercaptopurine?
Purinethol/ purixan Oral Anti-metabolite Allopurinol and febuxustate because 6MP requires XO to metabolize Bactrim can increase myelosuppressive effect Azathioprine
44
Cytarabine Brand ROA Class
Cytosar IV/ intrathecal Anti-metaboliteF
45
Fludarabine Brand ROA ADE
Fludara IV Significant immunosuppression ("AIDS in a bottle") Neurotoxicity
46
Bleomycin ROA ADE Class
IV/IM/SQ Pulmonary fibrosis Hyperpigmentation Antibiotic
47
Doxorubicin / Daunorubicin Brand Class Prophylaxis and why? Lifetime dose ADE
Adriamycin Antibiotic Dexrazoxane (zinecard) protects against cardiotoxicity 550mg/m2 Red fluids, pregnancy category D, extravasation
48
Valrubicin Brand Indication Class
Valstar Bladder cancer Antibiotic
49
Dactinomycin ROA Class ADE Contraindication
IV Antibiotic Extravasation Active chicken pox or HSV
50
Mitoxantrone Brand ROA ADE Class
Novantrone IV Blue fluids, cardiotoxicity Antibiotic
51
Docetaxel Brand ROA Class ADE Premed
Docefrez, taxotere IV Plant alkaloid Hypersensitivity Edema Peripheral neuropathy Hepatic impairment Ocular effects Premedicate with steroid a day prior
52
Paclitaxel Brand ROA Class ADE What to store in
Taxol IV Plant alkaloid Hypersensitivity Peripheral neuropathy Disulfram reaction Use only non-PVC tubing
53
Etoposide / teniposide Brand ROA Class ADE
Etoposide (Toposar ) PO/IV Plant alkaloid Hypotension
54
Irinotecan / Topotecan Brand ROA Class ADE
Liposomal - onivyde Conventional - Camptosar IV Topotecan is IV and PO Plant alkaloid Diarrhea and dehydration
55
How must you NEVER administer vinca alkaloid?
Intrathecal - it is FATAL Only give IV
56
What is the most common ADE of each vinca alkaloid ? What do they all cause equally?
Vin Cristine - CNS Vin Blastine - Bone marrow suppression Vin Orelbine - Alopecia All cause peripheral neuropathy and constipation
57
All Tyrosine kinase inhibitors have what suffix and come in what route? ADE?
- tinib ORAL Diarrhea and nausea
58
EGFR Inhibitors Pantiumumab BRAND Cetuximab BRAN
Vectibix Erbitux
59
Bevacixumab Class Brand
VEGF Avastin
60
What are three histone deacetylase inhibitors and their brand names?
Vorinostat - Zolinza Belinostat - Beleodaq Romidepsin - Istodax
61
If pre-menopausal, what is the only hormonal therapy option for breast cancer?
Tamoxifen - Soltamox
62
Tamoxifen Brand Class / MOA Dose ADE PGX
Soltamox SERM - STIMULATES estrogen receptors (which is why risk of endometrial cancer) 20mg PO QD Clots, hyperCa2+, endometrial cancer Converted to active form via 2D6
63
Raloxifene Brand Class/ MOA Dose Indications
Evista SERM - BLOCKS estroen receptors 60mg PO QD Postmenopaulsal with osteoporosis or breast cancer
64
Anastrazole Brand Class Dose
Arimidex Aromatase inhibitors 1mg QD
65
Letrozole Brand Class Dose
Femara Aromatase inhibitors 2.5mg QD
66
Exemestane Brand Class Dose
Aromasin Aromatase inhibitors 25mg QD
67
Three targeted therapies for hormone receptor-positive breast cancer
palbociclib , ribociclib , Everlimus
68
Palbociclib Brand Class ADE
Ibrance CDK4/6 Inhibitor Neutropenia, PE, BMS
69
Ribociclib Brand Class
Kisqali CDK 4/6 inhibitor
70
Everolimus Brand MOA Dose
Afinitor, Zortress mTOR kinase inhibitor 10 mg PO QD WITH exemestane
71
Fulvestrant Brand MOA ROA/Dose Hepatic adjustment ADE
Faslodex Estrogen receptor antagonist 500mg IM monthly 1/2 dose if hepatic impairment Bleeding (because you're blocking estrogen)
72
Four HER2 positive targeted therapies
Trastuzumab Pertuzumab Ado-trastuzumab emtansine Lapatinib
73
Trastuzumab Brand Class ROA / duration BBW
Herceptin HER2+ antagonist IV for 1 year CHF , Pulmonary toxicity, anaphylaxis, angioedema
74
Pertuzumab Brand Class ROA BBW
Perjeta HER2+ antagonist IV Cardiac failure
75
Ado-trastuzumab Brand Class ROA BBW When to use
Kadcyla HER2+ antagonist IV Heptatox, LVD, fetal tox LAST LINE
76
Lapatinib Brand MOA Dose PGX ADE
Tykerb TKI PO empty stomach 3A4 substrate Diarrhea , hand/foot syndrome
77
Ixabepilone BRand MOA Dosage form Premedicate
Ixempra Pothilone microtubule inhibitor Contains alcohol and castor oil Pretreat with H1 and H2 blockers
78
Eribulin mesylate Brand ROA MOA When to use
Halaven IV Microtubule inhibitor LAST LINE
79
Megestrol Brand Indication ADE
Megace Advanced breast and endometrial cancer, and increase appetitie Thromboembolism
80
What do you use to test for prostate cancer and what are the values?
PSA blood test >10ng/mL =suspicious
81
What do you give prior to LH-RH analogs and why?
Tumor flare can be prevented with anti-androgens like flutamide, bicalutamide, and nilutamide.
82
List 4 LH-GnRH analogs and brand names and ROA
Goserelin - Zoladex - SC Leuprolide - Lupron - IM Triptorelin - Trelstar - IM Histrelin - Vantas - SC
83
Degarelix Brand MOA Dose
Firmagon LHRH antagonist 80mg SC monthly
84
Four anti-androgens with brand name and dose and special probelm with each
Biclutamide - casodex - 50mg QD - interacts with warfarin Flutamide - Eulexin - 250mg Q8H - worst diarrhea Nilutamide - nilandron - 150mg WD - disulfram like reactions Enzalutamide - xtandi - 160mg QD (LAST LINE) - seizures
85
What is a salvage therapy hormone option for prostate cancer?
Ketoconazole (nizoral) because it reduces testosterone and cortisol
86
Two options for prevention of prostate cancer MOA?
Finasteride - proscar - 5mg Dutasteride - avodart - 0.5mg Inhibit 5-alpha reductase
87
Sipuleucel - T Brand MOA Indication
Provenge a "vaccine" Advanced prostate cancer
88
Pembrolizumab Brand MOA Indication
Keytruda PD1 inhibitor (immunotherapy) Melanoma, lung / head/ neck cancer
89
Tisagenlecleucel Brand MOA BBW
Kymriah T-cell gene therapy Neurological toxicities
90
What is the AMES test for?
Tests if a chemical is a mutagen or has mutagenic potential

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