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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
Q

What are three major classes that cause chemo-induced peripheral neuropathy?

A

Platinum drugs
Taxanes
Alkaloids

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26
Q

Cisplatin

Class
ADE
What to give prior and why?

A

Alkylating agent

Nephrotoxic , ototoxic, peripheral neuropathy , decrease phosphate/potassium/magnesium

Give hydration and amifostine to prevent nephrotox

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27
Q

Major ADE of amifostine?

A

severe hypotension so D/C HTN meds at least 2 hours prior

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28
Q

Do you throw away the mannitol bags if you see crystals?

A

No, just warm up, shake, and cool down

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29
Q

Carboplatin Brand

Oxaliplatin Brand

A

Paraplatin

Eloxatin

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30
Q

Busulfan

Brand / ROA
Class
ADE

A

Busulfex IV
Myleran PO

Alkylating agent

Increase uric acid
Pulmonary fibrosis
SEIZURES
Hyperpigmentation
Bone marrow Suppression

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31
Q

Cyclophosphamide

Brand
Class
ROA
ADE
What to give prior and why?

A

Cytoxan

IV

Alkylating agent

Hemmorhagic cystitis
Sterility
Hepatotox
Renal tubular necrosis
Alopecia

Give MESNA to prevent hemorhagic cystitis

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32
Q

Ifosfamide

Brand
ROA
Alkylating agent
Prophylaxis?

A

Ifex

IV

Alkylating agent

GIve MESNA to protect bladder

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33
Q

Carmustine / Lomustine

Brand
ADE
Class

A

Carmustine - BiCNU
Lomustine - Gleostine

Pulmonary fibrosis
Hepatotox
Nephrotox
Bone marrow suppression

Alkylating agent

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34
Q

Streptozocin

Brand
ROA
Indication
ADE
Class

A

Zanosar

IV

Pancreatic cancer

Extravasation and nephrotox

Alkylating agent

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35
Q

Melphalan

Brand
RIA
ADE
Stability
Class

A

Alkeran

IV/ PO

Fertility impairement

Use within 60 minutes of reconstitution

Alkylating agent

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36
Q

Mechlorethamine

Brand
ROA
ADE

A

Mustargen, valchlor

IV

Extravasation and fertility impairment

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37
Q

Altretamine

Brand
ROA
Indication
ADE
Class

A

Hexalen

PO

Ovarian cancer

Neurotoxicity

Alkylating agent

38
Q

Procarbazine

Brand
ROA
Class (2)
ADE

A

Matulane

PO

Alkylating agent AND MAOI

Disulfram-like reaction

39
Q

Bendamustine

Brand
ROA
Indication
Stabiity/storage
Class
ADE

A

Treanda

IV

Chronic lymphocytic leukemia

24H in fridge or 3 hours at room temp

Alkylating agent

Myelosuppression, infusion reactions, TLS

40
Q

Methotrexate

ROA
ADE
Class
Antidote
What can you give to protect the kidneys?

A

Intrathecal
PO/IM/SC

Liver/renal/lung tox
Photosensitivity
Mucositits

Anti-metabolite

Leucovorin

Sodium bicarb and hydration

41
Q

Fluorouracil

Brand
ROA
Class
ADE
What can you give to increase concentration ?

A

Adrucil IV
Effudex cream

Anti-metabolite

Increase INR
Hand-foot syndrome (turns red/peeling)

Give leucovorin

42
Q

Capecitabine

Brand
ROA
Class
Box warning

A

Xeloda

PO

Anti-metabolite

Warfarin interaction

43
Q

Mercaptopurine

Brand
ROA
Class
Interactions
What drug metabolizes into mercaptopurine?

A

Purinethol/ purixan

Oral

Anti-metabolite

Allopurinol and febuxustate because 6MP requires XO to metabolize
Bactrim can increase myelosuppressive effect

Azathioprine

44
Q

Cytarabine

Brand
ROA
Class

A

Cytosar

IV/ intrathecal

Anti-metaboliteF

45
Q

Fludarabine

Brand
ROA
ADE

A

Fludara

IV

Significant immunosuppression (“AIDS in a bottle”)
Neurotoxicity

46
Q

Bleomycin

ROA
ADE
Class

A

IV/IM/SQ

Pulmonary fibrosis
Hyperpigmentation

Antibiotic

47
Q

Doxorubicin / Daunorubicin

Brand
Class
Prophylaxis and why?
Lifetime dose
ADE

A

Adriamycin

Antibiotic

Dexrazoxane (zinecard) protects against cardiotoxicity

550mg/m2

Red fluids, pregnancy category D, extravasation

48
Q

Valrubicin

Brand
Indication
Class

A

Valstar

Bladder cancer

Antibiotic

49
Q

Dactinomycin

ROA
Class
ADE
Contraindication

A

IV

Antibiotic

Extravasation

Active chicken pox or HSV

50
Q

Mitoxantrone

Brand
ROA
ADE
Class

A

Novantrone

IV

Blue fluids, cardiotoxicity

Antibiotic

51
Q

Docetaxel

Brand
ROA
Class
ADE
Premed

A

Docefrez, taxotere

IV

Plant alkaloid

Hypersensitivity
Edema
Peripheral neuropathy
Hepatic impairment
Ocular effects

Premedicate with steroid a day prior

52
Q

Paclitaxel

Brand
ROA
Class
ADE
What to store in

A

Taxol

IV

Plant alkaloid

Hypersensitivity
Peripheral neuropathy
Disulfram reaction

Use only non-PVC tubing

53
Q

Etoposide / teniposide

Brand
ROA
Class
ADE

A

Etoposide (Toposar )

PO/IV

Plant alkaloid

Hypotension

54
Q

Irinotecan / Topotecan

Brand
ROA
Class
ADE

A

Liposomal - onivyde
Conventional - Camptosar

IV
Topotecan is IV and PO

Plant alkaloid

Diarrhea and dehydration

55
Q

How must you NEVER administer vinca alkaloid?

A

Intrathecal - it is FATAL

Only give IV

56
Q

What is the most common ADE of each vinca alkaloid ?

What do they all cause equally?

A

Vin Cristine - CNS

Vin Blastine - Bone marrow suppression

Vin Orelbine - Alopecia

All cause peripheral neuropathy and constipation

57
Q

All Tyrosine kinase inhibitors have what suffix and come in what route?

ADE?

A
  • tinib

ORAL

Diarrhea and nausea

58
Q

EGFR Inhibitors

Pantiumumab BRAND
Cetuximab BRAN

A

Vectibix

Erbitux

59
Q

Bevacixumab

Class
Brand

A

VEGF
Avastin

60
Q

What are three histone deacetylase inhibitors and their brand names?

A

Vorinostat - Zolinza

Belinostat - Beleodaq

Romidepsin - Istodax

61
Q

If pre-menopausal, what is the only hormonal therapy option for breast cancer?

A

Tamoxifen - Soltamox

62
Q

Tamoxifen

Brand
Class / MOA
Dose
ADE
PGX

A

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
Q

Raloxifene

Brand
Class/ MOA
Dose
Indications

A

Evista

SERM - BLOCKS estroen receptors

60mg PO QD

Postmenopaulsal with osteoporosis or breast cancer

64
Q

Anastrazole

Brand
Class
Dose

A

Arimidex

Aromatase inhibitors

1mg QD

65
Q

Letrozole

Brand
Class
Dose

A

Femara

Aromatase inhibitors

2.5mg QD

66
Q

Exemestane

Brand
Class
Dose

A

Aromasin

Aromatase inhibitors

25mg QD

67
Q

Three targeted therapies for hormone receptor-positive breast cancer

A

palbociclib , ribociclib , Everlimus

68
Q

Palbociclib

Brand
Class
ADE

A

Ibrance

CDK4/6 Inhibitor

Neutropenia, PE, BMS

69
Q

Ribociclib

Brand
Class

A

Kisqali

CDK 4/6 inhibitor

70
Q

Everolimus

Brand
MOA
Dose

A

Afinitor, Zortress

mTOR kinase inhibitor

10 mg PO QD WITH exemestane

71
Q

Fulvestrant

Brand
MOA
ROA/Dose
Hepatic adjustment
ADE

A

Faslodex

Estrogen receptor antagonist

500mg IM monthly

1/2 dose if hepatic impairment

Bleeding (because you’re blocking estrogen)

72
Q

Four HER2 positive targeted therapies

A

Trastuzumab
Pertuzumab
Ado-trastuzumab emtansine
Lapatinib

73
Q

Trastuzumab

Brand
Class
ROA / duration
BBW

A

Herceptin

HER2+ antagonist

IV for 1 year

CHF , Pulmonary toxicity, anaphylaxis, angioedema

74
Q

Pertuzumab

Brand
Class
ROA
BBW

A

Perjeta

HER2+ antagonist

IV

Cardiac failure

75
Q

Ado-trastuzumab

Brand
Class
ROA
BBW
When to use

A

Kadcyla

HER2+ antagonist

IV

Heptatox, LVD, fetal tox

LAST LINE

76
Q

Lapatinib

Brand
MOA
Dose
PGX
ADE

A

Tykerb

TKI

PO empty stomach

3A4 substrate

Diarrhea , hand/foot syndrome

77
Q

Ixabepilone

BRand
MOA
Dosage form
Premedicate

A

Ixempra

Pothilone microtubule inhibitor

Contains alcohol and castor oil

Pretreat with H1 and H2 blockers

78
Q

Eribulin mesylate

Brand
ROA
MOA
When to use

A

Halaven

IV

Microtubule inhibitor

LAST LINE

79
Q

Megestrol

Brand
Indication
ADE

A

Megace

Advanced breast and endometrial cancer, and increase appetitie

Thromboembolism

80
Q

What do you use to test for prostate cancer and what are the values?

A

PSA blood test

> 10ng/mL =suspicious

81
Q

What do you give prior to LH-RH analogs and why?

A

Tumor flare can be prevented with anti-androgens like flutamide, bicalutamide, and nilutamide.

82
Q

List 4 LH-GnRH analogs and brand names and ROA

A

Goserelin - Zoladex - SC
Leuprolide - Lupron - IM
Triptorelin - Trelstar - IM
Histrelin - Vantas - SC

83
Q

Degarelix

Brand
MOA
Dose

A

Firmagon

LHRH antagonist

80mg SC monthly

84
Q

Four anti-androgens with brand name and dose and special probelm with each

A

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
Q

What is a salvage therapy hormone option for prostate cancer?

A

Ketoconazole (nizoral) because it reduces testosterone and cortisol

86
Q

Two options for prevention of prostate cancer

MOA?

A

Finasteride - proscar - 5mg

Dutasteride - avodart - 0.5mg

Inhibit 5-alpha reductase

87
Q

Sipuleucel - T

Brand
MOA
Indication

A

Provenge

a “vaccine”

Advanced prostate cancer

88
Q

Pembrolizumab

Brand
MOA
Indication

A

Keytruda

PD1 inhibitor (immunotherapy)

Melanoma, lung / head/ neck cancer

89
Q

Tisagenlecleucel

Brand
MOA
BBW

A

Kymriah

T-cell gene therapy

Neurological toxicities

90
Q

What is the AMES test for?

A

Tests if a chemical is a mutagen or has mutagenic potential

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