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Drug List Flashcards

1
Q

Abiraterone

Class of drug

A

Anti-androgen

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2
Q

Abiraterone

Mechanism of action

A

Selective CYP17 inhibitor

  • -> inhibit androgen production in testes/prostate/adrenal glands
  • -> inhibit testosterone-stimulated growth in prostatic tumours
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3
Q

Abiraterone

Indication

A

Prostate cancer

Only if androgen-specific

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4
Q

Abiraterone

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

Combination with prednisone

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5
Q

Abiraterone

Important cautions (2)/contraindications (1)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Use condoms
  • Pregnant women use gloves when handling

CONTRAINDICATIONS
- Pregnancy & breastfeeding

INTERACTIONS
- Dexamethasone –> increased hypokalaemia/torsade de pointes risk

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6
Q

Abiraterone

Monitoring (4)

A

BP
K+
Fluid balance
Liver function

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7
Q

Abiraterone

Side effects (4)

A

Hypertension
Hypokalaemia
Peripheral oedema
UTI

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8
Q

Amikacin

Class of drug

A

Aminoglycoside

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9
Q

Amikacin

Mechanism of action

A

Irreversibly bind to 30S ribosome subunit

  • -> alter cell membrane permeability
  • -> inhibit protein synthesis (bactericidal)
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10
Q

Amikacin

Indication

A

SERIOUS gram-negative infections resistant to gentamicin (1st-line aminoglycoside)

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11
Q

Amikacin

Why this over another drug? (Place in therapy)

A

Last resort: if resistant to gentamicin/other aminoglycosides

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12
Q

Amikacin

Important cautions (1)/contraindications (2)/interactions

*include bracketed numbers if applicable

A

CAUTIONS
- Dehydration

CONTRAINDICATIONS

  • Myasthenia gravis
  • Ototoxicity with previous aminoglycoside use
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13
Q

Amikacin

Monitoring (3)

A

Renal function
Hearing
Serum concentration

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14
Q

Amikacin

Side effects (2)

A

Nephrotoxicity

Ototoxicity (irreversible)

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15
Q

Anastrozole

Class of drug

A

Anti-oestrogen

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16
Q

Anastrozole

Mechanism of action

A

Aromatase inhibitor

  • -> inhibits oestradiol production via aromatase enzyme in postmenopausal women
  • -> reduce turnover of breast tissue cells
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17
Q

Anastrozole

Indication

A

Breast cancer in postmenopausal women

only if oestrogen receptor specific

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18
Q

Anastrozole

Why this over another drug? (Place in therapy)

A

First-line or after 2-3 years of tamoxifen therapy

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19
Q

Anastrozole

Important cautions (2)/contraindications (2)/interactions

*include bracketed numbers if applicable

A

CAUTIONS

  • Susceptible to osteoporosis (may further weaken bones)
  • Severe liver/renal impairment

CONTRAINDICATIONS

  • Premenopausal women
  • Pregnancy & breastfeeding
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20
Q

Anastrozole

Monitoring (2; generalised)

A
  • Mammogram

- Breast examination –> physically feeling for abnormalities/lumps

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21
Q

Anastrozole

Side effects (6)

A 
Musculoskeletal aches/pains
Numb/tingling fingers
Hot flushing
Vaginal dryness
Hair loss/thinning
Stomach upset
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22
Q

Aprepitant

Class of drug

A

Antiemetic –> neurokinin receptor antagonist

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23
Q

Aprepitant

Mechanism of action

A

NK1 receptor antagonist in brain (neurokinin)

  • -> in combination: augments other antiemetic activity
  • -> inhibit emesis/vomiting
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24
Q

Aprepitant

Indication

A

Nausea & vomiting due to chemotherapy/post-operation

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25
Q

Aprepitant

Why this over another DRUG/CLASS? (Place in therapy)

A

In combination with other antiemetics eg. steroids

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26
Q

Aprepitant

Important cautions (2)/interactions (2)

*include bracketed numbers if applicable

A

CAUTIONS

  • Liver impairment
  • Two forms of contraception

INTERACTIONS

  • CYP3A4 –> increase half-life of 3A4-metabolised drugs/increase effect
  • Fentanyl –> prolonged sedation, increased risk of respiratory depression
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27
Q

Aprepitant

Monitoring (1)

A

Liver function

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28
Q

Aprepitant

Side effects (4)

A

Decreased appetite
Hiccups
Asthenia (decreased muscle strength)
ALT increased

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29
Q

Bicalutamide

Class of drug

A

Anti-androgen

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30
Q

Bicalutamide

Mechanism of action

A

Gonadorelin analogue

  • -> inhibits androgen receptors
  • -> deterioration of prostate tumours
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31
Q

Bicalutamide

Indication

A

Prostate cancer

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32
Q

Bicalutamide

Why this over another DRUG/CLASS? (Place in therapy)

A

Combination with another gonadorelin analogue (if monotherapy-resistant) or surgical castration

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33
Q

Bicalutamide

Important cautions (3)/contraindications (1)/interactions (1)

A

CAUTIONS

  • Liver impairment
  • Photosensitivity
  • QT prolongation

CONTRAINDICATIONS
- Women & children

INTERACTIONS
Domperidone –> QT prolongation

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34
Q

Bicalutamide

Monitoring (2)

A

Liver function

QT prolongation –> ECG

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35
Q

Bicalutamide

Side effects (6)

A 
Constipation
Abdominal pain
Nausea
Flatulence
Jaundice
Oedema
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36
Q

Bisacodyl

Class of drug

A

Stimulant laxative

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37
Q

Bisacodyl

Mechanism of action

A

Stimulates peristalsis of colon/large intestine

  • -> promotes water accumulation & electrolytes
  • -> softens stool & reduces transit time

does not act on small intestine

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38
Q

Bisacodyl

Indication

A

Constipation; preparation for surgery/diagnostic procedures

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39
Q

Bisacodyl

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

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40
Q

Bisacodyl

Important cautions (1)/contraindications (5)/interactions

*include bracketed numbers if applicable

A

CAUTIONS
- Prolonged/excessive use –> dehydration, hypokalaemia

CONTRAINDICATIONS

  • Acute IBD
  • Acute abdominal surgery
  • Severe dehydration
  • Intestinal obstruction
  • Abdominal pain associated with nausea & vomiting
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41
Q

Bisacodyl

Monitoring

A

Electrolytes

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42
Q

Bisacodyl

Side effects (6)

A 
Abdominal pain
Diarrhoea
Nausea & vomiting
Dizziness
Syncope/fainting
Rectal burning
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43
Q

Capecitabine

Class of drug

A

Antimetabolite

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44
Q

Capecitabine

Mechanism of action (3 points)

A

Prodrug –> tumour-activated into fluorouracil

False nucleotide incorporated into DNA & RNA
–> prevent normal cell division esp. S-phase

Inhibition of thymidylate synthetase
–> inhibit DNA & RNA synthesis

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45
Q

Capecitabine

Indication (4 cancers)

A

Breast
Colon
Colorectal
Oesophago-gastric

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46
Q

Capecitabine

Why this over another DRUG/CLASS? (Place in therapy)

A

Breast: combination therapy, or monotherapy if combo not indicated

Colon: combination therapy, or monotherapy if combo not indicated

Colorectal: 1st-line if metastatic

Oesophago-gastric: 1st-line if advanced; combo with Pt-based chemo

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47
Q

Capecitabine

Important cautions (3)/contraindications (3)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Liver impairment
  • Renal impairment –> reduce dose
  • Pregnancy –> proper cytotoxic procedures

CONTRAINDICATIONS

  • Dihydropyrimidine dehydrogenase deficiency
  • Severe liver impairment
  • Breastfeeding

INTERACTIONS
- Capecitabine –> increased myelosuppression risk; separate filgrastim 1 day before & after capecitabine treatment

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48
Q

Capecitabine

Monitoring (3)

A

Liver function
Renal function
Electrolytes (if experience diarrhoea)

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49
Q

Capecitabine

Side effects (4)

A

Mucositis (sore mouth)
Nausea & vomiting
Diarrhoea
Alopecia

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50
Q

Carboplatin

Class of drug

A

Platinum-based antineoplastic

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51
Q

Carboplatin

Mechanism of action

A

Alkylating-type agent

  • -> does DNA cross-linking & interrupt structure (NOT cell-cycle phase specific)
  • -> inhibit DNA, RNA & protein synthesis
  • -> prevent cell replication
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52
Q

Carboplatin

Indication (2 cancers)

A

Ovarian

Lung

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53
Q

Carboplatin

Why this over another DRUG/CLASS? (Place in therapy)

A

Less likely severe nausea & vomiting than cisplatin

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54
Q

Carboplatin

Important cautions (1)/contraindications (2)/interactions (2)

*include bracketed numbers if applicable

A

CAUTIONS
- Renal impairment –> reduce dose

CONTRAINDICATIONS

  • Pregnancy (1st trimester) & breastfeeding
  • Severe renal impairment

INTERACTIONS

  • Filgrastim –> increased myelosuppression risk; separate treatments by 1 day
  • Gentamicin –> increase risk of renal impairment
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55
Q

Carboplatin

Monitoring (3)

A

Renal function
Neurological tests
Hearing tests

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56
Q

Carboplatin

Side effects (7)

A 
Thrombocytopenia (low platelet count)
Neurotoxicity
Ototoxicity
Mucositis (sore mouth)
Nausea & vomiting
Diarrhoea
Alopecia
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57
Q

Ceftriaxone

Class of drug

A

3rd-generation cephalosporin

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58
Q

Ceftriaxone

Mechanism of action

A

Attach to penicillin-binding proteins in bacteria

  • -> interrupt cell wall biosynthesis
  • -> bacterial cell lysis & death (bactericidal)
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59
Q

Ceftriaxone

Indication (3 serious infections +1)

A

Septicaemia
Pneumonia
Meningitis

Surgical prophylaxis

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60
Q

Ceftriaxone

Why this over another DRUG/CLASS? (Place in therapy)

A

Widest spectrum –> most active against gram-negative

Half-life allows for OD dosing

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61
Q

Ceftriaxone

Important cautions (1)/contraindications (1)/interactions (2)

*include bracketed numbers if applicable

A

CAUTIONS
- Severe liver & renal impairment

CONTRAINDICATIONS
- Cephalosporin allergy

INTERACTIONS

  • Concomitant parenteral nutrition containing calcium –> precipitation
  • Warfarin –> increased INR & anticoagulant activity
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62
Q

Ceftriaxone

Monitoring (2)

A

Liver function

Renal function

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63
Q

Ceftriaxone

Side effects (2)

A

GI upset

Thrush (vaginal/oral)

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64
Q

Cefuroxime

Class of drug

A

2nd-generation cephalosporin

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65
Q

Cefuroxime

Mechanism of action

A

Attach to penicillin-binding proteins in bacteria

  • -> interrupt cell wall biosynthesis
  • -> bacterial cell lysis & death (bactericidal)
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66
Q

Cefuroxime

Indication

A

Surgical prophylaxis

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67
Q

Cefuroxime

Why this over another DRUG/CLASS? (Place in therapy)

A

Less susceptible than 1st-gen (cefazolin etc.) to beta-lactamase inactivation –> greater activity against H. influenzae

Preferred in dialysis

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68
Q

Cefuroxime

Important cautions (1)/contraindications (1)/interactions (2)

*include bracketed numbers if applicable

A

CAUTIONS
- Renal impairment –> reduce dose

CONTRAINDICATIONS
- Cephalosporin allergy

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69
Q

Cefuroxime

Monitoring (1)

A

Renal function

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70
Q

Cefuroxime

Side effects (2)

A

GI upset

Thrush (vaginal/oral)

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71
Q

Cisplatin

Class of drug

A

Platinum-based antineoplastic

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72
Q

Cisplatin

Mechanism of action

A

Alkylating-type agent

  • -> does DNA cross-linking & interrupt structure (NOT cell-cycle phase specific)
  • -> inhibit DNA, RNA & protein synthesis
  • -> prevent cell replication
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73
Q

Cisplatin

Indication (BOTH CL cancers)

A

Bladder
Ovarian
Testes
Head/neck

UNAPPROVED
Cervical
Lung

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74
Q

Cisplatin

Why this over another DRUG/CLASS? (Place in therapy)

A

Less likely for severe thrombocytopenia (low platelet count) than carboplatin

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75
Q

Cisplatin

Important cautions (1)/contraindications (1)/interactions (2)

*include bracketed numbers if applicable

A

CAUTION
- Renal impairment –> alternative preferred

CONTRAINDICATIONS
- Pregnancy (1st trimester) & breastfeeding

INTERACTIONS

  • Filgrastim –> increased myelosuppression risk; separate treatments by 1 day
  • Cisplatin –> increased risk of renal impairment & ototoxicity
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76
Q

Cisplatin

Monitoring

A

Renal function
Neurological tests
Hearing tests

77
Q

Cisplatin

Side effects

A 
Nausea & vomiting
Neurotoxicity
Ototoxicity
Mucositis (sore mouth)
Diarrhoea
Alopecia
78
Q

Cyclizine

Class of drug

A

1st-generation antihistamine

79
Q

Cyclizine

Mechanism of action

A

Histamine H1 receptor antagonist

  • -> may inhibit midbrain area emetic centre
  • -> reduce vomiting

Anticholinergic activity
- but no marked sedating effect

80
Q

Cyclizine

Indication

A

Nausea & vomiting

81
Q

Cyclizine

Why this over another DRUG/CLASS? (Place in therapy)

A

Vomiting associated with breast cancer radiotherapy –> does not elevate prolactin levels

Preferred if less sedation wanted

82
Q

Cyclizine

Important cautions (3)/contraindications (1)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • GI obstruction
  • Angle-closure glaucoma (high-risk of)
  • Severe heart failure

CONTRAINDICATIONS
- Severe liver impairment

INTERACTIONS
- Alcohol –> increase sedating effects

83
Q

Cyclizine

Monitoring (1)

A

Liver function

84
Q

Cyclizine

Side effects (6)

A 
Drowsiness
Dry mouth/nose/throat
Blurred vision
Tachycardia
Urinary retention
Constipation
85
Q

Cyclophosphamide

Class of drug

A

Alkylating agent

Immunosuppressant

86
Q

Cyclophosphamide

Mechanism of action

A

Alkylating agent

  • -> does DNA cross-linking & interrupt structure
  • -> inhibit DNA, RNA & protein synthesis
  • -> prevent cell replication; immunosuppression
87
Q

Cyclophosphamide

Indication

A

Leukaemia
Lymphoma
Some solid tumours
Rheumatoid arthritis

88
Q

Cyclophosphamide

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

89
Q

Cyclophosphamide

Important cautions (2)/contraindications (2)/interactions

*include bracketed numbers if applicable

A

CAUTIONS

  • Liver impairment –> reduce dose
  • Renal impairment –> reduce dose

CONTRAINDICATIONS

  • Haemorrhagic cystitis (bladder UTI)
  • Pregnancy (1st trimester) & breastfeeding
90
Q

Cyclophosphamide

Monitoring (2)

A

Liver function

Renal function

91
Q

Cyclophosphamide

Side effects (4)

A

Myelosuppression
Nausea & vomiting
Alopecia
Bladder toxicity (haemorrhagic cystitis)

92
Q

Dexamethasone

Class of drug

A

Glucocorticoid

93
Q

Dexamethasone

Mechanism of action

A
  1. Reduce expression of pro-inflammatory genes
  2. Increase expression of anti-inflammatory genes
  3. Decrease synthesis of cytokines
    - -> suppress inflammation
    - -> immunosuppression due to direct inhibition of lymphocyte proliferation & function
94
Q

Dexamethasone

Indication

A

Nausea & vomiting with chemotherapy/palliative care

95
Q

Dexamethasone

Why this over another DRUG/CLASS? (Place in therapy)

A

Added if metoclopramide & domperidone not sufficiently effective

Before starting docetaxel chemo

96
Q

Dexamethasone

Important cautions (4)/contraindications (1)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Hypertension
  • Hypothyroidism
  • Liver impairment
  • Glaucoma

CONTRAINDICATIONS
- Systemic infections UNLESS antimicrobial also given

INTERACTIONS
- Abiraterone –> increased hypokalaemia/torsades de pointes risk

97
Q

Dexamethasone

Monitoring

A

Liver function

Renal function

98
Q

Dexamethasone

Side effects

A
  • Hypertension
  • Fluid retention
  • Diabetes
  • Osteoporosis
99
Q

Docetaxel

Class of drug

A

Antineoplastic

Taxane

100
Q

Docetaxel

Mechanism of action

A

Promote assembly of tubulin into stable microtubules & inhibit disassembly

  • -> decreases free tubulin
  • -> disrupts cell microtubular network
  • -> disrupts mitotic & interphase cell functions
101
Q

Docetaxel

Why this over another DRUG/CLASS? (Place in therapy)

A

Breast: locally-advanced/metastatic with failed previous chemo

Non-small cell lung: locally-advanced/metastatic with failed Pt-based chemo

Ovarian: after failure of previous chemo, may combine with Pt-based chemo

Head/neck: combo with cisplatin & fluorothiouracil

Prostate: androgen-independent/hormone refractory

102
Q

Docetaxel

Why this over another DRUG/CLASS? (Place in therapy)

A

Breast: locally-advanced/metastatic with failed previous chemo

Non-small cell lung: locally-advanced/metastatic with failed Pt-based chemo

Ovarian: after failure of previous chemo, may combine with Pt-based chemo

Head/neck: combo with cisplatin & fluorothiouracil

Prostate: androgen-independent/hormone refractory

103
Q

Docetaxel

Important cautions (3)/contraindications (1)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Pregnancy
  • Oedema –> pre-treat with dexamethasone
  • Liver impairment –> reduce dose

CONTRAINDICATIONS
- Breastfeeding

INTERACTIONS
- CYP3A4 inhibitors –> increase docetaxel half-life

104
Q

Docetaxel

Monitoring (2)

A

Liver function

CBC

105
Q

Docetaxel

Side effects (4)

A

Neutropenia (low neutrophils)
Oedema
Alopecia
Musculoskeletal pain

106
Q

Docusate

Class of drug

A

Stool softeners

107
Q

Docusate

Mechanism of action

A

Increases amount of water absorbed by stool in gut

  • -> softens stool
  • -> facilitates passing
108
Q

Docusate

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

109
Q

Docusate

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

110
Q

Docusate

Important cautions (2)/contraindications (3)/interactions

*include bracketed numbers if applicable

A

CAUTIONS

  • Prolonged/excessive use
  • Haemorrhoids, anal fissures

CONTRAINDICATIONS

  • Intestinal obstruction
  • Undiagnosed rectal bleeding
  • Appendicitis
111
Q

Docusate

Side effects (4)

A

Abdominal cramps
Diarrhoea
Nausea
Rash

112
Q

Docusate

Side effects (4)

A

Abdominal cramps
Diarrhoea
Nausea
Rash

113
Q

Domperidone

Class of drug

A

Antiemetic (peripheral)

114
Q

Domperidone

Mechanism of action

A
  1. Stimulates GI peristalsis
  2. Lowers oesophageal sphincter pressure
  3. Dopamine receptor antagonist in chemoreceptor trigger zone
115
Q

Domperidone

Indication

A

Nausea & vomiting

116
Q

Domperidone

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

117
Q

Domperidone

Important cautions (3)/contraindications (3)/interactions (3)

*include bracketed numbers if applicable

A

CAUTIONS

  • Electrolyte disturbances
  • Renal impairment –> reduce frequency
  • Pregnancy & breastfeeding

CONTRAINDICATIONS

  • Prolactinoma
  • Intestinal obstruction, GI haemorrhage
  • Liver impairment

INTERACTIONS

  • CYP3A4 inhibitors –> QT prolongation
  • Bicalutamide –> QT prolongation
  • Epirubicin –> QT prolongation
  • Goserelin –> Qt prolongation
118
Q

Domperidone

Monitoring (3)

A

ECG
Liver function
Renal function

119
Q

Domperidone

Side effects (1)

120
Q

Epirubicin

Class of drug

A

Anthracycline cytotoxic antibiotic

like doxorubicin [not in drug list]

121
Q

Epirubicin

Mechanism of action (3)

A

Intercalate DNA base pairs

  • -> modify DNA structure
  • -> inhibit DNA & RNA synthesis; cause DNA fragmentation

Interfere with action of topoisomerase II

  • -> promote DNA cleavage & inhibit repair
  • -> inhibit DNA & RNA synthesis; cause DNA fragmentation

React with iron –> generate free radicals
–> cellular damage

NOT cell cycle specific

122
Q

Epirubicin

Indication (4)

A

Breast cancer
Non-Hodgkin’s lymphoma
Soft tissue sarcoma
Superficial bladder cancer

123
Q

Epirubicin

Why this over another DRUG/CLASS? (Place in therapy)

A

Better cardiotoxicity threshold over doxorubicin –> allows for higher dosing

124
Q

Epirubicin

Important cautions (4)/contraindications (6)/interactions (3)

*include bracketed numbers if applicable

A

CAUTIONS

  • When handling –> irritant to tissues
  • Cardiotoxicity –> determined max. dose
  • Liver impairment –> reduce dose
  • Severe renal impairment –> reduce dose

CONTRAINDICATIONS

  • Severe myocardial insufficiency
  • Recent myocardial infarction
  • Severe arrhythmia
  • Previous treatment with max. dose of other anthracycline
  • Severe liver impairment
  • Pregnancy (1st trimester) & breastfeeding

INTERACTIONS

  • Domperidone –> QT prolongation
  • Filgrastim –> increased myelosuppression (decreased bone marrow)
  • Pegfilgrastim –> increased myelosuppression (decreased bone marrow)
125
Q

Epirubicin

Monitoring (2)

A

Liver function –> bilirubin

Renal function

126
Q

Epirubicin

Side effects (2)

A

Hyperpigmentation of skin, nails, oral mucosa

Red-coloured urine

127
Q

Exemestane

Class of drug

A

Aromatase inhibitor

128
Q

Exemestane

Mechanism of action

A

Irreversibly inhibits aromatase enzyme in peripheral tissues

  • -> no androgen conversion into oestrogen
  • -> reduce proliferation of breast tissue
  • -> helps control & manage breast tumours
129
Q

Exemestane

Indication

A

Breast cancer

only if oestrogen receptor-specific

130
Q

Exemestane

Why this over another DRUG/CLASS? (Place in therapy)

A
  • Early breast cancer after 2-3 years of tamoxifen

- Advanced breast cancer after other failed treatments

131
Q

Exemestane

Important cautions (3)/contraindications (2)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Susceptibility to osteoporosis
  • Menopause –> lab test to confirm
  • Liver & renal impairment

CONTRAINDICATIONS

  • Premenopausal women
  • Pregnancy & breastfeeding

INTERACTIONS
- Hormone replacement therapy, tamoxifen, tibolone –> effects cancel out

132
Q

Exemestane

Monitoring (1)

A

Bone mineral density

133
Q

Exemestane

Side effects (8)

A 
Nausea, vomiting
Abdominal pain
Dyspepsia
Constipation
Dizziness, fatigue, headache
Depression
Hot flushes, sweating
Alopecia
134
Q

Fentanyl

Class of drug

A

Opioid agonist

135
Q

Fentanyl

Mechanism of action

A

Bind to opiate receptors in CNS

  • -> inhibit ascending pain pathway signals
  • -> alter pain perception & response
136
Q

Fentanyl

Indication

A

Chronic cancer pain

137
Q

Fentanyl

Why this over another DRUG/CLASS? (Place in therapy)

A

Pain ladder in reverse for cancer pain

Breakthrough pain when on other opioids for chronic cancer pain

138
Q

Fentanyl

Important cautions (3)/contraindications (2)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Pupil assessments –> affect responses vital for neurological assessment
  • Impaired respiratory function eg. asthma
  • Obstructive or inflammatory bowel disorders
  • Dose titration –> needs to be gradual
  • Liver & renal impairment –> reduce dose

CONTRAINDICATIONS

  • Acute respiratory depression
  • Comatose patients
  • COPD

INTERACTIONS
- Aprepitant –> increased fentanyl activity

139
Q

Fentanyl

Monitoring

A

Liver & renal function

140
Q

Fentanyl

Side effects

A

Nausea, vomiting
Abdominal pain
Constipation
Drowsiness, dizziness, confusion

141
Q

Filgrastim

Class of drug

A

Recombinant human granulocyte-colony stimulating factor (rhG-CSF)

142
Q

Filgrastim

Mechanism of action

A

Stimulate production & release of functional neutrophils from blood precursor cells in bone marrow
–> increase neutrophil count & reverse neutropenia

143
Q

Filgrastim

Indication

A

Neutropenia –> reduction in duration

144
Q

Filgrastim

Why this over another DRUG/CLASS? (Place in therapy)

A

INCOMPLETE FLASHCARD

145
Q

Filgrastim

Important cautions (3)/contraindications (1)/interactions (5)

*include bracketed numbers if applicable

A

CAUTIONS

  • Premalignant/malignant myeloid conditions
  • Sickle-cell anaemia
  • Osteoporosis

CONTRAINDICATIONS
- Severe congenital neutropenia

INTERACTIONS

  • Capecitabine –> increased myelosuppression risk; separate filgrastim 1 day before & after capecitabine treatment
  • Carboplatin –> increased myelosuppression risk; separate treatments by 1 day
  • Cisplatin –> increased myelosuppression risk; separate treatments by 1 day
  • Epirubicin –> increased myelosuppression risk; separate treatments by 1 day
  • Fluorouracil –> increased myelosuppression risk; separate treatments by 1 day
146
Q

Filgrastim

Monitoring

A

Bone mineral density

CBC

147
Q

Filgrastim

Side effects

A 
Nausea, vomiting
Generalised weakness
Headache
Constipation, diarrhoea
Anorexia
Chest pain
Alopecia
148
Q

Fluorouracil

Class of drug

A

Antimetabolite –> pyrimidine analogue

149
Q

Fluorouracil

Mechanism of action

A

False nucleotide incorporated into DNA & RNA
–> prevent normal cell division esp. S-phase

Inhibition of thymidylate synthetase
–> inhibit DNA & RNA synthesis

150
Q

Fluorouracil

Indication (3)

A

GI tract cancers
Breast cancer
Skin cancer (topical)

151
Q

Fluorouracil

Why this over another DRUG/CLASS? (Place in therapy)

A

Only when other methods have failed

Combination with antineoplastics eg. capecitabine
Combination with folinic acid/calcium folinate in colorectal cancer

152
Q

Fluorouracil

Important cautions (2)/contraindications (1)/interactions (4)

*include bracketed numbers if applicable

A

CAUTIONS

  • When handling –> irritant to tissues
  • Over 70yo

CONTRAINDICATIONS
- Pregnancy (1st trimester) & breastfeeding

INTERACTIONS
- Filgrastim –> increased myelosuppression risk; separate filgrastim 1 day before & after fluorouracil treatment

153
Q

Fluorouracil

Monitoring (2)

A

Platelet count

WBC

154
Q

Fluorouracil

Side effects (4)

A

Nausea, vomiting
Alopecia
Confusion
Soreness in mouth, dysphagia, ulceration

155
Q

Flutamide

Class of drug

A

Anti-androgen

156
Q

Flutamide

Mechanism of action

A

Inhibit nuclear binding of androgen

  • -> inhibit androgen uptake in prostate
  • -> reduce tumour
157
Q

Flutamide

Indication

A

Advanced prostate cancer

only if androgen-specific

158
Q

Flutamide

Why this over another DRUG/CLASS? (Place in therapy)

A

Monotherapy

Combination with LHRH (luteinising hormone-releasing hormone)

159
Q

Flutamide

Important cautions (5)/contraindications (1)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS

  • Cardiac disease –> oedema
  • Excessive alcohol consumption –> liver cirrhosis
  • Diabetes
  • Osteoporosis
  • Women –> may be teratogenic

CONTRAINDICATIONS
- Severe liver impairment

INTERACTIONS
- Domperidone –> QT prolongation

160
Q

Flutamide

Monitoring

A

Liver function
Bone mineral density
Respiratory symptoms

161
Q

Flutamide

Side effects (12)

A 
Jaundice
Hepatic encephalopathy
Hepatic necrosis
Hot flushes
Decreased libido
Impotence
Diarrhoea
Nausea & vomiting
Gynaecomastia (man boobs)
Drowsiness
Depression
Anxiety, nervousness
162
Q

Folic acid

Mechanism of action

A

Synthetic folate pathway coenzyme

  • -> important for erythropoiesis
  • -> important for producing/maintaining new cells
163
Q

Folic acid

Indication

A

Megaloblastic anaemia (if folate-deficient)

Prevention of methotrexate side effects
Rheumatic disease

164
Q

Folic acid

Why this over another DRUG/CLASS? (Place in therapy)

A

Megaloblastic anaemia & methotrexate

165
Q

Folic acid

Important cautions (1)/contraindications (1)

*include bracketed numbers if applicable

A

CAUTIONS
- Simultaneous administration with methotrexate

CONTRAINDICATIONS
- Monotherapy for pernicious anaemia (poor vit B12 uptake)/vit B12 deficiency –> increased risk of neurological conditions

166
Q

Folic acid

Side effects (1)

A

GI disturbances

167
Q

Folic acid

Class of drug

A

Synthetic B vitamin

168
Q

Folinic acid/calcium folinate

Class of drug

A

Synthetic B vitamin

169
Q

Folinic acid/calcium folinate

Mechanism of action

A

Derivative of folic acid

170
Q

Folinic acid/calcium folinate

Important contraindications (1)

*include bracketed numbers if applicable

A

CAUTIONS
- Avoid simultaneous administration of methotrexate

CONTRAINDICATIONS

  • Intrathecal injection (into spinal canal)
  • Pernicious anaemia (poor vit B12 uptake)/vit B12 deficiency –> increased risk of neurological conditions
171
Q

Folinic acid/calcium folinate

Why this over another DRUG/CLASS? (Place in therapy)

A

Combo with fluorouracil in colorectal cancer
Only methotrexate, not megaloblastic anaemia

Better for folic acid antagonists -> those inhibit folic acid conversion into folinic acid, but not folinic acid itself

172
Q

Folinic acid/calcium folinate

Important cautions (1)/contraindications (2)/interactions (1)

*include bracketed numbers if applicable

A

CAUTIONS
- Avoid simultaneous administration of methotrexate

CONTRAINDICATIONS

  • Intrathecal injection (into spinal canal)
  • Pernicious anaemia (poor vit B12 uptake)/vit B12 deficiency –> increased risk of neurological conditions

INTERACTIONS
- Capecitabine –> reduced tolerated dose of capecitabine

173
Q

Folinic acid/calcium folinate

Monitoring

A

Methotrexate levels if applicable –> determine dose & duration of folinic acid

174
Q

Folinic acid/calcium folinate

Side effects (2; rare)

A

Insomnia

Agitation

175
Q

Gentamicin

Class of drug

A

Aminoglycoside

176
Q

Gentamicin

Mechanism of action

A

Irreversibly bind to 30S ribosome subunit

  • -> alter cell membrane permeability
  • -> inhibit protein synthesis (bactericidal)
177
Q

Gentamicin

Indication

A

Empirical treatment of febrile neutropenia in chemo

Gram-negative infections

178
Q

Gentamicin

Why this over another DRUG/CLASS? (Place in therapy)

A

1st-line aminoglycoside for gram-negative infections, febrile neutropenia in chemo

179
Q

Gentamicin

Important cautions (3)/contraindications (2)/interactions (2)

*include bracketed numbers if applicable

A

CAUTIONS

  • Dehydration
  • Elderly
  • Renal impairment

CONTRAINDICATIONS

  • Myasthenia gravis
  • Ototoxicity with previous aminoglycoside use

INTERACTIONS

  • Carboplatin –> increased risk of renal impairment
  • Cisplatin –> increased risk of renal impairment & ototoxicity
180
Q

Gentamicin

Monitoring (3)

A

Renal function
Hearing
Serum concentration

181
Q

Gentamicin

Side effects (2)

A

Nephrotoxicity

Ototoxicity (irreversible)

182
Q

Goserelin

Class of drug

A

Gonadorelin analogue

Hormone antagonist

183
Q

Goserelin

Mechanism of action

A

Initial phase of stimulation
Continued use followed by downregulation of GnRH receptors (gonadotrophin-releasing hormone receptors)
–> reduces release of gonadotrophins (FSH, LH)
–> inhibit androgen & oestrogen production

184
Q

Goserelin

Indication (2)

A

Breast cancer
Prostate cancer

(more not in oncology)

185
Q

Goserelin

Why this over another DRUG/CLASS? (Place in therapy)

A

Breast cancer: premenopausal & perimenopausal women

186
Q

Goserelin

Important cautions (7)/contraindications (1)/interactions (3)

*include bracketed numbers if applicable

A

CAUTIONS

  • Depression
  • Hypertension
  • Metabolic bone disease –> risk of decrease bone mineral density)
  • PCOS
  • Diabetes
  • Risk of ureter obstruction & spinal cord compression in men (tumour ‘flare’)
  • Risk of cardiovascular events in men

CONTRAINDICATIONS
- Pregnancy & breastfeeding

INTERACTIONS

  • Domperidone –> QT prolongation
  • Bisacodyl –> increased risk of hypokalaemia –>monitor
  • Haloperidol –> QT prolongation
187
Q

Goserelin

Monitoring (3)

A 
Abdominal haemorrhage
Blood glucose (if diabetes)
Potassium levels (if also on bisacodyl
188
Q

Goserelin

Side effects (5)

A 
Injection site injury --> pain, haemorrhage
Hot flushes, sweating
Sexual dysfunction
Gynaecomastia, changes in breast size
Initial worsening of symptoms of cancer

411 Oncology (9 decks)

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