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Oncology > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What is Mosteller Method of dose calculation?

A
  • BSA = ROOT{ [Height(in) *Weight (lb)]/3131}
  • BSA = ROOT{ [Height(cm)*Weight(kg)]/3600}
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2
Q

What is Calvert Equation?

A

Carboplatin dose calculation
- Dose (mg) = Target AUC*(GFR+25)

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3
Q

High emetogenic parenteral chemotherapeutic agents

A
  • AC regimen = anthracycline + cyclophosphamide
  • Cisplatin
  • Sacituzumab govitecan-hziy
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4
Q

CINV: 5-HT3RA indication, SEs, agents

A
  • Acute & breakthrough
  • Constipation, QTc prolongation, serotonin syndrome
  • Ondasetron, Granisetron, Palonosetron (only acute, bradycardia, lowest QTc)
  • Dolasetron
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5
Q

CINV: NK1RA indication, agents

A
  • Acute & delayed
  • Fosaprepitant, aprepitant
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6
Q

CINV: Corticosteroids indication, SEs, agents

A
  • Acute & delayed
  • Insomnia, dyspepsia
  • Dexamethasone
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7
Q

CINV: Dopamine RA indication, SEs, agents

A
  • Breakthrough/refractory prevention & tx (Olanzapine also acute & delayed)
  • Extrapyramidal symptoms (EPS)
  • Metoclopramide, Olanzapine, Prochlorperazine, Promethazine (IV not rec)
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8
Q

CINV: Benzodiazepines indication, agent

A
  • Anticipatory
  • Lorazepam (BW: respiratory depression w/ opioid)
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9
Q

CINV: Antihistamines use, SE, agents

A
  • Breakthrough
  • Anticholinergic effects
  • Hydroxyzine, Scopolamine
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10
Q

CINV: Cannabinoids indication, SEs, agents

A
  • Refractory
  • A lot
  • Dronabinol, Nabilone
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11
Q

CINV: high emetic risk prevention
- Day 1, Day 2-4

A

Day 1
1. Olanzapine 5-10 mg once
2. NK1 RA
3. 5-HT3 RA
4. Dexamethasone 12 mg IV/PO once
Day 2-4
1. Olanzapine 5-10 mg once
2. Aprepitant 80 mg PO daily on days 2-3 if used
3. Dexamethasone 8 mg IV/PO daily on days 2,3,4

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12
Q

CINV: management of breakthrough

A

Add one agent from a different drug class than current scheduled preventative regimen

Olanzapine 5-10 mg daily (preferred)

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13
Q

CINV: prevention of anticipatory CINV

A

Only Lorazepam

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14
Q

Chemo Related Fatigue (CRF): nonpharmacologic therapy

A
  1. Cognitive behavioral therapy
  2. Supportive expressive
  3. Psycho-educational

Counseling, music therapy, stress reduction therapy, journal writing, meditation

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15
Q

CRF: pharmacologic therapy
- Recommended vs not recommended

A
  • Methylphenidate: AEs insomnia, weight loss, decreased appetite
  • Antidepressants not recommended
  • Corticosteroids (dexamethasone, methylprednisolone) not routinely recommended
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16
Q

Anemia is low

A

RBC

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17
Q

Thrombocytopenia is low

A

Platelets

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18
Q

Leukopenia is low

A

WBC

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19
Q

What relative time points do we see anemia, neutropenia, thrombocytopenia?

A
  1. Neutropenia
  2. Thrombocytopenia
  3. Anemia
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20
Q

CRF: Anemia treatment

A

RBC transfusion in symptomatic or any pt with Hgb <7

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21
Q

CRF: ESAs treatment

A

Reseserved for palliative

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22
Q

Causes of constipation

A

Vincristine, opioids, 5HT3RA SE, changes in routine/diet

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23
Q

Gold standard for constipation tx

A

Laxative

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24
Q

Types of laxatives

A

Bulk-forming (slow onset, for maintenance), osmotic, emollient (stool softeners), lubricant (short onset, C/I in elderly), stimulant (short onset, stimulate GI peristalsis)

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25
Q

Causes of diarrhea

A
  • Irinotecan, immunotherapy, HER2i (neratinib), Sacituzsumab govitecan
  • Mucositis/GI inflammation
  • C. diff
  • Change in diet/nutrition
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26
Q

Pharmacologic therapy for diarrhea

A
  • Loperamide
  • Octreotide if refractory to loperamide
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27
Q

Irinotecan induced diarrhea early onset: cause & tx

A
  • Increased cholinergic transmission due to blockage of ACh
  • Atropine
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28
Q

Irinotecan induced diarrhea late onset: cause & tx

A
  • Mucosal damage from SN-38
  • Loperamide 4 mg initially, then 2 mg after every loose stool
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29
Q

Immunotherapy induced diarrhea mild tx

A
  • Consider holding immunotherapy
  • Loperamide for 2-3 days
  • If persistent check lactoferrin/calprotectin
    (+: treat as moderate vs -: add mesalamine &/or cholestyramine)
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30
Q

Immunotherapy induced diarrhea moderate tx

A
  • Hold immunotherapy until resolution of symptoms
  • Pathologically confirmed microscopic colitis; oral budesonide
  • Not confirmed; oral prednisone or methylprednisolone
  • If no response, add infliximab or vedolizumab
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31
Q

Immunotherapy induced diarrhea severe tx

A
  • IV methylprednisolone
  • If no response, add infliximab or vedolizumab
  • G3: permanently d/c anti-CTLA-4 and resume anti-PD 1/L1 after resolution
  • G4: permanently d/c any immunotherapy
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32
Q

Neratinib induced diarrhea tx

A

Antidiarrheal prophylaxis for the first 56 days
- 1-2: loperamide TID
- 3-8: loperamide BID
- 9-d/c: loperamide PRN
May add oral budesonide or colestipol

33
Q

Sacituzumab govitecan induced diarrhea tx

A
  • Early: atropine
  • Late: loperamide
  • If severe, withhold drug until resolved to grade 1 (BW) & reduce subsequent dose
34
Q

Cyclophosphamide supportive care

A

Mesna for HD = >1 g/m^2 or >50 mc/kg

35
Q

Cyclophosphamide toxicity

A

Hemorrhagic cystitis, cardiotoxicity, myelosuppression

36
Q

Ifosfamide toxicity

A

Neurotoxicity, hemorrhagic cystitis, Myelosuppression

37
Q

Platinum analogs agents

A

Cisplatin, Carboplatin, Oxaliplatin

38
Q

Topoisomerase I inhibitors agent

A

Irinotecan

39
Q

Topoisomerase II inhibitors agent

40
Q

Topoisomerase II inhibitor anthracycline agents

A

Doxorubicin, Daunorubicin, Idarubicin

41
Q

Topoisomerase II inhibitor anthracycline class supportive care

A

Dexrazoxane

42
Q

Topoisomerase I and II inhibitors arrest cell in which phase?

A

S or G2 (II: early)

43
Q

Topoisomerase II inhibitor anthracyclin + antimetabolite agent

A

Liposomal Daunorubicin/Cytarabine

44
Q

Topoisomerase II inhibitor MISC agent & why MISC?

A

Mitoxantrone; does not form free oxygen radicals

45
Q

Antitumor antibiotic agent and toxicity

A

Bleomycin; pulmonary toxicity

46
Q

Taxane agents

A

Paclitaxel, docetaxel

47
Q

Vinca alkaloid agents

A

Vincristine, Vinblastine

48
Q

Folate antagonist agent, rescue, antidote

A

Methotrexate; leucovorin; glucarpidase

49
Q

Purine analog agents

A

Mercaptopurine, fludarabine

50
Q

Pyrimidine analog agents

A

Fluorouracil, Capecitabine, Cytarabine (AraC)

51
Q

Cytarabine (AraC) high dose & toxicity

A

> 1000 mg/m^2, neurotoxicity, ocular

52
Q

Tyrosine kinase inhibitors 5 classes

A
  1. BCR-ABL
  2. FLT3
  3. BTK
  4. EGFR
  5. HER2
53
Q

BCR-ABL inhibitors agents

A
  • 1st gen: Imatinib
  • 2nd gen: Dasatinib, Nilotinib, Bosutinib
  • 3rd gen: Ponatinib, Asciminib –> indicated for T315l mutation+ disease
54
Q

FLT3 inhibitor agents

A
  • 1st gen: Midostaurin
  • 2nd gen: Gilteritinib, Quizartinib (REMS)
55
Q

BKT inhibitor agents

A
  • 1st gen: Ibrutinib
  • 2nd gen: Acalabrutinib, Zanubrutinib
56
Q

EGFR inhibitor TKI agents in solid malignancies

A
  • 1st gen: Erlotinib
  • 3rd gen: Osimertinib (T790M mutation+), Mobocertinib (Exon 20 insertion+)
57
Q

HER2 inhibitor TKI agents

A

Lapatinib, Neratinib

58
Q

Antineoplastic SERMs agents

A

Tamoxifen, Toremifene, Raloxifene

59
Q

SERD agent

A

Fulvestrant

60
Q

Aromatase inhibitor agents

A

Anastrozole, Letrozole, Exemestane

61
Q

GnRH agonist agents

A

Leuprolide, Histrelin, Triptorelin, Goserelin
Tumor flare

62
Q

GnRH antagonist agent

63
Q

2nd gen androgen receptor antagonist agent

A

Bicalutamide

64
Q

3rd gen androgen receptor antagonist agents

A

Enzalutamide, Apalutamide, Darolutamide

65
Q

Steroidal anti-androgen agent

A

Abiraterone (must be given with corticosteroid)

66
Q

Proteasome inhibitor

A
  • 26S: Bortezomib, reversibly
  • 20S: Carfilzomib, irreversibly
67
Q

Immunomodulatory drugs (IMiDs)

A

Thalidomide, Lenalidomide, Pomalidomide

68
Q

Anti-CD20 MAbs

A

Rituximab, Obinutuzumab, Ofatumuma

69
Q

Anti-CD52 MAb

A

Alemtuzumab

70
Q

EGFR inhibitors monoclonal antibodies agents

A

Cetuximab, Panitumumab

71
Q

HER2 inhibitors monoclonal antibodies agents

A

Trastuzumab, Pertuzumab

72
Q

VEGF inhibitors

A

Bevaicizumab, Ramucirumab

73
Q

CTLA-4 inhibitors

A

Ipilimumab

74
Q

PD-1 inhibitors

A

Nivolumab, Pembrolizumab

75
Q

PD-L1 inhibitors

A

Atezolizumab, Durvalumab

76
Q

Antibody drug conjugate: HER2 target

A
  • DM1 cytotoxic: Ado-trastuzumab emstansine
  • DXd cytotoxic: Fam-Trastuzumab Derutecan
77
Q

Ab drug conjugate: Calicheamicin derivative

A
  • CD22: Inotuzumab ozogamicin
  • CD33: Gemtuzumab ozogamicin
78
Q

Ab drug conjugate: Monomethyl auristatin E (MMAE)-containing

A
  • CD30: Brentuximab vedotin
  • CD79b: Polatuzumab vedotin

Oncology (4 decks)

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