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Oncology > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Corrected Calcium calculation

A

Corrected Ca = Measured Ca + 0.8*(4 - serum albumin)

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2
Q

HCM management

A
  1. Hydration
  2. Diuresis with furosemide
  3. Bisphosphonates: zoledronic acid > pamidronate
  4. Adjunctive: calcitonin, denosumab
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3
Q

ANC calculation

A

ANC = (% segmented + % bands) * WBC/100

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4
Q

What is febrile neutropenia?

A
  1. Severe neutropenia ANC <500
  2. Fever (101+ F)
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5
Q

FN low risk criteria

A
  1. MASCC 21+, CISNE <3
  2. Outpatient when having fever
  3. No comorbid illness requiring hospitalization
  4. Short duration <7 days
  5. Good performance score ECOG 0-1
  6. No hepatic or renal insufficiency
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6
Q

FN high risk criteria

A
  1. MASCC <21, CISNE 3+
  2. Inpatient when having fever
  3. Comorbid illness or clinically unstable
  4. Prolonged duration 7+ days
  5. uncontrolled/progressive cancer
  6. Hepatic or renal insufficiency
  7. pneumonia or other infections
  8. HSCT or hematologic malignancy
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7
Q

FN high risk empiric therapy

A
  • Pip/tazo, cefepime, meropenem, imipenem/cilastatin
  • Carbapenems if ESBL
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8
Q

FN low risk empiric therapy

A
  • Cipro + amoxicillin/clavulanate
  • Cipro + clindamycin, levofloxacin, moxifloxacin
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9
Q

FN Vanco addition

A
  1. MRSA or PCN-resistant
  2. Skin and soft tissue infection
  3. Pneumonia
  4. IV catheter-related infection
  5. Gram+ culture
  6. Clinical instability: HoTN, shock
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10
Q

TLS complications

A
  • Hyper: phosphatemia, kalemia, uricemia
  • Hypocalcemia
  • AKI
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11
Q

TLS uric acid abnormality

A

> 8.0 mg/dL

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12
Q

TLS phosphate abnormality

A

> 4.5 in adults, >6.5 in children

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13
Q

TLS potassium abnormality

A

> 6.0 mg/dl

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14
Q

TLS calcium abnormality

A

Corrected calcium <7.0 mg/dl or measured calcium <1.12

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15
Q

TLS low risk management

A

IV fluids, allopurinol, daily labs

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16
Q

TLS intermediate risk management

A

IV fluids, allopurinol, labs Q8-12H

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17
Q

TLS high risk management

A

IV fluids, rasburicase, labs Q6-8H, cardiac monitoring

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18
Q

TLS established management

A

IV fluids, rasburicase, labs Q4-6H, cardiac monitoring

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19
Q

TLS fluids backbone

A

crystalloids

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20
Q

TLS hyperkalemia backbone

A
  • Stabilize myocardium: calcium gluconate/chloride
  • Intracellular shift of K: regular human insulin, sodium bicarb, albuterol
  • Elimination of K: loop diuretics, sodium polystyrene, sulfonate, hemodialysis
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21
Q

TLS hyperphosphatemia backbone

A

Calcium carbonate/acetate, Sevelamer, Lanthanum

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22
Q

TLS hypocalcemia backbone

A

Treat if symptomatic with IV Ca2+

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23
Q

TLS hyperuricemia backbone

A
  • Allopurinol
  • Rasburicase: high UA >7.5
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24
Q

Breast cancer risk factors (12)

A
  1. Female
  2. > 65 yrs
  3. non-Hispanic whites & blacks
  4. Higher endo/exogenous estrogen exposure
  5. Genetic mutations: BRCA1/2, TP53, PTEN
  6. FH of breast & ovarian cancer
  7. Personal hx of BC
  8. DCIS, LCIS
  9. Benign breast disease
  10. Breast density
  11. Prior thoracic irradiation 10-30 yrs
  12. Environment/lifestyle
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25
Q

BC risk factor: higher endogenous estrogen exposure

A
  1. Early menarche <11 yrs
  2. Older age at birth of first child (>30 yrs) or nulliparity
  3. Later menopause >55 yrs
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26
Q

BC risk factor: higher exogenous estrogen exposure

A
  1. Risk of postmenopausal estrogen replacement therapy & OC controversial
    - OC: benefits far outweigh the small increased risk of developing BC
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27
Q

BC when to use Gail model

A

> 35 yrs with a family history

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28
Q

BC when NOT to use Gail model

A
  1. Predisposing genetic mutation
  2. Hx of thoracic radiation
  3. Prior hx of BC
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29
Q

BC NCCN screening recommendation

A

40+ yrs annual mammogram with tomosynthesis

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30
Q

BC ACS screening recommendation

A
  • 40-44 optional annual mammogram
  • 45-55 annual mammograms
  • 55+: mammograms every 1,2 yrs
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31
Q

BC USPSTF screening recommendation

A
  • 40-49: optional mammograms every 2 yrs
  • 50-74: mammograms every 2 yrs
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32
Q

BC chemoprevention agents

A

Tamoxifen, raloxifene, anastrozole, exemestane

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33
Q

BC: node-, HER2+, ER/PR+

A
  • <0.5cm: none
  • 0.6-1 cm: endocrine
  • > 1cm: endocrine + chemo + trastuzumab
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34
Q

BC: node-, HER2+, ER/PR-

A
  • <1cm: none
  • > 1cm: chemo + trastuzumab
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35
Q

BC: node-, HER2-, ER/PR+

A
  • <0.5cm: none
  • 0.6-1cm: Oncotype DX RS <26 = endo, RS 26+ = endo + chemo
  • > 1cm: same as above
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36
Q

BC: node-, HER2-, ER/PR-

A
  • <1cm: none
  • > 1cm: chemo
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37
Q

BC: node+, ER/PR+

A
  • Endo + chemo
  • If HER2+: trastuzumab + pertuzumab
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38
Q

BC: node+, ER/PR-

A
  • Chemo
  • If HER2+: trastuzumab + pertuzumab
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39
Q

BC Stages I-III, HER2-

A
  1. Dose-dense AC -> T = doxorubicin (Adriamycin) and Cyclophosphamide + Paclitaxel
  2. TC = docetaxel (Taxotere) and Cyclophosphamide
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40
Q

BC anthracyclines toxicities, monitor

A
  • Cardiotoxicity
  • Echocardiogram or MUGA
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41
Q

BC Stages I-III, HER2+

A
  1. TCH +/- pertuzumab = Docetaxel (Taxotere), Carboplatin, Trastuzumab (Herceptin) +/- pertuzumab
  2. Paclitaxel + trastuzumab –> reserved for low risk, not eligible for other regimens
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42
Q

BC HER2i toxicities, monitor

A
  • Cardiotoxicity
  • ECHO or MUGA
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43
Q

BC adjuvant endocrine therapy for premenopausal

A

Tamoxifen

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44
Q

BC adjuvant endocrine therapy for postmenopausal

A
  • TAM
  • AI (preferred): Anastrozole, Letrozole, Exemestane
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45
Q

BC Stage IV, ER/PR+, HER2-

A
  • AI + CDK4/6i
  • Fulvestrant + CDK4/6i
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46
Q

BC Stage IV, ER/PR+, HER2-, visceral crisis or endocrine refractory
- BRCA mutation vs no

A
  • BRCA1/2: PARPi (olaparib, talazoparib)
  • No: single chemo
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47
Q

BC Stage IV, ER/PR+, HER2+

A
  1. AI +/- trastuzumab or lapatinib or both
  2. Fulvestrant +/- trastuzumab
  3. TAM +/- trastuzumab
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48
Q

BC Stage IV, ER/PR-, HER2+

A

Pertuzumab + trastuzumab + docetaxel (preferred) or paclitaxel

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49
Q

BC Stage IV ER/PR-, HER2- (TNBC):
- PDL1+ vs -

A
  • PDL1+: pembrolizumab + carboplatin + paclitaxel/albumin-bound/ gemcitabine
  • PDL1-: BRCA1/2 = PARPi or platinums vs no mutation = single chemo
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50
Q

NHL: DLBCL stages I-II

A

R-CHOP
Rituximab, Cyclophosphamide, Doxorubicin (Hydroxydaunomycin), Vincristine (Oncovin), Prednisone

51
Q

NHL: DLBCL stages III-IV

A

R-CHOP or Pola-RCHP
Polatuzumab vedotin, Rituximab, Cyclophosphamide, Doxorubicin (Hydroxydaunomycin), Prednisone

52
Q

NHL: vincristine toxicity

A

Neurotoxicity, constipation

53
Q

NHL: Polatuzumab vedotin: target, cytotoxic payload, toxicities, premed

A
  1. CD79b
  2. MMAE
  3. Peripheral neuropathy
  4. Antihistamine, antipyretic
54
Q

HL: Stages I-II cHL treatment

A

ABVD
Doxorubicin (Adriamycin), Bleomycin, Vinblastine, Dacarbazine

55
Q

HL: Stages III-IV cHL treatment

A

ABVD or AAVD
Doxorubicin (Adriamycin), Brentuximab vedotin (Adcetris), Vinblastine, Dacarbazine

56
Q

HL: bleomycin vs brentuximab vedotin toxicity

A
  • Bleo: pulmonary toxicity (fibrosis)
  • B.v: peripheral neuropathy
57
Q

CML chronic phase blast count

58
Q

CML accelerated phse blast count

59
Q

CML blast crisis blast count

60
Q

CML chronic phase initial treatment

A

1st/2nd gen TKIs: imatinib, dasatinib, nilotinib, bosutinib

60
Q

CML accelerated phase initial treatment

A

2nd/3rd gen TKIs: dasatinib, nilotinib, bosutinib, ponatinib

61
Q

CML 1st gen TKI toxicity

A
  • Imatinib: fluid retention (periorbital edema)
62
Q

CML 2nd gen TKI toxicity

A
  • Dasatinib: fluid retention (pleural or pericardial effusions)
  • Nilotinib: QTc prolongation & sudden death –> monitor electrocardiogram (ECG)
  • Bosutinib: diarrhea
63
Q

CML 3rd gen TKI indication, toxicity

A
  • Ponatinib: T315I+, arterial occlusion, VTE, HF, hepatotoxicity
  • Ascminib: STAMPi, 3rd line, T315I+; pancreatitis, HTN, hypersensitivity, muscle pain
64
Q

AML WHO 2016 classification

A
  1. 20+% blast count
  2. Cytogenic mutations even with <20%: t(8;21), t(16;16), inv(16)
65
Q

AML favorable risk

A

t(8;21), t(16;16), inv(16)

66
Q

AML poor risk

A

Complex (3+ chromosomal abnormalities) or monosomal karyotype, -5,del(5q),-7, TP53

67
Q

AML Cytarabine toxicities, supportive care, monitoring

A
  • High dose (1000+ mg/m2): neurotoxicity, ocular / NV
  • Prophylactic steroid eye drops (high dose), antiemetics
  • Cerebellar function before each dose (high dose)
68
Q

AML gemtuzumab ozogamicin: target, cytotoxic payload, toxicities, premed

A
  • CD33
  • Calicheamicin derivative
  • Hepatotoxicity (veno-occlusive), infusion rxn
  • Corticosteroid, antipyretic, antihistamine
69
Q

AML favorable risk induction, postremission: CD33-

A
  1. 7+3 = Cytarabine 7 days, Daunorubicin or Idarubicin 3 days
  2. HiDAC = High-dose Ara-C = Cytarabine on days 1, 3, 5
70
Q

AML favorable risk induction, postremission: CD33+

A
  1. 7+3 + Gemtuzumab ozogamicin (GO) = Cytarabine 7 days, Daunorubicin or Idarubicin 3 days, GO on days 1, 4, 7
  2. HiDAC + GO = High-dose Ara-C = Cytarabine on days 1, 3, 5, GO on day 1 of first 2 cycles
71
Q

AML Midostaurin: class, indication, toxicities

A
  • 1st gen, type 1 FLT3i
  • FLT3+ ITD & TKD
  • N/V
72
Q

AML Quizartinib: class, indication, toxicities

A
  • 2nd gen, type 2 FLT3i
  • FLT3 ITD+
  • QTc prolongation –> monitor electrocardiograms (ECGs) [REMS]
73
Q

AML FLT3-TKD induction, postremission

A
  1. 7+3 + midostaurin
  2. HiDAC + midostaurin
74
Q

AML FLT3-ITD induction, postremission

A
  1. 7+3 + midostaurin OR quizartinib
  2. HiDAC + midostaurin OR quizartinib
  3. Hematopoietic stem cell transplant ASAP
75
Q

AML Liposomal Daunorubicin-Cytarabine (CPX-351): indication, toxicities, monitor, clinical pearls

A
  • Therapy-related AML
  • Cardiotoxicity
  • ECHO/MUGA
  • Longer time to recover bone marrow, no alopecia
76
Q

AML hypomethylating agents (HMA): agents, toxicities, onset

A
  • Azacitidine, Decitabine
  • Myelosuppression
  • Slow onset
77
Q

AML Venetoclax (VEN): dose reduction needed when, toxicities

A
  • Moderate or strong CYP3A4 inhibitor
  • Bone marrow suppression
78
Q

AML IDH inhibitors: agents, toxicities

A
  • Ivosidenib (IDH1), Enasidenib (IDH2)
  • Differentiation syndrome
79
Q

AML low intensity w/o mutation

80
Q

AML low intensity IDH1 mutation

A
  • VEN + HMA
  • Ivosidenib + azacitidine
  • Ivosidenib
81
Q

AML low intensity IDH2 mutation

A
  • VEN + HMA
  • Enasidenib
82
Q

AML low intensity FLT3 mutation

83
Q

ALL cytogenetic poor risk

A
  • TP53 mutation
  • Complex karyotype (5+ chromosomal abnormalities)
  • t(9;22)
  • Hypodiploidy (<44 chromosomes)
  • Ph-like ALL
84
Q

ALL philadelphia chromosome breakpoints in BCR gene in CML vs ALL

A
  • CML: p210
  • ALL: p190
85
Q

ALL induction therapy backbone

A

Vincristine + Corticosteroids (dexamethasone OR prednisone) + Anthracyclines (Daunorubicin OR doxorubicin)

86
Q

ALL consolidation therapy

A

High-dose MTX, cytarabine, 6-mercaptopurine, pegaspargase

87
Q

ALL maintenance therapy

A

Weekly MTX, periodic vincristine + corticosteroids, daily 6-mercaptopurine

88
Q

ALL Hyper CVAD

A
  • A cycle: Hyperfractionated Cyclophosphamide (+mesna) + Vincristine + doxorubicin (Adriamycin) + Dexamethasone
  • B cycle: High dose MTX + high dose cytarabine
89
Q

ALL relapsed/refractory Ph-

A
  • Blinatumomab
  • Inotuzumab ozogamicin
  • Brexucabtagene autoleucel, tisagenlecleucel (<25 yrs or 2+ relapses)
90
Q

ALL relapsed/refractory Ph+

A
  • TKI +/- chemo or corticosteroid
  • Blinatumomab or inotuzumab ozogamicin +/- TKI
  • Brexucabtagene autoleucel monotherapy
  • Tisagenlecleucel (<25 yrs or 2+ relapses and failure of 2 TKIs)
91
Q

ALL BiTE binds to which CD__ on B-cells & T-cells?

A
  • CD19 on B
  • CD3 on T
92
Q

PedM Childhood vs adult cancer

A
  1. Rarely genetically linked or attributed to lifestyle/ environmental factors
  2. Types of cancer that are prevalent
  3. Higher survival rates
  4. Treatment often more “intense” with curative agent
  5. Larger concern for long-term effects of cancer tx
  6. Less well-established tx regimens
93
Q

PedM B-cell ALL standard risk

A

1-10 yrs, <50,000 WBC

94
Q

PedM B-cell ALL high risk

A

<1 yr or >10 yrs, >50,000+ WBC

95
Q

PedM B-cell ALL standard risk induction

A

3 drug induction
Dexamethasone, vincristine, asparaginase

96
Q

PedM B-cell ALL high risk induction

A

4 drug induction
Dexamethasone (>10 yrs Prednisone), vincristine, asparaginase, daunorubicin

97
Q

PedM AML Induction I vs II

A
  • I: DA10 + GO = cytarabine 10 days, daunorubicin days 1, 3, 5 + gemtuzumab ozogamicin
  • II: DA8 = cytarabine 8 days + daunorubicin days 1, 3, 5
98
Q

PedM Neuroblastoma staging by tumor location: I, II, III, IV, IV-S

A

I: confined to area of origin and completely resected
II: localized
III: tumor crosses midline or positive contralateral lymph nodes
IV: distant metastasis
IV-S: metastasis confined to skin, liver, BM in <1 yrs

99
Q

PedM Neuroblastoma intermediate risk

A
  • <18 yrs
  • Hyperploidy
  • Stage I, II
  • Stage III non MYCN amplified
  • Stage IV-S non MYCN amplified
100
Q

PedM Neuroblastoma high risk

A
  • >18mo
  • Hypodiploidy
  • Stage III MYCN amplified
  • Stage IV and IV-S MYCN amplified
  • MYCN amplification
101
Q

PedM Neuroblastoma high risk induction chemo

A

Cisplatin, etoposide, vincristine, doxorubicin

102
Q

PedM Dinutuximab premedication

A
  1. IV hydration
  2. Antihistamine
  3. Antipyretic: APAP
  4. Analgesics: morphine
  5. Antiemetics
103
Q

PedM Osteosarcoma arise from ___, treatment

A
  • Immature spindle cells
  • MAP = High dose MTX, Doxorubicin, Cisplatin
104
Q

PedM Ewing Sarcoma arise from ___, molecular genetics

A
  • Neuroectodermal cell
  • Reciprocal translocations on chromosome 22q12 = EWSR1 gene
105
Q

PedM Ewing Sarcoma treatment

A
  • Radiation
  • VDC/IE = Vincristine, doxorubicin, cyclophosphamide / ifosfamide, etoposide
106
Q

PedM anthracycline associated with ___ toxicity

107
Q

PedM secondary malignancies associated with which chemo?

A

Alkylating agents, Etoposide

108
Q

PedM neuro-cognitive effects are associated with ___ (3)

A
  1. Craniospinal radiation
  2. High-dose cytarabine
  3. Occupational, vocational therapy
109
Q

PedM infertility associated with ___

A
  • Alkylating agents: carboplatin, cisplatin
  • Radiation to abdomen/pelvis
110
Q

PedM pulmonary fibrosis associated with ___, screening, lifetime max dose

A
  • Bleomycin
  • Yearly pulmonary function test
  • 400 units
111
Q

PedM ototoxicity is associated with ___, screening

A
  • Platinum agents: cisplatin > carbo
  • Audiometry testing
112
Q

SCD HbSS

A

Sickle cell disease

113
Q

SCD HbSC

A
  • More “mild”
  • 1 gene for hemoglobin S, one for another abnormal HbC
114
Q

SCD HbSA

A
  • Sickle cell trait
  • 1 for hemoglobin S, 1 for hemoglobin A
  • X manifestations but can pass along S gene
115
Q

SCD HbS beta-thalassemia

A

1 for hemoglobin S and 1 for beta-thalassemia

116
Q

SCD complications

A
  1. Vaso-occlusive crisis
  2. Splenic sequestration
  3. Acute chest syndrome
  4. Priapism
  5. Pneumococcal infection
  6. Cerebral infarction
  7. End-organ damage
117
Q

SCD Vaso-occlusive crisis: what it is, treatment

A
  • Sudden severe pain
  • Dactylitis: swelling of hands and feet
  • NSAID + APAP + Opioid , fluids, ketorolac (IV NSAID)
118
Q

SCD Streptococcus pneumoniae vaccine

A
  1. 15-valent (PCV15) or 20-valent (PCV20)
    - 4 doses given at 2, 4, 6, mo and 12-15 mo
  2. 23-valent (PPSV23)
    - Age 2-5 if given at least 1 dose of PCV20 –> X
    - Age 2-5 if no PCV20 given –> 1 dose of PCV20 or PPSV23 at least 8 weeks after the most recent PCV
    - If PPSV23 given, 1 dose of PCV20 or second PPSV23 dose at least 5 yrs later
119
Q

SCD Pneumococcal infection prevention: Antimicrobial prophylaxis

A

PCN V Potassium (PenVK)
- Infants, <3 yrs: 125 mg BID
- >3+ yrs: 250 mg BID

120
Q

SCD Meningococcal vaccine

A
  1. Menveo
    - Dose 1 at 8 wks: 4-dose series 2, 4, 6, 12 mo
    - Dose 1 at 7-23 mo: 2-dose series (dose 2 at least 12 wks after dose 1 and after the 1st bday)
    - Dose 1 at 24 mo or older: 2-dose series at least 8 wks apart
  2. MenQuadFi
    - 24 mo or older: 2 doses at least 8 wks apart
121
Q

SCD Acute chest syndrome: treatment

A
  • 3rd gen cephalosporins (Ceftriaxone) + Macrolide (Azithromycin)
  • Oxygen supplementation if hypoxic
  • Pain management: NSAID + APAP +/- Opioid
  • IV hydration
122
Q

SCD Hydroxyurea: MoA, treatment increases production of ___, AEs

A
  • Ribonucleoside diphosphate reductase inhibitor
  • Fetal hemoglobin
  • Myelosuppression

Oncology (4 decks)

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