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IHOP Drug Review FINAL Flashcards

1
Q

What is the MOA of Cisplatin?

Alkylating agent

A
  1. Cl(-) leaves the molecule
  2. DNA cross-linking
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2
Q

What are the side effects of Cisplatin?

A

-N/V !!! (causes the most N/V of cancer drugs)

-Neuropathy (chronic)

-Nephrotoxicity (acute and chronic)
Hypokalemia and Hypomagnesemia

-Ototoxicity

-Gonadal toxicity (risk of infertility)

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3
Q

What should be given with Cisplatin to prevent Nephrotoxicity?

A

IV normal saline (1L) before and after treatment

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4
Q

What is the brand name of Capecitabine?

A

Xeloda

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5
Q

What is the MOA of Capecitabine?

A

-inhibits Thymidylate-Synthase
-RNA false base pair

it is a prodrug of 5-FU

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6
Q

What are the side effects of Capecitabine?

A

-Hand-foot syndrome
-Diarrhea
-Photosensitivity

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7
Q

What is a common DDI of Capecitabine? BBW

A

DDI with Warfarin (CYP2C9 inhibition)

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8
Q

What is the MOA of Cytarabine?

A

inhibits DNA polymerase in the S-phase
-pyrimidine false base pair

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9
Q

What are the side effects of Cytarabine?
Which pre-med is required?

A

HiDAC (high-dose Ara-C)

-Cerebellar dysfunction
-chemical conjunctivitis/keratitis
-> Prophylactic corticosteroid eyedrops

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10
Q

What is the brand name of Bevacizumab?

A

Avastin

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11
Q

What is the MOA of Bevacizumab?

A

VGEF blockage

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12
Q

What are the side effects of Bevacizumab?

A

Bleeding
clotting
impaired wound healing
proteinuria
HTN

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13
Q

What is the MOA of Carboplatin?

A

DNA crosslinks

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14
Q

What is a common side effect of Carboplatin?

A

Bone marrow suppression

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15
Q

How is the dose of Carboplatin determined?

A

Calvert equation

dose (mg) = AUC x (GFR (CrCl) + 25)

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16
Q

What is the MOA of Carmustine?
(Mustard agent, Alkylating agent)

A
  1. Cl(-) leaves the molecule
  2. DNA cross-linking -> covalently
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17
Q

What is a side effect of Carmustine and other alkylating agents?

A

Secondary leukemias

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18
Q

What is the brand name of Cetuximab?

A

Erbitux

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19
Q

What is the MOA of Cetuximab?

A

EGFR blockage

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20
Q

What are the side effects of Cetuximab?

A

Rash
Diarrhea
Infusion reaction
Hypomagnesemia

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21
Q

What is the brand name of Pembrolizumab?

A

Keytruda

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22
Q

What is the MOA of Pembrolizumab?

A

PD-1 blocker
Immune checkpoint inhibitor

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23
Q

What are the side effects of Pembrolizumab?

A

LEGS
L: liver - hepatitis
E: endocrinopathies - hypothyroid, hyperthyroid, low cortisol (adrenal insufficiency)
G: GI - diarrhea, colitis
S: skin - dermatitis

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24
Q

What is the MOA of Oxaliplatin?

A

DNA crosslinks

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25
Q

What are the side effects of Oxaliplatin?

A

acute: cold-exacerbated neuropathy

chronic: peripheral neuropathy

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26
Q

What is the brand name of Doxorubicin?

A

Adriamycin

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27
Q

What is the MOA of Doxorubicin?

A
  1. Topoisomerase II inhibition
  2. DNA intercalation
  3. Free radical production
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28
Q

What are the side effects of Doxorubicin?

A

-red tears and urine
-Cardiomyopathy (decrease in LVEF)
-Secondary leukemias

it is a Vesicant (causes necrosis after extravasation)

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29
Q

What should be monitored before starting Anthracyclines?

A

Echocardiogramm (for LVEF)

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30
Q

Which drug is used to treat Vesicant injuries (extravasation)?

A

Dexrazoxane (Totect)

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31
Q

What is the maximum accumulative lifetime dose of Anthracyclines?

A

400-550 mg/m2

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32
Q

What is the brand name of Vincristine?

A

Oncovin (the O in CHOP)

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33
Q

What is the MOA of Vincristine?

A

it inhibits microtubule assembly

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34
Q

What safety precautions are necessary when handling Vincristine?

A

prepare it in a bag to prevent confusing it with an IT syringe

-intrathecal administration can be fatal
-auxiliary label is required: “Fatal when given intrathecally)”

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35
Q

What are the side effects of Vincristine?

A

peripheral neuropathy
autonomic neuropathy -> constipation -> need Bowel regimen

-NO Myelosuppression

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36
Q

What is the MOA of Etoposide?

A

inhibits Topoisomerase II

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37
Q

What are the side effects of Etoposide?

A

Secondary leukemias (mutation in the MLL gene)
-when given too fast it can cause Hypotension

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38
Q

What is the brand name of Cyclophosphamide?

A

Cytoxan

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39
Q

What is the MOA of Cyclophosphamide?

Alkylating agent

A

inter and intrastrand crosslinks

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40
Q

What are the side effects of Cyclophosphamide?

How do we prevent/treat?

A

Hemorrhagic cystitis (caused by Acrolein)

give fluids to prevent it
consider Mesna for high doses of Cyclophosphamide

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41
Q

What is the brand name of Imatinib?

A

Gleevec

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42
Q

What is the MOA of Imatinib?

A

inhibits Tyrosine kase of BCR-ABL

prevents ATP binding to the pocket of the BCR-ABL fusion protein (the BCR-ABL needs ATP to work)

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43
Q

What is the brand name of Trastuzumab?

A

Herceptin

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44
Q

What is the MOA of Trastuzumab?

A

Her2 blockade

45
Q

What are the side effects of Trastuzumab?

A

-Cardiomyopathy (reversible LVEF reduction) - need an ECHO every 3 months

-myelosuppression (thrombocytopenia)
-LFT
-arthralgia (joint pain)
-myalgia

46
Q

What is the brand name of Methotrexate?

A

Trexall, Rheumatrex

47
Q

What is the MOA of Methotrexate?

A

Dihydrofolate reductase (antifolate)

48
Q

What are the side effects of Methotrexate?

A

Mucositis
Myelosuppression

49
Q

What needs to be given with Methotrexate?

A

-Leucovorin (with high dose Mtx)

-IV fluids with an alkylating agent (sodium bicarbonate)
-> increases solubility and urine excretion

monitor urine output and urine pH

50
Q

What is Leucovorin?

A

reduced folic acid
-it rescues healthy cells when ha igh dose of Mtx is given

51
Q

What is the antidote of Methotrexate?

A

Glucarpridase (Voraxaze)
-hydrolyzes methotrexate

52
Q

What are the DDI with Methotrexate?

A

drugs that are also eliminated through the kidney
-Penicillin
-Bactrim, Sulfonamides
-NSAIDs
-PPIs
-Probenecid (used for gout)
-> Increase in Methotrexate concentration

53
Q

What is the MOA of 5-Fluorouracil?

A

-inhibits Thymidylate-Synthase
-RNA false base pair

54
Q

What are the side effects of 5-FU?

A

-Myelosuppression (more false DNA base pair)
-N/V

55
Q

Which drug increases the effect of 5-FU?

A

Leucovorin

56
Q

What is the MOA of Leuprolide?

A

-they cause a negative feedback loop leading to suppression of LH and FSH secretion
-> NO Testosterone secretion by the testes

57
Q

What are the side effects of Leuprolide?

A

-tumor flare with the first dose, in the first 2 weeks (due to LNRH stimulation -> later negative feedback)

-hot flashes
-metabolic syndrome
-Erectile dysfunction
-prostate pain
-libido goes down
-BMD decline
-depression

58
Q

What is the brand name of Irinotecan?

59
Q

What is the MOA of Irinotecan?

A

Topo I inhbition

60
Q

What are the side effects of Irinotecan?

A

-early diarrhea -> cholinergic storm (SLUD: salivation, lacrimation (tears), urination, defecation)

-late diarrhea (12-24h after infusion)

61
Q

Which drugs are used for Irinotecan-induced diarrhea?

A

early diarrhea:
treat with anticholinergic atropine 0.25 to 1 mg IV

late diarrhea:
Loperamide 4mg, then 2 mg q2h until no loose stools for 12h (may exceed the OTC max dose (16mg/day))

62
Q

What is the brand name of Gemcitabine?

63
Q

What is the MOA of Gemcitabine?

A

Pyrimidine false base pair

64
Q

What are the side effects of Gemcitabine?

A

-Thrombocytopenia

-Hemolytic uremic syndrome (thrombotic thrombocytopenic purpura, rare)

65
Q

What is the MOA of 6-MP?

A

Purine false base pair

66
Q

What are the side effects of 6-MP?

A

-Myelosuppression
-Hepatoxicity

DDI with Allopurinol (increases 6-MP concentration)

67
Q

Before using 6-mercaptopurine and 6-thioguanine patients need to be tested for what?

A

TPMT and NUDT15 PGx testing

counsel: avoid taking with milk

68
Q

What is the brand name of Paclitaxel?

69
Q

What is the MOA of Paclitaxel?

A

prevents microtubule disassembly

70
Q

What are the side effects of Paclitaxel?

A

-Hypersensitivity reactions to the Cremophor (diluent) in the formulation

-Peripheral Neuropathy

71
Q

What premeds are required for Paclitaxel?

A

Dexamethasone, diphenhydramnie, H2RA

72
Q

What has to be considered for the administration of Paclitaxel?

A

-Special “Taxol” tubing required
-has to be DHEP-free and In-line (0.22 micron) filter

-Vesicant precautions

73
Q

What is the brand name of Dexamethasone?

74
Q

What is the role of Dexamethasone in cancer therapy?

A

CINV (N/V treatment
-often used as premedication
-kills lymphoma, myeloma and acute lymphocytic leukemia

75
Q

What is the brand name of Bortezomib?

76
Q

What is the MOA Bortezomib?

A

Protease inhibitor

77
Q

What are the side effects of Bortezomib?

A

peripheral neuropathy (given SC bc if this)

need HSV/VZV prophylaxis
Acyclovir or Valacyclovir

78
Q

What is the MOA of Ibrutinib?

A

Bruton’s Tyrosine kinase inhibitors (B-cells)

Bru in the name

79
Q

What are the side effects of Ibrutinib?

A

-Infections (bc we inhibit B-cell activation)
-HTN
-Afib
-increased bleeding

80
Q

What is the brand name of Docetexel?

81
Q

What is the MOA of Docetexel?

A

Prevents microtubule disassembly

82
Q

What are the side effects of Docetaxel?

A

-edema (use dexamethasone)
-Hypersensitivity (less common than paclitaxel)
-Peripheral neuropathy (less severe than paclitaxel)

83
Q

Which premeds are needed for Docetexel?

A

Dexamethasone for edema

84
Q

What is the brand name of Lenalidomide?

85
Q

What are the side effects of Lenalidomide?

A

-VTE !!!
-peripheral neuropathy
-myelosuppression
-somnolence
-rash
-REMS program (teratogenicity)

86
Q

What is the brand name of Rituximab?

87
Q

What is the MOA of Rituximab?

A

binds to CD20 (on B-cells)

88
Q

What are the side effects of Rituximab?

A

-infusion reactions (Tylenol, Benadryl, infuse slowly)

-reactivating of Hep B virus
check Hep serum !!!

-also decreases vaccine response for 6-12 after treatment

89
Q

What is the brand name of Palbociclib?

90
Q

What is the MOA of Palbociclib?

has cicl in the name -> CDK

A

CDK 4/6 inhibitor

91
Q

What are the side effects of Palbociclib?

A

Minichemo:
-Myelosuppression (21 days on, 7 days off to allow the bone marrow to recover)

-nausea
-alopecia
-diarrhea
-Qt prolongation

92
Q

What is the brand name of Pemetrexed?

93
Q

What is the MOA of Pemetrexed?

A

blocks multiple enzymes in the folate pathway
-most important: blocks Thymidylate-Synthase

94
Q

What are the required premeds for Pemetrexed?

A

to prevent myelosuppression
-Folic acid 400-1000 mcg daily
-Vit B12 100 mcg every 9 weeks

to prevent skin reaction:
-Dexamethasone

95
Q

Pemetrexed has lower efficacy in what type of cancer?

A

squamous cancer in the lungs

because it has higher levels of Thymidylate synthetase enzymes (TS) -> greater resistance to the drug (cant block it enough)

96
Q

What is the brand name of Tamoxifen?

97
Q

What is the MOA of Tamoxifen?

A

SERM

blocks estrogen receptors in the breast
(acts like estrogen in other tissues)

98
Q

What are the toxicities of Tamoxifen (SERM) and AIs?

A

-Hot flashes, night sweats !!!
-risk of endometrial cancer
-thrombotic risk
-arthralgia, myalgia

99
Q

What is the dose of Tamoxifen?

A

20 mg daily

100
Q

What is the brand name of Anastrozole?

101
Q

What is the MOA of Anastrozole?

A

Aromatase inhibitor

102
Q

What are the side effects of Anastrozole?

A

-Hot flashes
-arthralgia, myalgia
-BMD decline

103
Q

What is the dose of Anastrozole?

104
Q

At what age do we screen for Breast cancer?

What is the screening method?

A

40

mammography

105
Q

At what age do we screen for prostate cancer?

What is the screening method?

A

at 55

PSA (prostate-specific antigen test)

106
Q

At what age do we screen for colon cancer?

What is the screening method?

A

age 45

-Colonoscopy /gold stanadard)
-DNA stool test
-DNA blood test
-fecal occult test
-sigmoidoscopy

107
Q

At what age do we screen for cervical cancer?

What is the screening method?

A

age 21

Pap smear (cytology)
Pap smear for HPV screen

108
Q

At what age do we screen for lung cancer?

What is the screening method?

A

age 55-80 if 30 year-pack history and smoked for the last 15 years

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