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Pharmacology > Introduction to Oncology > Flashcards

Introduction to Oncology Flashcards

1
Q

what are the 4 pillars of cancer treatment?

A

surgery, radiation, chemotherapy and immunotherapy

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2
Q

what is neoadjuvant and adjuvant?

A

treatment before surgery and after surgery

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3
Q

what side effect of chemotherapy is most feared by patients?

A

n/v

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4
Q

what side effect of chemotherapy is most common?

A

myelosuppression

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5
Q

what are the NCI-CTCAE grades for nausea?

A

Grade 1: loss of appetite without alteration in eating habits
Grade 2: oral intake decreased without significant weight loss, dehydration or malnutrition
Grade 3: inadequate oral caloric or fluid intake, tube feeding, TPN or hospitalization indicated

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6
Q

what are the NCI-CTCAE grades for vomiting?

A

Grade 1: intervention not indicated
Grade 2: outpatient IV hydration, medical intervention indicated
Grade 3: tube feeding, TPN or hospitalization indicated
Grade 4: life-threatening consequences
Grade 5: death

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7
Q

describe cisplatin

A

class: alkylating agent/platinums
MOA: inhibits DNA synthesis by the formation of DNA cross-links, not cell cycle specific
uses: lung, head, neck, pancreatic, ovarian, unknown primary carcinoma
AEs: n/v, nephrotoxicity, peripheral neuropathy, myelosuppression, ototoxicity
monitoring: CBC, CMP, audiometric testing at baseline, neuro exam

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8
Q

what is acute emesis?

A

begins in 1-2 hours of chemotherapy and peaks in 4-6 hours

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9
Q

what is delayed emesis?

A

occurs more than 24 hours after chemotherapy

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10
Q

what is anticipatory emesis?

A

occurs prior to treatment as a conditioned response in patients who have developed significant n/v during previous chemotherapy

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11
Q

what are the classes of antiemetics for CINV?

A

5-HT3 receptor antagonists (ondansetron)
Neurokinin-1 receptor antagonists, best for delayed (aprepitant, fosaprepitant)
other options (dexamethasone, olanzapine, steroids)

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12
Q

what are the mechanisms for chemotherapy induced diarrhea?

A

increased secretion of electrolytes due to decreased absorption, increased intraluminal osmotic substance, altered GI motility

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13
Q

how do you treat chemotherapy induced diarrhea?

A

mild: imodium, lomotil
severe: sandostatin or ocretodie

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14
Q

what is the class, MOA, use, adverse effects and monitoring of irinotecan/captosar?

A

class: plant alkaloid
MOA: topoisomerase I inhibitor (S and G2 phase)
use: colon and pancreatic cancer
AEs: diarrhea, CINV, neutropenia, fatigue
monitoring: CBC, CMP, magnesium, phosphate

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15
Q

what occurs in chemotherapy induced myelosuppression?

A

one or more cells lines are effects (RBCs, WBCs and/or platelets)

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16
Q

how do you manage, treat and prevent chemotherapy induced myelosuppression?

A

dose reduction and dose delay, can be prevented with growth factors that can help with neutropenia, with prolonged neutropenia prophylactic antibiotics, antivirals and antifungals can be used
can be treated with platelet and pRBC transfusions

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17
Q

what is the class, MOA and uses of dose dense AC for HER2-breast cancer?

A

class: doxorubicin (adriamycin): anthracycline, cyclophosphamide: alkylating agent
MOA: doxorubicin: intercalation between DNA base pairs by inhibition of topoisomerase II and by steric obstruction
cyclophosphamide: cross-linking DNA strands and decreasing DNA synthesis
uses: neoadjuvant chemotherapy for locally advanced stage 3 HER2-breast cancer

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18
Q

what is the cycle length, adverse effects and monitoring of dose dense AC for HER2-breast cancer?

A

cycle length: given 1 day of each 14 day cycle for 4 cycles followed by weekly taxol for 12 cycles
AEs: neutropenia, CINV, infusion site reaction, cardiotoxicity
monitoring: CBC, CMP, echo before, at completion and 6 months post doxorubicin

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19
Q

what is classified at neutropenia and severe neutropenia?

A

neutropenia: absolute neutrophil count of <1500
sever: absolute neutrophil count of <500

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20
Q

how do you control neutropenia?

A

hand hygiene, no dry or fresh flowers, no DRE, rectal thermometers or enemas, granulocyte colony stimulating factors (G-CSF) prophylaxis

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21
Q

what are the risk factors of chemotherapy induced neutropenia?

A

65+, previous chemotherapy or radiation, open wounds, recent surgery, poor nutritional status, multiple comorbidities, HIV

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22
Q

what are some examples of G-CSFs?

A

filgrastim, pegfilgrastim

23
Q

what is the MOA, AEs and monitoring of G-CSFs?

A

MOA: bind to hematopoietic cell receptors and stimulates production, maturation and activation of neutrophils
AEs: bone pain, loratadine before and after to prevent, NSAIDs to opioids for pain management, leukocytosis
monitoring: CBC, fever curves

24
Q

what is febrile neutropenia?

A

fever is neutropenic patient that is defined as a single oral temperature of 101 or a temperature of 100/4 lasting for longer than 1 hour

25
Q

what is the triage to treat febrile neutropenia?

A

identifiying when patient received chemotherapy, regimen, measure of ANC, blood cultures and empiric broad spectrum IV antibiotics (vancomyocine and zosyn or vancomycin and cefepime) within 1 hours of presentation
after: imaging, urinalysis, lactic acid, procalcitonin

26
Q

define low risk groups of febrile neutropenia

A

includes those recieveing OP chemotherapy, little to no other symptoms, no significant comorbidities, good performance status, expected to recover counts quickly OP treatment with oral fluoroquinolone plus amoxicillin/clavulanate or clindamycin in penicillin allergy

27
Q

describe high risk groups of febrile neutropenia

A

those with severe neutropenia for greater than 7 days with or without severe comorbidities, including renal or hepatic dysfunction, admit and continue IV antibiotics until defervescence

28
Q

what are the classes for each medication in R-CHOP?

A

rituximab: monoclonal anti-CD20 antibody
cyclophosphamide: alkylating agent
doxorubicin: anthracycline
vincristine/oncovin: vinca alkaloid
prednisone: glucocorticoid

29
Q

what are the uses, cycle length, adverse effects and monitoring of R-CHOP?

A

use: aggressive non-Hodgkin’s lymphomas
cycle length: 21 days
AEs: myelosuppression, infusion reactions, neuropathy, cardiotoxicity
monitoring: CBC, CMP, HBV, HCV, Echp

30
Q

what can chemotherapy agents do to the heart?

A

arrhythmias, heart failure, myocardial necrosis causing dilated cardiomyopathy, vasospasms or vasoocclusion resulting in angina or MI, pericardial disease, arterial occlusive events

commonly caused by: anthracyclines, fluropyrimidines and HER2-targeted therapies

31
Q

what are the uses, cycle length, adverse effects and monitoring of R-CHOP?

A

use: aggressive non-Hodgkin’s lymphomas
cycle length: 21 days
AEs: myelosuppression, infusion reactions, neuropathy, cardiotoxicity
monitoring: CBC, CMP, HBV, HCV, Echo

32
Q

chemotherapy induced peripheral neuropathy is most common with what kind of cancer treatments?

A

treating colon cancer with oxaliplatin and treating breast cancer with taxanes

33
Q

what are the class, MOA, uses, adverse effects and monitoring of taxol/paclitaxel?

A

class: taxane
MOA: microtubule dysregulation
uses: breast, gynecological, non small cell lung, esophageal and bladder cancer
AEs: CIPN, muscle aches, infusion reactions, alopecia with higher doses, myelosuppression, mucositis
monitoring: CBC, CMP, neuro exam

34
Q

what are some common presentations of patients with a brain mass?

A

new onset seizures, focal neurologic symptoms, headache worse when bending over, better when laying down, vision changes, dizziness, confusion, refractory n/v, increased intracranial pressure

35
Q

what is the most common primary brain tumor in adults and what is the most common malignant primary brain tumor in adults?

A

meningioma, glioblastoma

36
Q

what is the management for brain masses?

A

steroids for cerebral edema (dexomethasone), surigcal resection, radiation therapy

37
Q

what are the class, MOA, uses, adverse effects and monitoring of imatinib/gleevec?

A

class: tyrosine kinase inhibitor
MOA: inhibits Bcr-Abl tyrosine kinase, the constitutive abnormal gene product of the Philadelphia chromosome
uses: CML, Ph chromosome positive ALL
AEs: edema, rash, msk pain, n/v/d, myelosuppression
monitoring: CBC, CMP, Bcr-Abl transcript levels

38
Q

what are the 3 breast cancer biomarkers?

A

HR positive, HER2+ and triple negative

39
Q

describe HR positive

A

between 70-80% of breast cancers are ER/PR positive, neoadjuvant or adjuvant treatment with aromatase inhibitor or tamoxifen

40
Q

describe HER2+

A

about 15% of breast cancers, more unfavorable prognosis

41
Q

describe triple negative

A

about 10-15% of breast cancers, most unfavorable prognosis, up to 20% have a BRCA mutation, African Americans > caucasians > premenopausal > postmenopausal, only breast cancer that immunotherapy is approved in

42
Q

what are the class, MOA, uses, adverse effects and monitoring of herceptin/trastuzamab?

A

class: monoclonal antibody
MOA: blocks transmembrane HER2 receptors whose downstream signals promote cell proliferation, may also have antibody-dependent, cellular cytotoxicity
uses: HER2+ breast cancer, colon, gastric and endometrial cancer
AEs: cardiotoxicity, infusion reactions, pulmonary toxicity, rash, n/v/d
monitoring: CBC, CMP, echo every 3 months

43
Q

what is epidermal growth factor receptor (EGFR)?

A

non small cell lung cancer targeted therapy

44
Q

what are EGFR toxiciteis?

A

rash, diarrhea, QTC prolongation, decreased EF, ocular

45
Q

what cancers are immunotherapy widely used for?

A

melanoma, RCC, NSCLC, heavily pretreated cHL

46
Q

what cancers does immunotherapy not have much success in?

A

breast cancer, CRC, SCLC, primary CNS tumors, pancreatic cancer

47
Q

what immune biomarkers can be used to predict response to immunotherapy?

A

PD-L1, TMB, MMR status

48
Q

what are immunotherapy toxicities?

A

dermtologic conditions, endocrinopathies, diarrhea/colitis, constiutional symptoms, pneumonitis, hepatitis

49
Q

what is the management of grade 1 immune related adverse events?

A

supportive measures, continue treatment and monitor

50
Q

what is the management of grade 2 immune related adverse events?

A

consider PO steroids like prednisone, consider dose delay

51
Q

what is the management of grade 3 immune related adverse events?

A

PO steroids 1-2 mg/kg, alterante immunosuppression if persistent, hold immunotherapy only if prednisone is 10 mg or less

52
Q

what is the management of grade 4 immune related adverse events?

A

hospitalize, IV steroid 1-2 mg/kg followed by alternate immunosuppression, discontinue immunotherapy

53
Q

what do CAR-T cells treat and what are adverse reactions of them?

A

ALL, lymphoma, multiple myeloma
cytokine release syndrome and ICANS

Pharmacology (4 decks)

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