IV Oncology drugs Flashcards
1
Q
A
Methotrexate
2
Q
Fill in the blank: _______ is a common side effect that occurs due to damage to the gastrointestinal tract from chemotherapy.
A
Mucositis
3
Q
What is the significance of the ‘dose-dense’ chemotherapy regimen?
A
It involves administering chemotherapy more frequently to improve outcomes.
4
Q
Name a common side effect of anthracycline antibiotics.
A
Cardiotoxicity
5
Q
Fill in the blank: _______ is a chemotherapy drug used primarily for breast cancer that acts as a hormonal therapy.
A
Tamoxifen
6
Q
Multiple Choice: Which drug is commonly used to treat leukemia? A) Doxorubicin B) Cytarabine C) Paclitaxel
A
B) Cytarabine
7
Q
Chemotherapies used as radiosensitizers include:
A
5-fluorouracil (Adrucil®), cetuximab (Erbitux®), cisplatin (Platinol®-AQ) and mitomycin (Jelmyto®).
8
Q
What is the standard chemotherapy approach for anal cancer?
A
Neoadjuvant chemotherapy
9
Q
What type of chemotherapy drugs tends to be effective for tumor cells in the G0 phase?
A
Cell-cycle nonspecific medications
10
Q
Oxaliplatin Classification
A
non cell-cycle specific, platinum-based alkylating agent.
11
Q
Oxaliplatin monitoring
A
CBC with differential
LFTs
pregnancy testing
serum creatinine
serum electrolytes
12
Q
fluorouracil classification
A
fluorinated pyrimidine and acts as an antimetabolite antineoplastic agent
13
Q
fluorouracil monitoring
A
CBC with differential
neurologic function
14
Q
Bevacizumab classification
A
vascular endothelial growth factor (VEGF)-directed monoclonal antibody
15
Q
Bevacizumab monitoring
A
blood pressure
urinalysis (protein)
16
Q
Fluorouracil indications
A
CRC, anal CA, gastric CA, pancreatic cancer, HER2-positive breast cancer in combination with epirubicin and cyclophosphamide (FEC-75), followed by paclitaxel and trastuzumab, head and neck cancer, actinic keratosis
17
Q
Bevacizumab indications
A
metastatic colorectal cancer, in combination with irinotecan, leucovorin, and fluorouracil, non-small cell lung cancer, renal cell cancer, metastatic breast cancer, glioblastoma, ovarian cancer, hepatocellular cancer,
18
Q
What is methotrexate primarily used to treat?
A
Methotrexate is primarily used to treat cancer, autoimmune diseases, and ectopic pregnancies.
19
Q
True or False: Methotrexate is an antimetabolite.
A
True
20
Q
Which vitamin’s metabolism is affected by methotrexate?
A
Folate
21
Q
What is the role of leucovorin in methotrexate treatment?
A
Leucovorin is used to rescue normal cells from methotrexate toxicity.
22
Q
Multiple Choice: Which of the following is a serious side effect of methotrexate? A) Hair loss B) Liver toxicity C) Skin rash D) Headaches
A
B) Liver toxicity
23
Q
True or False: Methotrexate can cause pulmonary toxicity.
A
True
24
Q
What monitoring is required during methotrexate therapy?
A
Regular blood tests to monitor liver function and blood cell counts.
25
What is the impact of methotrexate on immune function?
Methotrexate suppresses the immune system.
26
Fill in the blank: Methotrexate is sometimes used to treat _____.
ectopic pregnancy
27
What is the significance of the term 'high-dose methotrexate'?
High-dose methotrexate is used in certain cancers and requires leucovorin rescue to prevent toxicity.
28
Cemiplimab type
Cemiplimab is a monoclonal antibody used as an immunotherapy treatment.
29
What type of cancer is cemiplimab primarily used to treat?
Cemiplimab is primarily used to treat cutaneous squamous cell carcinoma (CSCC).
30
Cemiplimab works by inhibiting which protein?
Cemiplimab inhibits the PD-1 (programmed cell death protein 1) pathway.
31
What is the recommended route of administration for cemiplimab?
Cemiplimab is administered via intravenous infusion.
32
Fill in the blank: Cemiplimab is used to treat patients with advanced CSCC who are not candidates for _______.
surgery or radiation.
33
Multiple Choice: What is the primary mechanism of action of cemiplimab? A) Chemotherapy B) Targeted therapy C) Immune checkpoint inhibition D) Radiotherapy
C) Immune checkpoint inhibition.
34
True or False: Cemiplimab is effective in treating melanoma.
False.
35
What are common side effects associated with cemiplimab?
Common side effects include fatigue, rash, and diarrhea.
36
Multiple Choice: Which of the following is NOT a potential side effect of cemiplimab? A) Pneumonitis B) Colitis C) Hypertension D) Hyperglycemia
D) Hyperglycemia.
37
What is the dosing schedule for cemiplimab in the treatment of CSCC?
Cemiplimab is typically administered every 2 weeks.
38
What type of patients are considered for cemiplimab therapy?
Patients with locally advanced or metastatic CSCC who are not suitable for curative surgery or radiation.
39
True or False: Cemiplimab can be used as a first-line treatment for all types of skin cancer.
False.
40
What is the importance of biomarkers in cemiplimab treatment?
Biomarkers can help predict the response to immunotherapy and guide treatment decisions.
41
Fill in the blank: Cemiplimab is administered in a healthcare setting due to the risk of _______.
infusion-related reactions.
42
Multiple Choice: Which of the following is a contraindication for cemiplimab? A) Active autoimmune disease B) Previous skin cancer C) Hypertension D) Diabetes
A) Active autoimmune disease.
43
True or False: Cemiplimab is only effective in patients with a specific genetic mutation.
False.
44
What is Trastuzumab commonly used to treat?
Trastuzumab is commonly used to treat HER2-positive breast cancer.
45
Trastuzumab type
monoclonal antibody
46
What does HER2 stand for?
HER2 stands for Human Epidermal growth factor Receptor 2.
47
Fill in the blank: Trastuzumab is also known by the brand name _____ .
Herceptin.
48
What mechanism does Trastuzumab use to combat cancer cells?
Trastuzumab works by binding to the HER2 receptor, inhibiting cell proliferation and inducing apoptosis.
49
How does Trastuzumab affect the immune system?
Trastuzumab can enhance the immune response against cancer cells.
50
What are common side effects of Trastuzumab?
Common side effects include fever, chills, nausea, and potential heart problems.
51
Fill in the blank: Trastuzumab is often used after _____ .
surgery.
52
What type of drug is Trastuzumab classified as?
Trastuzumab is classified as a targeted therapy.
53
True or False: Trastuzumab can be used to treat gastric cancer.
True.
54
What is the role of HER2 in cancer progression?
HER2 promotes cell growth and division, leading to aggressive cancer behavior.
55
What is the typical duration of Trastuzumab treatment?
Treatment duration can vary but often lasts for a year.
56
Multiple Choice: Which of the following is a potential serious side effect of Trastuzumab? A) Hair loss B) Heart failure C) Fatigue
B) Heart failure.
57
What is the significance of HER2 testing in breast cancer?
HER2 testing determines eligibility for Trastuzumab treatment.
58
True or False: Trastuzumab can be administered as a subcutaneous injection.
True.
59
What is an important monitoring parameter for patients on Trastuzumab?
Cardiac function should be monitored due to risk of heart problems.
60
Fill in the blank: Trastuzumab may be used in combination with _____ for better efficacy.
chemotherapy.
61
What is cetuximab?
Cetuximab is a monoclonal antibody used in cancer treatment.
62
True or False: Cetuximab is primarily used to treat colorectal cancer.
True
63
Which type of receptor does cetuximab target?
Epidermal growth factor receptor (EGFR)
64
Fill in the blank: Cetuximab is used in combination with _______ for treating head and neck cancers.
radiation therapy
65
Multiple choice: Which of the following cancers is NOT typically treated with cetuximab? A) Colorectal B) Lung C) Head and neck D) Pancreatic
D) Pancreatic
66
What are common side effects of cetuximab?
Rash, diarrhea, and infusion reactions.
67
True or False: Cetuximab can be used in patients with KRAS mutations.
False
68
Multiple choice: Cetuximab is classified as which type of drug? A) Chemotherapy B) Monoclonal antibody C) Hormonal therapy D) Radiotherapy
B) Monoclonal antibody
69
What is the recommended initial dose of cetuximab?
400 mg/m² as a loading dose.
70
True or False: Cetuximab can be used as a single agent.
True
71
Fill in the blank: Patients should be screened for _______ mutations before starting cetuximab.
KRAS
72
What is the brand name for cetuximab?
Erbitux
73
What type of therapy is cetuximab considered?
Targeted therapy
74
Fill in the blank: Cetuximab may cause _______ as a skin-related side effect.
acneiform rash
75
What is the typical frequency of cetuximab administration after the initial dose?
Every week or every two weeks, depending on the regimen.
76
True or False: Cetuximab is a first-line treatment for all types of cancer.
False
77
ABVD
doxorubicin, bleomycin, vinblastine, and dacarbazine
78
Ipilimumab (AKA)
Yervoy
79
Cetuximab AKA
Erbitux
80
Which of the following agents should be added to the treatment plan for a 45-year-old male patient newly diagnosed B-cell ALL who was found to be Philadelphia chromosome positive?
Dasatinib
Philadelphia chromosome positivity in an ALL patient calls for the addition of a TKI agent. The following agents are approved to treat Ph+ (Philadelphia chromosome positive) ALL: imatinib, dasatinib, and ponatinib. Vyxeos is approved for adults with treatment-related AML. Inotuzumab is indicated for relapsed/refractory B-ALL. Blinatumomab is indicated for relapsed/refractory B-cell ALL or B-cell ALL with minimal residual disease detected.
81
What type of brain tumor has the highest incidence of affecting the cerebrum?
Astrocytoma
Astrocytomas primarily affect the cerebrum of the brain and are responsible for half of the brain tumors. Glioblastomas involve multiple glial cells. Medulloblastomas and hemangioblastomas develop in the cerebellum
82
What targeted therapy has been successful in treating astrocytoma cell carcinoma?
. Everolimus (Afinitor)
Everolimus blocks the mTOR protein on brain cancer cell, preventing the creation of new blood supply. Cetuximab, an epidermal growth factor agent, has been successful in treating squamous cell carcinoma. Dabrafenib (Tafinlar), Encorafenib (Braftovi), and Vemurafenib are BRAF Inhibitors used to treat melanoma.
83
Cisplatin classification
non-cell-cycle specific alkylating agent
84
Cytarabine (Ara-C) considerations
Administer eye drops as ordered
Liver functions
Monitor for cerebellar ataxia (check handwriting)
85
Mercaptopurine considerations
Liver and kidney functions
86
major S/E of panobinostat
Severe diarrhea occurred in 25% of panobinostat-treated patients. Monitor for symptoms, institute antidiarrheal treatment, interrupt panobinostat, and then reduce dose or discontinue panobinostat.
87
Belantamab considerations
Restricted access: Available only through the REMS program due to the risk of ocular toxicity. Corneal epithelium changes resulting in changes in vision, including severe vision loss and corneal ulcer, and symptoms, such as blurred vision and dry eyes.
Conduct ophthalmic exams at baseline, prior to each dose, and promptly for worsening symptoms.
Withhold belantamab mafodotin until improvement and resume, or permanently discontinue, based on severity.
88
Bleomycin lifetime dose
<400 units
89
Radioprotectant Agents
Radioprotectant Agents to Reduce the Risk of Radiation Pneumonitis
Amifostine, Clarithromycin
Radioprotectant agents can be used to protect healthy normal tissues against damage from radiation. Currently, amifostine is the only radioprotectant available to help reduce radiation toxicity in cancer patients. Amifostine has been studied as a radioprotectant for radiation pneumonitis with positive results as well as being administered subcutaneously to reduce side effects, but further data are needed. See Box 22.4 for the proper administration of amifostine. Side effects of amifostine include nausea/vomiting, sleepiness, hypotension, dyspnea, skin reactions, allergic/hypersensitivity reactions, and hypocalcemia.
90
Proper Administration of Amifostine
Amifostine in the radiation patient with head and neck cancer:
Dose is 200 mg/m2 IV over 3 min prior to each radiation treatment.
Must be administered within 15 to 30 min PRIOR to each radiation treatment.
Blood pressure should be monitored before infusion, after, and as indicated.
Amifostine in the chemotherapy patient:
Dose is 910 mg/m2 IV over 15 min prior to each chemotherapy treatment.
Must be administered within 30 min PRIOR to each chemotherapy treatment.
Prolonged infusion >15 min will result in a higher incidence of side effects.
Blood pressure should be monitored at baseline, every 5 min during the infusion, and after as indicated.
Amifostine CANNOT be administered to dehydrated patients. Patients should be adequately hydrated prior to receiving amifostine.
Patients should WITHHOLD antihypertensive medication 24 hours prior to receiving amifostine. Patients who must continue their antihypertensive medications CANNOT receive amifostine.
Support hypotension with normal saline IV bolus via a separate IV line.
It is recommended to administer antiemetics prior to the amifostine infusion.
Patients should remain SUPINE during the amifostine infusion.
91
Clarithromycin
Clarithromycin
Clarithromycin (CAM) is an antibiotic with immunomodulatory effects prescribed for inflammatory respiratory diseases (e.g., diffuse panbronchiolitis, cystic fibrosis). It has also been noted that CAM improved pulmonary function and frequency of exacerbations in patients with COPD, asthma, bronchiectasis, and chronic sinusitis. Side effects of CAM include hepatotoxicity, QT prolongation, Clostridium difficile associated diarrhea, and exacerbation of myasthenia gravis.
CAM has been studied as prophylactic therapy for the prevention of radiation pneumonitis following stereotactic body radiotherapy with positive results. CAM has also been noted to significantly reduce the severity of radiation pneumonitis. At this time, it is still unknown what the CAM dosage and duration should be. It is recommended that further prospective studies be performed
92
Dexrazoxane (Zinecard®
is a cardio protectant agent that can be administered to minimize the incidence and severity of cardiomyopathy and reduce QT prolongation when treating with anthracyclines such as doxorubicin. It is administered intravenously over 15 minutes, just prior to the anthracycline. It should only be administered when a patient’s cumulative dose of doxorubicin has reached 300 mg/m2 and will continue with doxorubicin therapy. Dexrazoxane may interfere with the antitumor activity of the chemotherapy regimen; therefore, it is not initially included with the chemotherapy cycles.
93
Arsenic trioxide
is used to treat refractory or relapsed acute promyelocytic leukemia (APL). The cardiac conduction abnormalities that have been observed with arsenic trioxide include QTc prolongation, atrioventricular block, as well as torsade de pointes (TdP), which can quickly progress to ventricular fibrillation. Arsenic trioxide should not be administered to a patient with pre-existing ventricular arrhythmia or QTc prolongation.
94
Etoposide classification
Antineoplastic Plant Alkaloids and Other Natural Agents
Podophyllotoxin Derivatives
95
Etoposide monitoring and considerations
extravasation, CBC with differential
LFTs
serum creatinine/BUN
96
Octreotide classification
synthetic analog of the naturally occurring hormone somatostatin
97
Octreotide indication
For the treatment of symptoms associated with carcinoid tumors, specifically, diarrhea and cutaneous flushing
98
Palifermin classification
mucocutaneous epithelial human growth factor. It is indicated to decrease the incidence and duration of severe oral mucositis in patients with hematologic malignancies who are receiving myelotoxic preparative regimens prior to an autologous hematopoietic stem cell transplant that are predicted to result in a high incidence of WHO Grade 3 or 4 mucositis. Palifermin is not recommended for use in patients with nonhematologic malignancies due to a potential for tumor proliferation or in patients receiving an allogeneic stem-cell transplantation or melphalan 200 mg/m2 as a conditioning regimen due to lack of efficacy.[54912]
99
. Recurrent cervical cancers are treated with
cisplatin (Platinol AQ®), carboplatin, and etoposide (Toposar®) (NCCN, 2021).
100
Hydroxyurea indications
For the treatment of acute myelogenous leukemia (AML)
to lower peripheral blast blood counts prior to induction therapy, For the treatment of advanced non-small cell lung cancer (NSCLC)†, in combination with chemotherapy, For the treatment of locally advanced squamous cell head and neck cancer (excluding the lip) in combination with chemoradiation therapy
101
Hydroxyurea monitoring
CBC with differential
platelet count
pregnancy testing
serum creatinine/BUN
102
Hydroxyurea precautions
Do not initiate hydroxyurea in patients with marked bone marrow suppression. Hydroxyurea can cause severe myelosuppression, even at the recommended initial doses. Use hydroxyurea with caution in patients who have received previous radiation therapy or cytotoxic chemotherapy; myelosuppression is more common in these patients
103
mitoxantrone indications
acute myelogenous leukemia (AML)
104
mitoxantrone precautions
Severe cardiotoxicity , may cause a new primary malignancy
105
Plerixafor indications
For peripheral blood stem cell (PBSC) mobilization for collection and subsequent autologous transplantation in patients with non-Hodgkin lymphoma and multiple myeloma, in combination with a granulocyte colony stimulating factor (G-CSF)
106
Plerixafor precautions
life-threatening hypersensitivity reactions, Do not use plerixafor for hematopoietic stem-cell (HSC) mobilization and harvest in patients with leukemia.,
107
Luspatercept indications
Anemia and Myelodysplastic Syndromes
108
Luspatercept classification
recombinant fusion protein that functions as an erythroid maturation agent to restore red blood cell (RBC) production and ameliorate anemia
109
Carmustine (BCNU)* indicaitons
brain tumors including malignant first-line treatment of metastatic malignant melanoma in combination with dacarbazine, cisplatin, and tamoxifen†glioma and glioblastoma multiforme, For the treatment of multiple myeloma in combination with prednisone
110
Lomustine (CCNU)* indications
For the treatment of Hodgkin lymphoma in patients who have progressive disease following initial chemotherapy, in combination with other chemotherapeutic agents, For the treatment of metastatic malignant melanoma† in combination with dacarbazine-containing chemotherapy, For the treatment of brain tumors, including malignant glioma, and brain metastases
111
Procarbazine (Matulane) indications
Hodgkin lymphoma
112
Pemetrexed (Alimta)*
113
Atezolizumab (Tecentriq):
114
Carmustine classification
nitrosourea alkylating agent.
115
Lomustine classification
nitrosourea alkylating agent
116
Lomustine monitoring
CBC
LFTs
pulmonary function tests (PFTs)
serum creatinine/BUN
serum electrolytes
117
Procarbazine classification
Procarbazine is an oral, cell cycle-phase specific antineoplastic agent used in the treatment of Hodgkin lymphoma, non-Hodgkin's lymphomas, brain tumors, and lung cancers.
118
Procarbazine monitoring
CBC with differential
LDH
LFTs
reticulocyte count
serum creatinine/BUN
urinalysis
