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CDM 4 Exam 3 > Lecture 6 - Oral Chemo > Flashcards

Lecture 6 - Oral Chemo Flashcards

1
Q

IV vs Oral

A

Advantages: pt preference, flexibility of admin, reduce healthcare resources, improve QOL

Disadvantages: non-traditional settings, adherence, DI, Food interactions, toxicity, co-pay, N/V

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2
Q

Capecitabine (Xeloda) uses

A

Colorectal
Breast
Pancreatic Cancer

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3
Q

Capecitabine (Xeloda) MOA

A

Prodrug of 5-FU
Disrupt DNA synthesis

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4
Q

Capecitabine (Xeloda) dosing

A

based on surface area
BID X 2 weeks, then 1 week off

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5
Q

Capecitabine (Xeloda) Drug Interactions

A

Avoid antacids, space apart
inc INR on warfarin
inc phenytoin lvls

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6
Q

Capecitabine (Xeloda) Toxicity management

A

Consult doctor if….
> 4 movements of diarrhea, occurs at night or have blood
> 1 episode/24hrs vomiting
Pain, redness, blistering, swelling or numbness in hands/feet

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7
Q

Hand-foot syndrome info

A

Hold capecitabine
Consider steroids = high potency topical steroids to affected areas
Prednisone 1mg/kg QD X 7-10 days
opiates if needed

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8
Q

Capecitabine (Xeloda) Side effects

A

Diarrhea
Mild Nausea
Vomiting
Fatigue
Hand-foot syndrome
Lymphopenia, anemia
Hyperbilirubinemia

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9
Q

Regorafenib (Stivarga) indicated

A

Advanced colorectal cancer failing prior therapies
hepatocellulr carcinoma progressed on sorafenib

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10
Q

Regorafenib (Stivarga) MOA

A

Multi-kinase inhibitor

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11
Q

Regorafenib (Stivarga) dosing info

A

Q AM with low fat breakfast

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12
Q

Regorafenib (Stivarga) Adverse effects

A

Hand-foot syndrome
Rash
Bleeding
HTN
Cardiac ischemia
GI perforation
Hepatic failure

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13
Q

Lapatinib (Tykerb) use

A

advanced, metastatic Her2+ breast cancer in combo w/ Capecitabine

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14
Q

Lapatinib (Tykerb) MOA

A

Dual Tyrosine kinase inhib

EGFR n Her2 inhibitor for txm-refractory metastatic breastcancer

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15
Q

Lapatinib (Tykerb) Dose

A

Taken daily

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16
Q

Lapatinib (Tykerb) DI

A

CYP3A4

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17
Q

Erlotinib (Tarceva) use

A

treatment of NSCLC after failure of atleast 1 prior chemo regimen

Locally advanced metastatic pancreatic cancer in combo w/ gemcitabine

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18
Q

Erlotinib (Tarceva) MOA

A

HER1/EGFR tyrosine kinase inhib

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19
Q

Erlotinib (Tarceva) Dosing

A

NSCLC: 150mg QD >1hr before or 2hrs after food
Pancreatic cancer: 100mg QD + gemcitabine

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20
Q

Erlotinib (Tarceva) ADE

A

Rash - Acneiform skin rash ~75%
Diarrhea
Interstitial Lung Disease
stomatitis
skin n mucous membrane stuff

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21
Q

Erlotinib may work better in patients who haven’t….

A

smoked

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22
Q

Dacomitinib (Vizimpro) info

A

EGFR positive NSCLC 1st line therapy (Exam 19 deletion or Exon 21 sub)
45mg QD w/ or w/o food
ADE> 20% D, rash, dec weight, alopecia, cough, dry skin, stomatitis
Avoid PPI n 2D6 inhib

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23
Q

Osimertinib (Tagrisso) info

A

EGFR positive NSCLC 1st line (Exam 19 deletion or Exon 21 Sub)
ADE > 20% diarrhea, rash, dry skin, nail toxicity, stomatitis, fatigue, dec appetite
Serious ADE = Pneumonitis, keratitis, cardiomyopathy, QTC prolong

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24
Q

Afatinib (Gilotrif) indications

A

1st line therapy for stage 4 NSCLC w/ EGFR +, non-resistant tumors

Metastatic squamous NSCLC progressing after platinum-based therapy

40mg QD

Bunch of Skin ADE again

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25
Alectinib (Alecensa) indication
ALK-positive metastatic NSCLC w/ prior crizotinib therapy 600mg BID w/ food
26
Alectinib (Alecensa) ADE
Edema Myalgias n muscle pain common Hepatotoxicity Interstitial lung disease Fetal toxicity, need protection
27
Crizotinib (Xalkor) indication
ALK-positive or ROS-1 positive metastatic NSCLC 250mg PO BID
28
Crizotinib (Xalkor) info
50-60% response rate, median 41-48wks CYP3A4 DI
29
Crizotinib (Xalkor) ADE
vision issues flash of light N/D/V n constipation Edema Liver toxicity, QTC prolongation Pneumonitis
30
Lorlatinib (Lorbrena) indication
ALK-positive NSCLC progressed on 1 other ALK inhib (Alectinib or Ceritinib) 100mg QD, avoid CYP3A4 inhib
31
Lorlatinib (Lorbrena) ADE
> 20% edema, peripheral neuropathy, cognitive effects, weight gain, mood effects,diarrhea
32
Brigatinib (Alunbrig) indication
ALK-positive NSCLC progressed or intolerant to 1 or more ALK inhib 90mg QD for 7days, then 180mg QD
33
Brigatinib (Alunbrig) ADE
> 25% = D, Fatigue, Cough, HA Severe = HTN, inc CPK, hyperglycemia, visual disturbances, pancreatice elevation, pneumonitis
34
CML 1st line therapy
Imatinib = 400-800mg QD Bosunitib = 500mg QD, can inc to 600mg QD
35
CML 1st or 2nd line therapy
Dasatinib = 100-140mg QD = main one used Nilotinib =300 BID Naive pts, 400mg BID refractory pts *typically used pts resistant to Imatinib* Issues w/ prologued QT interval
36
CML Refractory therapy
Ponatinib = 45mg QD Efficacy in T315I mutation pts bunch of warnings/cautions
37
What chromosome causes cancer?
Philadelphia chromosome
38
Natural Course of CML
Slowly progressive chronic phase = ~ 36 months enlarged liver/spleen possible more men get CML over women
39
Imatinib Mesylate (Gleevec) approved for....
Ph+ CML and GIST
40
Imatinib Mesylate (Gleevec) dosing
400-800 QD Take once daily with meal and large glass of water
41
Imatinib Mesylate (Gleevec) Drug interactions
Avoid alc Avoid St.johns wart CYP3A4 interactions
42
Imatinib Mesylate (Gleevec) ADE
Diarrhea, Muscle pain, cramps, arthralgia and edema problematic can supplement with K/Mag to see if electrolyte issue ** Calcium/mag for muscle cramps**
43
Dasatinib (Sprycel) MOA
bind to active n inactive BCR-ABL domains Binds more tightly than imatinib, used for resistance
44
Dasatinib (Sprycel) Dosing
100mg QD or 140mg QD ** Dont crush or cut, film coating for protection **
45
Dasatinib (Sprycel) Drug interactions
Avoid co-admin w/ H2 n PPIs....use antacids but separate admin time by 2hrs CYP3A4 Avoid St.john wart
46
Dasatinib (Sprycel) ADE
Fluid retention, rash, diarrhea, HA, neutropenia...shit load of stuff
47
Nilotinib (Tasigna) info
Dosing = 400mg BID empty stomach Caution = QT interval > 480msec
48
CML Therapy
1. Hematologic response = highest % 2. Cytogenetic response = mild % 3. molecular = lowest % if no response after 3 months, inc therapy.... at 6 months should have cytogenetic response, can inc dose if partial or switch drug reassess response 12, 18 months to max dose
49
Max doses for CML therapy
Imatinib = 800mg QD Dasatinib = 180 QD Nilotinib = 400mg BID
50
CML TKI managing toxicity, if neutrophils count < 1000 then....
Hold imatinib until ANC > 1500, if recovery takes > 2 wks dec dose by 25%
51
CML TKI managing toxicity, if thrombocytopenia < 50,000 then.....
Hold imatinib until Plt > 75,000, if recovery takes > 2ks dec dose by 25%
52
Sunitinib (Sutent) indications
GI stromal tumor after imatinib failure/intolerance Advanced renal cell carcinoma
53
Sunitinib (Sutent) MOA
inhibits several receptor tyrosine kinases
54
Sunitinib (Sutent) Doses
50mg QD, used to be 4wk on 2 off
55
Sunitinib (Sutent) DI
CYP3A4
56
Sunitinib (Sutent) SE
Rash HTN Skin/hair changes LFT inc
57
Cabozantinib (Cabometyx) info
For: pts advanced renal cell carcinoma, 2nd line hepatocellular carcinoma Dose:60mg QD on empty stomach ADE: D/N, Fatigue, V, HeadFoot Serious ADE: HTN, Osteonecrosis of jaw, PPE, thrombosis
58
Lenvatinib (Lenvima) dosing RCC
18mg QD in combo w/ everolimus
59
Lenvatinib (Lenvima) dosing HCC
12mg QD if > 60 KG
60
Lenvatinib (Lenvima) ADE
HTN Fatigue Diarrhea HeadFoot syndrome shit load
61
Sorafenib (Nexavar) use
can be used in advanced renal cancer, more common in liver cancer
62
Sorafenib (Nexavar) dosing
400mg BID on empty stomach, high fat meals dec absorption
63
Sorafenib (Nexavar) DI
CYP3A4 substrate UGT1A9 inhibitor
64
Sorafenib (Nexavar) ADE
Rash Hand-foot syndrome HTN Hypophosphatemia** (low phosphate) Lipase elevations some hair loss
65
Everolimus (Affinitor) approved for...
advanced renal cell carcinoma Hormone receptor positive breast cancer Neuroendocrine tumors of pancreas, Lung, GI tract
66
Everolimus (Affinitor) MOA
Unique mTOR inhibitor
67
Everolimus (Affinitor) Dosing
initial 10mg QD, same time each day with glass of water onc dose = higher than transplant
68
Everolimus (Affinitor) ADE
Pneumonitis = 10%, pretty common Hyperglycemia Hypertriglyceridemia Hypercholesterolemia bunch of metabolic stuff
69
Pazopanib (Votrient) Approved for....
advanced renal cell cancer Sarcoma
70
Pazopanib (Votrient) MOA
VEGF inhibitor
71
Pazopanib (Votrient) Dosing
800mg QD, take on empty stomach**
72
Pazopanib (Votrient) ade
Hair color change Nausea Diarrhea HTN Fatigue Anorexia Vomiting
73
Matching Toxicity with Target: MET
N/V Elevated AmylaseLipase Peripheral edema
74
Matching Toxicity with Target: HER2
Diarrhea RashLV Dysfunction
75
Matching Toxicity with Target: HER2
Diarrhea Rash LV Dysfunction
75
Matching Toxicity with Target: ALK
N/V Diarrhea Elevated AST/ALT Pneumonitis
76
Matching Toxicity with Target: JAK
Anemia Thrombocytopenia Fatigue Diarrhea
77
Matching Toxicity with Target: BCR-ABL
Cytopenia LV dysfunction QTC prolongation Hypothyroidism PAD/PAH
78
Matching Toxicity with Target: EGFR
Skin Rash Diarrhea Mucositis Pneumonitis
79
Matching Toxicity with Target: VEGF
Shit load
80
Vemurafenib (Zelboraf) approved for....
metastatic or unresectable melanoma with BRAF(V600E) mutation
81
Vemurafenib (Zelboraf) dosing
960mg PO BID, dont drop below 480mg BID Take med 12hrs apart, with or without meals
82
Vemurafenib (Zelboraf) MOA
BRAF serine-threonine Kinase inhibitor
83
Vemurafenib (Zelboraf) warnings
perform skin exam before therapy and every 2 months on therapy monitor QTC before, at day 15, then monthly for 3 months, then every 3 months (hold med if QTC > 500) Monitor Bilirubin n LFTs at BL and monthly
84
Vemurafenib (Zelboraf) DI
CYP3A4 inducer CYP1A2 and 2D6 inhibitor
85
Vemurafenib (Zelboraf) ADE
Photosensitivity Hyperkeratosis dry skin rash
86
Dabrafenib (Tafinlar) Indication
indicated for unresectable melanoma w/ BRAF(V600E) mutation
87
Dabrafenib (Tafinlar) Dosing
150mg QD
88
Dabrafenib (Tafinlar) what to monitor
monitor for new cutaneous malignancies every 2 months on therapy and 6 months post D/C
89
Dabrafenib (Tafinlar) Serious ADE
Thrombosis Cardiomyopathy Ocularmyopathy Hyperglycemia
90
Trametinib (Mekinist) Indication
un-resectable melanoma w/ BRAF V600E/K mutation...no prior BRAFi use Liposarcoma n Leimyosarcoma after anthracycline therapy
91
Trametinib (Mekinist) Dosing
2mg QD 1hr before or 2hrs after meal approved in combo w/ Dabrafenib (commonly used)
92
Trametinib (Mekinist) ADE
Cardiomyopathy retinal detachment retinal vein occlusion interstitial lung disease
93
Drugs for Refractory Melanoma
Encorafenib & Binimetinib (Braftovi & Mektovi) = 2nd line
94
Thalidomide (Thalomid) indication
Multiple Myeloma
95
Thalidomide (Thalomid) Dose
Start 50mg QD, titrate to 400-800mg QD take at bedtime to minimize sedative effects
96
Special issues with Thalidomide
Teratogenic No refills, no telephone RXs Fill Rx within 7 days of prescribed
97
Thalidomide pt counseling
2 Birthcontrol methods bunch of monitoring so dont have messed up babies
98
Thalidomide ADE
Neuropathy constipation Sedation
99
Lenalidomide (Revlimid) Use
Multiple myeloma in pts who received at least 1 prior therapy
100
Lenalidomide (Revlimid) dose
25mg QD w/ water
101
Lenalidomide (Revlimid) special issues
RevAssist program No more than 28 day supply dispense
102
Lenalidomide ADE
DVT/PE monitoring Thrombocytopenia, possible to get prophylaxis txm Neutropenia
103
Pomalidomide (Pomalyst) indication
multiple myeloma in combo w/ dexamethasone after failing lenalidomide and a proteasome inhibitor
104
Pomalidomide (Pomalyst) dosing
4mg BID X 21 days, 7 days off then restart
105
Pomalidome (Pomalyst) common ADE
DVT/PE, thromboprohlyaxis req Dizziness n neuropathy Neutropenia, Thrombocytopenia smoking can induce CYP1A2 and dec conc
106
Procarbaxine (Matulane) info
Use: Hodgkin's lymphoma MOA: inhibit DNA,RNA & protein synthesis Dose: 100mg/m2 QD X 14 days every 4 weeks ** Avoid Tyramine-containing foods**

CDM 4 Exam 3 (11 decks)

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