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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
Q

Alectinib (Alecensa) indication

A

ALK-positive metastatic NSCLC w/ prior crizotinib therapy

600mg BID w/ food

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26
Q

Alectinib (Alecensa) ADE

A

Edema
Myalgias n muscle pain common
Hepatotoxicity
Interstitial lung disease
Fetal toxicity, need protection

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27
Q

Crizotinib (Xalkor) indication

A

ALK-positive or ROS-1 positive metastatic NSCLC

250mg PO BID

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28
Q

Crizotinib (Xalkor) info

A

50-60% response rate, median 41-48wks

CYP3A4 DI

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29
Q

Crizotinib (Xalkor) ADE

A

vision issues flash of light
N/D/V n constipation
Edema
Liver toxicity, QTC prolongation
Pneumonitis

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30
Q

Lorlatinib (Lorbrena) indication

A

ALK-positive NSCLC progressed on 1 other ALK inhib (Alectinib or Ceritinib)

100mg QD, avoid CYP3A4 inhib

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31
Q

Lorlatinib (Lorbrena) ADE

A

> 20% edema, peripheral neuropathy, cognitive effects, weight gain, mood effects,diarrhea

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32
Q

Brigatinib (Alunbrig) indication

A

ALK-positive NSCLC progressed or intolerant to 1 or more ALK inhib

90mg QD for 7days, then 180mg QD

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33
Q

Brigatinib (Alunbrig) ADE

A

> 25% = D, Fatigue, Cough, HA

Severe = HTN, inc CPK, hyperglycemia, visual disturbances, pancreatice elevation, pneumonitis

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34
Q

CML 1st line therapy

A

Imatinib = 400-800mg QD
Bosunitib = 500mg QD, can inc to 600mg QD

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35
Q

CML 1st or 2nd line therapy

A

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

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36
Q

CML Refractory therapy

A

Ponatinib = 45mg QD
Efficacy in T315I mutation pts
bunch of warnings/cautions

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37
Q

What chromosome causes cancer?

A

Philadelphia chromosome

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38
Q

Natural Course of CML

A

Slowly progressive
chronic phase = ~ 36 months
enlarged liver/spleen possible
more men get CML over women

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39
Q

Imatinib Mesylate (Gleevec) approved for….

A

Ph+ CML and GIST

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40
Q

Imatinib Mesylate (Gleevec) dosing

A

400-800 QD
Take once daily with meal and large glass of water

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41
Q

Imatinib Mesylate (Gleevec) Drug interactions

A

Avoid alc
Avoid St.johns wart
CYP3A4 interactions

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42
Q

Imatinib Mesylate (Gleevec) ADE

A

Diarrhea, Muscle pain, cramps, arthralgia and edema problematic

can supplement with K/Mag to see if electrolyte issue
** Calcium/mag for muscle cramps**

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43
Q

Dasatinib (Sprycel) MOA

A

bind to active n inactive BCR-ABL domains
Binds more tightly than imatinib, used for resistance

44
Q

Dasatinib (Sprycel) Dosing

A

100mg QD or 140mg QD
** Dont crush or cut, film coating for protection **

45
Q

Dasatinib (Sprycel) Drug interactions

A

Avoid co-admin w/ H2 n PPIs….use antacids but separate admin time by 2hrs
CYP3A4
Avoid St.john wart

46
Q

Dasatinib (Sprycel) ADE

A

Fluid retention, rash, diarrhea, HA, neutropenia…shit load of stuff

47
Q

Nilotinib (Tasigna) info

A

Dosing = 400mg BID empty stomach
Caution = QT interval > 480msec

48
Q

CML Therapy

A
  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
Q

Max doses for CML therapy

A

Imatinib = 800mg QD
Dasatinib = 180 QD
Nilotinib = 400mg BID

50
Q

CML TKI managing toxicity, if neutrophils count < 1000 then….

A

Hold imatinib until ANC > 1500, if recovery takes > 2 wks dec dose by 25%

51
Q

CML TKI managing toxicity, if thrombocytopenia < 50,000 then…..

A

Hold imatinib until Plt > 75,000, if recovery takes > 2ks dec dose by 25%

52
Q

Sunitinib (Sutent) indications

A

GI stromal tumor after imatinib failure/intolerance
Advanced renal cell carcinoma

53
Q

Sunitinib (Sutent) MOA

A

inhibits several receptor tyrosine kinases

54
Q

Sunitinib (Sutent) Doses

A

50mg QD, used to be 4wk on 2 off

55
Q

Sunitinib (Sutent) DI

A

CYP3A4

56
Q

Sunitinib (Sutent) SE

A

Rash
HTN
Skin/hair changes
LFT inc

57
Q

Cabozantinib (Cabometyx) info

A

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
Q

Lenvatinib (Lenvima) dosing RCC

A

18mg QD in combo w/ everolimus

59
Q

Lenvatinib (Lenvima) dosing HCC

A

12mg QD if > 60 KG

60
Q

Lenvatinib (Lenvima) ADE

A

HTN
Fatigue
Diarrhea
HeadFoot syndrome
shit load

61
Q

Sorafenib (Nexavar) use

A

can be used in advanced renal cancer, more common in liver cancer

62
Q

Sorafenib (Nexavar) dosing

A

400mg BID on empty stomach, high fat meals dec absorption

63
Q

Sorafenib (Nexavar) DI

A

CYP3A4 substrate
UGT1A9 inhibitor

64
Q

Sorafenib (Nexavar) ADE

A

Rash
Hand-foot syndrome
HTN
Hypophosphatemia** (low phosphate)
Lipase elevations
some hair loss

65
Q

Everolimus (Affinitor) approved for…

A

advanced renal cell carcinoma
Hormone receptor positive breast cancer
Neuroendocrine tumors of pancreas, Lung, GI tract

66
Q

Everolimus (Affinitor) MOA

A

Unique mTOR inhibitor

67
Q

Everolimus (Affinitor) Dosing

A

initial 10mg QD, same time each day with glass of water

onc dose = higher than transplant

68
Q

Everolimus (Affinitor) ADE

A

Pneumonitis = 10%, pretty common
Hyperglycemia
Hypertriglyceridemia
Hypercholesterolemia

bunch of metabolic stuff

69
Q

Pazopanib (Votrient) Approved for….

A

advanced renal cell cancer
Sarcoma

70
Q

Pazopanib (Votrient) MOA

A

VEGF inhibitor

71
Q

Pazopanib (Votrient) Dosing

A

800mg QD, take on empty stomach**

72
Q

Pazopanib (Votrient) ade

A

Hair color change
Nausea
Diarrhea
HTN
Fatigue
Anorexia
Vomiting

73
Q

Matching Toxicity with Target: MET

A

N/V
Elevated AmylaseLipase
Peripheral edema

74
Q

Matching Toxicity with Target: HER2

A

Diarrhea
RashLV Dysfunction

75
Q

Matching Toxicity with Target: HER2

A

Diarrhea
Rash
LV Dysfunction

75
Q

Matching Toxicity with Target: ALK

A

N/V
Diarrhea
Elevated AST/ALT
Pneumonitis

76
Q

Matching Toxicity with Target: JAK

A

Anemia
Thrombocytopenia
Fatigue
Diarrhea

77
Q

Matching Toxicity with Target: BCR-ABL

A

Cytopenia
LV dysfunction
QTC prolongation
Hypothyroidism
PAD/PAH

78
Q

Matching Toxicity with Target: EGFR

A

Skin Rash
Diarrhea
Mucositis
Pneumonitis

79
Q

Matching Toxicity with Target: VEGF

A

Shit load

80
Q

Vemurafenib (Zelboraf) approved for….

A

metastatic or unresectable melanoma with BRAF(V600E) mutation

81
Q

Vemurafenib (Zelboraf) dosing

A

960mg PO BID, dont drop below 480mg BID

Take med 12hrs apart, with or without meals

82
Q

Vemurafenib (Zelboraf) MOA

A

BRAF serine-threonine Kinase inhibitor

83
Q

Vemurafenib (Zelboraf) warnings

A

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
Q

Vemurafenib (Zelboraf) DI

A

CYP3A4 inducer
CYP1A2 and 2D6 inhibitor

85
Q

Vemurafenib (Zelboraf) ADE

A

Photosensitivity
Hyperkeratosis
dry skin
rash

86
Q

Dabrafenib (Tafinlar) Indication

A

indicated for unresectable melanoma w/ BRAF(V600E) mutation

87
Q

Dabrafenib (Tafinlar) Dosing

A

150mg QD

88
Q

Dabrafenib (Tafinlar) what to monitor

A

monitor for new cutaneous malignancies every 2 months on therapy and 6 months post D/C

89
Q

Dabrafenib (Tafinlar) Serious ADE

A

Thrombosis
Cardiomyopathy
Ocularmyopathy
Hyperglycemia

90
Q

Trametinib (Mekinist) Indication

A

un-resectable melanoma w/ BRAF V600E/K mutation…no prior BRAFi use

Liposarcoma n Leimyosarcoma after anthracycline therapy

91
Q

Trametinib (Mekinist) Dosing

A

2mg QD 1hr before or 2hrs after meal
approved in combo w/ Dabrafenib (commonly used)

92
Q

Trametinib (Mekinist) ADE

A

Cardiomyopathy
retinal detachment
retinal vein occlusion
interstitial lung disease

93
Q

Drugs for Refractory Melanoma

A

Encorafenib & Binimetinib (Braftovi & Mektovi) = 2nd line

94
Q

Thalidomide (Thalomid) indication

A

Multiple Myeloma

95
Q

Thalidomide (Thalomid) Dose

A

Start 50mg QD, titrate to 400-800mg QD
take at bedtime to minimize sedative effects

96
Q

Special issues with Thalidomide

A

Teratogenic
No refills, no telephone RXs
Fill Rx within 7 days of prescribed

97
Q

Thalidomide pt counseling

A

2 Birthcontrol methods
bunch of monitoring so dont have messed up babies

98
Q

Thalidomide ADE

A

Neuropathy
constipation
Sedation

99
Q

Lenalidomide (Revlimid) Use

A

Multiple myeloma in pts who received at least 1 prior therapy

100
Q

Lenalidomide (Revlimid) dose

A

25mg QD w/ water

101
Q

Lenalidomide (Revlimid) special issues

A

RevAssist program
No more than 28 day supply dispense

102
Q

Lenalidomide ADE

A

DVT/PE monitoring
Thrombocytopenia, possible to get prophylaxis txm
Neutropenia

103
Q

Pomalidomide (Pomalyst) indication

A

multiple myeloma in combo w/ dexamethasone after failing lenalidomide and a proteasome inhibitor

104
Q

Pomalidomide (Pomalyst) dosing

A

4mg BID X 21 days, 7 days off then restart

105
Q

Pomalidome (Pomalyst) common ADE

A

DVT/PE, thromboprohlyaxis req
Dizziness n neuropathy
Neutropenia, Thrombocytopenia

smoking can induce CYP1A2 and dec conc

106
Q

Procarbaxine (Matulane) info

A

Use: Hodgkin’s lymphoma
MOA: inhibit DNA,RNA & protein synthesis
Dose: 100mg/m2 QD X 14 days every 4 weeks
** Avoid Tyramine-containing foods**

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