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Counseling Points > Naplex Oncology Notes > Flashcards

Naplex Oncology Notes Flashcards

1
Q

Positive Reed-Sternberg cells in the lymph node biopsy indicates what kind of diagnosis?

A

Hodgkin’s Lymphoma

Epstein Barr virus acquired thru HIV also increases risk of HD

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2
Q

Good recommendations to prevent colorectal cancer

A

Increase calcium intake, as well as fiber and antioxidants, and decrease fats

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3
Q

What are indications for a poor prognosis of breast cancer

A

Young (<35 yo); premenopausal, African American, and

HER2/neu overexpression

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4
Q

Primary side effects of Cyclophosphamide?

A

Hemorrhagic cystitis (inflammation of bladder - may see blood in urine); high N/V; mucositis

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5
Q

What can be used to help minimize the side effects of Cyclophosphamide?

A

Maintain adequate hydration to avoid inflammation of bladder, and Mensa

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6
Q

What is the side effect profile of Chlorambucil (Leukeran)?

A

Bone marrow suppression, infertility, secondary leukemias, SJS, hepatotoxicity

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7
Q

Should Leukeran be taken with food or on an empty stomach?

A

Empty stomach

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8
Q

Side effect profile of Carmustine?

A

Severe N/V profile, pulmonary fibrosis, HoTN, secondary leukemias (w/ long term use), reversible increase in LFTs

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9
Q

What is the side effect profile for the -Platin’s: cisplatin, carboplatin, oxaliplatin (Eloxin)

A

Dose-related myelosuppression, Nephrotoxicity!, peripheral neuropathy, rhabdomyolysis (oxaliplatin)

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10
Q

What a side effect special for cisplatin? And Level of emetogenic potential

A

Ototoxicity, high emetogenic potential

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11
Q

What is the max dose for cisplatin?

A

Do not administer doses exceeding 100mg/m^2 every 3 weeks

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12
Q

Of the 3 platin chemotherapies (cisplatin, carboplatin, and oxaliplatin) which 2 are renally dose adjusted?

A

Carboplatin and oxaliplatin

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13
Q

What is the MOA of Cyclophosphamide, Chlorambucil, and Carmustine? Hint all are in the same class.

A

Alkylate DNA, make it more prone to breakage, most effective against rapidly dividing cells

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14
Q

What is the MOA of the platin drugs? (Cisplatin, carboplatin, oxaliplatin)

A

Crosslink DNA, causing it to break

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15
Q

What is the MOA of Irinotecan and Etoposide? (Same drug class)

A

Target enzymes responsible for DNA replication and repair

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16
Q

What is the brand name for Irinotecan and Irinotecan liposomal?

A

Irinotecan = Camptosar

Irinotecan liposomal = Onivyde

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17
Q

What is the major side effect of Irinotecan?

A

Diarrhea, severe and life-threatening

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18
Q

How would you treat the major side effect of Irinotecan?

A

Atropine in early-onset OR loperamide for late-onset diarrhea

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19
Q

How should you administer Etoposide?

A

IV, NOT IV push!

and NOT IM - cases NECROSIS!

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20
Q

What is the MOA of Vincristine, Vinblastine, Paclitaxel, Paclitaxel, and Docetaxel? (Same drug class)

A

Spindle poisons; interfere with mitotic spindle; prevent chromosome segregation and lead to cell death

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21
Q

What are major side effects of Vincristine?

A

Constipation!, Peripheral neuropathy

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22
Q

How do you administer Vincristine?

A

IV, do NOT give intrathecally, AVOID extravasation (vesicant)
Pt should be on a prophylactic bowel management regimen (SE: constipation)

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23
Q

What are major side effects of Paclitaxel (protein bound particles) [Abraxane]?

A

Bone marrow suppression (dose-limiting), peripheral neuropathy, cardiac rhythm abnormalities, MUCOSITIS, STOMATITIS (SEVERE!!)

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24
Q

Max dose for Vincristine?

A

do NOT exceed 2mg/dose

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25
Q

Max dose for Docetaxel?

A

AVOID doses > 100 mg/m^2

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26
Q

Taxotere and Docefrez are the brand names for what chemo-drug?

A

Docetaxel

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27
Q

What is the MOA of antimetabolites (Cytarabine and 5FU)

A

Nucleoside analogs

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28
Q

MOA of Trexall (MTX)?

A

Folic acid antagonist

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29
Q

What can be used as a rescue for patients treated with MTX?

A

Leucovorin - can be highly toxic
Give 24hrs after MTX to limit toxicities;
Can enhance 5FU effects

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30
Q

What is the side effect profile of Methotrexate (MTX)

A

Nephrotoxicity, BMS, SJS, severe diarrhea and ulcerative stomatitis, neurotoxicity, hepatotoxicity, pneumonitis, TLS

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31
Q

Side effects of Daunorubicin (Cerubidine) and Doxorubicin (liposomal - Doxil)

A

Cardiotoxicity!! (Dose-related), severe bone marrow suppression, secondary leukemias, red colorations of body fluids!!! Vesicant

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32
Q

What is the MOA of anthracyclines? (Daunorubicin and Doxorubicin)

A

Intercalated DNA and desecrate reactive oxygen species

33
Q

What is the life-time cumulative dose of anthracyclines? And why is there a life-time max?

A

Greatest risk of irreversible myocardial damage at cumulative dose > 550 mg/m^2

34
Q

What can be used to prevent doxorubicin induced cardiotoxicity or to treat anthracycline-induced extravasation?

A

Dexrazoxane

35
Q

What 3 types of cancers can Liposomal doxorubicin be used for?

A
  1. Kaposi’s sarcoma, 2. multiple myeloma, and 3. ovarian cancer
36
Q

Which 3 anti-hormonal drugs can be used for postmenopausal women?

A

Anastrozole (Arimidex), Exmestane (Aromasin), Letrozole (Femara)

37
Q

What are the major contraindications for Tamoxifen anti-cancer therapy?

A

Concurrent warfarin therapy, Hx of DVT or PE

38
Q

What are the major side effects of Leuprolide (Eligard, Lupron Depot)?

A

Abnormal menses, exacerbation of endometriosis, hot flashes/sweats, decreased BMD (if used > 6 mon), tumor flare, depression, mood disturbances!!

39
Q

How do you administer Lupron aka Eligard?

A

SQ inj daily or IM injection Q 1-6 mon depending on dosage

Rotate inj sites!!

40
Q

What may seem like a side effect, but may be an indication of a good therapeutic response of Tamoxifen?
And how can it be managed?

A

Bone pain,

Can be managed with mild analgesic

41
Q

What is the side effect profile of tamoxifen?

A

Thromboembolic events, increased risk of endometrial cancer (duration dep on menopausal status), hot flashes, altered menses, mood disturbances/depression, decreased BMD

42
Q

Which chemotherapy drugs have the common side effect of Cardiotoxicity? (7)

A

Doxorubicin, Daunorubicin, Idarubicin, Lapatinib, Mitoxantrone, Pertuzumab, Trastuzumab

43
Q

Which chemotherapy drugs have the common side effect of N/V? (5)

A

Cisplatin, Carboplatin, Cytarabine, Doxorubicin, Cyclophosphamide

44
Q

Which chemotherapy drugs have the common side effect of Mucositis? (4)

A

Cytarabine, Cyclophosphamide, 5FU, MTX

45
Q

Which chemotherapy drugs have the common side effect of Neuropathy? (4)

A

Vincristine, Vinblastine, Oxaliplatin, Paclitaxel

46
Q

Which chemotherapy drugs have the common side effect of renal impairment? (3)

A

Cisplatin, Cyclophosphamide, Ifosfamide

47
Q

Which chemotherapy drugs have the common side effect of pulmonary fibrosis? (2)

A

Cleomycin, Busulfan

48
Q

Which chemotherapy drugs have the common side effect of Infusion reactions? (2)

A

Monoclonal antibodies and Paclitaxel

49
Q

Which 4 chemo drugs have a MOA/Target of the CD20 antigen?

A

Ibritumomab tiuxetan (Zevalin), Obinutuzumab (Gazyva), Ofatumumab (Arzerra), and Rituximab (Rituxan)

Do NOT administer live vaccines in these patients!!

50
Q

Which monoclonal antibody chemo drugs would you want to pre-treat with antihyperuricemics and hydration in patients at high risk of TLS?
As well as screen for HBV prior to treatment?
*Same drugs

A

Gazyva, Arzerra, and Rituxan

51
Q

What are the major EGFR inhibitors used for chemotherapy? (11)

A

Afatinib (Gilotrif), Cetuximab (Erbitux), Erlotinib (Tarceva), Gefitinib (Iressa), Lapatinib (Tykerb), Necitumumab (Portrazza), Osimertinib (Tagrisso), Panitumumab (Vectibix), Pertuzumab (Perjeta), Trastuzumab (Herceptin), and Ado-Trastuzumab emtansine (Kadcyla)

52
Q

Of the 11 EGFR inhibitors, which ones are PO? (5)

A

Gilotrif, Tarceva, Iressa, Tykerb, and Tagrisso

53
Q

Which EGFR inhibitors are used for HER2 positive metastatic breast cancer? (4)

A

Lapatinib (Tykerb), Pertuzumab (Perjeta), Trastuzumab (Herceptin - also used for gastric cancer), and Ado-Trastuzumab emtansine (Kadcyla)

54
Q

What are major side effects specific for Cetuximab (Erbitux)?

A

Sudden cardiac death, electrolyte abnormalities

55
Q

Major side effects specific for Erlotinib (Tarceva)?

A

Renal failure, GI perforation, MI, Rash

56
Q

Which chemo drugs are VEGF inhibitors? (6)

A

Axitinib (Inlyta), Bevacizumab (Avastin), Cabozantinib (Cabometyx), Ramucirumab (Cyramza), Sorafenib (Nexavar), Sunitinib (Sutent)

57
Q

Which of the VEGF inhibitors are Oral?

A

Inlyta, Nexavar, and Sutent

58
Q

What are common side effects of EGFRs?

A

Diarrhea, Rash, Interstitial Lung Disease (ILD), Hepatotoxicity

59
Q

What are common side effects for VEGF inhibitors?

A

Thromboembolic events (except Sorafenib and Sunitinib), Hemorrhage, Diarrhea, increased LFTs, Rash, impaired healing, HTN

60
Q

Which VEGF inhibitor can affect thyroid function?

A

Axitinib (Inlyta)

61
Q

Which VEGF inhibitor can be used for metastatic colorectal cancer?

A

Bevacizumab (Avastin) - infusion related rxns

62
Q

Which chemo drugs are Tyrosine Kinase Inhibitors? (5)

MOA: halt proliferation of tumor cells by inhibiting TK

A

Bosutinib (Bosulif), Dasatinib (Sprycel), Imatinib (Gleevec), Lenvatinib (Lenvima), Nilotinib (Tasigna)

63
Q

Of all the Oral Tyrosine Kinase Inhibitors, which ones are used for Philadelphia-positive CML and ALL? (4)

A

Bosulif, Sprycel, Gleevec, and Tasigna

All TKI’s are oral

64
Q

What are common side effects of Tyrosine Kinase Inhibitors?

A

Myelosuppression, rash, TLS, HTN,hemorrhage

65
Q

Which TKI’s can cause Hypothyroidism? (2)

A

Gleevec and Lenvima

66
Q 
Which TKI's are 3A4 substrates? (4)
3A4 Inhibitors (3)?
A

Bosutinib, Sprycel (inhibitor), Gleevec (inhibitor), Tasigna (inhibitor)

67
Q

Which TKI increases risk of TdP with other drugs that prolong QT interval?

A

Lenvatinib (Lenvima)

68
Q

Which chemo drugs are Anaplastic Lymphoma Kinase inhibitors? (3)
ALK inhibitors - and which are PO?

A

Alectinib (Alecensa), Ceritinib (Zykadia, Crizotinib (Xalkori)
ALL are PO!

69
Q

What are ALK inhibitors used in cancer therapy?

A

Mainly for ALK-positive metastatic NSCLC

70
Q

Which chemo drug contains radioactive isotopes which require handling?

A

Zevalin

71
Q

Which anti-nausea drugs would you use for anticipatory nausea?

A

Benzodiazepines

72
Q

Which anti-emetic would you use for delayed (N/V)? - such seen with cisplatin, Cyclophosphamide, and doxorubicin

A

Aprepitant

73
Q

Which anti-emetics would you use for less severe cases of N/V with chemotherapy?

A

Prochlorperazine or metoclopramide

74
Q

Which CYP enzyme is use by Aprepitant?

A

3A4, substrate and inhibitor

75
Q

Which anti-emetic class should be avoided with serotonergic agents due to increased risk of serotonin syndrome?

A

5HT3 antagonists such as ondansetron (Zofran), other brand names of 5HT3 antags are Sancuso, Anzemet, Suplenz, Aloxi

76
Q

Which 5HT3 antagonist can be effective in preventing acute and delayed N/V?

A

Palonosetron (Aloxi)

77
Q

What is a major contraindication of Metoclopramide?

A

Seizure disorders

78
Q

What is a major side effect specific for Reglan?

A

Extrapyramidal Symptoms (EPS)

79
Q

What are the 3 CSFs?

A

Filgrastim (Grantix, Neupogen, Zarxio), PEG-Filgrastim (longer t1/2) (Neulasta), and Sargramostim (Leukine)

Counseling Points (2 decks)

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