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TOP 300 drugs - NAPLEX > Oncology > Flashcards

Oncology Flashcards

1
Q

External factors causing cancer

A

Chemical
Radiation
Bacteria
Viruses

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2
Q

Internal factors causing cancers

A

Genetic mutations
Hormones
Sunlight exposure
Tobacco use
Excessive EtOH intake
Obesity
Older age
Poor diet
Low physical activity

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3
Q

Warning signs of cancer

A

CAUTION
Change in bowel or bladder habits
A sore throat that does not heal
Unusual bleeding/discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

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4
Q

Breast cancer screening

A

Begin yearly mammograms at age 45–54
Mammograms every 2 years or annually at ages ≥ 54 yrs

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5
Q

Cervical cancer screening

A

Pap smear every 3 years
HPV DNA test every 5 years
PAP smear + HPV DNA test every 5 years
For years 25-65 years

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6
Q

Colorectal cancer screening

A

Stool-based tests (if +, f/u with colonoscopy): FIT yearly, gFOBT yearly, or MT-sDNA every 3 years

Visual exams: colonoscopy every 10 years, CT colonography every 5 years, FSIG every 5 years

For M/F ≥ 45 yrs old

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7
Q

Lung cancer screening

A

Annual CT scan if all of the following:
1. 20 pack-year+ smoking history
2. Still smoking or quit smoking in the past 15 years
For F/M ≥ 50 years

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8
Q

Prostate cancer screening

A

If a patient chooses to be tested:
- PSA blood test with/without DRE

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9
Q

Bleomycin: dosing considerations

A

Lifetime cumulative dose: 400 units
Pulmonary toxicity

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10
Q

Doxorubicin: dosing considerations

A

Lifetime cumulative dose: 450-550 mg/m2
Cardiotoxicity

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11
Q

Cisplatin: dosing considerations

A

Dose per cycle not to exceed 100 mg/m2
Nephrotoxicity

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12
Q

Vincristine: dosing considerations

A

Single dose “capped” at 2 mg
Neuropathy

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13
Q

Medication given to prevent cardiotoxicity from doxorubicin

A

Dexrazoxane

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14
Q

Chemotherapy agents that don’t cause myelosuppression

A

Bleomycin
Vincristine
Asparaginase

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14
Q

Chemotherapies MOST known to cause N/V

A

Cisplatin
Ifosfamide
Cyclophosphamide

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14
Q

Chemotherapies MOST known to cause Mucositis

A

Fluorouracil
Methotrexate

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14
Q

Chemotherapies MOST known to cause Cardiotoxicity

A

Anthracyclines
HER2 inhibitors
Arsenic Trioxide
Many TKIs

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14
Q

Chemotherapies MOST known to cause pulmonary toxicity

A

Bleomycin
Busulfan
Carmustine/Lomustine
Methotrexate & MAbs (pneumonitis)

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14
Q

Chemotherapies MOST known to cause Nephrotoxicity

A

Cisplatin
Methotrexate (high doses)

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15
Q

Chemotherapies MOST known to cause constipation

A

Vincristine

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15
Q

Chemotherapies MOST known to cause diarrhea

A

Irinotecan
Capecitabine/5-FU
Methotrexate

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15
Q

Chemotherapies MOST known to cause neuropathy

A

Vinca alkaloids
Platinums
Taxanes

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15
Q

Chemotherapies MOST known to cause clotting

A

SERMs
Aromatase inhibitors
Immunomodulators

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15
Q

Chemotherapies MOST known to cause Hepatotoxicity

A

Anti-androgens (bicalutamide, flutamide, nilutamide)
Methotrexate

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15
Q

Drug to give prophylactically with cisplatin to prevent nephrotoxicity

A

Amifostine (Ethyol)
Also, maintain adequate hydration and do not exceed max dose of 100 mg/m2/cycle

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15
Q

Nadir: defination

A

Lowest point that WBCs & RBCs reach

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15
Q

WBC/platelet nadir

How many days after chemotherapy?

A

7-14 days after chemotherapy

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16
Q

RBC nadir

A

Much later, usually months d/t long lifespan of RBCs (~120 days)

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16
Q

How long does it generally take for WBCs & platelets to recover?

A

3-4 weeks post-treatment

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17
Q

Neutropenia & severe neutropenia definitions

A

Neutropenia: < 1,000 cells/mm3
Severe neutropenia: < 500 cells/mm3

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18
Q

Filgrastim (Neupogen) side effects

A

Bone pain, fever

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19
Q

Febrile neutropenia diagnosis requirements

A

Fever of > 38.3 degrees Celsius and ANC < 500 cells/mm3

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20
Q

Issues with ESAs and cancer

A

Can shorten survival and inc tumor progression. For this reason, they are NOT recommended in a patient pursuing curative intent

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21
Q

When to initiate ESAs

A

Hgb < 10 mg/dL
Use the lowest dose needed to avoid RBC transfusions

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22
Q

When to initiate platelet transfusions for thrombocytopenia

A

PLT count < 10,000 or
< 30,000 and active bleeding is present

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23
Q

Droperidol: issue

A

QTc prolongation

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24
Q

Cannabinoids (e.g. dronabinol, nabilone) side effects

A

Inc. appetite
Sedation
Dysphoria
Euphoria

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25
Q

Aprepitant & dexamethasone DI

A

Aprepitant is an CYP3A4 inhibitor
**decrease dexamethasone dose

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26
Q

Max dose of Loperamide under medical supervision

A

16mg/day

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27
Q

Hand-foot syndrome management

A

Limit daily activities to reduce friction and heat exposure to hands/feet
Avoid prolonged exposure to hot water
Avoid use of dishwashing gloves
Avoid inc. pressure on the soles of feet & palm of hands

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28
Q

TLS complications

A

Hyperkalemia (arrhythmias)
Hypercalcemia (anorexia, nausea, seizures)
Hyperuricemia (Uric acid crystallizes, causing acute renal failure)

29
Q

TLS treatment

A

Hyperuricemia: allopurinol, rasburicase for high-risk patients, and NS for all
Hypercalcemia: mild (hydration), moderate-severe (IV hydration with NS, IV bisphosphonates (Zometa), and calcitonin (up to 2 days) for severe cases. Xgeva for hypercalcemia refractory to bisphosphonates

30
Q

Major vesicants

A

anthracyclines & vinca alkaloids

31
Q

Anthracyclines extravasation management

A

Dexrazoxane or dimethyl suloxide plus cold compresses

32
Q

Vinca alkaloids: Extravasation treatment

A

Hyaluronidase plus warm compresses

33
Q

Warning signs of melanoma skin cancer

A

ABCDE
Asymmetry
Border
Color
Diameter
Evolving

34
Q

Klinefelter syndrome

A

When males have 1 Y chromosome and 2+ X chromosomes
Males with this genetic condition have a higher risk of breast cancer

35
Q

Adjuvant treatment for breast cancer in a premenopausal women

A

Tamoxifen, SERM, antagonist in the breast cells
GnRH agonist (gosereline or leuprolide) to induce menopause IF this then AI is a reasonable option

36
Q

Adjuvant treatment for breast cancer in a postmenopausal women

A

Aromatase inhibitors (anastrozole)
Raloxifene for breast cancer prevention in post-menopausal females

37
Q

Raloxifene: issues

A

Blood clots & hot flashes

38
Q

Oncogene

A

Protein that turns a normal cell into a cancer cell (e.g. HER2)

39
Q

What supplements to take with tamoxifen (soltamax)

A

Ca/Vit D

40
Q

Tamoxifen metabolism

A

Prodrug, metabolized by CYP2D6
why venlafaxine is preferred for hot flashes instead of fluoxetine & paroxetine

40
Q

Prostate cancer treatments

A
41
Q

GnRH antagonists: examples

A

Degarelix (Firmagon)
Relugolix (Orgovyx)

42
Q

GnRH agonists: examples

A

Leuprolide (Lupon, Depot)
Gosereline (Zoladex)

43
Q

Anti-androgens (first-generation): examples

A

Bicalutamide (Casodex)
Flutamide
Nilutamide (Nilandron)

44
Q

Antiandrogen (2nd generation) examples

A

Apalutamide (Erleada)
Darolutamide (Nabeqa)
Enzalutamide (Xtandi)

45
Q

Which prostate chemo drugs can cause an initial surge in testosterone (Tumor flare), and thus must be given with an anti-androgen for several weeks?

A

GnRH agonists

45
Q

Androgen deprivation therapy (ADT) side effects

A

Impotence
Weakness
Hot flashes
Loss of bone density

46
Q

Mesna (Mesnex) use

A

Given prophylactically with ifosfamide and high doses of cyclophosphamide to prevent hemorrhagic cystitis

46
Q

Platinums: issues

A

Peripheral sensory neuropathy
Ototoxicity
Nephrotoxicity

47
Q

Carboplatin dosing

A

Use the Calvert formula
(Target AUC) * (GFR + 25)

48
Q

Oxaliplatin: unique issues

A

Cold sensitivity
QT prolongation

49
Q

Topoisomase I example

A

Irinotecan
Topotecan

49
Q

Mtoxantrone: discoloration

A

Blue

50
Q

Topoisomase II examples

A

Etoposide
Bleomycin

50
Q

Etoposide IV concerns

A

Infusion-related hypotension (infuse over atleast 30-60 minutes)
Prepare concentration to ≤ 0.4mg/mL to avoid precipitation

51
Q

Vinca alkaloids concerns (all)

A

peripheral sensory and autonomic neuropathies (constipation)

52
Q

Vinca alkaloid most associated with CNS toxicity

A

Vincristine

53
Q

Vincaalkaloids most associated with BMS

A

Vinblastine
Vinorelbine

53
Q

Vincristine: DI

A

Major substrate of CYP3A4
Caution with Azole antifungals

54
Q

Taxanes: DI

A

Elimination reduced when given after cisplatin/carboplatin. Give taxanes BEFORE platinum-based compounds

54
Q

Taxanes: common side effects

A

Peripheral sensory neuropathies
HSR and fatal anaphylaxis
Require adjustment for hepatic impairment

55
Q

Paclitaxel: premedication

A

Benadryl, steroid, H2RA

56
Q

Docetaxel: premedication

A

Premedicate with steorids for 3 days, starting 1 day prior to docetaxel

57
Q

Docetaxel: unique concern

A

severe fluid retention

57
Q

Abraxane: characteristics

A

Paclitaxel bound to albumin
No need to premedicate

58
Q

Pyrimidine Analog Antimetabolites: MOA

A

active metabolite (F-UMP) is incorporated into RNA to replace uracil & inhibit cell growth while another active metabolite (5-dUMP) inhibits thymidylate synthetase

59
Q

Capecitabine Boxed Warning/Contraindication

A

BW: Significant increase in INR during and up to 1 month after treatment
C/I: CrCl < 30 mL/min

60
Q

What is given with fluorouracil to increase efficacy?

A

Leucovorin

61
Q

Dihydropyrimidine dehydrogenase (DPD) deficiency increases toxicity from which drugs?

A

Capecitabine
Fluorouracil

62
Q

What drug is the active form of folic acid?

A

Leucovorin

63
Q

What is given to rapidly lower MTX levels in patients with MTX-induced AKI & delayed clearance?

A

Glucarpidase (Voraxane)

64
Q

If given intrathecally, what formulation of MTX must be used?

A

Preservative-free

65
Q

Lenalidomide: Boxed warning

A

Severe birth defects
Thrombosis

66
Q

Common characteristics of MAbs

A

All given as IV infusions
Most associated with infusion related reactions
Agents conjugated to cytotoxic drugs are associated with additional side effects d/t the conjugate
Agents that activate the immune system can be associated with life-threatening autoimmune-mediated side effects

67
Q

Bevacizumab/Ramucirumab: MoA + common toxicities

A

MoA: inhibits blood vessel growth
HTN, leading to proteinuria, hemorrhage, thrombosis, impaired wound healing

68
Q

Cetuximab/Panitumumab: MoA + common toxicities

A

EGFR antagonist, inhibits growth factor binding to the surface of tumor cells.
EGFR > Epidermis > Skin toxicity (acneform rash)
Rash = working!

69
Q

Trastuzumab/Pertuzumab: MoA + common toxicity

A

HER2 receptor antagonist.
Cardiotoxicity

70
Q

Rituximab/Brentuximab: MoA + common toxicities

A

Bind to antigens (CD20, CD30, etc) expressed in specific hematopoietic cells & cause cell death.
BMS, inc. risk of viral infection reactivation

71
Q

Ipilimumab/Pembrolizumab: MoA + common toxicities

A

Increases immune recognition of tumor antigens.
Over-active immune system = colitis, hepatotoxicity, thyroid dysfunction, myocarditis

72
Q

Bevacizumab (Avastin): unique concerns

A

Impairs wound healing: do not administer 28 days before or after surgery

73
Q

Trastuzumab (Herceptin): monitoring

A

LVEF (using ECHO or MUGA) at baseline and during treatment
Pharmacogenomics: test for HER2 gene expression

74
Q

Cetuximab: genomics

A

Test for EGFR gene expression and KRAS mutation. Must be KRAS wild-type to use in colorectal cancer.

75
Q

Rituximab: unique concerns

A

MUST premedicate with Benadryl, Tylenol & steroid.
Must be CD20 positive to use
Hep B reactivation and PML are boxed warnings
Check Hep B panel prior to administration

76
Q

TKI examples

A

Imatinib (Gleevic)
All end in “nib”

77
Q

TKI common characteristics

A

Require pharmaogenomic testing
Oral bioavailability may be altered with food

78
Q

TKI: common toxicities

A

Hypothyroidism
QT prolongation
Rash Correlated with efficacy
Hepatic toxicity
Diarrhea
Those that are multi-targeted may cause HTN, hand-foot syndrome d/t interference with growth of blood vessels (VEGF)

79
Q

Which oral chemo drugs should be taken with meals or within 1 hour after food?

A

Imatinib
Capecitabine

TOP 300 drugs - NAPLEX (12 decks)

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