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NAPLEX Review UWorld > Oncology > Flashcards

Oncology Flashcards

1
Q

Which of the following should be preparedin a non-PVC container and infused with non-PVC tubing? (SelectALLthat apply.)

A. Docetaxel

B. Doxorubicin

C. Vinblastine

D. Paclitaxel

E. Vincristine

A

Docetaxel

Paclitaxel

These can cause leaching of DEHP when placed in PVC containers.

Also use 0.22 micron filter

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2
Q

Taxanes

What phase of the cell cycle does Taxanes work in?

A

M phase

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3
Q

Taxanes

MOA

A

Inhibit depolymerization (which stabilizes microtubules)

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4
Q

Taxanes

Meds

A

Paclitaxel

Docetaxel

Cabazitaxel (Jevtana)

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5
Q

Taxanes

Safety Concern

A

Peripheral neuropathy

Hypersensitivity rxn

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6
Q

Taxanes: Safety Concern

Peripheral neuropathy

Monitoring & Management

A

Monitoring: Neuropathy S/S (eg, numbness, paresthesia)

Management: Symptomatic care (eg, neuropathic pain medications)

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7
Q

Taxanes: Safety Concern

Hypersensitivity rxn

Monitoring & Management

A

Monitoring:
* Anaphylaxis S/S
* Vital signs (eg, BP, HR)

Management:
* Premedications w/ a systemic steroid, diphenhydramine & an H2RA
* Stop therapy
* Symptomatic care (eg, O2, bronchodilators)

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8
Q

Taxanes: Safety Concern

Docetaxel

Monitoring & Management

A

Severe fluid retention

Monitoring: Fluid retention S/S (eg, edema)

Management:
* Premedication w/ a systemic steroid
* Symptomatic care (eg, diuretics)

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9
Q

A pharmacist has filled a prescription for exemestane (Aromasin). She should include the following points in her counseling to the patient: (Select ALL that apply.)

A. Ensure adequate calcium intake.

B. Ensure adequate vitamin D supplementation.

C. Ensure adequate iron intake.

D. Get immediate help if the patient notices any new or worsening chest pain or becomes short of breath.

E. The patient may experience weakness, extreme fatigue and a desire to eat non-food substances such as paper. If this happens, report these symptoms immediately to a physician.

A

Ensure adequate calcium intake.

Ensure adequate vitamin D supplementation.

Get immediate help if the patient notices any new or worsening chest pain or becomes short of breath.

Aromasin (exemestane) is an aromatase inhibitor that decreases bone mineral density and has an increased risk for cardiovascularevents.

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10
Q

Breast Cancer Risk

A

Female sex

Family History

Genetics
* BRCA1 & BRCA2 gene mutations
* Klinefelter syndrome

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11
Q

Breast Cancer Prevention

A

Surgery (eg, mastectomy)

Risk-reducing medications

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12
Q

Breast Cancer Prevention: Risk-reducing medications

Premenopausal

A

SERM: Tamoxifen (Soltamox)

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13
Q

Breast Cancer Prevention: Risk-reducing medications

Postmenopausal

A

SERM: Tamoxifen, Raloxifene

AI: Exemestane, Anastrozole

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14
Q

Breast Cancer Tx

A

Surgery

Radiation

Chemotherapy

Hormone Receptor-Positive Tx (Endocrine Therapy)

HER2-Positive Tx

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15
Q

Hormone Receptor-Positive Tx (Endocrine Therapy)

Premenopausal

A

SERM: tamoxifen

AI + ovarian ablation/suppression

Ovarian ablation/suppression: Surgery, radiation, or a gonadotropin-release hormone agonist (eg, goserelin, leuprolide)

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16
Q

Hormone Receptor-Positive Tx (Endocrine Therapy)

Postmenopausal

A

SERM: tamoxifen (Soltamax)

AI (eg, anastrozole [Arimidex])

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17
Q

Tamoxifen Safety Concerns

A

Vasomotor Symptoms (eg, hot flashes, night sweats)

↑ risk of thromboembolic events

↑ risk of uterine or endometrial cancer

Vaginal bleeding/discharge

↓ bone density

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18
Q

Tamoxifen

Box Warnings

A

↑ risk of thromboembolic events

↑ risk of uterine or endometrial cancer

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19
Q

Tamoxifen drug intxn

A

Is a prodrug converted via CYP2D6 to endoxifen

Don’t take w/ most antidepressants except venlafaxine

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20
Q

Tamoxifen

What is the preferred antidepressant for hot flashes?

A

Venlafaxine

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21
Q

What supplements should be taken w/ Tamoxifen?

A

Calcium & Vit D

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22
Q

Selective Estrogen Receptor Degrader

Fulvestrant (Faslodex)

A

↑ LFTs

Injection site pain (IM)

Hot flashes

For advance breast cancer

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23
Q

Aromatase inhibitors meds

A

Anastrozole

Letrozole

Exemestane

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24
Q

AI Safety Concerns

A

Osteoporosis
* Calcium & vitamin D supplementation
* Wt bearing exercise
* DEXA screening

↑ risk of cardiovascular disease

Hot flashes/night sweats

Arthralgia/myalgia

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25
Q

HER2-Positive Tx

A

trastuzumab (Herceptin)

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26
Q

A pharmacist receives a prescription for Aloxi. Which drug should be dispensed?

A. Ondansetron

B. Granisetron

C. Dolasetron

D. Palonosetron

E. Netupitant

A

Palonosetron

The generic name of Aloxi is palonosetron.

It is available only in an IV preparation, but is available as PO formulation when in combination with netupitant (Akynzeo).

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27
Q

Chemotherapy-Induced N/V (CINV)

Classfication

A

Anticipatory

Acute

Delayed

Breakthrough

Refractory

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28
Q

Chemotherapy-Induced N/V (CINV)

Anticipatory

A

Before chemo

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29
Q

Chemotherapy-Induced N/V (CINV)

Acute

A

W/in 24 hrs after chemo

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30
Q

Chemotherapy-Induced N/V (CINV)

Delayed

A

> 24 hrs after chemo

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31
Q

Chemotherapy-Induced N/V (CINV)

Breakthrough

A

Any time after chemo despite antiemetic PPx

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32
Q

Chemotherapy-Induced N/V (CINV)

Refractory

A

When antiemetic PPx and/or rescue Tx is ineffective

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33
Q

Chemotherapy-Induced N/V (CINV)

Types of Antiemetics

A

Neurokinin-1 receptor antagonists (NK1 RAs)

Serotonin receptor antagonists (5-HT3 RAS)

Dopamine receptor antagonists

Other

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34
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Neurokinin-1 receptor antagonists (NK1 RAS)

Common Drugs

A

Aprepitant (Emend, Cinvanti)

Fosaprepitant (Emend)

Rolapitant (Varubi

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35
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Neurokinin-1 receptor antagonists (NK1 RAS)

Safety concerns

A

Generally well tolerated

Can cause abdominal pain or dizziness

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36
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Dopamine receptor antagonists

Common Drugs

A

Olanzapine (Zyprexa)

Prochlorperazine (Compro)

Promethazine

Metoclopramide (Reglan)

Haloperidol

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37
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Dopamine receptor antagonists

Safety Concerns

A

Acute extrapyramidal Symptoms

QT prolongation

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38
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Serotonin receptor antagonists (5-HT3 RAS)

Common Drugs

A

Ondansetron (Zofran)

Granisetron (Sancuso, Sustol)

Palonosetron (Aloxi)

Dolasetron (Anzemet)

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39
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Serotonin receptor antagonists (5-HT3 RAS)

Safety Concerns

A

QT prolongation (limit IV ondasetron to 16 mg)

Serotonin syndrome

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40
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Other

A

Dexamethasone

Dronabinol (Marinol)

Lorazepam (Ativan)

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41
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Dexamethasone

Safety Concerns

A

↑ appetite

Insomnia

42
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Dronabinol (Marinol)

Safety Concerns

A

Somnolence

Euphoria

↑ appetite

43
Q

Chemotherapy-Induced N/V (CINV): Types of Antiemetics

Lorazepam (Ativan)

Safety Concerns

A

Anterograde amnesia

44
Q

Chemotherapy-Induced N/V (CINV): Antiemetic Regimens

Goals: Prevent N/V

How?

A

Give at least 30 minutes before chemotherapy

Continue for the full period of emetic risk

Add lorazepam for anticipatory nausea and vomiting

Have breakthrough agents available

45
Q

Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk

High emetic risk:

A

3 or 4 drugs

NK1 RA + 5-HT3 RA + olanzapine + dexamethasone
NK1 RA + 5-HT3 RA + dexamethasone
Palonsetron + olanzapine + dexamethasone

90% frequency of acute emesis

eg, cisplatin, regimen w/ anthracycline + cyclophosphamide

46
Q

Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk

Moderate emetic risk:

A

2 or 3 drugs

NK1 RA + 5-HT3 RA + dexamethasone
5-HT3 RA + dexamethasone
Palonsetron + olanzapine + dexamethasone

30-90% frequency of acute emesis

47
Q

Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk

Low emetic risk:

A

1 drug
5-HT3 RA
Dexamethasone
Metoclopramide
Prochlorperazine

10-30% frequency of acute emesis

48
Q

Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk

Minimal emetic risk:

A

No routine PPX

< 10% frequency of acute emesis

49
Q

Generic

Akynzeo

A

Palonosetron + netupitant

50
Q

During treatment, ST develops an ANC of 326 cells/mm3 and a temperature of 39 degrees Celsius. Which of the following is an appropriate treatment based on these findings?

A. Start a 5HT-3 receptor antagonist until the temperature returns to normal

B. Start an erythropoiesis-stimulating agent

C. Monitor for symptoms of an infection; start antibiotics if symptoms develop

D. Start a colony stimulating factor daily until the ANC recovers

E. Start broad-spectrum antibiotics

A

Monitor for symptoms of an infection; start antibiotics if symptoms develop

Patients with neutropenia are at risk of death due to sepsis.

For febrile neutropenia, broad-spectrum antibiotics should be started immediately and should include activity against Gram-negatives, including Pseudomonas.

A colony stimulating factor would be considered for the next cycle of chemotherapy to prevent neutropenia recurrence.

51
Q

Absolute Neutrophil Count

A

WBC x (%segs + %bands)/100

Segs can also be neutrophils, polys, or polymorphonuclear leukocytes.

52
Q

Neutropenia Category

Neutropenia

A

< 1,000

53
Q

Neutropenia Category

Sever Neutropenia

A

< 500

54
Q

Neutropenia Category

Profound Neutropenia

A

< 100

55
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Effects

A

Stimulate production of white blood cells

Shorten duration of neutropenia and reduce mortality from infections

Given prophylactically after chemotherapy in high-risk patients

56
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Drugs

A

Filgrastim (Neupogen)

Pegilgrastim (Neulast, Neulast OnPro)

57
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Pegilgrastim

Dose

A

Pegylated form of filgrastim → extended half-life

6 mg SC once per chemo cycle

58
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Filgrastim

Dose

A

5 mcg/kg IV/SC QD

Treat through post-nadir recovery

59
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

When to administor?

A

No sooner than 24 hrs after chemo

60
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Side effects

A

Bone pain

Splenic rupture

Rash

Hypersensitivity/Allergic reaction

61
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Monitoring

A

CBC w/ differential

Vital Signs

Upper abdominal pain

62
Q

Granulocyte Colony-Stimulating Factors (G-CSFs)

Storage

A

Refrigerate

Protect vials & syringes from light

63
Q

Febrile Neutropenia Diagnosis

Fever

A

Single oral temp ≥ 101 F (38.3 C)
OR
≥ 100.4 F (38 C) for > 1 hr

iFever and Neutropenia meet creteria

64
Q

Febrile Neutropenia Diagnosis

Neutropenia

A

ANC < 500
OR
ANC < 1000 & likely to decline to < 500 over the next 48 hrs

Fever and Neutropenia meet criteria

65
Q

What to do if Febrile Neutropenia occurs?

A

Start empiric antibiotics immediately w/ antipseudomonal coverage

66
Q

Febrile Neutropenia

High risk

Criteria

A

ANC ≤ 100 for ≥ 7 days, comorbidities

67
Q

Febrile Neutropenia Tx

High risk

A

IV anti-pseudomonal beta-lactams

Cefepime or ceftazidime

Imipenem/cilastatin or meropenem

Piperacillin/tazobactam

68
Q

Febrile Neutropenia

Low risk

Criteria

A

ANC ≤ 100 for < 7 days, no comorbidities

69
Q

Febrile Neutropenia Tx

Low risk

A

Oral anti-pseudomonal antibiotics

Ciprofloxacin or levofloxacin + amoxicillin/clavulanate or clindamycin (if penicillin allergy)

70
Q

Thrombocytopenia

A

↓ in platelets result in uncontrollable bleeding

Platelets < 10,000

Platelet transfusion

71
Q

Anemia Management

A

Observation

RBC transfusion

Erythropoiesis-stimulating agent (ESA)

72
Q

Anemia

Erythropoiesis-stimulating agent (ESA)

A

Epoetin alfa (Epogen, Procrit)

Darbepoetin alfa (Aranesp)

73
Q

Anemia

Which ESA is short acting?

A

Epoetin alfa (Epogen, Procrit)

74
Q

Anemia

Which ESA is long acting?

A

Darbepoetin alfa (Aranesp)

75
Q

Anemia

ESA Benefits

A

Improved quality of life

↓ Blood transfusions

76
Q

Anemia

ESA Risks

A

Shortened survival

Tumor progression

Thrombotic events

↑ All-cause mortality

Do not use w/ chemo for curative intent

77
Q

ESA Admin

A

Initiate only when hemoglobin < 10 g/dL

Use lowest dose needed to avoid RBC transfusions

Assess serum ferritin, transferrin saturation, and total iron binding capacity

ESAs work optimally in patients with adequate iron stores

78
Q

Anthracyclines MOA

A

inhibits DNA & RNA synthesis:
* Intercalation into DNA
* Inhibition of Topoisomerase II

Creation of oxygen-free radicals

79
Q

What part of the cell cycle does anthracyclines work on?

A

The entire cycle

80
Q

Anthracyclines

Side Effect

A

Cardiotoxicity

Main Side Effect

81
Q

Anthracyclines

Doxorubicin (Adriamycin) Dosing

A

Max lifetime cumulative dose: 450-500 mg/m2

To prevent Cardiotoxicity

82
Q

Next step if doxorubicin therapy is reached?

A

Doxorubicin ≥ 300 mg/m2 →
Consider dexrazoxane (if continuing Tx)

dexrazoxane (Totect, Zinecard)

83
Q

Anthracyclines

Doxorubicin (Adriamycin) Monitoring

A

LVEF before & after Tx (w/ an ECG or MUGA scan)
HF S/Sx (eg, edema, SOB) during Tx

84
Q

What medications related to anthracyclines turns the pt blue?

A

Mitoxantrone

85
Q

What SPF spectrum should be use to prevention skin cancer?

A

SPF 30

Reapply ever 2 hrs

86
Q

Warnings Signs of Melanoma

Mnemonic

A

ABCDE
Asymmetry
Border
Color
Diameter > 6 mm
Evolving

87
Q

Breast Cancer Screening

Age & Freq

A

Start ≥ 45 y/o
Annually
≥ 55 y/o can switch to q 2 yrs

88
Q

Cervical Cancer

Age & Freq

A

Age 25-65

Pap smear q 3 yrs
HPV DNA test q 5 yrs
Combo q 3 yrs

89
Q

Colorectal Cancer

Age & Freq

A

≥ 45 y/o

Stool-based tests q 3 yrs

Visual exams
* Colonoscopy q 10 yrs
* CT colonography or flexible sigmoidoscopy q 5 yrs

90
Q

Lung Cancer

Age & Freq

A

≥ 50 y/o

Annual CT if:
* ≥ 20 pack-year smoking history
* Still smoking or quit smoking w/in the past 15 yrs

91
Q

Prostate Cancer

A

Prostat-specific antigen blood test
± digital rectal exam

92
Q

Monoclonal Antibodies are use for:

A

Targeted Therapy

For specific biomarkers & proteins

93
Q

Targeted Therapy Actions

A

Enhances immune system’s ability to destroy cancer cells (eg, immunotherapy)

Interrupts signals that cause cancer growth

Inhibits angiogenesis

Induces apoptosis

Starves cancer cells of hormones needed to grow (eg, hormone or endocrine therapy

94
Q

Monoclonal Antibodies Infusion-related Reactions

Monitoring

A

Signs & symptoms (eg, fever, flushing, dyspnea, rash, anaphylaxis)

Vital signs (eg, BP, HR)

95
Q

Monoclonal Antibodies Infusion-related Reactions

Prevention

A

Premedication with acetaminophen & an antihistamine (eg, diphenhydramine)

96
Q

Monoclonal Antibodies Infusion-related Reactions

Treatment

A

Symptomatic care (eg, oxygen, bronchodilators)

97
Q

Rituximab (Rituxan)

Mechanism

A

Binds to CD20 antigen

98
Q

Rituximab (Rituxan)

Key Safety Concerns

A

Hepatitis B reactivation

Check hepatitis B panel before starting

99
Q

Cetuximab (Erbitux)

Mechanism

A

Binds to epidermal growth factor receptor (EGFR)

100
Q

Cetuximab (Erbitux)

Key Safety Concerns

A

Dermatologic toxicity (eg, acneiform rash)

Use general skin care (eg, sunscreen) & prophylactic measures (eg, antibiotics)

NAPLEX Review UWorld (15 decks)

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