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NAPLEX: Evan > Oncology 2: Evan > Flashcards

Oncology 2: Evan Flashcards

1
Q

list SERMs brand/generic

A

tamoxifen (Soltamox)
fulvestrant (Faslodex)
raloxifene (Evista)
toremifene (Fareston)

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2
Q

list AIs brand/generic

A

anastrozole (Arimidex)
letrozole (Femara)
exemestane (Aromasin)

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3
Q

list CDK4/6-Is brand/generic

A

palbociclib (Ibrance)
abemaciclib (Verzenio)
ribociclib (Kisqali)

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4
Q

most significant SEs of SERMs?

A 
VTE
menopausal symptoms
hot flashes
flushing
edema
weight gain
HTN
mood changes
amenorrhea
vaginal bleeding/discharge
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5
Q

most significant SEs of AIs?

A 
edema
VTE
bone pain
osteoporosis (common)
menopausal symptoms
hot flashes
arhralgia (common)/myalgia
lethary/fatige
N/V
rash
hepatotoxicity
HTN
HLD
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6
Q

what should not be taken with AIs?

A

SERMs or estrogen containing products

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7
Q

what drug should be used for hot flashes in patients taking tamoxifen (Soltamox)? why?

A

venlafaxine b/c it doesn’t inhibit CYP2D6 like paroxetine and fluoxetine

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8
Q

place in therapy for roloxifene (Evista)?

A

for prophylaxis of breast cancer, not treatment

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9
Q

what is used to treat men with breast cancer?

A

tamoxifen (Soltamox)

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10
Q

place in therapy for hormonal therapies with regards to breast cancer?

A

patients with ER+/PR+ breast cancer

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11
Q

place in therapy for AIs with regards to breast cancer

A

postmenopausal

CAN be premenopausal, but requires GnRH agonist: leuprolide or goserelin

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12
Q

place in therapy for SERMs with regards to breast cancer?

A

pre- and postmenopausal

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13
Q

list GnRH agonists brand/generic

A

leuprolide (Lupron Depot)

Goserelin (Zoladex)

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14
Q

complications of GnRH agonists?

A

osteoporosis
tumor flare (remember these overload the system)
- consider antiandrogen during beginning phase

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15
Q

most significant SEs of GnRH agonists?

A 
hot flashes
impotence
gynecomastia
peripheral edema
bone pain
injection site pain
QT prolongation
dyslipidemia
hyperglycemia
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16
Q

list GnRH antagonists brand/generic

A

degarelix (Firmagon)

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17
Q

complications of GnRH antagonsits?

A

osteoporosis

No tumor flare here

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18
Q

most significant SEs of GnRH antagonists?

A

hypersensitivity reactions

plust same as agonists

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19
Q

place in therapy for first generation antiandrogens with regards to prostate cancer?

A

used (only) in combination with GnRH agonists for the first couple of weeks to prevent tumor flares

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20
Q

list first generation antiandrogens brand/generic

A

bicalutamide (Casodex)
flutamide
nilutamide (Nilandron)

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21
Q

list place in therapy for second generation antiandrogens. Why does this differ from 1st gen?

A

can be used as monotherapy b/c they don’t cause an upregulation of androgen receptors

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22
Q

GnRH agonist also known as?

A

leutinizing hormone releaseing hormone (LHRH) agonists

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23
Q

GnRH MOA?

A

reduce testosterone production through negative feedback, which can cause a tumor flare

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24
Q

androgen biosynthesis inhibitor MOA?

A

they interfere with CP-17s involvement in the biosynthesis of testosterone from the testes and DHEA/androstenedione from the andrenal glands

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25
Q

adjunctive therapy required with androgen biosynthesis inhibtors and why?

A

prednisone to cause negative feedback to the adrenals, which prevents them from overproducing aldosterone

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26
Q

list androgen biosynthesis inhibitors brand/generic

A

abiraterone (Zytiga)

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27
Q

phases of cell cycle

A 
M - mitosis (cell splits)
G0 - rest
or
G1 - post-mitotic (enzyme/protein synth)
S - DNA synthesis/duplication
G2 - pre-mitotic (RNA/protein synth
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28
Q

Dubois and Dubois equation

A

BSA = 0.007184

  • (height in cm)^0.725
  • (weight in kg)^0.425
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29
Q

Mosteller equation

A

BSA = square root of
((height in cm *
weight in kg)
/ 3,600)

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30
Q

cell cycle non-specific classes

A

alkylating agents (technically work on G0 though too)
platinum agents
anthracyclines

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31
Q

cell cycle specific classes

A 
vinca alkaloids
taxanes
topo I inhibitors
topo II inhibitors
pyrimidine analog antimetabolites
folate antimetabolites
miscellaneous
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32
Q

targeted therapy classes

A

MABs

TKIs

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33
Q

where do alkylating agents work in the cell cycle?

A

non cell cycle specific

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34
Q

where do platinum based compounds work in the cell cycle?

A

non cell cycle specific

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35
Q

where do anthracyclines work in the cell cycle?

A

non cell cycle specific

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36
Q

where do vinca alkaloids work in the cell cycle?

A

M phase

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37
Q

where do taxanes work in the cell cycle?

A

M phase

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38
Q

where do topo I inhibitors work in the cell cycle?

A

S phase

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39
Q

where do topo II inhibitors work in the cell cycle?

A

G2 phase

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40
Q

where do pyrimidine analog antimetabolites work in the cell cycle?

A

S phase

41
Q

where do folate antimetabolites work in the cell cycle?

A

S phase

42
Q

list alkylating agents only brand/generic

A 
cyclophosphamide (Cytoxan)
ifosfamide (Ifex)
carmustine (BiNCU, Gliadel Wafer)
bendamustine (Bendeka, Treanda)
busulfan (Myleran, Busulfex)
melphalan (Alkeran, Evomela)
43
Q

most important boxed warnings for platinum agents?

A

anaphylaxis
nephrotoxicity
ototoxicity

44
Q

most important SE of platinum agents?

A

neuropathy

N/V w/ cisplatin > carboplatin

45
Q

What is the Calvert Formula used for? what is it?

A

dosing of carboplatin

total dose (mg) =
(target AUC)
* (GFR + 25)

AUC 2-8 usually
GFR capped at 125

46
Q

why should patient avoid cold with oxaliplatin?

A

acute sensory neuropathy

47
Q

alkylators MOA?

A

non cell cycle specific (G0 phase though)

cross-link DNA strands

48
Q

platinum agent MOA?

A

non cell cycle specific

cross-link DNA strands

49
Q

antracycline MOA?

A

non cell cycle specific

intercalaction into DNA
inhibit topo II
create oxygen free-radicals

50
Q

boxed warnings for antracyclines?

A

cardiotoxicity
vesicant properties (not liposomal or mitoxantrone)
myelosuppression

51
Q

SE unique to liposomal anthracyclines compared to other anthracyclines?

A

hand-foot syndrome

52
Q

concerns with anthracyclines aside from boxed warnings?

A 
red urine (mito blue)
N/V
53
Q

list anthracyclines brand/generic

A

doxorubicin (Adriamycin)
daunorubicin
epirubicin (Ellence)
idarubicin (Idamycin PFS)
valrubicin (Valstar) - only for bladder instillation
daunorubicin and cytarabine liposomal (Vyxeos)
doxorubicin liposomal (Doxil, Lipodoxe50)
mitoxantrone

54
Q

vinca alkaloids MOA?

A

M phase

inhibit the function of microtubles

55
Q

main concerns with vinca alkaloids?

A

for IV use ONLY (intrathecal fatal)
peripheral neuropathies
autonomic neuropathies (constipation > gastroparesis)
vesicant properties

56
Q

how to vincristine and vinblastine differ in their SEs?

A

vincristine

  • neuropathy more CNS related
  • neuropathic constipation more severe
  • not myelosuppressive

vinblastine

  • neuropathy more peripheral
  • neuropathic constipation less severe
  • myelosuppressive
57
Q

taxane MOA

A

M phase

inhibit the function of microtubules

58
Q

main concerns with vinca alkaloids?

A

infusion-related hypersensitivity reactions which can be fatal
peripheral sensory neuropathies

59
Q

do not prepare vincristine in a ___?

A

syringe

60
Q

list taxane brand/generic

A

paclitaxel (Taxol)
docetaxel (Taxetere)
cabazitaxel (Jevtana)
paclitaxel albumin-bound (Abraxane)

61
Q

SE unique to doxetaxel (Taxotere) compared to other taxanes? management?

A

severe fluid retention which requires premedication with dexamethasone

62
Q

note regarding preparations of taxanes?

A

use non-PVC bag and tubing (except Abraxane)

63
Q

topo I inhibitor MOA?

A

S phase

block DNA coiling/uncoiling
breaks single and double strand DNA
prevents re-ligation as well

64
Q

list topo I inhibitors brand/generic

A

irinotecan (Camptosar)

topotecan (Hycamtin)

65
Q

boxed warning unique to irinotecan compared to topotecan? management?

A

early diarrhea: atropine

delayed diarrhea: loperamide

66
Q

boxed warning unique to topotecan compared to irinotecan? management?

A

use only when ANC >1500 and platelets >100k

67
Q

topo II inhibitors MOA?

A

G2 phase

block DNA coiling/uncoiling
breaks single and double strand DNA
prevents re-ligation as well

68
Q

list topo II inhibitors brand/generic

A 
etoposide IV (Toposar)
etoposide phosphate (Etopophos)
etoposide capsules (VePesid) - the important one
69
Q

concern unique to VePesid capsules compared to other etoposide topo II inhibitor formulations?

A

refrigerate capsules

70
Q

main side effect with topo II inhibitors?

A

hypersensativity reactions

71
Q

concerns unique to etoposide iv compared to other formulations of etoposide (the only topo II inhibitor)?

A

infusion rate must be at least 30-60 minutes
precipitation issues ([ ] must be 0.4mg/mL or greater)
use non-PVC IV bag and tubing d/t leaching

72
Q

pyrimidine analog antimetabolites MOA?

A

S phase
F-UMP active metabolilte replaces uracil in RNA to inhibit pyrimidine synthesis
5-dUMP active metabolite inhibits thymidylate synthetase

73
Q

list pyrimidine analog antimetabolites brand/generic

A 
fluorouracil = 5-FU (Adrucil)
capecitabine (Xeloda)
cytarabine
cytarabine liposomal (DepoCyt)
gemcitabine (Gemzar)
74
Q

CI for capecitabine (Xeloda)?

A

CrCl < 30

75
Q

boxed warning for capecitabine (Xeloda)?

A

can increase INR for up to 1 months post-treatment

76
Q

folate antimetabolite MOA?

A

S phase

interfere with folic acid cycle by blocking purine and pyrimidine synthesis

77
Q

most important boxed warning for methotrexate?

A

there are many, but myelossuppression

78
Q

most important SEs for folate antimetabolites?

A

nephrotoxicity

hepatotoxicity

79
Q

most important SEs for MTX?

A

HD related nephrotoxicity

chronic-use related hepatotoxicity

80
Q

what dose of MTX requires leucovorin rescue?

A

500mg/m2 or greater

81
Q

what adjunctive measures are taken with MTX in addition to leucovorin/levoleucovorin? why?

A

hydration and IV sodium bicarb, which are used to alkalinize the urine to decrease the risk of nephrotoxicity

82
Q

most important drug interactions with MTX? why?

A

NSAIDs and aspirin, their renal affects will decrease the clearance of MTX

83
Q

list folate antimetabolites brand/generic

A

MTX (Trexall, Otrexup, Rasuvo, Xatmep)
pemetrexed (Alimta)
pralatrexate (Folotyn)

84
Q

intrathecal MTX must be free of ___?

A

preservatives

85
Q

folate antimetabolites are given with ___?

A

folic acid or derivative

vitamin B12

86
Q

what is given with pemetrexed (Alimta) in addition to folic acid and vitamin b12? why?

A

dexamethasone for dermatologic toxicity

87
Q

tretinoin AKA all-trans AKA retinoic acid

A

1st line for APL
Pregnancy issue
RA-APL differentiation syndrome

88
Q

arsenic trioxide

A

2nd line for APL
QT prolongation
RA-APL differentation syndrome

89
Q

asparaginase and pegaspargase

A

for leukemia
hepersensitivity (less with peg)
prolonged PT/INR

90
Q

bleomycin

A

not myelosuppressive
max life dose of 400 d/t pulmonary fibrosis
hypersensitivity reactions

91
Q

brand name, MOA as anti-cancer, and SEs of everolimus

A

Afinitor, Afinitor Disperz (Zortress is for transplant)

mTOR inhibitor that also inhibits downstream regulation of VEGF

dyslipidemia, rash, stomatitis, interstitial lung disease

92
Q

brand name, MOA as anti-cancer, and SEs of temsirolimus

A

Torisel (no PVC)

mTOR inhibitor that also inhibits downstream regulation of VEGF

dyslipidemia, hyperglycemia, myelosuppression, interstitial lung disease

93
Q

list immunomodulators brand/generic

A

lenalidomide (Revlimid)
pamolidomide (Pomalyst)
thalidomide (Thalomid)

94
Q

main issue with immunomodulators?

A

Fetal risk of severe birth-defects

95
Q

list proteasome inhibitors brand/generic

A

bortezomib (Velcade)

cafilzomib (Kyprolis)

96
Q

what is used to prevent herpes reactivation as zoster or simplex d/t bortezomib (Velcade)?

A

acyclovir or valacyclovir

97
Q

what is the main side effect if the proteasome inhibitors?

A

peripheral neuropathy

98
Q

class wide issue with MABs?

A

infusion-related reactions

NAPLEX: Evan (7 decks)

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