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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
adjunctive therapy required with androgen biosynthesis inhibtors and why?
prednisone to cause negative feedback to the adrenals, which prevents them from overproducing aldosterone
26
list androgen biosynthesis inhibitors brand/generic
abiraterone (Zytiga)
27
phases of cell cycle
``` M - mitosis (cell splits) G0 - rest or G1 - post-mitotic (enzyme/protein synth) S - DNA synthesis/duplication G2 - pre-mitotic (RNA/protein synth ```
28
Dubois and Dubois equation
BSA = 0.007184 * (height in cm)^0.725 * (weight in kg)^0.425
29
Mosteller equation
BSA = square root of ((height in cm * weight in kg) / 3,600)
30
cell cycle non-specific classes
alkylating agents (technically work on G0 though too) platinum agents anthracyclines
31
cell cycle specific classes
``` vinca alkaloids taxanes topo I inhibitors topo II inhibitors pyrimidine analog antimetabolites folate antimetabolites miscellaneous ```
32
targeted therapy classes
MABs | TKIs
33
where do alkylating agents work in the cell cycle?
non cell cycle specific
34
where do platinum based compounds work in the cell cycle?
non cell cycle specific
35
where do anthracyclines work in the cell cycle?
non cell cycle specific
36
where do vinca alkaloids work in the cell cycle?
M phase
37
where do taxanes work in the cell cycle?
M phase
38
where do topo I inhibitors work in the cell cycle?
S phase
39
where do topo II inhibitors work in the cell cycle?
G2 phase
40
where do pyrimidine analog antimetabolites work in the cell cycle?
S phase
41
where do folate antimetabolites work in the cell cycle?
S phase
42
list alkylating agents only brand/generic
``` cyclophosphamide (Cytoxan) ifosfamide (Ifex) carmustine (BiNCU, Gliadel Wafer) bendamustine (Bendeka, Treanda) busulfan (Myleran, Busulfex) melphalan (Alkeran, Evomela) ```
43
most important boxed warnings for platinum agents?
anaphylaxis nephrotoxicity ototoxicity
44
most important SE of platinum agents?
neuropathy | N/V w/ cisplatin > carboplatin
45
What is the Calvert Formula used for? what is it?
dosing of carboplatin total dose (mg) = (target AUC) * (GFR + 25) AUC 2-8 usually GFR capped at 125
46
why should patient avoid cold with oxaliplatin?
acute sensory neuropathy
47
alkylators MOA?
non cell cycle specific (G0 phase though) | cross-link DNA strands
48
platinum agent MOA?
non cell cycle specific | cross-link DNA strands
49
antracycline MOA?
non cell cycle specific intercalaction into DNA inhibit topo II create oxygen free-radicals
50
boxed warnings for antracyclines?
cardiotoxicity vesicant properties (not liposomal or mitoxantrone) myelosuppression
51
SE unique to liposomal anthracyclines compared to other anthracyclines?
hand-foot syndrome
52
concerns with anthracyclines aside from boxed warnings?
``` red urine (mito blue) N/V ```
53
list anthracyclines brand/generic
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
vinca alkaloids MOA?
M phase | inhibit the function of microtubles
55
main concerns with vinca alkaloids?
for IV use ONLY (intrathecal fatal) peripheral neuropathies autonomic neuropathies (constipation > gastroparesis) vesicant properties
56
how to vincristine and vinblastine differ in their SEs?
vincristine - neuropathy more CNS related - neuropathic constipation more severe - not myelosuppressive vinblastine - neuropathy more peripheral - neuropathic constipation less severe - myelosuppressive
57
taxane MOA
M phase | inhibit the function of microtubules
58
main concerns with vinca alkaloids?
infusion-related hypersensitivity reactions which can be fatal peripheral sensory neuropathies
59
do not prepare vincristine in a ___?
syringe
60
list taxane brand/generic
paclitaxel (Taxol) docetaxel (Taxetere) cabazitaxel (Jevtana) paclitaxel albumin-bound (Abraxane)
61
SE unique to doxetaxel (Taxotere) compared to other taxanes? management?
severe fluid retention which requires premedication with dexamethasone
62
note regarding preparations of taxanes?
use non-PVC bag and tubing (except Abraxane)
63
topo I inhibitor MOA?
S phase block DNA coiling/uncoiling breaks single and double strand DNA prevents re-ligation as well
64
list topo I inhibitors brand/generic
irinotecan (Camptosar) | topotecan (Hycamtin)
65
boxed warning unique to irinotecan compared to topotecan? management?
early diarrhea: atropine | delayed diarrhea: loperamide
66
boxed warning unique to topotecan compared to irinotecan? management?
use only when ANC >1500 and platelets >100k
67
topo II inhibitors MOA?
G2 phase block DNA coiling/uncoiling breaks single and double strand DNA prevents re-ligation as well
68
list topo II inhibitors brand/generic
``` etoposide IV (Toposar) etoposide phosphate (Etopophos) etoposide capsules (VePesid) - the important one ```
69
concern unique to VePesid capsules compared to other etoposide topo II inhibitor formulations?
refrigerate capsules
70
main side effect with topo II inhibitors?
hypersensativity reactions
71
concerns unique to etoposide iv compared to other formulations of etoposide (the only topo II inhibitor)?
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
pyrimidine analog antimetabolites MOA?
S phase F-UMP active metabolilte replaces uracil in RNA to inhibit pyrimidine synthesis 5-dUMP active metabolite inhibits thymidylate synthetase
73
list pyrimidine analog antimetabolites brand/generic
``` fluorouracil = 5-FU (Adrucil) capecitabine (Xeloda) cytarabine cytarabine liposomal (DepoCyt) gemcitabine (Gemzar) ```
74
CI for capecitabine (Xeloda)?
CrCl < 30
75
boxed warning for capecitabine (Xeloda)?
can increase INR for up to 1 months post-treatment
76
folate antimetabolite MOA?
S phase | interfere with folic acid cycle by blocking purine and pyrimidine synthesis
77
most important boxed warning for methotrexate?
there are many, but myelossuppression
78
most important SEs for folate antimetabolites?
nephrotoxicity | hepatotoxicity
79
most important SEs for MTX?
HD related nephrotoxicity | chronic-use related hepatotoxicity
80
what dose of MTX requires leucovorin rescue?
500mg/m2 or greater
81
what adjunctive measures are taken with MTX in addition to leucovorin/levoleucovorin? why?
hydration and IV sodium bicarb, which are used to alkalinize the urine to decrease the risk of nephrotoxicity
82
most important drug interactions with MTX? why?
NSAIDs and aspirin, their renal affects will decrease the clearance of MTX
83
list folate antimetabolites brand/generic
MTX (Trexall, Otrexup, Rasuvo, Xatmep) pemetrexed (Alimta) pralatrexate (Folotyn)
84
intrathecal MTX must be free of ___?
preservatives
85
folate antimetabolites are given with ___?
folic acid or derivative | vitamin B12
86
what is given with pemetrexed (Alimta) in addition to folic acid and vitamin b12? why?
dexamethasone for dermatologic toxicity
87
tretinoin AKA all-trans AKA retinoic acid
1st line for APL Pregnancy issue RA-APL differentiation syndrome
88
arsenic trioxide
2nd line for APL QT prolongation RA-APL differentation syndrome
89
asparaginase and pegaspargase
for leukemia hepersensitivity (less with peg) prolonged PT/INR
90
bleomycin
not myelosuppressive max life dose of 400 d/t pulmonary fibrosis hypersensitivity reactions
91
brand name, MOA as anti-cancer, and SEs of everolimus
Afinitor, Afinitor Disperz (Zortress is for transplant) mTOR inhibitor that also inhibits downstream regulation of VEGF dyslipidemia, rash, stomatitis, interstitial lung disease
92
brand name, MOA as anti-cancer, and SEs of temsirolimus
Torisel (no PVC) mTOR inhibitor that also inhibits downstream regulation of VEGF dyslipidemia, hyperglycemia, myelosuppression, interstitial lung disease
93
list immunomodulators brand/generic
lenalidomide (Revlimid) pamolidomide (Pomalyst) thalidomide (Thalomid)
94
main issue with immunomodulators?
Fetal risk of severe birth-defects
95
list proteasome inhibitors brand/generic
bortezomib (Velcade) | cafilzomib (Kyprolis)
96
what is used to prevent herpes reactivation as zoster or simplex d/t bortezomib (Velcade)?
acyclovir or valacyclovir
97
what is the main side effect if the proteasome inhibitors?
peripheral neuropathy
98
class wide issue with MABs?
infusion-related reactions

NAPLEX: Evan (7 decks)

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