Oncology

Question 1

DC is a 44 year-old female with a history of motion sickness who has experienced debilitating nausea and vomiting with her last chemotherapy cycle. She currently complains of “feeling bloated.” She is due to receive the same regimen again. Choose the risk factors present in this patient that put her at high emetogenic risk: (Select ALL that apply.)
Answer

A
Female gender
B
History of nausea and vomiting with prior regimen
C
Age less than 50 years
D
History of motion sickness
E
Fluid overload

Answer 1

A
Female gender
B
History of nausea and vomiting with prior regimen
C
Age less than 50 years
D
History of motion sickness

Incorrect
Female, age < 50 years, history of motion sickness, and prior nausea and vomiting with previous chemotherapy regimen are risk factors for CINV.

Question 2

Mucositis is a well-known toxicity of which chemotherapeutic agent:
Answer

A
Asparaginase
B
Vincristine
C
Etoposide
D
Nilotinib
E
Methotrexate

Answer 2

E
Methotrexate
Incorrect
Methotrexate carries a boxed warning for stomatitis, one form of mucositis.

Question 3

Which of the following statements is true regarding dolasetron?
Answer

A
Only the sustained-release injection should be used for CINV.
B
The brand name is Kytril.
C
It does not have a risk of QT prolongation.
D
It is available in a patch formulation.
E
It should not be given intravenously for CINV.

Answer 3

E
It should not be given intravenously for CINV.
Incorrect
Dolasetron (Anzemet) is not indicated for intravenous use for CINV due to increased risk of QT prolongation.

Question 4

Hand-foot syndrome is associated with use of which one of the following chemotherapeutic agents:
Answer

A
Epirubicin
B
Liposomal doxorubicin
C
Cisplatin
D
Docetaxel
E
Vincristine

Answer 4

B
Liposomal doxorubicin
Incorrect
The brand names of liposomal doxorubicin are Doxil and Lipodox50. Hand-foot syndrome is also associated with cytarabine.

Question 5

Which of the following chemotherapeutic agents is considered a high emetic risk drug?
Answer

A
Fluorouracil
B
Irinotecan
C
Cisplatin
D
Oxaliplatin
E
Etoposide

Answer 5

Incorrect
Cisplatin has high emetic risk (> 90%).
Next

Question 6

A patient is receiving cisplatin therapy. She may receive the following agent to reduce the risk of renal damage:
Answer

A
Mesnex
B
Zinecard
C
Procrit
D
Vistogard
E
Ethyol

Answer 6

E
Ethyol
Incorrect
Amifostine (Ethyol) may be used prophylactically, along with hydration, to reduce the risk of renal toxicity.

Question 7

A patient complains of tender, red hands after starting Xeloda. What should the pharmacist recommend to alleviate the early stages of hand-foot syndrome?
Answer

A
Folic acid
B
Vitamin B6
C
Vitamin B12
D
Emollient
E
Aspirin

Answer 7

D
Emollient
Incorrect
Emollients to moisturize the hands have shown benefit in alleviating the symptoms of hand-foot syndrome. Cold compresses can help relieve the pain. Systemic steroids and pain medications may also be used.

Question 8

Choose the correct chemotherapeutic medication:adjunctive medication pair:
Answer

A
Ifosfamide:Amifostine
B
Cisplatin:Mesna
C
Fluorouracil:Uridine triacetate
D
Docetaxel:Dexrazoxane
E
Irinotecan:Leucovorin

Answer 8

C
Fluorouracil:Uridine triacetate
Incorrect
Uridine triacetate (Vistogard) is an antidote for fluorouracil or capecitabine overdose or to treat severe or early-onset toxicity.

Question 9

What conditions need to be met for the addition of epoetin alfa to be appropriate to stimulate red blood cell production in a patient with cancer? (Select ALL that apply.)
Answer

A
The provider must be enrolled in the APPRISE program.
B
The baseline hemoglobin should be at least 12 g/dL.
C
Use the lowest dose possible to avoid RBC transfusions.
D
The cancer must be curable.
E
Iron stores must be adequate.

Answer 9

C
Use the lowest dose possible to avoid RBC transfusions.
E
Iron stores must be adequate.

Incorrect
If used in patients with cancer, the hemoglobin should be < 10 g/dL and the cancer must be incurable. In addition, the patient should be symptomatic and iron stores adequate. The ESA APPRISE REMS program was discontinued by the FDA in early 2017. Patients should still be counseled regarding the risks of tumor growth.

Question 10

During a follow up phone call with a patient, the oncology pharmacist finds out the patient had experienced nausea and vomiting about 6 hours after receiving chemotherapy in the infusion center. How should this patient’s chemotherapy-induced nausea and vomiting be classified?
Answer

A
Immediate
B
Acute
C
Delayed
D
Anticipatory
E
Refractory

Answer 10

B
Acute
Incorrect
Since the nausea and vomiting occurred within 24 hours of receiving chemotherapy, it is classified as acute.

Question 11

Choose the correct statement/s regarding the treatment of hypercalcemia of malignancy (Select ALL that apply.)
Answer

A
Zometa is administered intravenously. 
B
Zometa inhibits osteoclast function.
C
Zometa contains denosumab.
D
Xgeva is administered subcutaneously.
E
Xgeva is a bisphosphonate used for hypercalcemia of malignancy.

Answer 11

A
Zometa is administered intravenously. 
B
Zometa inhibits osteoclast function.
D
Xgeva is administered subcutaneously.
Incorrect
Zometa contains zoledronic acid, an IV bisphosphonate. Reclast is zoledronic acid dosed at 5 mg yearly for osteoporosis. Xgeva is the monoclonal antibody denosumab. Prolia is the branded denosumab used for osteoporosis. Due to the delayed onset of action (24 hours or more), these agents are generally combined with other treatments (e.g., fluid and diuretics) when treating hypercalcemia.

Question 12

Which of the following chemotherapeutic agents is most likely to cause constipation?
Answer

A
Vincristine
B
Irinotecan
C
Capecitabine
D
Methotrexate
E
Trastuzumab

Answer 12

Incorrect

Vincristine is associated with autonomic neuropathy (causing constipation) as well as peripheral sensory neropathy.

Question 13

Which of the following statements are true regarding extravasation of chemotherapy? (Select ALL that apply.)
Answer

A
Cold compresses should be used for all agents except vinca alkaloids and etoposide.
B
Warm compresses should be used for all agents except vinca alkaloids and etoposide.
C
Dexrazoxane can be used for anthracycline extravasation.
D
Extravasation is the leakage of the drug from a vein into the extravascular space.
E
Glucarpidase can be used for extravasation from irinotecan.

Answer 13

A
Cold compresses should be used for all agents except vinca alkaloids and etoposide.
C
Dexrazoxane can be used for anthracycline extravasation.
D
Extravasation is the leakage of the drug from a vein into the extravascular space.
Incorrect
Cold compresses should be used for all agents except vinca alkaloids and etoposide which require warm compresses.

Question 14

In cancer patients, erythropoiesis-stimulating agents are rarely used to treat anemia due to which of the following concerns: (Select ALL that apply.)
Answer

A
Neutropenia
B
Shortened survival
C
Severe nausea and vomiting
D
Increased tumor progression in certain cancers
E
Drug contamination

Answer 14

B
Shortened survival
D
Increased tumor progression in certain cancers
Incorrect
Shortened survival and increased tumor progression have limited the use of ESAs in cancer patients.

Question 15

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

A
Ondansetron
B
Granisetron
C
Dolasetron
D
Palonosetron/Netupitant
E
Netupitant

Answer 15

A
Ondansetron

Incorrect
This is the ondansetron film formulation.

Question 16

CM is receiving Zofran for nausea. Choose the correct mechanism of action for this agent:
Answer

A
5HT3 receptor agonist
B
Dopamine receptor antagonist
C
Neurokinin-1 receptor agonist
D
Substance P inhibitor
E
5HT3 receptor antagonist

Answer 16

Incorrect

Zofran (ondansetron) is a 5HT3 receptor antagonist.

Question 17

Which medication can be given to prevent hemorrhagic cystitis in patients receiving high doses of cyclophosphamide?
Answer

A
Totect
B
Voraxaze
C
Ethyol
D
Varubi
E
Mesnex

Answer 17

E
Mesnex
Correct
Mesnex is used for prophylaxis to prevent hemorrhagic cystitis with ifosfamide and high-dose cyclophosphamide.

Question 18

HM has been using prochlorperazine for nausea several times daily. She is 86 years old and frail. Which of the following statements is/are correct regarding prochlorperazine? (Select ALL that apply.)
Answer

A
This drug can cause acute extrapyramidal symptoms.
B
This drug can decrease the seizure threshold.
C
The brand name is Complera.
D
This drug can cause strong anticholinergic side effects.
E
This drug is a dopamine receptor agonist.

Answer 18

A
This drug can cause acute extrapyramidal symptoms.
B
This drug can decrease the seizure threshold.
D
This drug can cause strong anticholinergic side effects.

Incorrect
Prochlorperazine (Compazine) is a dopamine receptor antagonist. EPS can be treated with diphenhydramine or benztropine.

Question 19

MT is a 62 year-old female (64 inches, 71 kg) who has breast cancer and just completed cycle 2 of her AC regimen today. She had developed neutropenia after her first cycle of AC. Her labs 7 days after her first cycle of AC were: WBC 1,200 cells/mm^3, 30% segs and 2% bands. A dose of Neulasta is ordered to be administered tomorrow. Which of the following statements regarding granulocyte colony stimulating factors (G-CSFs) is NOT correct?
Answer

A
G-CSF is used to shorten the duration of neutropenia after chemotherapy.
B
Bone pain is a common side effect of filgrastim and pegfilgrastim.
C
Refrigerated storage is required.
D
The branded pegfilgrastim product is called Leukine.
E
Neulasta is given subcutaneously

Answer 19

D
The branded pegfilgrastim product is called Leukine.

Correct
Pegfilgrastim is longer acting than filgrastim and the branded product is called Neulasta. It is given once per chemo cycle because it has a long duration of action (equals approximately 14 daily doses of filgrastim).

Question 20

Which of the following chemotherapeutic medications is associated with the highest incidence of hand-foot syndrome?
Answer

A
Fluorouracil
B
Thalidomide
C
Vincristine
D
Rituximab
E
Kytril

Answer 20

A
Fluorouracil

Incorrect
This adverse effect is also associated with capecitabine (a prodrug of fluorouracil).

Question 21

JF is a 64 year-old female (Ht. 5’7” Wt. 118 kg) who is receiving the following chemotherapy regimen for breast cancer. She will not undergo any radiation as part of her treatment.

Doxorubicin 60 mg/m2 IV on day 1
Cyclophosphamide 600 mg/m2 on day 1
Repeat cycles every 21 days for 4 cycles

Which of the following anti-emetic regimens are recommended for highly emetogenic chemotherapy? (Select ALL that apply.)
Answer

A
Olanzapine + dexamethasone + palonosetron
B
Akynzeo + dexamethasone
C
Aprepitant + dexamethasone + prochlorperazine
D
Fosaprepitant + dexamethasone + ondansetron
E
Fosaprepitant + dexamethasone + rolapitant

Answer 21

A
Olanzapine + dexamethasone + palonosetron

B
Akynzeo + dexamethasone
D
Fosaprepitant + dexamethasone + ondansetron

Incorrect
Olanzapine + dexamethasone (Decadron) + palonosetron or an NK-1 inhibitor + dexamethasone + a 5HT3 receptor antagonist are the 3-drug regimens that can be used to prevent CINV with highly emetic regimens. A 4-drug regimen is an option as well NK1-RA + 5HT3-RA + dexamethasone + olanzapine.

Question 22

What are the two indications of Zinecard and Totect, respectively?
Answer

A
Treatment of doxorubicin-induced cardiomyopathy; treatment of anthracycline extravasation
B
Prophylaxis of doxorubicin-induced cardiomyopathy; treatment of anthracycline extravasation
C
Prophylaxis of trastuzumab-induced cardiomyopathy; prevention of anthracycline extravasation
D
Treatment of doxorubicin-induced extravasation; treatment of doxorubicin-induced cardiomyopathy
E
Prevention of doxorubicin-induced cardiomyopathy; prevention of anthracycline extravasation

Answer 22

B
Prophylaxis of doxorubicin-induced cardiomyopathy; treatment of anthracycline extravasation

Incorrect
Both contain dexrazoxane. Zinecard is used for prophylaxis of doxorubicin-induced cardiomyopathy (use considered when cumulative dose > 300 mg/m^2), while Totect is used for the treatment of anthracycline extravasation. The brand name is likely to be used in pratice to indicate the drug and indication.

Question 23

A patient received prophylaxis for CINV 30 minutes prior to her chemotherapy, but developed nausea and occasional vomiting the following day. Which of the following is not an oral option for treating breakthrough nausea and vomiting?
Answer

A
Aloxi
B
Phenergan
C
Reglan
D
Zofran
E
Cesamet

Answer 23

A
Aloxi

Incorrect
N/V occurring 1-7 days after chemotherapy is called delayed N/V. Aloxi (palonosetron) is approved for delayed emesis, but is available only in an injection. Breakthrough nausea and vomiting could be treated with 5HT3-RA, dopamine receptor antagonists and cannabinoids.

Question 24

JP, a 46 year-old male (Ht. 6’2”, Wt. 231 lbs, BSA 2.31 m^2) with colorectal cancer, is receiving the following chemotherapeutic regimen:

Oxaliplatin 85 mg/m2 IV on day 1
Leucovorin 400 mg/m2 IV on day 1
Fluorouracil 400 mg/m2 IV bolus after leucovorin on day 1, then 1,200 mg/m2/day x 2 days given via continuous IV infusion
Bevacizumab 5 mg/kg IV on day 1
Repeat every 14 days
Other meds include:
Saliva substitute PRN dry/sore mouth
Lidocaine 2% topical solution 15 mL swish and spit Q3H PRN
Compazine 10 mg PO Q6H PRN N/V
Question

At one point during his treatment JP had an ANC of 326 cells/mm^3 developed a temperature of 39 degrees Celsius and antibiotics are needed. Which of the following would be appropriate empiric therapy?
Answer

A
Ampicillin/Sulbactam
B
Ceftaroline
C
Ceftriaxone
D
Ertapenem
E
Piperacillin/Tazobactam

Answer 24

E
Piperacillin/Tazobactam
Incorrect
Patients with neutropenia are at risk of death due to sepsis. Regimens for febrile neutropenia should be started immediately and should include activity against Gram-negatives, including Pseudomonas.

Question 25

Which of the following screening tests are used to screen for colon cancer? (Select ALL that apply.)
Answer

A
Colonoscopy
B
Flexible sigmoidoscopy
C
Digital rectal exam
D
CT colonography
E
Fecal occult blood test annually
Incorrect
Colon cancer screening should start at age 50. The digital rectal exam is used to screen for prostate cancer.

Answer 25

A
Colonoscopy
B
Flexible sigmoidoscopy

D
CT colonography
E
Fecal occult blood test annually
Incorrect
Colon cancer screening should start at age 50. The digital rectal exam is used to screen for prostate cancer.

Question 26

ST is a 44 year-old female (Ht. 5’5” Wt. 48 kg, BSA 1.5 m^2) who is receiving the following chemotherapy regimen for breast cancer. She will not be undergoing any radiation as part of her treatment.

Doxorubicin 60 mg/m^2 IV on day 1
Cyclophosphamide 600 mg/m^2 on day 1
Zofran 16 mg IV prior to chemotherapy
Dexamethasone 20 mg IV prior to chemotherapy
Repeat cycles every 21 days for 4 cycles
Question

What is the recommended maximum lifetime cumulative dose of doxorubicin for this patient?
Answer

A
500 mg
B
550 mg
C
650 mg
D
775 mg
E
825 mg

Answer 26

E
825 mg
Incorrect
The maximum lifetime cumulative dose of doxorubicin for ST is 825 mg (550 mg/m^2 x 1.5 m^2).

Question 27

Which of the following is/are true regarding myelosuppression with chemotherapy? (Select ALL that apply.)
Answer

A
Thrombocytosis can cause increase bleeding risk.
B
Neutropenia increases risk of infections, sepsis and death.
C
The primary treatment for thrombocytopenia is platelet transfusions.
D
The lowest point the WBC and platelets reach usually occurs between 3-5 days after chemotherapy is administered.
E
The lowest point of the WBC and platelets is called the nadir.

Answer 27

B
Neutropenia increases risk of infections, sepsis and death.
C
The primary treatment for thrombocytopenia is platelet transfusions.
E
The lowest point of the WBC and platelets is called the nadir.
Incorrect
Thrombocytopenia (low platelets) increases the risk of bleeding. The nadir generally occurs between 7-14 days after chemotherapy, although it can occur later with some agents, and they generally recover 3-4 weeks post treatment.

Question 28

What is the advantage in using darbepoetin over epoetin alfa?
Answer

A
Less frequent dosing
B
Decreased side effects
C
Faster response time
D
Oral route of administration
E
No need for iron supplementation

Answer 28

A
Less frequent dosing
Incorrect
Darbepoetin can be given less frequently than epoetin alfa. ESAs will not work properly if iron stores are not adequate (evaluate folate and B12 levels).

Question 29

Which of the following are true of intrathecal chemotherapy? (Select ALL that apply.)
Answer

A
Intrathecal chemotherapy is administered into the cerebrospinal fluid.
B
The medications must contain a preservative to avoid any possible bacterial contamination.
C
Low-dose vincristine can be administered intrathecally.
D
High-dose vincristine cannot be administered intrathecally.
E
Mesna is commoly administered intrathecally.
Incorrect
Intrathecal medications must be preservative free. Vincristine (at any dose) can be fatal if administered intrathecally.

Answer 29

A
Intrathecal chemotherapy is administered into the cerebrospinal fluid.
D
High-dose vincristine cannot be administered intrathecally.

Incorrect
Intrathecal medications must be preservative free. Vincristine (at any dose) can be fatal if administered intrathecally.