Oncology Flashcards
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
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.
Mucositis is a well-known toxicity of which chemotherapeutic agent:
Answer
A Asparaginase B Vincristine C Etoposide D Nilotinib E Methotrexate
E
Methotrexate
Incorrect
Methotrexate carries a boxed warning for stomatitis, one form of mucositis.
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.
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.
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
B
Liposomal doxorubicin
Incorrect
The brand names of liposomal doxorubicin are Doxil and Lipodox50. Hand-foot syndrome is also associated with cytarabine.
Which of the following chemotherapeutic agents is considered a high emetic risk drug?
Answer
A Fluorouracil B Irinotecan C Cisplatin D Oxaliplatin E Etoposide
Incorrect
Cisplatin has high emetic risk (> 90%).
Next
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
E
Ethyol
Incorrect
Amifostine (Ethyol) may be used prophylactically, along with hydration, to reduce the risk of renal toxicity.
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
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.
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
C
Fluorouracil:Uridine triacetate
Incorrect
Uridine triacetate (Vistogard) is an antidote for fluorouracil or capecitabine overdose or to treat severe or early-onset toxicity.
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.
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.
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
B
Acute
Incorrect
Since the nausea and vomiting occurred within 24 hours of receiving chemotherapy, it is classified as acute.
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.
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.
Which of the following chemotherapeutic agents is most likely to cause constipation?
Answer
A Vincristine B Irinotecan C Capecitabine D Methotrexate E Trastuzumab
Incorrect
Vincristine is associated with autonomic neuropathy (causing constipation) as well as peripheral sensory neropathy.
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.
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.
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
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.
A pharmacist receives a prescription for Zuplenz. Which drug should be dispensed?
Answer
A Ondansetron B Granisetron C Dolasetron D Palonosetron/Netupitant E Netupitant
A
Ondansetron
Incorrect
This is the ondansetron film formulation.
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
Incorrect
Zofran (ondansetron) is a 5HT3 receptor antagonist.
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
E
Mesnex
Correct
Mesnex is used for prophylaxis to prevent hemorrhagic cystitis with ifosfamide and high-dose cyclophosphamide.
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.
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.
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
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).
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
A
Fluorouracil
Incorrect
This adverse effect is also associated with capecitabine (a prodrug of fluorouracil).
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
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.
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
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.
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
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.
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
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.
