Oncology

Question 1

chemo drugs that cause Myelosuppression

Answer 1

almost all except: asparaginase, bleomycin, vincristine; most monoclonal antibodies and many tyrosine kinase inhibitors.

Question 2

chemo drugs that cause nausea and vomiting

Answer 2

cisplatin, cyclophosphamide, ifosfamide

Question 3

chemo drugs that cause mucositis

Answer 3

fluorouracil, capecitabine, irinotecan, methotrexate. many TKIs (afatinib, ponatinib, sorafenib, sunitinib)

Question 4

chemo drugs that cause diarrhea

Answer 4

fluorouracil, capecitabine, irinotecan

Question 5

chemo drugs that cause constipation

Answer 5

vincristine, pomalidomide, thalidomide

Question 6

chemo drugs that cause xerostomia

Answer 6

radiation therapy to head or neck

Question 7

chemo drugs that cause cardiomyopathy

Answer 7

anthracyclines, HER2 inhibitors (ado-trastuzumab, trastuzumab, pertuzumab), fluorouracil, lapatinib

Question 8

chemo drugs that cause QT prolongation

Answer 8

arsenic trioxide, many TKIs (dasatinib, nilotinib, vemurafenib, dabrafenib, trametinib, crizotinib, ceritinib, erlotinib, gefitinib, lapatinib, sorafenib, sunitinib) and leuprolide

Question 9

chemo drugs that cause pulmonary fibrosis

Answer 9

bleomycin, busulfan, carmustice, lomustine

Question 10

chemo drugs that cause pneumonitis

Answer 10

methotrexate (chronic use), immune therapy MABs (atezolizumab, ipilimumab, nivolumab, pembrolizumab)

Question 11

chemo drugs that cause hepatotoxicity

Answer 11

antiandorgens (bicalutamide, flutamide, nilutamide), folate antimetabolites (methotrexate, pemetrexed, pralatrexate), pyrimidine analog antimetabolites (cytarabine, gemcitabine), many tyrosine kinase inhibitors, ipilimumab, pembrolizumab, nivolumab, atezolizumab

Question 12

chemo drugs that cause nephrotoxicity

Answer 12

cisplatin, methotrexate (especially high doses), pemetrexed, pralatrexate, carfilzomib, bevacizumab, nivolumab, pembrolizumab, ipilimumab, atezolizumab

Question 13

chemo drugs that cause hemorrhagic cystitis

Answer 13

ifosfamide (all doses), cyclophosphamide (higher doses, >1 g /m2)

Question 14

chemo drugs that cause peripheral sensory neuropathy

Answer 14

vinca alkaloids (vincristine, vinblastine, vinorelbine), platinums (cisplatin, oxaliplatin), taxanes (paclitaxel, docetaxel, cabazitaxel) proteasome inhibitors (bortezomib, carfilzomib), thalidomide, ado-trastuzumab, cytarabine (high doses) brentuzimab

Question 15

chemo drugs that cause autonomic neuropathy

Answer 15

vinca alkaloids

Question 16

chemo drugs that cause thromboembolic risk

Answer 16

aromatase inhibitors (e.g. anastrozole, letrozole), SERMs (tamoxifen), immunomodulators (thalidomide, lenalidomide, pomalidomide)

Question 17

management of chemo-induced myelosuppression

Answer 17

neutropenia: colony-stimulating factors
anemia: RBC transfusions and erythropoiesis-stimulating agents (ESA)
thrombocytopenia: platelet transfusions

Question 18

management of chemo-induced nausea-vomiting

Answer 18

1. neurokinin-1 receptor antagonist (NK1-RA)
2. serotonib-3 receptor antagonist (5HT3-RA)
3. dexamethasone
4. metoclopramide
5. prochlorperazine
6. IV/PO fluid hydration

Question 19

management of chemo-induced mucositis

Answer 19

1. symptomatic treatment

2. mucosal coating agents, topical local anesthetics

Question 20

management of chemo-induced diarrhea

Answer 20

1. IV/PO fluid hydration
2. antimotility agents (e.g. loperamide)
3. irinotecan: atropine for early onset diarrhea

Question 21

management of chemo-induced constipation

Answer 21

1. stimulant laxatives

2. polyethylene glycol

Question 22

management of chemo-induced xerostomia

Answer 22

1. artifical saliva substitutes

2. pilocarpine

Question 23

management of chemo-induced cardiomyopathy

Answer 23

1. do not exceed 450-550 mg/m2 for doxorubicin

2. dexrazoxane prophylactically

Question 24

management of chemo-induced nephrotoxicity

Answer 24

1. amifostine (Ethyol) may be given prophylactically)
2. ensure adequate hydration
3. do not exceed 100 mg/m2/cycle for cisplatin

Question 25

management of chemo-induced hemorrhagic cystitis

Answer 25

1. ifosfamide: mesna (Mesnex)

2. ensure adequate hydration

Question 26

management of chemo-induced neuropathy

Answer 26

1. vincristine: limit dose to 2 mg per week
2. oxaliplatin: avoid cold temperature and avoid drinking cold beverages
3. bortezomib: SC less neuropathy than IV

Question 27

what adjucant medication is given with fluorouracil to enhance efficacy as a cofactor

Answer 27

leucovorin or levoleucovorin

Question 28

what adjucant medication is given with fluorouracil as an antidote

Answer 28

uridine triacetate (Vistogard)

Question 29

what adjuvant medication is given with methotrexate as an antidote

Answer 29

glucarpidase (Voraxaze)