Oncology Flashcards
Define carcinoma
cancer that starts in skin or in the tissues that line or cover internal organs
Define multiple myeloma
a type of bone marrow cancer
Define sarcoma
cancer in connective tissues including fat, muscle, blood vessels and bone
which type of skin cancer is the worst
melanoma
Define adjuvant
treatment given after the primary therapy or concurrent with other therapy
Define neoadjuvant
treatment given before the primary therapy to shrink the size of the tumor and make surgery more effective
What is bleomycin lifetime max dose and reason why
400 units
pulmonary toxicity
What is doxorubicin lifetime max dose and reason why
450-550 mg/m^2
cardiotoxicity
What is cisplatin max dose per cycle and reason why
100 mg/m^2
nephrotoxicity
What is vincristine single dose cap and reason why
2 mg
neuropathy
what drug prevents cardiac damage while taking doxorubicin
dexrazoxane
Which chemo agents do NOT cause myelosuppression
asparaginase bleomycin vincristine MABs TKIs (tyrosine kinase inhibitors)
3 common chemo agents that cause N/V
cisplatin
cyclophosphamide
ifosfamide
2 common chemo agents that cause mucositis
MTX
fluorouracil
4 common chemo agents that cause diarrhea
irinotecan
capecitabine
fluorouracil
MTX
treatment for irinotecan early onset diarreha
atropine
common chemo agent that causes constipation
vincristine
common chemo agents (2) that cause QT prolongation
arsenic trioxide
TKI
4 common chemo agents that cause pulmonary fibrosis
bleomycin
busulfan
carmustine
iomustine
common chemo agent class that causes hepatoxicity
antiandrogens
- bicalutmaide
- flutamide
- nilutamide
2 common chemo agents that cause nephrotoxicity
cisplatin
HD-MTX
what drug is given with cisplatin to prevent nephrotixicity
amifostine
2 common chemo agents that cause hemorrhagic cystitis
ifosfamide
cyclophosphamide
drug that’s given with ifosfamide and cyclophosphamide to prevent hemorrhagic cystitis
mesna
3 chemo classes that cause neuropathy
vinca alkaloids -vincristine -vinblasstine -vinorelbine platinums -cisplatin -oxaliplatin taxanes -paclitaxel -docetaxel -cabazitaxel
major SE of oxaliplatin
causes cold-mediated sensory neuropathy
-pt should avoid cold temperatures and cold beverages
fluorouracil common adjuvant
leucovorin to increase efficacy as a cofactor
fluorouracil or capecitabine antidote
uridine triacetate
Define nadir
the lowest point that WBCs and platelets reach
when does nadir occur
7-14 days after chemotherapy
when will WBC and platelets return to normal after chemo
3-4 weeks
Define neutropenia
ANC < 1000
Define severe neutropenia
ANC < 500
Define profund neutropenia
ANC < 100
List colony stimulating factors
filgrastim
pegflgrastim
How to dx febrile neutropenia
Fever > 101
ANC < 500
Which bacteria have the highest risk for causing sepsis in febrile neutropenia
Gram negative
Treatment for febrile neutropenia if patient is low-risk
Anti-pseudomonal
- cipro + augmentin
- cipro +/- clindamycin
- levofloxacin
Treatment for febrile neutropenia if patient is high risk
IV anti-pseudomonal beta-lactams
- cefepime
- ceftazidime
- meropenem
- imipenem-cilastin
- zosyn
normal Hgb level
12-16 females
13.5-18 men
when are platelet transfusions recommended
when the count falls below 10,000
patient factors which increase N/V
female < 50 dehydration history of motion sickness history of N/V
treatment for delayed N/V
netupitant
palonostron
is cisplatin a high or low emetic risk drug
high
list 5-HT3-RA anti-emetic drugs
ondansetron
granisetron
dolasetron
palonosetron
list NK1-RA anti-emetic drugs
aprepitant
fosaprepitant
rolapitant
Treatment for high-emetic risk regimens
NK1-RA + 5HT-3-RA + dexamethasone
olanzapine + palonosetron + dexamethasone
NK1-RA + 5HT-3-RA + olanzapine + dexamethasone
Treatment for moderate-emetic risk regimens
NK1-RA + 5HT-3-RA + Dexamethasone
5HT3-RA + Dexamehtasone
Netupitant/palonosetrn + Dexamethasone
Olanzapine + palonosetron + Dexamethasone
Treatment for low-emetic risk regimens
no NK1-RA 5HT3-RA Dexamethasone Prochlorperazine metoclopramide
MOA of NK1-RA anti-emetics
inhibit the substance P/neurokinin 1 receptor, therefore augmenting teh antiemetic activity of 5HT3 receptor antagonists and corticosteroids to inhibit acute and delyaed phases of CINV
List dopamine receptor antagonists anti-emetic drugs
prochlorperazine
promethazine
metoclopramide
olanzapine
Which 2 chemo drugs cause Hand-foot syndrome
capecitabine
fluorouracil
Treatment for tumor lysis syndrome
allopurinol
rasburicase
antidote for vinca alkaloid and etoposide extravasation
hyaluronidase
ABCDE of skin cancer
asymmetry border-edges irregular color-not same consistency diameter: >6 mm evolving
BRCA 1/2 genes do what
normally suppress tumor growth
Define Klinefelter syndrome
men have one Y chromosome and 2 or more X chromosomes leading to increased estrogen and increased risk for breast cancer
Breast cancer treatment for hormone sensitive (ER+) in premenopausal women
tamoxifen
Tamoxifen MOA
binds to estrogen receptors on tumors, preventing estrogen from binding to the receptors “SERM”
Estrogen source in premenopausal and postmenopausal women
pre: estrogen from produced estrodiol
post: estrogen from androgen conversion via aromatase
aromatase inhibitor moa
block the aromatase enzyme that catalyzes the conversion
Breast cancer treatment for hormone sensitive (ER+) in postmenopausal women
Aromatase inhibitors
Raloxifen MOA
SERM used for breast cancer prophylaxis not for treatment it increases bone density and indicated for osteoporosis
gonadotropin-releasing hormone agonist MOA
decreases LH and FSH which suppresses ovarian estradiol production thus putting a premenopausal women into menopause and an AI can be used at this time as well
Define oncogene
a protein that an turn a normal cell into a cancer cell
What does HER2 gene do
an oncogene that promotes breast tumor growth
List SERMs used in breast cancer
tamoxifen
fulvestrant
SE of a SERM
hot flashes
night sweats
What treatment to use for hot flashes if someone has breast cancer
normally estrogen, but this can’t be used in breast cancer
instead use venlafaxine
boxed warning for SERMs
increased risk of uterine/endometrial cancer
increased risk of thromboembolic events
List aromatase inhibitors
anastrozole
letrozole
exemestane
2 major risks of using aromatase inhibitors
osteoporosis
CVD
primary treatment mechanism of prostate cancer
block testosterone via ADT: androgen deprivation therapy gondadotropin-releasing hormone agonist (GnRH) -leuprolide -Gosrelin
MOA of alkylating agents
cross-linking DNA strands and inhibiting protein synthesis and DNA synthesis
List alkylating agents
cyclophosphamide
ifosfamide
carmustine
busulfan
SE of busulfan
pulmonary toxicity
platinum-based compounds MOA
cross-link DNA and interfere with DNA synthesis and cell replication
list platinum-based compounds
cisplatin
carboplatin
oxaliplatin
Antracyclines MOA
incalation into DNA
inhibiting topoisomerase 2
creating oxygen free radicals that damage cells
List antracyclines
doxorubicin
mitoxantrone
unique concern for mitoxantrone
blue urine discoloration
vinca alkaloids MOA
inhibit function of microtubules during M phase
major SE of vinca alkaloids
peripheral sensory and autonomic neuropathies b/c microtubules play an important role in transport in neurons
List vinca alkaloids
vincristine
vinblastine
vincristine vs vinblastine major toxicities
vinCristine: CNS toxicity
vinBlastine: bone marrow suppression
what happens if you give vinca alkaloids intrathecally
paralysis and death
MOA of taxanes
inhibit the function of microtubules during the M phase
list taxanes
paclitaxel
docetaxel
major boxed warning for taxanes
severe hypersensitivity reactions due to the solvent (Cremophor EL)
MOA of topoisomerase 1 inhibitors
block the coiling and uncoiling of the double stranded DNA helix during S phase; causes single and double strand breaks in DNA and prevents religation (sealing the DNA strands back together)
List topoisomerase 1 inhibitors
irinotecan
topotecan
topoisomerase 2 inhibitors MOA
block the coiling and uncoiling of double-stranded DNA during the G2 phase; this causes single and double strand breaks in the DNA and prevents religation
List topoisomerase 2 inhibitors
etoposide
bleomycin
pyrimidine analog antimetabolites MOA
inhibit pyrimidine synthesis during S phase; an active metabolite (F-UMP) is incorporated into RNA to replace uracil and inhibits cell growth, while another active metabolite (5-dUMP) inhibits thymidylate synthetase
list pyrimidine analog antimetabolites
fluorouracil
capecitabine
cytarabine
gemcitabine
folate antimetabolites MOA
interfere with the enzymes involved in the folic acid cycle, blocking purine and pyrimidine biosynthesis during S phase
Major SE of folate antimetabolites
nephrotoxicty
list folate antimetabolites
MTX
pemetrexed
Bevacizumab MOA
VEGF inhibitor
Trastuzumab MOA
HER2 inhibitor
