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NAPLEX 21 > ONCOLOGY I > Flashcards

ONCOLOGY I Flashcards

1
Q

What is recommended for prevention of colorectal cancer and CVD in patients who are 50-59y, >10% ASCVD, >10 year life expectancy, low risk bleeding

A

aspirin low dose

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2
Q

Screening for breast cancer

age 45-54

A

begin yearly mammograms

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3
Q

Screening for breast cancer

age >55

A

mammograms every 2 years or continue yearly

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4
Q

Cerivical cancer

age 21-29y

A

Pap smear every 3 years

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5
Q

cervical cancer

age 30-65

A

Pap smear + HPV every 5 years

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6
Q

Colon cancer

>45y

A

stool based tests, fecal occult blood test every year

colonoscopy every 10 years

FSIG every 5 years

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7
Q

prostate

>50

A

if a patient opts to be tested-

PSA +/- DRE

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8
Q

Lifetime cumulative dose of Bleomycin

A

400 units

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9
Q

reason for lifetime cumulative dose of bleomycin

A

pulmonary toxicity

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10
Q

lifetime dose of doxorubicin

A

450-550mg/m

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11
Q

reason for doxorubicin cumulative dose limit

A

cardiotoxicity

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12
Q

cisplatin dose per cycle max

A

100mg/m

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13
Q

cisplatin dose limitation is due to

A

nephrotoxicity

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14
Q

the single dose of vincristine is capped at

A

2mg

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15
Q

why is vincristine capped at 2mg

A

neuropathy

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16
Q

What is used to prevent cardiac damage from doxorubicin

A

dexrazoxane

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17
Q

What drugs don’t cause myelosuppression

A

Asparaginase
bleomycin
vincristine

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18
Q

How do you manage neutropenia

A

colony stimulating factors (CSFs)

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19
Q

how do you manage anemia

A

ESAs (in palliation only)

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20
Q

How do you manage thrombocytopenia

A

platelet transfusions when very low

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21
Q

What are the common drugs that cause N/V

A

cisplatin
cyclophosphamide
ifosfamine

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22
Q

management for NV

A

NK1-RA

5HT3-RA

dexamethasone

IV PO fluid rehydration

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23
Q

what common drugs cause mucositis

A

fluorouracil

methotrexate

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24
Q

Drugs that cause diarrhea

A

methotrexate
fluorouracail
capecitabine
irinotecan

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25
Q

What do you give to those that are taking irinotecan to help with early onset diarrhea

A

atropine

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26
Q

constipation drugs

A

vincristine

*stimulant laxatives, PEG

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27
Q

what can be used for xerostomia

A

artificial saliva substitutes and pilocarpine

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28
Q

What drugs are known for causing cardiomyopathy

A

anthracyclines

dexrazoxane given with doxorubicin

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29
Q

what drugs cause QT

A

arsenic trioxide, many TKIs (-inib)

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30
Q

What drugs cause pulmonary fibrosis

A

bleomycin
busulfan
carmustine
lomustine

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31
Q

What drugs cause pneumonitis

A

methotrexate and immune therapy MAbs

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32
Q

common drugs that cause hepatoxocity

A

anti androgens (bicalutamide, flutamide, nilutamide)

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33
Q

How do you manage hepatotoxicity

A

steroids, immune therapy MAbs

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34
Q

What drugs cause nephrotoxicity

A

cisplatin

methotrexate

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35
Q

What can help with cisplatin’s nephrotoxity?

A

Amifostine (Ethyol)

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36
Q

What drugs can cause hemorrhagic cystitis

A

ifosfamide (all doses)

cyclophosphamide (>1g)

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37
Q

What helps with hemorrhagic cysitis

A

mesa is always given with ifosfamide

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38
Q

What drugs cause peripheral neuropathy

A

vinca alkaloids (vincristine, vinblastine, vinorelbine)
platinums
taxanes

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39
Q

Which drug causes an acute cold mediated sensory neuropathy?

A

oxalipplatin - avoid cold temps and cold beverages

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40
Q

What drugs cause a risk for clotting

A

aromatase inhibitors (anastrozole, letrozole), SERMs (tamoxifen, raloxifene)

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41
Q

Bleomycin
Busulfan
Carmustine
Lomustine

A

pulmonary fibrosis

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42
Q

Platinum-based (cisplatin, carboplatin(

A

nephrotoxic/ototoxic

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43
Q

Doxorubicin and other anthracyclines

A

cardiotoxic

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44
Q

Methotrexate

A

mucositis

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45
Q

nitrosoureas (lomustine, carmustine)

A

neurotoxicity

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46
Q

Ifosfamide

cyclophosphamide

A

hemorrhagic cysitisis

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47
Q

vinka alkaloids

taxanes

A

peripheral neuropathy

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48
Q

immunotherapy targeting CTLA-4 or PD-L1 ipilimumab, atezolizumamb, durvalumab, nivolumab, pembrolizumab

A

autoimmune syndromes

49
Q

Bone marrow suppression is a common toxicity of many agents including:

A 
alkylators
anthracyclines
platinum based compounds (cisplatin)
taxanes
topoisomerase I and II inhibitors
antimetabolites
vinka alkaloids (blasten and vinorelbine)
50
Q

cistplatin+

A

amifostine (Ethyol)

nephrotoxicity

51
Q

Doxorubicin +

A

dexrazoxane (Zinecard)
Dexrazoxane (Totect)

prevent cardiomyopathy
treatment for extravasation

52
Q

Fluoruracil +

A

leucovorin or levoleucovorin (Fusilev)

enhance efficacy

53
Q

Fluoruracil or capecitabine +

antidote

A

uridine triacetate (Vistogard)

use within 96 hours

54
Q

Ifosfamide +

A

mesna (mesnex)

hemorrhagic cystitis

55
Q

Irinotecan +

A

atropine
loperamide

diarrhea

56
Q

Methotrexate+

A

leucovorin or levoleucovorin (Fusilev)

glucarpidase (Voraxaze) (antidote_

dec myelosuppression and mucositis

57
Q

What should you do when a drug damages the bladder or kidneys?

A

get it out!

normal saline

58
Q

What does myelosuppresion cause?

A

fewer RBCs, abcs platelets

59
Q

the lowest point that WBCs and platelets reach is called

A

nadir

occurs 7-14 days after chemo; recovers in 3-4 weeks

60
Q

ANC <1000 =

A

neutropenia

61
Q

ANC <500

A

severe neutropenia

62
Q

ANC<100

A

profound neutropenia

63
Q

____ are given prophylactically after chemo to shorten the time that a patient is at risk for infection due to neutropenia and reduce mortality

A

CSFs

64
Q

Brand: Neupogen

A

generic: filgrastim

* daily

65
Q

Brand: Neulasta

A

generic: pegfilrastin

* longer acting/12 days

66
Q

what are the common side effects of CSFs?

A

bone pain

67
Q

when are empiric antibiotics started?

A

if a fever occurs with neutropenia

*must cover pseudomonas

68
Q

Which bacteria have the highest risk for causing sepsis?

A

negative

69
Q

Patient is at low risk of neutropenia (expected ANC<500 for <7 days)
what empiric antibiotics?

A

oral anti-pseudomonas antibiotics
cipro or levo
PLUS
augmenting or clindamycin

70
Q

Patient is at high risk of neutropenia (expected ANC<100 for >7 days)
what empiric antibiotics?

A 
IV anti-pseudomonas beta lactams
cefepime
ceftazidime
meropenem
imipenem/cilastin
pip/tazo
71
Q

What levels need to be assessed when receiving ESAs?

A

serum ferritin
transferrin saturation
total iron binding capacity

72
Q

What factors increase risk of NV

A 
female
age <50
anxiety
depression
dehydration
history of motion sickness, N/V with prior regimens
73
Q

When do you administer CINV?

A

30 mins prior to chemo and provide take home meds

74
Q

Acute (within 24 hours after chemo) drug therapy?

A

5HT3 receptor antagonists (ondansetron, granisetron, dolasetron, palonosetron)

75
Q

Delayed (>24h after chemo)

A

NK1RA (aripeptant PO, fosaprepitant IV), corticosteroids, palonosetron
olanzapine

76
Q

Anticipaory (before chemo)

A

Benzes started evening prior

77
Q

High emetic risk antiemetic regimen

A

3 or 4 drugs
Aripeptant PO + ondansetron + olanzapine + dexamethasone

olanzapine + palonosetron + dexamethasone

Arepitenant PO + ondansetron + dexamethasone

78
Q

Moderate emetic risk

A

2 or 3 drugs
Arepitenant PO + ondansetron + dexamethasone

ondansetron + dexamethasone

79
Q

low emetic risk

A

1 drug (NO arepeptant)

80
Q

What medications may be beneficial for breakthrough CINV?

A

ondansetron
dopamine receptor antagonists (prochlorperazine, promethazine, metoclopramide)
cannabinoids
olanzapine

81
Q

How do you treat acute dystonic reactions? (EPS)

A

anticholinergics (benztropine, Benadryl)

82
Q

What are Substance P/Neurokinin-1 Receptor Antagonists?

A

Aprepitant (Emend)

PO, IV

83
Q

What is the IV version of aprepitant?

A

fosaprepitant (Emend)

84
Q

When aprepitent is administered what do you do with the steroid dose?

A

decrease, (3a4 inhibitors)

85
Q

Why can’t you administer ondansetron with apomorphine?

A

severe hypotension

86
Q

When do you apply the granisetron patch?

A

24-48 hours before chemo

87
Q

Brand: Sancuso

A

generic: granisetron

88
Q

Brand: aloxi

A

generic: palonosetron

89
Q

What are side effects of 5HT3-RA

A

headache

constipation

90
Q

Brand: Decadron

A

generic: dexamethasone

91
Q

Examples of dopamine receptor antagonists

A

prochlorperazine
promethazine
metoclopramide
olanzapine

92
Q

Brand: Compazine

A

generic: prochlorperazine

93
Q

Brand: Phenergan

A

generic: promethazine

* NOT IV* IM is preferred due to extravasation

94
Q

Brand: Reglan

A

generic: metoclopramide

95
Q

Brand: Zyprexa

A

generic: olanzapine

96
Q

Boxed warning for metoclopramide

A

tardive dyskinesia that can be irreversible

97
Q

Dronabinol capsules vs solution

A

capsule CIII

solution CII

98
Q

Brand: Marinol

A

generic: dronabinol

99
Q

Brand: Cesamet

A

generic: nabilone

100
Q

What is the max of loperamide increased to with CID

A

24mg/day

101
Q

What causes CID

A

fluorouracil, capecitabine, irinotecan

several days later

102
Q

oral mucositis increases the risk of what

A

candida infection

nystatin oral suspension or clotrimazole troches

103
Q

Treatment for oral mucositis

A

lidocaine 2% topical solution

104
Q

What syndrome happens commonly with capecitabine and fluorurcail

A

hand foot syndrome

105
Q

how can you help the hand foot syndrome sypmtoms

A

cooling hands/feet with cold compress
emollients (aquaphor, Udder cream, Bag balm)
steroids and pain meds

106
Q

In Tumor lysis syndrome, when the cell is lysed, the intracellular components that enter the bloodstream include:

A

potassium, phosphate, purines, and pyrimidines

*phosphate will bind to calcium = hypocalciema
hyperkalemia = arrhythmias
hyperurciema

107
Q

What is used in TLS to stop the conversion of purines into uric acid

A

xanthine oxidate inhibitor

allopurinol 400-800mg/day

108
Q

What can be added to allopurinol if it fails?

A

rasburicase (C/I in G6Pd def)

109
Q

How do you treat hypercalcemia of maligancy?

A

water & loops

110
Q

Calcium >12… treatment

A

IV hydration with normal saline
calcitonin (48h)
IV bisphosphonates are generally considered first line

pamidronate, zoledronic acid

111
Q

Brand: Miacalcin

A

generic: calcitonin

112
Q

Brand: Zometa

A

generic: zoledronic acid
4mg IV may repeat in 7 days
(not yearly like in osteoporosis)

113
Q

Brand: Xgeva

A

generic: denosumab

monthly!!!! (not every 6 years like in osteoporosis)

114
Q

how do you prevent immunologic reactions? (MAbs)

A

APAP

benadryl

115
Q

if extravasation occurs, apply cold compressed except with:

A

vinca alkaloids and etoposide (warm compress)

116
Q

antidote for anthracyclines with extravasation

A

dexrazoxane (Totect) or dimethyl sulfoxide

117
Q

antidote for vinca alkaloids and etoposide with extravasation

A

hyaluronidase

118
Q

what drugs can be given intrathecally

A 
cytarabine
methotrexate
hydrocortisone
thiotepa
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NAPLEX 21 (60 decks)

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