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NAPLEX: Evan > Oncology I > Flashcards

Oncology I Flashcards

1
Q

List ways on which adults can control their health and reduce their cancer risk

A

Stay away from tobacco (smoking cessation if needed)

Stay at a health weight

Get moving with regular physical activity

Eat healthy with plenty of fruits and vegetables

Limit how much alcohol u drink (if u drink at all)

Protect your skin

Know you’ll, ur FH and ur risks

Have regular check-ups and cancer screening tests

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2
Q

Most cancers will not relapse if a pt remains CA free for 5 yrs?

A

T

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3
Q

What’s most often the primary tx of CA?

A

Surgery (if CA is resectable)

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4
Q

Role of radiation or chemo?

A

Neoadjuvant therapy…. May be used b4 surgery to shrink tumor initially

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5
Q

What’s Neoadjuvant therapy?

A

Given B4 surgery

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6
Q

What’s adjuvant therapy?

A

Radiation and/or chemo done AFTER surgery (to eradicate residual dx and decease recurrence)

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7
Q

Chemo regimens are usually designed for synergy?

A

T

Chemo regimens are designed to complement each other (with different MOA, toxicities, and cell cycle specificity)

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8
Q

What’s the main cause of ADRs suffered by CA pts?

A

Damaging effects of chemo on rapidly dividing cells that are not cancerous

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9
Q

Where are the normal rapidly dividing cells? SEs from these?

A

GI, Hair follicles and bone marrow (blood cells)

T4, the most common SEs of chemo are

N/V; Alopecia; Myelosuppression

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10
Q

Why must the pts quality of Iife be accessed?

A

Bcuz of sever SEs of chemo

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11
Q

Is chemo advised during pregnacy (both males and females) and during breast feeding?

A

No

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12
Q

List the toxicities caused by chemo agents

A

Myelosuppression

Neuropathy

Cardiotoxicity

Pulmonary toxicity

Pneumonitis

Nephrotoxicity/Bladder toxicity (cystitis)

Acneform rash

Mucositis

Hand-foot syndrome

Hepatoxicity

Clotting risk

Alopecia

Extravasation

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13
Q

What’s Myelosuppression? Monitoring?

A

Bone marrow suppression => Decreased RBC, WBC, and platelets

CBC + differential (includes segs and bands, to calculate absolute neutrophil count (ANC))

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14
Q

Which drugs don’t cause Myelosuppression?

A

ABV

Asparaginase

Bleomycin

Vincristine

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15
Q

Classes with highest risk of Neuropathy?

A

PTV

Platinum agents

Taxanes

Vinca alkaloids

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16
Q

Monitoring for Cardiotoxicity? What should be avoided?

A

ECG or ECHO or MUGA monitoring

Chest radiation is avoided…causes more damage

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17
Q

Cardiotoxicity is more severe with what agents?

A

Cardiomyopathy:

  • Anthracyclines* (think chemo man doxorubicin-heart)
  • HER2-I’s
  • fluorouracil
  • lapatinib

QT Prolongation:

  • Arenicic trioxide*
  • TKIs
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18
Q

High risk agents for Pulmonary toxicity?

A

Pulmonary fibrosis:
- Belomycin and 3 specific alkylators: busulfan, carmustine, lomustine (think chemo man bleomycin lungs)*

Pneumonitis:

  • Methotrexate
  • Immune therapy MAB’s
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19
Q

What’s used to flush drug out and prevent bladder/renal toxicity?

A

Hydration

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20
Q

What may be used to reduce risk of Cisplatin-induced nal toxicity?

A

Amifostene (Ethyol)

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21
Q

What’s always given with Ifosfamide? Why?

A

MESNA (Mesnex) (also recommended in HIGH doses of cyclophosphamide)

To prevent hemorrhagic cystitis

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22
Q

Which agents cuz Acneiform rash?

A

Cetuximab

Erlotinib

Panitumumab

Sorafenib

Sunitinib

And all agents with EGFR inh MOA

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23
Q

What’s mucositis?

A

Painful inflammation of GI tract

Called oral mucositis if conc in mouth

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24
Q

High risk agents for Mucositis?

A

5- fluorouracil

Capecitabine

Irinotecan

Methotrexate

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25
Which 2 agents are mist prone to causing Hand-foot syndrome?
Capecitabine 5-FU
26
Agents at mist risk of causing clotting risk?
SERMs (monitor for DVT/PE) Some immunomodulators eg. Thalidomide Lenalidamide Pomalidomide
27
Which agents cause the highest risk of alopecia?
Taxanes Anthracyclines These cause alopecia in nearly 100% of pts
28
What's Extravasation?
Leakage of drug from vein into extravascular space.
29
How to deal with Extravasation? Exception?
Stop infusion Elevate limb Use cold compress (except with Vinca alkaloids and Etoposide - use warm compress)
30
Agents that have a high risk of Extravasation?
Anthracyclines Ixabepilone Mitomycin Teniposide Vinca alkaloids
31
Antidotes for Extravasation caused by Anthracyclines?
Dimethyl Sulfoxide (DMSO) or Dexrazoxane (Totect) - Main one Or Mitoxantrone
32
Antidotes for Extravasation caused by Vinca alkaloids?
Hyaluronidase
33
Antidotes for Extravasation caused by Mechlorethamine?
Sodium thiosulfate
34
When does the Nadir (lowest point that WBC and platelets reach) occur?
About 7-14 days after chemotherapy RBC - 120 days after chemo cuz of long lifespans
35
When do cell lines gen recover post-tx?
3-4 weeks pits tx
36
Effect of ESA on some CA?
ESAs can shorten and increase tumor progression in some CA
37
What must be fulfilled b4 ESA is used in CA?
ESA APPRISE (REMS program)
38
Normal hgb levels?
F - 12-16 g/dL M - 13.5-18g/dL
39
What's ordered to access iron storage and transport?
Serum ferritin + Transferrin saturation + Total iron-binding capacity (TIBC)
40
Why must iron storage and transport be measured b4 starting ESAs?
ESAs won't work well to correct anemia if iron levels are inadequate
41
BBWs for use of ESAs in CA?
Can shorten overall survival and/or increase the risk of tumor progression or recurrence Prescribers and hospitals must enroll in and comply with ESA APPRISE Pt must receive ESA MedGuide (when therapy begins and at least monthly, if continuing) ESAs shouldn't be used if hgb level < 10g/dL ESAs aren't indicated for pts when anticipated outcome is cure, since tumor may progress and there's thrombosis risk
42
At what level of hgb is ESA to recommended?
Hgb < 10g/dL
43
List ESA agents
Epoetin alfa (Epogen, Procrit) Darbepoetin (Aranesp)
44
Brand name of Epoetin alfa (ESA)?
Epogen Procrit
45
Brand name of Darbepoetin alfa (ESA)?
Aranesp
46
What may contribute to risk of ADRs with ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp)) use?
Rapid rise in hemoglobin (> 1 g/dL over 2 wks)
47
SEs of ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp))?
HTN Thrombosis
48
Monitoring while on ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp))?
Hgb Hct Transferrin saturation Serum ferritin BP
49
How do u categorize Neutropenia in CA?
< 1,000 mmol/L
50
How do u categorize Severe Neutropenia in CA?
< 500 mmol/L
51
How do u categorize Profound Neutropenia in CA?
< 100 mmol/L
52
Know how to calculate ANC?
Reviewed in calculations chapter
53
Role of CSFs (myeloid growth factors)?
When used prophylactically in pts with high risk of febrile neutropenia, that shorten risk of infection due to neutropenia and reduce mortality from inf
54
Agents under CSFs (myeloid growth factors)?
Sargramostim (Leukime) GM-SCG Filgrastim (Neupogen) G-CSF Pegfilgratim (Neulasta) Peglyated G-CSF
55
Brand name of Sargramostim - CSFs (myeloid growth factors)?
Leukine
56
Brand name of Filgrastim - CSFs (myeloid growth factors)?
Neupogen
57
Brand name of Pegfilgrastim - CSFs (myeloid growth factors)?
Neulasta
58
Ses of Filgrastim (Neupogen) & Pegfilgrastim (Neulasta)?
Bone pain
59
SEs of Sargramostim (Leukine)?
Fever Bone pain Arthralgias Myalgias Rash
60
When's platelet transfusion recommended in thrombocytopenia?
When counts fall below 10,000/mm^3 20,000/mm^3 if pt has an active bleed
61
List agents with high emetic risk (> 90% freq)
Cisplatin AC combo (Doxorubicin or Epirubici + Cyclophosphamide) Epirubicin > 90mg/m2 Ifofsamide >= 2 g/m2 per dose Cyclophosphamide > 1,500mg/m2 Doxorubicin >= 60 mg/m2
62
List agents with minimal emetic risk (< 10% freq)
``` Majority of monoclonal antibodies Bevacizumab Cetuximab Ipilimumab Panitumumab Pertuzumab Rituximab Trastuzumab ``` Bleomycin Vinca alkaloids
63
List Anti-Emetic regimens for acute nausea and vomiting
Aprepitant (IV = Fosaprepitant) + Dexamethasone + (1st two are for days 1-4) Ondansetron (PO/IV) / Granisetron (PO/IV) / Dolasetron (PO only) / Palonosetron (IV preferred) (for day 1 only)
64
What's the alternative for n/v?
Olanzapine-Containing regimen Olanzapine (PO) + Dexamethasone (IV) + Palonosetron (IV)
65
What's delayed emesis?
Vomiting occurring > 24 hrs after chemo
66
Prevention of delayed emesis?
Dexamethasone Aprepitant Palonosetron ( alone or in combo)
67
What may be added for anxiety/amnestic response?
Lorazepam (Ativan)
68
What could be used if upper GI sx similar to GERD are present?
H2RA or PPR
69
What's the gold standard to moderate emergencies chemo?
Steroid + 5-HT3 receptor antagonist
70
Agents used in Low emetic risk chemo?
Single agents eg Dexamethsone Or Prochlorperazine Or Metoclopramide
71
Concern with Phenothiazines and Metoclopramide use?
Dopamine-blocking agents... Could cause or worsen movement disorder Sedating and can cause cognitive dysfunctions
72
When do u reduce Metoclopramide dose?
Renal dysfunction
73
SEs of centrally-acting antihistamines eg diphenhydramine? Why?
Can cause central and periphetal anticholinergic SEs These may be intolerable in elderly pts
74
Which can be used a 2nd line agents in low emetic risk?
Dronabinol (Marinol) Nabilone (Cesamet) (These are delta-9-tetrahydrocannabinol...from cannabis (marijuana))
75
MOA of 5-HT3 antagonist?
Block serotonin, both peripherally on vagal nerve terminals and central in the chemoreceptor trigger zone
76
Agents under 5-HT3 antagonist?
All these can be used in high emetic risk Ondasetron (Zofran, Zuplenz film) Granisetron (Granisol soln, Sancuso transdermal patch) Dolasetron (Anzemet) Palonosetron (Aloxil)
77
Brand name of Ondansetron (5-HT3 antagonist)?
Zofran Zuplenz film IV, PO, ODT, soln
78
Brand name of Granisetron (5-HT3 antagonist)?
Granisol soln Sancuso transdermal patch IV, PO, soln
79
Brand name of Dolasetron (5-HT3 antagonist)?
Anzemet
80
Brand name of Palonosetron (5-HT3 antagonist)?
Aloxil
81
What's the single max IV & PO dose of Ondansetron (Zofran, Zuplenz film)?
IV dose - 16mg PO - 24mg
82
CIs to 5-HT3 antagonists use?
Don't use Dolasetron (Anzemet) IV for acute CINV (due to QT prolongation)
83
SEs to 5-HT3 antagonists use?
HA Fatigue Dizziness Constipation
84
Role of Sancuso patch (Granisetron) in therapy?
Useful if sores in mouth (mucositis) Apply day before chemo and leave on at least 24 hrs after last session - lasts up to 7 days
85
What's a risk associated with 5-HT3 antagonists use? What should be corrected b4 using 5-HT3 antagonist?
Risk of QT interval (torsades de Pointes) Correct Mg and K and monitor ECG
86
MOA of Phenothiazines?
Block dopamine receptors in the CNS, including the chemoreceptor trigger zone (among other mechanisms)
87
Agents under Phenothiazines?
Prochlorperazine (Compro) Chlorpromazine (Thorazine) Promethazine (Phenergan, Phenadoz, Promethegan)
88
Brand name of Prochlorperazine - Phenothiazines?
Compro
89
Brand name of Promethazine - Phenothiazines?
Phenergan Phenadoz Promethegan
90
CI to Phenothiazines?
Don't use in children < 2 yrs Don't admin Promethazine via SC route
91
SE to Phenothiazines?
Sedation Lethargy Acute EPS
92
List corticosteroid used in emetic?
Dexamethasone (Decadron) IV, PO
93
What's the brand name of Dexamethasone?
Decadron
94
Cannabinoids used as emetic?
Dronabinol (Marinol) - C III Nabilone (Cesamet) - C II
95
How should Dronabinol (Marinol) - C III be stored?
Refrigerate capsules
96
SEs to Cannabinoids (Dronabinol, Nabilone)?
Drowsiness Euphoria Increased appetite
97
Uses of Substance P/Neurokinin-1 receptor antagonist?
Acute and delayed emesis
98
Agents under Substance P/Neurokinin-1 receptor antagonist?
Aprepitant (Emend) Fosaprepitant (Emend for inj)
99
Brand name of Aprepitant and Fosaprepitant? (Substance P/Neurokinin-1 receptor antagonist)
Aprepitant (Emend) Fosaprepitant (Emend for inj
100
SEs of Substance P/Neurokinin-1 receptor antagonist (Aprepitant (Emend) and Fosaprepitant (Emend for inj))?
Dizziness Fatigue Constipation Hiccups
101
What's prophylaxis for mucositis that ALL pts can use? Which is FDA approved?
Saline rinse several times daily | Palifermin (Kepivance) is FDA-approved only for high dose chemo prior to stem cell transplant
102
What's best to prevent hand-foot syndrome?
Emollients such as petrolatum, Udderly smooth cream and Bag Balm Note: lotions don't provide adequate protection
103
Whats used early in metastatic dx to PREVENT SKELETAL-RELATED EVENTS (bone pain, skeletal damage eg fracture)
Bisphosphonates Or Denosumab (Xgeva)
104
List tx of hypercalcemia of malignancy tx
Hydration with normal saline Loos diuretics Calcitonin IV Bisphosphonates (Zoledronic acid (Zometa) or Pamidronate (Aredia))
105
How's loop diuretics used in CA?
Only with hydration
106
Vaccinations and chemo?
Avoid vaccinations during chemo Vaccinations must be given at least 2 wks b4 chemo starts
107
List the warning signs of cancer in adults
``` Change in bowel or bladder habits A sore that doesn't heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart or mole Nagging cough or hoarseness ``` CAUTION
108
Cancer screening recommendations in women:
Once 21 yo: pap smear q3yr Once 30 yo: pap smear + HPV test q5yr Once 45 yo: mammograms yearly, AND [fecal occult blood test yearly OR stool DNA test q3yr], AND [colonoscopy q10yr OR sigmoidoscopy q5yr] Once 55 yo: CT of chest yearly IF smoking Hx
109
Cancer screening recommendations in men:
Once 45 yo: [fecal occult blood test yearly OR stool DNA test q3yr], AND [colonoscopy q10yr OR sigmoidoscopy q5yr] Once 50 yo: if patient opts to be treated: PSA +/- DRE Once 55 yo: CT of chest yearly IF smoking Hx
110
Most important drugs regarding nephrotoxicity
Platinum agents, Cisplatin most importantly, and MTX. Hemorragic cystitis is apparently considered a separate complication.

NAPLEX: Evan (7 decks)

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