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Oncology II Flashcards

1
Q

Whats Dubois and Dubois Formular?

A

BSA (m^2) = 0.007184 x Height (cm)^0.725 x Weight (kg)^0.425

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2
Q

Whats Mosteller Formular? Also used for BSA calculation

A

BSA = | (Ht -cm x Wt -kg)/ 3600

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3
Q

List phases of cell cycle

A

M - mitosis - cell divides into 2 daughters

Go - Resting phase post mitosis - no cell division occurs

G1 - Post-mitotic phase - where enzymes & proteins are synthesized

S - DNA synthesis and duplication occurs

G2 - Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepare for cell division

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4
Q

What’s M-phase of the cell cycle? Drugs that work here?

A

Mitosis - cell divides into 2 daughter cell

Anti-mitotic drugs
Vinca alkaloids
Taxanes

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5
Q

What’s Go-phase of the cell cycle? Drugs that work here?

A

Resting phase (post mitosis) - no cell division occurs

None! No drugs work here

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6
Q

What’s G1-phase of the cell cycle? Drugs that work here?

A

Post-mitotic phase - where enzymes and proteins are synthesized (Cell growth and preparation for DNA replication)

None!

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7
Q

What’s S-phase of the cell cycle? Drugs that work here?

A

DNA synthesis and duplication occurs

Topoisomerase I inhibitors + Anti-metabolites

  • Irinotecan
  • Topocetan
  • MTX
  • 5-FU
  • Capecitabine
  • Pemetrexed
  • Cytarabine
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8
Q

What’s G2-phase of the cell cycle?

A

Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepared for cell division

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9
Q

Which drugs work on both G2 and S-phase?

A

Topoisomerase II inhibitors eg

Etoposide

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10
Q

List non-cell cycle specific agents

A

Alkylating agents

Anthracyclines

Platinum agents

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11
Q

MOA of Alkylators?

A

Non-cell cycle specific: Cross-links DNA, preventing cell replication

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12
Q

List the main Alkylators?

A

Cyclophosphamide (Cytoxan)

Ifofsamide (Ifex)

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13
Q

Brand name of Cyclophosphamide? Alkylator (non-cell cycle specific)

A

Cytoxan

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14
Q

Brand name of Ifosfamide? Alkylator (non-cell cycle specific)

A

Ifex

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15
Q

Whats concern with High-dose Cyclophosphamide (Cytoxan) and all doses of Ifosfamide (Ifex)? What’s done to mitigate concern?

A

Bladder toxicity

Give MESNA (Mesnex) + High-dose Cyclophosphamide (Cytoxan)

MESNA (Mesnex) + ALL doses of Ifosfamide (Ifex)

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16
Q

Which Alkylators is a MAO-I?

A

Procarbazine (avoid interacting drugs/food)

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17
Q

Which Alkylators is used with non-PVC bag and tubing due to leaching of DEHP?

A

Carmustine

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18
Q

BBW of Alkylators?

A

Hemorrhagic cystitis (Ifosfamide, cyclophosphamide)

Secondary malignany

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19
Q

Main SE of Busulfan, Carmustine, Lomustine (Alkyaltors)?

A

Pulmonary toxicity

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20
Q

Which Alkylators is highly emetogenic and can cause flu-like sx?

A

Dacarbazine (DTIC)

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21
Q

MOA of Anthracyclines?

A

Non-cell specific: works by various MOA, including intercalation into DNA

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22
Q

List Anthracyclines agents

A

Doxorubicin (Adriamycin)

Idarubicin (Idamycin)

Daunorubicin (Cerubidine)

Mitoxantrone (Novantrone)

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23
Q

Brand name of Doxorubicin? Anthracyclines

A

Adriamycin

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24
Q

Brand name of Doxorubicin Liposomal? Anthracyclines

A

Doxil

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25
Q

Brand name of Idarubicin? Anthracyclines

A

Idamycin

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26
Q

Brand name of Daunorubicin? Anthracyclines

A

Cerubidine

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27
Q

Brand name of Mitoxantrone? Anthracyclines

A

Novantrone

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28
Q

What limits use of Anthracyclines?

A

Very effective but use limited by cardiac toxicity and N/V

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29
Q

Anthracyclines are vesicants… What’s used as an antidote for them?

A

Dexrazoxane (Totect)

Or

Dimethyl Sulfoxide

Don’t use both!

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30
Q

How do u mitigate Cardiotoxicity caused by Anthracyclines?

A

There’s max lifetime doses for most of the,

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31
Q

What’s the max lifetime dose of Doxorubicin (Adriamycin)? With mediastinal radiation?

A

Doxorubicin = 450-550 mg/m^2

Mediastinal radiation = 450 mg/m^2

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32
Q

What’s the cardioprotective agent used with Doxorubicin?

A

Dexrazoxane (Zinecard)

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33
Q

When should u consider adding Dexrazoxane (Zinecard) to Doxorubicin?

A

When doxorubicin doses are anticipated to continue beyond 300 mg/m^2

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34
Q

What color do anthracyclines turn body fluids into? Exception?

A

Red

Mitoxantrone (Novantrone) turns body fluid BLUE

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35
Q

BBW of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?

A

Irreversible myocardial toxicity

Potent vesicant

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36
Q

SEs of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?

A

Alopecia

Extravasation

Red urine and body secretions (blue with mitoxantrone)

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37
Q

MOA of platinum-based compounds?

A

Non-cell cycle specific: cross-links DNA, leading to apoptosis

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38
Q

Agents under Platinum-based compounds?

A

Cisplatin (Platinol)

Carboplatin (Paraplatin-AQ)

Oxaliplatin (Eloxatin)

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39
Q

Brand name of Cisplatin? Platinum-based compounds

A

Platinol

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40
Q

Brand name of Carboplatin? Platinum-based compounds

A

Paraplatin-AQ

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41
Q

Brand name of Oxaliplatin? Platinum-based compounds

A

Eloxatin

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42
Q

Unique concerns of Ciplatin (Platinol) - Platinum-based compounds?

A

Nephrotoxicity (vigorous hydration & sometimes, mannitol)

Electrolyte wasting (req Mg and K supplementation)

Ototoxicity (audio grams recommended b4 each prior)

Severe N/V (use 3 drug combo antiemetic regimen)

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43
Q

What may be used prophylactically for renal protection when using Cisplatin (Platinol)?

A

Amifostine (Ethyol)

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44
Q

Unique concerns wrt Oxaliplatin (Eloxatin)? Platinum-based Compds

A

Neuropathy exacerbation by exposure to cold

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45
Q

BBW associated with Platinum-based Compds?

A

Cumulative renal toxicity

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46
Q

SEs associated with Platinum-based Compds?

A

Neuropathy

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47
Q

Moa of Folate Antimetabolites?

A

Cell cycle specific, S-phase: prevent DNA synthesis

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48
Q

Agents under Folate Antimetabolites?

A

Methotrexate (Trexail, Rheumatrex)

Pemetrexed (Alimta)

Pralatrexate (Folotyn)

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49
Q

What’s req with high-doses of MTX?

A

Leucovorin (or Levoleucovorin)

To reduce toxicity

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50
Q

What meds should be avoided with MTX? Why?

A

Aspirins, Beta-lactams, Probenecid and NSAIDs

Reduces active transport renal elimination => resulting in toxicity

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51
Q

What can be done to reduce toxicity of MTX?

A

Maintain hydration…drink fluids

Alkalinize urine (by giving bicarbonate IV)

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52
Q

What supplements should be used with Pemetrexed (Alimta)?

A

Folic acid supplements (1mg PO daily)

Vit. B12 (cyanocobalamin) + dexamethasone

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53
Q

BBWs of MTX?

A

Preserved formulation for intrathecal admin

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54
Q

SEs of MTX (Trexail, Rheumatrex)?

A

Myelosuppression

Mucositis

Hepatic and renal toxicity (renal is dose-related)

Pulmonary toxicity

Red-tender palms and feet (hand-foot syndrome)

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55
Q

MOA of Pyrimidine Analog Antimetabolites?

A

Cell cycle specific, S-phase: inihibits Pyrimidine synthesis

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56
Q

Agents under Pyrimidine Analog Antimetabolites?

A

Capecitabine (Xeloda)

Cytarabine (Ara-C, Cytosar)

Fluorouracil (5-FU, Adrucil)

Gemcitabine (Gemzar)

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57
Q

Brand name of Capecitabine? Pyrimidine Analog Antimetabolites

A

Xeloda

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58
Q

How should Capecitabine (Xeloda) be used?

A

PO — take with meal

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59
Q

What testing should done with Capecitabine (Xeloda) use?

A

Pharmacogenomics testing for Dihydropyrimidine dehydrogenase (DPD)

Deficiency increases risk of sever toxicity

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60
Q

Capecitabine (Xeloda) and INR?

A

Increases INR up to 91% due to 2C9 inhibition

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61
Q

CI to Capecitabine (Xeloda) use?

A

Dihydropyrimidine dehydrogenase (DPD) deficiency

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62
Q

SEs of Capecitabine (Xeloda)?

A

Hand-foot syndrome (more than 5-FU)

Diarrhea

Mucositis

Gastritis

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63
Q

Unique concerns wrt Cytarabine (Ara-C, Cytosar)?

A

Ara-C syndrome eg fever, gen weakness, fatigue, skin rash, reddened eyes, bone, muscle, joint and/or chest pain

Responds to Coticosteroids

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64
Q

Brand name of Fluorouracil (Pyrimidine Analog Antimetabolites)?

A

5-FU

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65
Q

What’s Fluorouracil given with? Why?

A

5-FU is given with Leucovorin

To increase efficacy of 5-FU

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66
Q

CI to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?

A

Dihydropyrimidine dehydrogenase (DPD) deficiency

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67
Q

SE to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?

A

Mucositis

Hand-foot syndrome (with continuos infusion)

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68
Q

Brand name of Gemcitabine? Pyrimidine Analog Antimetabolites

A

Gemzar

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69
Q

Unique concerns with Gemcitabine (Gemzar)? Pyrimidine Analog Antimetabolites

A

Prolonged infusion time may increased toxicities

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70
Q

MOA of Taxanes?

A

M-phase specific: Inhibit microtubule fxn

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71
Q

When used in combo, whys Taxanes given first?

A

Elimination of Taxanes is reduced when given immediately after admin of Cisplatin or Carboplatin

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72
Q

List Taxanes agents

A

Paclitaxel (Taxol)

Docetaxel (Taxotere)

Carbazitaxel (Jevtana)

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73
Q

Brand name of Paciltaxel? (Taxanes)

A

Taxol

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74
Q

Brand name of Docetaxel? (Taxanes)

A

Taxotere

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75
Q

Unique concerns of Paciltaxel (Taxol) - Taxanes?

A

Anaphylaxis, hypersensitivity rxn

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76
Q

What’s used to pre-.treat when using Paciltaxel (Taxol) - Taxanes?

A

Dexamethasone

Diphenhydramine

H2RA

(To reduce anaphylaxis, hypersensitivity rxns)

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77
Q

How should all Taxanes be given IV?

A

Use non-PVC IV bag and tubing, due to leaching of DEHP

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78
Q

SEs of Paciltaxel (Taxol); Docetaxel (Taxotere); Cabazitaxel - Taxanes?

A

Myelosuppression

Peripheral neuropathy

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79
Q

Unique concerns of Docetaxel (Taxotere)?

A

Hypersensitivity

Cardio-Pulmonary: Fluid retention
Pre-treat with dexamethasone 8mg bid x 3 days

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80
Q

SE unique to Docetaxel (Taxotere)? (In addition to Myelosuppression, peripheral neuropathy)

A

Fluid retention

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81
Q

MOA of Vinca Alkaloids?

A

M-phase specific: Inhibit microtubule fxn

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82
Q

List agents under Vinca Alkaloids

A

Vincristine (Vincasar, Oncovin)

Vinblastine (Velban)

Vinorelbine (Navelbine)

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83
Q

Brand name of Vincristine (Vinca Alkaloids)?

A

Vincasar

Oncovin

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84
Q

Brand name of Vinblastine (Vinca Alkaloids)?

A

Velban

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85
Q

Brand name of Vinorelbine (Vinca Alkaloids)?

A

Navelbine

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86
Q

Vinca alkaloids are vesicants, whats the preferred way they should be delivered to the body?

A

Via central line

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87
Q

How should Extravasation be treated in Vinca Alkaloids?

A

Warm compress + Hyaluronidase

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88
Q

What’s the only route of admin for vinca alkaloids?

A

IV only

Don’t admin intrathecally - fatal

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89
Q

Which Vinca Alkaloids causes only mild suppression?

A

Vincristine (Vincasar, Oncovin)

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90
Q

What’s the max single dose of Vincristine (Vincasar, Oncovin)?

A

2mg

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91
Q

BBWs of Vincristine (Vincasar, Oncovin)?

A

Intrathecal admin

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92
Q

Ses of Vincristine (Vincasar, Oncovin)?

A

Cumulative (dose-dependent) nerve damage/ peripheral neuropathy

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93
Q

BBWs of Vinblastine (Velban) and Vinorelbine (Navelbine)?

A

Myelosuppression

Peripheral neuropathy (less than vincristine)

Gastroparesis/constipation

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94
Q

MOA of Topoisomerase I inhibitors?

A

Blocks coiling uncoiling of DNA helix

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95
Q

Agents under Topoisomerase I inhibitors?

A

Irinotecan (Camptosar)

Topotecan (Hycamtin)

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96
Q

Brand name of Irinotecan? Topoisomerase I inhibitors

A

Camptosar

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97
Q

Types of diarrhea caused by Irinotecan (Camptosar) Topoisomerase I inhibitors? Tx?

A

Acute diarrhea (cholinergic sx) - treat with Atropine

Delayed diarrhea - treat with Loperamide (up to 24mg daily)

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98
Q

What’s req B4 use of Irinotecan (Camptosar) Topoisomerase I inhibitors?

A

Pharmacogenomic testing

Those who are homozygous for the UGT1A1*28 allele are at increased risk for neutropenia and other tcoxicities

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99
Q

SEs of Irinotecan (Camptosar) Topoisomerase I inhibitors?

A

Diarrhea

Myelosuppression

Mucositis

100
Q

MOA of Topoisomerase II inhibitors?

A

G2-phase specific

101
Q

Agents under Topoisomerase II inhibitors?

A

Etoposide (VePesid)

Teniposide (Vumon)

102
Q

Brand name of Etoposide? (Topoisomerase II inhibitors)

103
Q

Storage of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?

A

Refrigerate

104
Q

Main SE of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?

A

Hypotension

105
Q

What should be used to deliver Teniposide (Vumon) - Topoisomerase II inhibitors?

A

Non-PVC IV bag and tubing due to leaching of DEHP

106
Q

What’s the agent under Epothilone?

A

Ixabepilone (Ixempra)

107
Q

What should be used to deliver Ixabepilone (Ixempra)?

A

Use non-PVC IV bag and tubing due to leaching of DEHP

108
Q

List miscellaneous agents

A

Tretinoin (all-Trans Retinoic acid)

Arsenic trioxide (Trisenox)

L-Asparaginase (Elspar)

Bleomycin

Mitomycin (Mutamycin)

109
Q

Pregnancy category of Tretinion (All-Trans Retinoic Acid)?

110
Q

BBW of Tretinion (All-Trans Retinoic Acid) & Arsenic trioxide (Trisenox)?

A

RA-APL differentiation syndrome

111
Q

Monitoring of Arsenic trioxide (Trisenox)? Why?

A

Monitor ECG, keep Mg and K within normal range

Bcuz of QT prolongation

112
Q

Role of Erwinaze in therapy?

A

FDA proved for pts who develop allergic rxns to the E.coli derived Asparaginase

113
Q

SEs of L-Asparaginase (Elspar); Asparaginase (Erwinaze); Pegaspargase PEG (Oncaspar)?

A

Hypersensitivity rxns

Pancreatitis

114
Q

SEs of Bleomycin?

A

Hypersensitivity rxn

Pulmonary rxns (10%) - such as pneumonitis

115
Q

Advantage of Bleomycin?

A

Not myelosuppressive

116
Q

Maximum lifetime dose of Bleomycin? Why is there a max dose?

A

400 units (400mg) of Bleomycin

Due to pulmonary toxicity risk

117
Q

What’s the source of U-mab? (MAB = monoclonal antibody)

A

U-mab = hUman

118
Q

What’s the source of O-mab? (MAB = monoclonal antibody)

A

O-mab = mOuse

119
Q

What’s the source of Xi-mab? (MAB = monoclonal antibody)

A

Xi = Chimeric (human + animal source)

120
Q

What’s the source of Zu-mab? (MAB = monoclonal antibody)

121
Q

Target of Bevacizumab (Avastin)?

A

Binds to VEGF-A

122
Q

Target of Cetuximab (Erbitux)?

A

Binds to EGFR

123
Q

Target of Trastuzumab (Herceptin)?

A

Binds to HER-2/neu

124
Q

Target of Rituximab (Rituxan)?

A

Binds to CD-20

125
Q

Target of Ipilimumab (Yervoy)?

A

Binds to Cytotoxic T-lymphocyte antigen-4 (CTL4) receptor

126
Q

Brand name of Bevacizumab (Avastin)? Monoclonal antibodies

127
Q

Bevacizumab (Avastin) and wound healing?

A

Impairs wound healing: stop at least 28 days b4 elective surgery and may restart 28 days after surgery

128
Q

SE of Bevacizumab (Avastin)?

A

Bleeding

HTN

HF

Thrombosis (including DVT, PE and stroke)

GI perforation

Wound dehiscence

129
Q

Brand name of Trastuzumab?

130
Q

What’s required for Trastuzumab (Herceptin) use? And Ado-Trastuzumab Emtansine (Kadcyla)? And Petuzumab (Perjeta)

A

HER2/neu over-expression required for use (>= 2+ by immunohistochemical (IHC) testing to respond/use this drug)

Pharmacogenomics testing reveals this

131
Q

Is Trastuzumab (Herceptin) interchangeable with Ado-Trastuzumab emtansine (Kadcyla)?

132
Q

Ses of Trastuzumab (Herceptin)?

A

Cardiomyopathy

133
Q

SE of Ado-Trastuzumab emtansine (Kadcyla)?

A

Cardiac dysfunction

134
Q

What’s req for Cetuximab (Erbitux) & Panitumumab (Vectibix) use?

A

EGFR positive expressions (Correlates to better response rates)

K-Ras mutation (indicates poor response)

(T4 req EGFR +ve and K-Ras negative)

135
Q

What must be done before Cetuximab (Erbitux) & Panitumumab (Vectibix) use?

A

Pharmacogenomics testing

136
Q

SEs of Cetuximab (Erbitux) & Panitumumab (Vectibix)?

A

Acne-rash

Mg and Ca wasting

137
Q

Cell surface marker targeted therapies?

A

Rituximab (Rituxan)

138
Q

Brand name of Rituximab? (Cell surface marker targeted therapies)

139
Q

Moa of Rituximab (Rituxan)? (Cell surface marker targeted therapies)

A

Targets CD-20 antigen on B lymphocytes

140
Q

Where should the infusion of Rituximab (Rituxan) - (Cell surface marker targeted therapies) be done? Why?

A

In hospital or clinic

Since they can be fatal

141
Q

What can be done prior to Rituximab (Rituxan) - (Cell surface marker targeted therapies) infusions?

A

Use Diphenhydramine and Acetaminophen (30-120 mins b4 infusion)

142
Q

SE of Rituximab (Rituxan) - (Cell surface marker targeted therapies)?

A

Infusion rxn (chills, rigors, fever)

Tumor lysis syndrome

Reactivation of hepatitis B

143
Q

Agents under Immunotherapy: stimulates the patients immune system?

A

Ipilimumab (Yervoy)

144
Q

Unique SE of Ipilimumab (Yervoy)?

A

Primarily autoimmune system unchecked

145
Q

SE of Ipilimumab (Yervoy)?

A

Dermatologic (rash, pruritus)

146
Q

BBW of Ipilimumab (Yervoy)?

A

Fatal immune-mediated rxns

147
Q

What’s used in “castration sensitive” patient that has prostate CA?

A

Luteinizing Hormone-Releasing Hormone (LHRH) agonists

For chronic suppression of testosterone

148
Q

What’s usually started in “castration sensitive” pts that have prostate CA prior to LHRH? Why?

A

Antiandrogens are started 1-4 wks prior to LHRH agonists.

To help mitigate tumor flare

149
Q

MOA of Antiandrogens?

A

Block androgens at the receptor site

150
Q

List agents under Antiandrogens? Role in therapy?

A

Bicalutamide (Casodex)

Flutamide (Eulexin)

Nilutamide (Nilandron)

Use 1-4 wks prior to starting LHRH agonists to mitigate tumor flare

151
Q

What’s the brand name of Bicalutamide (Antiandrogens)?

152
Q

What’s the brand name of Flutamide (Antiandrogens)?

153
Q

List LHRH agonists (used in prostate CA in males)

Endometriosis, fibroids and breast CA in Females

A

Goserelin (Zoladex)

Leuprolide (Lupron)

Histrelin (Vantas)

Triptorelin (Trelstar)

154
Q

Brand name of Goserelin (LHRH agonists)?

155
Q

Brand name of Leuprolide (LHRH agonists)?

156
Q

Why’s supplementation req with LHRH agonist? What else is recommended?

A

Bcuz of low bone density and increased risk of Osteoporosis

Consider Ca + Vit. D

Weight-beating exercise + DEXA screening

157
Q

What should be started at least 1 wk prior to use of LHRH agonists (Goserelin (Zoladex); Leuprolide (Lupron))?

A

Antiandrogens eg

Bicalutamide (Casodex)

Flutamide (Eulexin)

Nilutamide

158
Q

SEs of LHRH agonists? (Goserelin (Zoladex); Leuprolide (Lupron))?

A

Hot flashes

Bone pain

Impotence

Injection site pain/swelling

Dyslipidemia

QT prolongation

Gynecomastia (men)

Peripheral edema

159
Q

List Gonadotropin-Releasing Hormone (GRA) antagonist used in prostate CA

A

Degarelix (Firmagon)

160
Q

Agent under Antiandrogen: inhibits the production of Androgen (Testosterone)?

A

Abiraterone acetate (Zytiga)

161
Q

SEs of Abiraterone acetate (Zytiga)?

A

Mineralcorticoid elevation with fluid retention

162
Q

Agent under Antiandrogen: Receptor-signaling pathway inhibitor?

A

Enzalutamide (Xtandi)

163
Q

Ses of Enzalutamide (Xtandi)?

A

Seizures (~ 1%)

164
Q

Vaccine: Re-programs the immune system against advanced prostate CA?

A

Sipuleucel-T (Provenge)

165
Q

What’s the role of hormonal therapy in breast CA?

A

To prevent recurrence

166
Q

In what Grp of pts is hormonal therapy recommended, to prevent recurrence?

A

1) ER/PR+ (pre-menopausal) = SERM for 5-10yr (tamoxifen is 1st line)

2) ER/PR+ (post-menopausal) = Aromatase Inhibitor (AI) for 5-10 yrs
(Anastrozole is 1st line)

3) ER/PR (negative) = no benefit with hormonal agents
4) Malr breast CA pts with ER/PR+ will receive oral hormonal therapy (SERM agent for 5-10 yrs; Tamoxifen is typically 1st agent)

167
Q

Whats 1st line in HER2/neu tve pts?

A

Pertzumab + Trastuzumab + Docetaxel

168
Q

Role of Antiandrogen-Antiestrogen: Aromatase Inhibitors (AIs) -ALL ORAL?

A

Used in POST-menopausal women (not FDA-approved for men with breast cancer)

169
Q

Aromatase Inhibitors (AIs) agents?

A

Anastrozole (Arimidex)

Letrozole (Femara)

Exemestane (Aromasin)

Mitotane (Lysodren ) non-selective

170
Q

Brand name of Anastrozole? (Aromatase inhibitor -AI)?

171
Q

Brand name of Letrozole? (Aromatase inhibitor -AI)?

172
Q

Brand name of Exemestane? (Aromatase inhibitor -AI)?

173
Q

Supplement to be used with AIs? Why?

A

Ca + Vit. D

Other things to consider include: wt beating exercise & DEXA screen

Cuz of low bone density + high risk for osteoporosis

174
Q

Cardiovascular dx risk of AIs compared to SERMs?

A

AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin))

Have a HIGHER cardiovascular dx risk compared to SERMs

175
Q

What supplementation is req with Mitotane use only?

A

Glucocorticoid + Mineralocorticoid supplementation

176
Q

SEs to AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin)) use?

A

Arthralgia

Edema

Lethargy/fatigue

Rash

Menopausal sx/hot flashes

Hepatoxicity

N/V

Weakness

Joint pain

Bone pain

HTN

Depression

177
Q

Role of Antiestrogens/SERMs in therapy?

A

Used in PRE-menopausal women

Except Tamoxifen, which is indicated for Pre- & Post- menopausal women and men

178
Q

Brand name of Tamoxifen? (SERMs)

179
Q

Brand name of Fulvestrant? (SERMs)

180
Q

Brand name of Raloxifene? (SERMs)

181
Q

Uses of Raloxifene (Evista)?

A

For osteoporosis in women at risk of breast CA

182
Q

Concern with Tamoxifen (Soltamox) use?

A

Increases risk of Endometrial CA (others decrease risk)

183
Q

What’s recommended for pts experiencing hot flashes due to Tamoxifen use?

A

Venlafaxine (over Fluoxeyine and Paroxetine)

184
Q

SEs of SERMs (Tamoxifen; Fulvestrant; Raloxifene)?

A

DVT/PE

Menopausal sx

Hot flashes

Flushing

N/V

Edema

Weight gain

Increased blood pressure

Mood changes

Vaginal bleeding/discharge

Skin changes

Cataracts (Tamoxifen)

185
Q

What’s the concern with Lapatinib (Tykerb) use?

A

Tyrosine kinase inh (TKIs) targeting HER-2 neu

All TKIs are substrates of CYP3A4 & have many drug-drug interactions, some of which req dose modification

186
Q

Main SE of Lapatinib (Tykerb)?

A

Decreased LVEF

187
Q

What’s renal cell cancer (RCC)?

A

Mist common type of kidney CA in adults

Primary therapy is surgery (radical or partial nephrectomy) and is for
CURATIVE intent

188
Q

Agents under Tyrosine kinase inh (TKIs): targeting multiple kinases

A

Sunitinib (Sutent)

Pazopanib (Votreint)

Sorafenib (Nexavar)

189
Q

Brand name of Sunitinib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)

190
Q

Brand name of Pazopanib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)

191
Q

Brand name of Sorafenib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)

192
Q

Which Tyrosine kinase inh (TKIs): targeting multiple kinases is used without regard to food?

A

Sunitinib (Sutent)

193
Q

SEs of Sunitinib (Sutent) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?

A

Rash

Hand-for syndrome

HF

Reduced LVEF

QT prolongation

194
Q

SEs of Pazopanib (Votrient) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?

A

Htn

Prolongs QT interval

195
Q

SEs of Sorafenib (Nexavar) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?

A

Fatigue

HTN

Hand-foot syndrome

Diarrhea

196
Q

SEs of Axitinib (Inlyta)? (Tyrosine Kinase inh (TKIs) targeting VEGF)?

A

HTN

Hand-foot syndrome

Dysphonia

197
Q

Role of Everolimus (Afinitor) in therapy?

A

CA and transplantation

198
Q

SEs of Everolimus (Afinitor)?

A

Dyslipidemia

Rash

Stomatitis

Interstitial lung dx

199
Q

How should Temsirolimus (Torisel) be delivered to pts?

A

Use non-PVC bag & tubing due to leaching of DEHP

200
Q

SEs of Temsirolimus (Torisel)?

A

Dyslipidemia

Hyperglycemia

Myelosuppression

Interstitial lung dx

201
Q

List TKIs agents? What must be done prior to use of these agents?

A

Imatinib (Gleevec)

Nilotinib (Tasigna)

Dasatinib (Sprycel)

Bosutinib (Bosulif)

Use of these agents req pharmacogenomic testing for presence of bcr-able fusion gene

202
Q

Brand name of Imatinib?

203
Q

SEs of Imatinib (Gleevec)?

A

Fluid retention

Skin rash

Diarrhea

204
Q

SEs of Nilotinib (Tasigna)?

A

Prolongs QT interval

205
Q

SEs of Dasatinib (Sprycel)?

A

Pleural effusions

Fluid retention

Edema

206
Q

SEs of Bosutinib (Bosulif)?

207
Q

Agents under Tyrosine kinase inh (TKIs): Targeting EGFR? For non-small cell lung CA

A

Erlotinib (Tarceva)

Afatinib (Gilotrif)

208
Q

Brand name of Erlotinib? Used in non-small cell lung CA

209
Q

Dose of Erlotinib (Tarceva)?

A

150mg daily PO

Take 1 hr b4 or 2 hr after meal

210
Q

In what type of pts do Erlotinib (Tarceva) work best?

A

EGFR mutation positive

211
Q

Ses of Erlotinib (Tarceva)?

A

Acneiform rash

Diarrhea

Hepatoxicity

GI perforation

212
Q

In what type of pt is Afatinib (Gilotrif) approved for?

A

Pts with metastatic NSCLC + known EGFR exon 19 deletions or exon. 21 substitution

213
Q

Ses of Afatinib (Gilotrif)?

A

Acneiform rash

Diarrhea

Stomatitis

Dry skin

Paronychia

Reduced appetite

Prurities

214
Q

What condition must be met b4 using Crizotinib (Xalkori)?

A

Pt must be ALK tve to use this drug (Pharmacogenomics test req)

215
Q

Ses of Crizotinib (Xalkori)?

A

Swelling (edema)

N/V/D

Constipation

Vision disturbances

216
Q

List drugs used in melanoma

A

TKIs targeting BRAF: BRAF protein kinase mutation
Vemurafenib (Zelboraf)

Dabrafenib (Tafinlar)

Inh of Mitogen-Activated Extracellular Signal Kinase 1 and 2 (MEK1 and MEK 2)

Trametinib (Mekinist)

217
Q

Role of Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar) in therapy?

A

Metastatic melanoma pts with BRAF V600E mutations

218
Q

Which has less skin toxicities? Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar)?

A

Dabrafenib (Tafinlar)

219
Q

Se of Dabrafenib (Tafinlar)?

220
Q

SE of Vemurafenib (Zelboraf)?

A

Dermatologic disorders (rashes, photosensitivity, alopecia, pruritus, SJS/TEN)

Prolonged QT syndrome

221
Q

Role of Trametinib (Mekinist) in therapy?

A

For metastatic melanoma pts with BRAF V600E or V600K mutations

222
Q

SEs of Trametinib (Mekinist)?

A

Hand foot syndrome

Increased LFTs

Diarrhea

Anemia

Lymphedema

223
Q

What must not happen when a pt is on Immunomodulators?

A

Pt must not get pregnant using these drugs

224
Q

List agents under immunomodulators

A

Lenalidomide (Revlimid)

Pomalidomide (Pomalyst)

Thalidomide (Thalomid)

225
Q

Brand name of Lenalidomide (immunomodulator)?

226
Q

Brand name of Pomalidomide (immunomodulator)?

227
Q

Brand name of Thalidomide (immunomodulator)?

228
Q

Pregnancy cat of immunomodulators?

229
Q

When should u seek medical help? On which med?

A

If u develop SOB, chest pain, or arm or leg swelling

Lenalidomide (Revlimid)

230
Q

MOA of Proteasome inh?

A

26S Proteasome inh

231
Q

SEs of Bortezomib (Velcade) & Carfilzomib (Kyprolis)?

A

Peripheral neuropathy (worse with Bortezomib)

232
Q

What’s used with Bortezomib (Velcade) to prevent zoster reactivation?

233
Q

What’s the prevalent toxicities of Bleomycin, Busulfan, Carmustine, Lomustine?

A

Pulmonary Fibrosis

234
Q

What’s the prevalent toxicities of Cisplatin, Carboplatin?

A

Nephrotoxicity

Ototoxicity

235
Q

What’s the prevalent toxicities of Doxorubicin & other Anthracyclines?

A

Cardiotoxic

236
Q

What’s the prevalent toxicities of Methotrexate?

237
Q

What’s the prevalent toxicities of Nitrosoureas (Lomustine, Carmustine)

A

Neurotoxicity (cross BBB)

238
Q

What’s the prevalent toxicities of Ifosfamide & Cyclophosphamide?

A

Hemorrhagic Cystitis

239
Q

What’s the prevalent toxicities of Vinca Alkaloids (Vincristine, Vinblastine & Vinorelbine) and Taxanes (Paclitaxel, Docetaxel)?

A

Peripheral Neuropathy

240
Q

Bone marrow suppression (BMS) Is a common toxicity of many chemo agents, including

A

Alkylators

Anthracyclines

Folate antagonist

Platinum based Compds (Cisplatin)

Purine Antimetabolites

Pyrimidine Antimetabolites

Taxanes

Topoisomerase I and II inhi

Antimetabolites

Vinca alkaloids (Vinblastine & Vinorelbine)

241
Q

Main concern with using SERMs (tamoxifen)

A

Endometrial CA

Strokes

Blood clot

Increases risk of cataract

242
Q

When should Evista be d/c?

A

At least 72 hrs prior to and during immobilization

243
Q

Role of Aromatase inh?

A

Best for post-menopausal women

244
Q

Common SEs of AIs?

A

Joint pain

Osteoporosis

245
Q

What’s the most commonly used calculations for dosing, body surface area (BSA)?

A

DuBois and DuBois formula

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