Oncology II Flashcards
1
Q
Whats Dubois and Dubois formula used for? What is the formula?
A
body surface area
BSA (m^2) = 0.007184 x Height (cm)^0.725 x Weight (kg)^0.425
2
Q
Whats Mosteller formula used for? What is the formula?
A
body surface area
BSA = | (Ht -cm x Wt -kg)/ 3600
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
4
Q
M phase drugs
A
Vinca alkaloids
Taxanes
5
Q
G0 phase drugs
A
None! No drugs work here
6
Q
G1 phase drugs
A
Post-mitotic phase - where enzymes and proteins are synthesized (Cell growth and preparation for DNA replication)
None!
7
Q
S phase drugs
A
Topoisomerase I inhibitors
Antimetabolites
- Pyrimidine-analog antimetabolites
- Folate antimetabolites
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
9
Q
G2 phase drugs
A
Topoisomerase II inhibitors
10
Q
List non-cell cycle specific agents
A
Alkylating agents
Anthracyclines
Platinum agents
11
Q
MOA of Alkylators?
A
Non-cell cycle specific: Cross-links DNA, preventing cell replication
12
Q
List the main Alkylators?
A
Cyclophosphamide (Cytoxan)
Ifofsamide (Ifex)
13
Q
Brand name of Cyclophosphamide? Alkylator (non-cell cycle specific)
A
Cytoxan
14
Q
Brand name of Ifosfamide? Alkylator (non-cell cycle specific)
A
Ifex
15
Q
Whats concern with High-dose Cyclophosphamide (Cytoxan) and all doses of Ifosfamide (Ifex)? What’s done to mitigate concern?
A
Hemorrhagic cystitis
Give MESNA (Mesnex) + High-dose Cyclophosphamide (Cytoxan)
MESNA (Mesnex) + ALL doses of Ifosfamide (Ifex)
16
Q
Which Alkylators is also an MAO-I?
A
Procarbazine (avoid interacting drugs/food)
17
Q
Which Alkylators is used with non-PVC bag and tubing due to leaching of DEHP?
A
Carmustine
18
Q
Key BBW of Alkylators?
A
Hemorrhagic cystitis (Ifosfamide, cyclophosphamide)
19
Q
Main SE of Busulfan, Carmustine, Lomustine (Alkyaltors)?
A
Pulmonary toxicity
20
Q
MOA of Anthracyclines?
A
Non-cell specific: works by various MOA, including intercalation into DNA
21
Q
List Anthracyclines agents
A
Doxorubicin (Adriamycin)
Idarubicin (Idamycin)
Daunorubicin (Cerubidine)
Mitoxantrone (Novantrone)
22
Q
Brand name of Doxorubicin? Anthracyclines
A
Adriamycin
23
Q
Brand name of Doxorubicin Liposomal? Anthracyclines
A
Doxil
24
Q
Brand name of Idarubicin? Anthracyclines
A
Idamycin
25
Brand name of Daunorubicin? Anthracyclines
Cerubidine
26
Brand name of Mitoxantrone? Anthracyclines
Novantrone
27
What limits use of Anthracyclines?
Very effective but use limited by cardiac toxicity and N/V
28
Anthracyclines are vesicants... What's used as an antidote for them?
Dexrazoxane (Totect)
Or
Dimethyl Sulfoxide
29
How do u mitigate Cardiotoxicity caused by Anthracyclines?
There's max lifetime doses for most of them
30
What's the max lifetime dose of Doxorubicin (Adriamycin)?
Doxorubicin = 450-550 mg/m^2
31
What's the cardioprotective agent used with Doxorubicin?
Dexrazoxane (Zinecard)
32
When should u consider adding Dexrazoxane (Zinecard) to Doxorubicin?
When cumulative doxorubicin doses > 300 mg/m^2
33
What color do anthracyclines turn body fluids into? Exception?
Red
Mitoxantrone (Novantrone) turns urine BLUE
34
BBW of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Myocardial toxicity
Vesicant
Myelosuppresion
35
SEs of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Hand-foot syndrome
Alopecia
Extravasation
Red urine and body secretions (blue with mitoxantrone)
36
MOA of platinum-based compounds?
Non-cell cycle specific: cross-links DNA, leading to apoptosis
37
Agents under Platinum-based compounds?
Cisplatin (Platinol)
Carboplatin (Paraplatin-AQ)
Oxaliplatin (Eloxatin)
38
Brand name of Cisplatin? Platinum-based compounds
Platinol
39
Brand name of Carboplatin? Platinum-based compounds
Paraplatin-AQ
40
Brand name of Oxaliplatin? Platinum-based compounds
Eloxatin
41
Unique concerns of Cisplatin (Platinol) - Platinum-based compounds?
Nephrotoxicity (vigorous hydration & sometimes, mannitol)
Ototoxicity (audio grams recommended b4 each prior)
Highly emetogenic (use high-risk antiemetic regimen)
42
What may be used prophylactically for renal protection when using Cisplatin (Platinol)?
Amifostine (Ethyol)
43
Unique concerns wrt Oxaliplatin (Eloxatin)? Platinum-based Compds
Acute sensory neuropathy exacerbation by exposure to cold
44
BBW associated with Platinum-based Compds?
Anaphylactic-like reactions - risk increased with repeated exposure
Renal toxicity
Ototoxicity
45
SEs associated with Platinum-based Compds?
Peripheral neuropathy
46
Moa of Folate Antimetabolites?
Cell cycle specific, S-phase: prevent DNA synthesis
47
Agents under Folate Antimetabolites?
Methotrexate (Trexail, Rheumatrex)
Pemetrexed (Alimta)
Pralatrexate (Folotyn) - less important
48
What's req with high-doses of MTX?
Leucovorin or Levoleucovorin (Fusilev)
49
What meds should be avoided with MTX? Why?
Most important: Aspirin and NSAIDs
Also: beta-lactams, and probenecid
All decrease renal clearance of MTX
50
What can be done to reduce nephrotoxicity of MTX?
Hydration and IV bicarbonate
51
What supplements should be used with Pemetrexed (Alimta)?
folic acid supplements (1mg PO daily)
Vit. B12 (cyanocobalamin)
dexamethasone
52
Consideration regarding intrathecal MTX admin?
Only preservative free formulations
53
SEs of MTX (Trexail, Rheumatrex)?
Most important: Nephrotoxicity (dose related) and Hepatotoxicity (more common w/ chronic use)
Mucositis
Pulmonary toxicity
Red-tender palms and feet (hand-foot syndrome)
Myelosuppression
54
MOA of Pyrimidine Analog Antimetabolites?
Cell cycle specific, S-phase: inihibits Pyrimidine synthesis
55
Agents under Pyrimidine Analog Antimetabolites?
Capecitabine (Xeloda)
Cytarabine (Ara-C, Cytosar)
Fluorouracil (5-FU, Adrucil)
Gemcitabine (Gemzar)
56
Brand name of Capecitabine? Pyrimidine Analog Antimetabolites
Xeloda
57
How should Capecitabine (Xeloda) be used?
PO --- take with meal
58
What testing should done with Capecitabine (Xeloda) use?
Pharmacogenomics testing for Dihydropyrimidine dehydrogenase (DPD)
Deficiency increases risk of sever toxicity
59
Capecitabine (Xeloda) and INR?
Increases INR up to 91% due to 2C9 inhibition
60
CI to Capecitabine (Xeloda) use?
Dihydropyrimidine dehydrogenase (DPD) deficiency
61
SEs of Capecitabine (Xeloda)?
Hand-foot syndrome (more than 5-FU)
Diarrhea
Mucositis
Gastritis
62
Unique concerns wrt Cytarabine (Ara-C, Cytosar)?
Ara-C syndrome eg fever, gen weakness, fatigue, skin rash, reddened eyes, bone, muscle, joint and/or chest pain
Responds to Coticosteroids
63
Brand name of Fluorouracil (Pyrimidine Analog Antimetabolites)?
5-FU
64
What's Fluorouracil given with? Why?
5-FU is given with Leucovorin
To increase efficacy of 5-FU
65
CI to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Dihydropyrimidine dehydrogenase (DPD) deficiency
66
SE to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Mucositis
Hand-foot syndrome (with continuos infusion)
67
Brand name of Gemcitabine? Pyrimidine Analog Antimetabolites
Gemzar
68
Unique concerns with Gemcitabine (Gemzar)? Pyrimidine Analog Antimetabolites
Prolonged infusion time may increased toxicities
69
MOA of Taxanes?
M-phase specific: Inhibit microtubule fxn
70
When used in combo, whys Taxanes given first?
Elimination of Taxanes is reduced when given immediately after admin of Cisplatin or Carboplatin
71
List Taxanes agents
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Carbazitaxel (Jevtana)
72
Brand name of Paciltaxel? (Taxanes)
Taxol
73
Brand name of Docetaxel? (Taxanes)
Taxotere
74
Unique concerns of Paciltaxel (Taxol) - Taxanes?
Anaphylaxis, hypersensitivity rxn
75
What's used to pre-.treat when using Paciltaxel (Taxol) - Taxanes?
Dexamethasone
Diphenhydramine
H2RA
(To reduce anaphylaxis, hypersensitivity rxns)
76
How should all Taxanes be given IV?
Use non-PVC IV bag and tubing, due to leaching of DEHP
77
SEs of Paciltaxel (Taxol); Docetaxel (Taxotere); Cabazitaxel - Taxanes?
Myelosuppression
Peripheral neuropathy
78
Unique concerns of Docetaxel (Taxotere)?
Hypersensitivity
| Cardio-Pulmonary: Fluid retention
Pre-treat with dexamethasone 8mg bid x 3 days
79
SE unique to Docetaxel (Taxotere)? (In addition to Myelosuppression, peripheral neuropathy)
Fluid retention
80
MOA of Vinca Alkaloids?
M-phase specific: Inhibit microtubule fxn
81
List agents under Vinca Alkaloids
Vincristine (Vincasar, Oncovin)
Vinblastine (Velban)
Vinorelbine (Navelbine)
82
Brand name of Vincristine (Vinca Alkaloids)?
Vincasar
Oncovin
83
Brand name of Vinblastine (Vinca Alkaloids)?
Velban
84
Brand name of Vinorelbine (Vinca Alkaloids)?
Navelbine
85
Vinca alkaloids are vesicants, whats the preferred way they should be delivered to the body?
Via central line
86
How should Extravasation be treated in Vinca Alkaloids?
Warm compress + Hyaluronidase
87
What's the only route of admin for vinca alkaloids?
IV only
Don't admin intrathecally - fatal
88
Which Vinca Alkaloids causes only mild suppression?
Vincristine (Vincasar, Oncovin)
89
What's the max single dose of Vincristine (Vincasar, Oncovin)?
2mg
90
BBWs of Vincristine (Vincasar, Oncovin)?
Intrathecal admin
91
Ses of Vincristine (Vincasar, Oncovin)?
Cumulative (dose-dependent) nerve damage/ peripheral neuropathy
92
BBWs of Vinblastine (Velban) and Vinorelbine (Navelbine)?
Myelosuppression
Peripheral neuropathy (less than vincristine)
Gastroparesis/constipation
93
MOA of Topoisomerase I inhibitors?
Blocks coiling uncoiling of DNA helix
94
Agents under Topoisomerase I inhibitors?
Irinotecan (Camptosar)
Topotecan (Hycamtin)
95
Brand name of Irinotecan? Topoisomerase I inhibitors
Camptosar
96
Types of diarrhea caused by Irinotecan (Camptosar) Topoisomerase I inhibitors? Tx?
Acute diarrhea (cholinergic sx) - treat with Atropine
Delayed diarrhea - treat with Loperamide (up to 24mg daily)
97
What's req B4 use of Irinotecan (Camptosar) Topoisomerase I inhibitors?
Pharmacogenomic testing
Those who are homozygous for the UGT1A1*28 allele are at increased risk for neutropenia and other tcoxicities
98
SEs of Irinotecan (Camptosar) Topoisomerase I inhibitors?
Diarrhea
Myelosuppression
Mucositis
99
MOA of Topoisomerase II inhibitors?
G2-phase specific
100
Agents under Topoisomerase II inhibitors?
Etoposide (VePesid)
Teniposide (Vumon)
101
Brand name of Etoposide? (Topoisomerase II inhibitors)
VePesid
102
Storage of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?
Refrigerate
103
Main SE of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?
Hypotension
104
What should be used to deliver Teniposide (Vumon) - Topoisomerase II inhibitors?
Non-PVC IV bag and tubing due to leaching of DEHP
105
What's the agent under Epothilone?
Ixabepilone (Ixempra)
106
What should be used to deliver Ixabepilone (Ixempra)?
Use non-PVC IV bag and tubing due to leaching of DEHP
107
List miscellaneous agents
Tretinoin (all-Trans Retinoic acid)
Arsenic trioxide (Trisenox)
L-Asparaginase (Elspar)
Bleomycin
Mitomycin (Mutamycin)
108
Pregnancy category of Tretinion (All-Trans Retinoic Acid)?
D
109
BBW of Tretinion (All-Trans Retinoic Acid) & Arsenic trioxide (Trisenox)?
RA-APL differentiation syndrome
110
Monitoring of Arsenic trioxide (Trisenox)? Why?
Monitor ECG, keep Mg and K within normal range
Bcuz of QT prolongation
111
Role of Erwinaze in therapy?
FDA proved for pts who develop allergic rxns to the E.coli derived Asparaginase
112
SEs of L-Asparaginase (Elspar); Asparaginase (Erwinaze); Pegaspargase PEG (Oncaspar)?
Hypersensitivity rxns
Pancreatitis
113
SEs of Bleomycin?
Hypersensitivity rxn
Pulmonary rxns (10%) - such as pneumonitis
114
Advantage of Bleomycin?
Not myelosuppressive
115
Maximum lifetime dose of Bleomycin? Why is there a max dose?
400 units (400mg) of Bleomycin
Due to pulmonary toxicity risk
116
What's the source of U-mab? (MAB = monoclonal antibody)
U-mab = hUman
117
What's the source of O-mab? (MAB = monoclonal antibody)
O-mab = mOuse
118
What's the source of Xi-mab? (MAB = monoclonal antibody)
Xi = Chimeric (human + animal source)
119
What's the source of Zu-mab? (MAB = monoclonal antibody)
HumaniZed
120
Target of Bevacizumab (Avastin)?
Binds to VEGF-A
121
Target of Cetuximab (Erbitux)?
Binds to EGFR
122
Target of Trastuzumab (Herceptin)?
Binds to HER-2/neu
123
Target of Rituximab (Rituxan)?
Binds to CD-20
124
Target of Ipilimumab (Yervoy)?
Binds to Cytotoxic T-lymphocyte antigen-4 (CTL4) receptor
125
Brand name of Bevacizumab (Avastin)? Monoclonal antibodies
Avastin
126
Bevacizumab (Avastin) and wound healing?
Impairs wound healing: stop at least 28 days b4 elective surgery and may restart 28 days after surgery
127
SE of Bevacizumab (Avastin)?
Bleeding
HTN
HF
Thrombosis (including DVT, PE and stroke)
GI perforation
Wound dehiscence
128
Brand name of Trastuzumab?
Herceptin
129
What's required for Trastuzumab (Herceptin) use? And Ado-Trastuzumab Emtansine (Kadcyla)? And Petuzumab (Perjeta)
HER2/neu over-expression required for use (>= 2+ by immunohistochemical (IHC) testing to respond/use this drug)
Pharmacogenomics testing reveals this
130
Is Trastuzumab (Herceptin) interchangeable with Ado-Trastuzumab emtansine (Kadcyla)?
No!
131
Ses of Trastuzumab (Herceptin)?
Cardiomyopathy
132
SE of Ado-Trastuzumab emtansine (Kadcyla)?
Cardiac dysfunction
133
What's req for Cetuximab (Erbitux) & Panitumumab (Vectibix) use?
EGFR positive expressions (Correlates to better response rates)
K-Ras mutation (indicates poor response)
(T4 req EGFR +ve and K-Ras negative)
134
What must be done before Cetuximab (Erbitux) & Panitumumab (Vectibix) use?
Pharmacogenomics testing
135
SEs of Cetuximab (Erbitux) & Panitumumab (Vectibix)?
Acne-rash
Mg and Ca wasting
136
Cell surface marker targeted therapies?
Rituximab (Rituxan)
137
Brand name of Rituximab? (Cell surface marker targeted therapies)
Rituxan
138
Moa of Rituximab (Rituxan)? (Cell surface marker targeted therapies)
Targets CD-20 antigen on B lymphocytes
139
Where should the infusion of Rituximab (Rituxan) - (Cell surface marker targeted therapies) be done? Why?
In hospital or clinic
Since they can be fatal
140
What can be done prior to Rituximab (Rituxan) - (Cell surface marker targeted therapies) infusions?
Use Diphenhydramine and Acetaminophen (30-120 mins b4 infusion)
141
SE of Rituximab (Rituxan) - (Cell surface marker targeted therapies)?
Infusion rxn (chills, rigors, fever)
Tumor lysis syndrome
Reactivation of hepatitis B
142
Agents under Immunotherapy: stimulates the patients immune system?
Ipilimumab (Yervoy)
143
Unique SE of Ipilimumab (Yervoy)?
Primarily autoimmune system unchecked
144
SE of Ipilimumab (Yervoy)?
Dermatologic (rash, pruritus)
145
BBW of Ipilimumab (Yervoy)?
Fatal immune-mediated rxns
146
What's used in "castration sensitive" patient that has prostate CA?
Luteinizing Hormone-Releasing Hormone (LHRH) agonists
For chronic suppression of testosterone
147
What's usually started in "castration sensitive" pts that have prostate CA prior to LHRH? Why?
Antiandrogens are started 1-4 wks prior to LHRH agonists.
To help mitigate tumor flare
148
MOA of Antiandrogens?
Block androgens at the receptor site
149
List agents under Antiandrogens? Role in therapy?
Bicalutamide (Casodex)
Flutamide (Eulexin)
Nilutamide (Nilandron)
Use 1-4 wks prior to starting LHRH agonists to mitigate tumor flare
150
What's the brand name of Bicalutamide (Antiandrogens)?
Casodex
151
What's the brand name of Flutamide (Antiandrogens)?
Eulexin
152
List LHRH agonists (used in prostate CA in males)
| Endometriosis, fibroids and breast CA in Females
Goserelin (Zoladex)
Leuprolide (Lupron)
Histrelin (Vantas)
Triptorelin (Trelstar)
153
Brand name of Goserelin (LHRH agonists)?
Zoladex
154
Brand name of Leuprolide (LHRH agonists)?
Lupron
155
Why's supplementation req with LHRH agonist? What else is recommended?
Bcuz of low bone density and increased risk of Osteoporosis
Consider Ca + Vit. D
Weight-beating exercise + DEXA screening
156
What should be started at least 1 wk prior to use of LHRH agonists (Goserelin (Zoladex); Leuprolide (Lupron))?
Antiandrogens eg
Bicalutamide (Casodex)
Flutamide (Eulexin)
Nilutamide
157
SEs of LHRH agonists? (Goserelin (Zoladex); Leuprolide (Lupron))?
Hot flashes
Bone pain
Impotence
Injection site pain/swelling
Dyslipidemia
QT prolongation
Gynecomastia (men)
Peripheral edema
158
List Gonadotropin-Releasing Hormone (GRA) antagonist used in prostate CA
Degarelix (Firmagon)
159
Agent under Antiandrogen: inhibits the production of Androgen (Testosterone)?
Abiraterone acetate (Zytiga)
160
SEs of Abiraterone acetate (Zytiga)?
Mineralcorticoid elevation with fluid retention
161
Agent under Antiandrogen: Receptor-signaling pathway inhibitor?
Enzalutamide (Xtandi)
162
Ses of Enzalutamide (Xtandi)?
Seizures (~ 1%)
163
Vaccine: Re-programs the immune system against advanced prostate CA?
Sipuleucel-T (Provenge)
164
What's the role of hormonal therapy in breast CA?
To prevent recurrence
165
In what Grp of pts is hormonal therapy recommended, to prevent recurrence?
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)
166
Whats 1st line in HER2/neu tve pts?
Pertzumab + Trastuzumab + Docetaxel
167
Role of Antiandrogen-Antiestrogen: Aromatase Inhibitors (AIs) -ALL ORAL?
Used in POST-menopausal women (not FDA-approved for men with breast cancer)
168
Aromatase Inhibitors (AIs) agents?
Anastrozole (Arimidex)
Letrozole (Femara)
Exemestane (Aromasin)
Mitotane (Lysodren ) non-selective
169
Brand name of Anastrozole? (Aromatase inhibitor -AI)?
Arimidex
170
Brand name of Letrozole? (Aromatase inhibitor -AI)?
Femara
171
Brand name of Exemestane? (Aromatase inhibitor -AI)?
Aromasin
172
Supplement to be used with AIs? Why?
Ca + Vit. D
Other things to consider include: wt beating exercise & DEXA screen
Cuz of low bone density + high risk for osteoporosis
173
Cardiovascular dx risk of AIs compared to SERMs?
AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin))
Have a HIGHER cardiovascular dx risk compared to SERMs
174
What supplementation is req with Mitotane use only?
Glucocorticoid + Mineralocorticoid supplementation
175
SEs to AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin)) use?
Arthralgia
Edema
Lethargy/fatigue
Rash
Menopausal sx/hot flashes
Hepatoxicity
N/V
Weakness
Joint pain
Bone pain
HTN
Depression
176
Role of Antiestrogens/SERMs in therapy?
Used in PRE-menopausal women
Except Tamoxifen, which is indicated for Pre- & Post- menopausal women and men
177
Brand name of Tamoxifen? (SERMs)
Soltamox
178
Brand name of Fulvestrant? (SERMs)
Faslodex
179
Brand name of Raloxifene? (SERMs)
Evista
180
Uses of Raloxifene (Evista)?
For osteoporosis in women at risk of breast CA
181
Concern with Tamoxifen (Soltamox) use?
Increases risk of Endometrial CA (others decrease risk)
182
What's recommended for pts experiencing hot flashes due to Tamoxifen use?
Venlafaxine (over Fluoxeyine and Paroxetine)
183
SEs of SERMs (Tamoxifen; Fulvestrant; Raloxifene)?
DVT/PE
Menopausal sx
Hot flashes
Flushing
N/V
Edema
Weight gain
Increased blood pressure
Mood changes
Vaginal bleeding/discharge
Skin changes
Cataracts (Tamoxifen)
184
What's the concern with Lapatinib (Tykerb) use?
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
185
Main SE of Lapatinib (Tykerb)?
Decreased LVEF
186
What's renal cell cancer (RCC)?
Mist common type of kidney CA in adults
Primary therapy is surgery (radical or partial nephrectomy) and is for
CURATIVE intent
187
Agents under Tyrosine kinase inh (TKIs): targeting multiple kinases
Sunitinib (Sutent)
Pazopanib (Votreint)
Sorafenib (Nexavar)
188
Brand name of Sunitinib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Sutent
189
Brand name of Pazopanib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Votrient
190
Brand name of Sorafenib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Nexavar
191
Which Tyrosine kinase inh (TKIs): targeting multiple kinases is used without regard to food?
Sunitinib (Sutent)
192
SEs of Sunitinib (Sutent) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Rash
Hand-for syndrome
HF
Reduced LVEF
QT prolongation
193
SEs of Pazopanib (Votrient) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Htn
Prolongs QT interval
194
SEs of Sorafenib (Nexavar) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Fatigue
HTN
Hand-foot syndrome
Diarrhea
195
SEs of Axitinib (Inlyta)? (Tyrosine Kinase inh (TKIs) targeting VEGF)?
HTN
Hand-foot syndrome
Dysphonia
196
Role of Everolimus (Afinitor) in therapy?
CA and transplantation
197
SEs of Everolimus (Afinitor)?
Dyslipidemia
Rash
Stomatitis
Interstitial lung dx
198
How should Temsirolimus (Torisel) be delivered to pts?
Use non-PVC bag & tubing due to leaching of DEHP
199
SEs of Temsirolimus (Torisel)?
Dyslipidemia
Hyperglycemia
Myelosuppression
Interstitial lung dx
200
List TKIs agents? What must be done prior to use of these agents?
Imatinib (Gleevec)
Nilotinib (Tasigna)
Dasatinib (Sprycel)
Bosutinib (Bosulif)
Use of these agents req pharmacogenomic testing for presence of bcr-able fusion gene
201
Brand name of Imatinib?
Gleevec
202
SEs of Imatinib (Gleevec)?
Fluid retention
Skin rash
Diarrhea
203
SEs of Nilotinib (Tasigna)?
Prolongs QT interval
204
SEs of Dasatinib (Sprycel)?
Pleural effusions
Fluid retention
Edema
205
SEs of Bosutinib (Bosulif)?
Diarrhea
206
Agents under Tyrosine kinase inh (TKIs): Targeting EGFR? For non-small cell lung CA
Erlotinib (Tarceva)
Afatinib (Gilotrif)
207
Brand name of Erlotinib? Used in non-small cell lung CA
Tarceva
208
Dose of Erlotinib (Tarceva)?
150mg daily PO
Take 1 hr b4 or 2 hr after meal
209
In what type of pts do Erlotinib (Tarceva) work best?
EGFR mutation positive
210
Ses of Erlotinib (Tarceva)?
Acneiform rash
Diarrhea
Hepatoxicity
GI perforation
211
In what type of pt is Afatinib (Gilotrif) approved for?
Pts with metastatic NSCLC + known EGFR exon 19 deletions or exon. 21 substitution
212
Ses of Afatinib (Gilotrif)?
Acneiform rash
Diarrhea
Stomatitis
Dry skin
Paronychia
Reduced appetite
Prurities
213
What condition must be met b4 using Crizotinib (Xalkori)?
Pt must be ALK tve to use this drug (Pharmacogenomics test req)
214
Ses of Crizotinib (Xalkori)?
Swelling (edema)
N/V/D
Constipation
Vision disturbances
215
List drugs used in melanoma
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)
216
Role of Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar) in therapy?
Metastatic melanoma pts with BRAF V600E mutations
217
Which has less skin toxicities? Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar)?
Dabrafenib (Tafinlar)
218
Se of Dabrafenib (Tafinlar)?
Pyrexia
219
SE of Vemurafenib (Zelboraf)?
Dermatologic disorders (rashes, photosensitivity, alopecia, pruritus, SJS/TEN)
Prolonged QT syndrome
220
Role of Trametinib (Mekinist) in therapy?
For metastatic melanoma pts with BRAF V600E or V600K mutations
221
SEs of Trametinib (Mekinist)?
Hand foot syndrome
Increased LFTs
Diarrhea
Anemia
Lymphedema
222
What must not happen when a pt is on Immunomodulators?
Pt must not get pregnant using these drugs
223
List agents under immunomodulators
Lenalidomide (Revlimid)
Pomalidomide (Pomalyst)
Thalidomide (Thalomid)
224
Brand name of Lenalidomide (immunomodulator)?
Revlimid
225
Brand name of Pomalidomide (immunomodulator)?
Pomalyst
226
Brand name of Thalidomide (immunomodulator)?
Thalomid
227
Pregnancy cat of immunomodulators?
X
228
When should u seek medical help? On which med?
If u develop SOB, chest pain, or arm or leg swelling
Lenalidomide (Revlimid)
229
MOA of Proteasome inh?
26S Proteasome inh
230
SEs of Bortezomib (Velcade) & Carfilzomib (Kyprolis)?
Peripheral neuropathy (worse with Bortezomib)
231
What's used with Bortezomib (Velcade) to prevent zoster reactivation?
Acyclovir
232
What's the prevalent toxicities of Bleomycin, Busulfan, Carmustine, Lomustine?
Pulmonary Fibrosis
233
What's the prevalent toxicities of Cisplatin, Carboplatin?
Nephrotoxicity
Ototoxicity
234
What's the prevalent toxicities of Doxorubicin & other Anthracyclines?
Cardiotoxic
235
What's the prevalent toxicities of Methotrexate?
Mucositis
236
What's the prevalent toxicities of Nitrosoureas (Lomustine, Carmustine)
Neurotoxicity (cross BBB)
237
What's the prevalent toxicities of Ifosfamide & Cyclophosphamide?
Hemorrhagic Cystitis
238
What's the prevalent toxicities of Vinca Alkaloids (Vincristine, Vinblastine & Vinorelbine) and Taxanes (Paclitaxel, Docetaxel)?
Peripheral Neuropathy
239
Bone marrow suppression (BMS) Is a common toxicity of many chemo agents, including
Alkylators
Anthracyclines
Folate antagonist
Platinum based Compds (Cisplatin)
Purine Antimetabolites
Pyrimidine Antimetabolites
Taxanes
Topoisomerase I and II inhi
Antimetabolites
Vinca alkaloids (Vinblastine & Vinorelbine)
240
Main concern with using SERMs (tamoxifen)
Endometrial CA
Strokes
Blood clot
Increases risk of cataract
241
When should Evista be d/c?
At least 72 hrs prior to and during immobilization
242
Role of Aromatase inh?
Best for post-menopausal women
243
Common SEs of AIs?
Joint pain
Osteoporosis
244
What's the most commonly used calculations for dosing, body surface area (BSA)?
DuBois and DuBois formula
245
BBW of MTX?
Myelosuppression is the biggest one
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aplastic anemia
renal damage
hepatoxicity
interstitial pneumonitis
SJS/TEN
diarrhea
stomatitis
dose adjustments or D/C for renal impairment or ascites or pleural effusions
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