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NAPLEX Prep > Oncology II: Common Cancer Types and Treatment > Flashcards

Oncology II: Common Cancer Types and Treatment Flashcards

Lung Cancer Skin Cancer Breast Cancer Prostate Cancer Cell cycle treatments BSA calculations Other Medicatoins McAbs

1
Q

skin cancer warning signs

A

ABCDE
Asymmetry
Border irregularities
Color inconsistent
Diameter >6mm
Evolving size, color, shape

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2
Q

breast cancer risk factors

A

female
alcohol use
smoking
inc BMI
no exercise
poor nutrition

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3
Q

why does an increased BMI present a risk factor for breast cancer development

A

as BMI increases, androgens stored in adipose are converted to estrogen via aromatase

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4
Q

what syndrome places males at a risk for breast cancer

A

Klinefelter Syndrome where patients have XXY chromosome

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5
Q

Patient is a pre-menopausal female with ER/PR + breast cancer. What is first line? Why?

A

SERM!
tamoxifen, bc it covers estrogen released from the ovaries which is the case in premenopausal
PLUS adjuvant for 5-10 years

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6
Q

Patient is post-menopausal female with ER/PR+ breast cancer. What is first line?

A

Aromatase inhibitor
anastrozole
letrozole
exemestane
PLUS adjuvant for 5-10 years

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7
Q

what medication is used as breast cancer prophylaxis in post-menopausal females who are ER/PR+

A

raloxifene

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8
Q

tamoxifen BBW

A

endometrial cancer
uterine cancer

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9
Q

tamoxifen
CI
ADE

A

CI in QT prolongation, warfarin use, DVT/PE hx, pregnancy
ADE: dec MBD –> + Ca and Vitamin D
hot flashes/night sweats

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10
Q

treatment of choice for tamoxifen-induced hot flashes/night sweats

A

venlafaxine

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11
Q

raloxifene BBW

A

increased risk of thromboembolism

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12
Q

anastrazole ADE

A

inc risk of OP –> + Ca and Vit D
inc risk CVD

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13
Q

which has a higher risk of CVD
SERM or aromatase inhibitors

A

aromatase inhibitor

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14
Q

treatment of choice for HER2+ breast cancer

A

trastuzumab
pertuzumab

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15
Q

what is the common toxicity with trastuzumab and pertuzumab for HER2+ breast cancer

A

cardiotoxicity

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16
Q

tamoxifen counseling points

A

take Ca and Vitamin D to promote bone health
endometrial cancer risk
hot flashes/night sweats - venlafaxine an option
vaginal bleeding possible
decreased libido

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17
Q

raloxifene counseling points

A

blood clot risk

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18
Q

aromatase inhibitor counseling points

A

(anastrazole, letrozole, exemestane)
hot flashes/night sweats
inc risk CVD
muscle damage/pain

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19
Q

prostate cancer treatment options

A

GnRH agonist PLUS antiandrogen
or
GnRH antagonist

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20
Q

GnRH agonists
medications
use
ADE

A

leuprolide (Lupron depot)
Goserelin (Zoladex)
for prostate cancer with an antiandrogen
ADE: dec MBD (Ca, Vit D, DEXA scans), hot flashes/night sweats, weakness, impotence, bone pain, difficulty urinating

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21
Q

antiandrogens
medications

A

first gen: bicalutamide
second gen: apalutamide
doralutamide
enzalutamide

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22
Q

GnRH antagonists
medications
ADE

A

Degarelix (Firmagen SQ)
Relugolix (Orgovyx)
ADE: OP risk (Ca, Vit D, DEXA scans!)

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23
Q

Which medications work in the M phase of the cell cycle

A

VT
Vinka alkaloids
- vincristine
- vinblastine

Taxanes
- paclitaxel
- docetaxel

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24
Q

Which medications work on the G1 phase of the cell cycle?

A

asparginase
interferons
steroids

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25
Q

Which medications work on the S phase of the cell cycle (DNA replication)?

A

antimetabolites
- MTX
- 5-FU
- capecitabine

Topo I inhibitors
- irinotecan
- topotecan

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26
Q

Medications that work on G2 phase of cell cycle?

A

Topo II inhibitors
- etoposide
- bleomycin

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27
Q

max life dose of bleomycin

A

400 units per life

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28
Q

max dose of vincristine

A

2mg/dose

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29
Q

cell cycle independent agenst

A

alkylating agents
- carmustine
- cyclophosphamide
- ifosfamide

anthracyclines
- doxorubicin
- mitoxantrone

platinum compounds
- cisplatin
- carboplatin

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30
Q

cyclophosphamide and ifosfamide
toxicity concern and prophylaxis?

A

hemorrhagic cystitis

mesna!

31
Q

BSA equation

A

square root of (cm x kg) / 3600

32
Q

alkylating agents
CC dependent or independent
meds
BBW
ADE

A

cc independent
busulfan, cyclophosphamide, ifosfamide
BBW: hemorrhagic cystitis (cyclo and ifos)
myelosuppression
ADE: SJS/TEN, infection reactivation (HBV, CML, TB, HCV), hepatotoxicity, emesis, mucositis, alopecia, neurotoxcity, secondary malignancy

33
Q

mesna
use
MOA

A

cyclophosphamide and ifosfamide induced hemorrhagic cystitis
cyclophsophamide is metabolized to acrolein which concentrates in bladder; mesna prevents concentration in bladder

34
Q

platinum-based chemo agents
cc dep or independent?
medications
ADE

A

cc independent
cisplatin, carboplatin
SE
cisplatin: nephro and oto toxicity, highly emetogenic, max is 100mg/m2/cycle to protect kidneys

35
Q

__________ is used for cisplatin-induced nephrotoxicity prophylaxis

A

amiphostine

36
Q

anthracyclines
cc dep or indep
medications
pearls
BBW

A

cc independent
doxorubicin: lifetime dose 450-550 mg/m2, consider dexrazoxazone at doses >300mg/m2, RED discoloration of bodily fluids
BBW: cardiotoxicity, vesicant, myelosupp, secondary
malignancy
mitoxantrone: BLUE discoloration of bodily fluids
BBW: cardiotoxicity, myelosupp, secondary
malignancy

37
Q

Irinotecan
MOA
SE
BBW

A

Topo-I - inhibitor
cell cycle S
SE: N/V/D, alopecia, diarrhea, abd pain, acute cholinergic sx
BBW: myelosupp, diarrhea (early and late)

38
Q

Patient presents with irinotecan-induced delayed diarrhea. Treatment?

A

loperamide

39
Q

Patient presents with irnotecan-induced cholinergic symptoms (flushing, sweating, diarrhea, cramps). Treatment?

A

atropine

40
Q

Etoposide
MOA
administration
BBW
ADE

A

MOA: Topo II inhib in G2 phase of cell cycle
admin: infuse over 30-60 min to prevent hypotension, IV prep must be </= 0.4mg/mL 2/2 poor aqueous solubility
BBW: myelosupp
ADE: HSRxn, anaphylaxis, secondary malignancy

41
Q

is bleomycin myelosuppressive

A

no

42
Q

bleomycin
MOA
administration
BBW
ADE

A

Topo II inhibitor in G2 phase of cell cycle
NEED TEST DOSE, max is 400 units/life
BBW: pulmonary fibrosis, anaphylaxis
ADE: HSRxn, pneumonitis, mucositis, hyperpigmentation, fever, chills, N/V (mild)

43
Q

vincristine
MOA
administration
ADE
pearls

A

vinka alkaloid in M phase of cell cycle
administered IV! Max is 2mg/dose
ADE: vesicant, CNS toxicity, peripheral neuropathy

C for CNS toxicity

44
Q

vinblastine
MOA
administration
ADE
pearls

A

vinka alkaloid in M phase of cell cycle
administered IV!
ADE: B for bone marrow suppression

45
Q

Which chemo agents are NOT myelosuppressive

A

bleomycin
vincristine

46
Q

vinka alkaloids BBW

A

IV administration only
vesicants
peripheral sensory neuropathies (parasthesias)
autonomic neuropathy (gastroparesis, constop), SIADH

47
Q

If a patient is receiving paclitaxel they should be pre-treated with _______________________

A

diphenhydramine, steroids and H2RA

48
Q

If a patient is receiving docetaxel they should be pre-treated with _______________________

A

steroids x3 days starting one day before docetaxel

49
Q

5-FU
MOA
given with __________ to inc efficacy
antidote
BBW
SE

A

pyrimidine analog/antimetabolite in the S phase of cell cycle
given with leucovirin to increase efficacy
antidote = uridine triacetate
BBW inc INR
SE: hand-foot-mouth, mucositis, diarrhea

50
Q

capecitabine
MOA
CI
SE
BBW
antidote

A

pyrimidine analog/antimetabolite in the S phase of cell cycle
po prodrug of 5-FU
CI CrCl <30mL/min
SE: hand-foot-mouth, mucositis, diarrhea
BBW: inc INR
antidote: uridine triacetate

51
Q

paclitaxel and docetaxel
MOA
BBW
SE
DDI

A

taxanes in M phase of cell cycle
BBW: severe HSRxn, myelosuppression, fluid retention (docetaxel)
SE: peripheral sensory neuropathy, myalgias, arthralgias, alopecia, hepatotoxicity
DDI: platinum-based (cisplatin and carboplatin) dec taxane eliminiation –> need to reduce taxane dose

52
Q

what is an additional benefit of pretreating docetaxel with steroids other than to curb HSRxn

A

aids in reducing fluid retention ADE

53
Q

Patient is on paclitaxel and provider wants to initiate cisplatin. How should dose be adjusted?
A. discontinue taxane
B. patient will require an increased cisplatin dose
C. patient will require and increased paclitaxel dose
D. patient will require a decreased paclitaxel dose

A

D. patient will require a decreased paclitaxel dose

Paclitaxel elimination is inhibited by cisplatin and other platinum, requiring a decreased paclitaxel dose

54
Q

Patient initiated on 5-FU and develops toxicity. What could be a possible explanation?
A. G6PD deficiency
B. HLA-B*5701 gene mutation
C. DPD deficiency
D. renal insufficiency

A

C. DPD deficiency

55
Q

When do we need to dose adjust taxanes paclitaxel and docetaxel

A

hepatic impairment

56
Q

methotrexate
doses >/= ______________ require the addition of ___________

A

500mg/m2
leucovirin

57
Q

Why is sodium bicarb added in methotrexate treatment

A

to alkalinize urine and decrease nephrotoxicity risk

58
Q

Avoid MTX in patients with _________ due to ________

A

3rd spacing (edema, ascites, pleural effusions)
decreased CL

59
Q

Patient initiated on MTX develops AKI. What is the antidote?
A. glucarpidase (Voraxane)
B. leucovirin
C. uridine triacetate
D. NS
E. lactated ringers

A

A. glucarpidase (Voraxane)

60
Q

Doses of MTX are higher or lower in chemo than in RA?

A

higher

61
Q

Match the McAb to the MOA

Bevacizumab (Avastin) EGFR-i
Trastuzumab (Herceptin) CD20-i
Cetuximab (Erbitux) VEGF-i
Rituximab (Rituxan) anti-HER2
Pembrolizumab (Keytruda) PD-L1 i
Nivolumab (Opdivo)

A

Trastuzumab (Herceptin) anti-HER2
Bevacizumab (Avastin) VEGF-i
Cetuximab (Erbitux) EGFR-i
Rituximab (Rituxan) CD20-i
Pembrolizumab (Keytruda) PD-L1 i
Nivolumab (Opdivo) PD-L1 i

62
Q

What drug am I?

I need to be pre treated with benadryl
Please test for EGFR gene expression first
BBW severe/fatal infusion reaction, cardiac arrest
Can cause an acneiform rash that, if occurs in first two weeks, is a sign treatment will be successful!
Avoid sunlight

A

cetuximab

63
Q

What drug am I?

I need to be pre-treated with benadryl, steroids and APAP
BBW: Hep B reactivation, PML, SJS/TEN, infusion reaction
Check for Hep B before starting me!

A

Rituximab (Rituxan)

64
Q

What drug am I?

I cannot be given 28 days before or after a surgery because I will impair wound healing and have BBW for severe fatal bleeding, GI perforation and wound opening.
Monitor for proteinuria, HTN, nephrotic syndrome, HF and thrombosis

A

Bevacizumab (Avastin)

65
Q

What drug am I?

You must use a 0.22 micron filter with me
I have BBW for HF, embryo-fetal death, birth defects, infusion reactions, pulm toxicty, hepatotox, interstital lung disease and pneumonitis

A

Trastuzumab (Herceptin)

66
Q
A
67
Q

MTX BBW

A

myelosupp
aplastic anemia
renal damage
hepatotoxicity
interstitial pneumonitis
SJS/TEN
GI tox
immunosuppression
TLS
teratogenicity/fetal death

68
Q

MTX DDI

A. NSAIDs, PPIs, cephalosporins, salicylates, probenacid
B. NSAIDs, H2RA, beta lactams, salicylates, probenacid, sulfonamides
C. NSAIDs, PPIs, beta lactams, salicylates, probenacid, sulfonamides
D. NSAIDs, H2RA, cephalosporins, salicylates, probenacid, sulfonamides

A

C. NSAIDs, PPIs, beta lactams, salicylates, probenacid, sulfonamides

69
Q

In order to use tyrosine kinase inhibitors, patients must be positive for ________________.

A

philadelphia chromosome (BCR-ABL)

70
Q

Oral chemo agents imatinib (Gleevec) and Capecitabine (Xeloda) must be given with or without food?

A

with food

71
Q

Common TK-inhibitor toxicities

A

heart - QTp
skin - acneiform rash, SJS/TEN
lg int - diarrhea
hand-foot syndrome
liver - 3A4 substrates (DDI and toxicities)

72
Q

What cancer are TK-i s commonly used in

A

CML

73
Q
A

NAPLEX Prep (57 decks)

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