Oncology Medications Flashcards
Enzalutamide
Androgen Receptor Antagonist
Enzalutamide Drug Interactions
CYP2C8 substrate
CYP3A4, CYP2C9, CYP2C19 inhibitor
- decreases warfarin concentrations
Enzalutamide Side Effects
seizures (lowers seizure threshold)
fatigue
weakness
falls
diarrhea
hot flashes
musculoskeletal pain
hypertension
enzulatamide syndrome (foggy)
Apalutamide
Androgen Receptor Antagonist
Apalutamide Drug Interactions
CYP3A4 and CYP2C8 substrate
Apalutamide Side Effects
seizure
fatigue
falls
diarrhea
hypertension
increased:
- cholesterol
- glucose
- triglycerides
- TSH levels
Darolutamide
Androgen Receptor Antagonist
TAKE WITH FOOD
Darolutamide Drug Interactions
CYP3A4 substrate
Darolutamide Side Effects
less seizures, falls, fractures, weight loss
fatigue
diarrhea
musculoskeletal pain
hypertension
rash
anemia
Abiraterone + Prednisone
must be given with prednisone to prevent adrenal insufficiency
TAKE WITHOUT FOOD
Abiraterone (+ Prednisone) Drug Interactions
CYP3A4 substrate
Abiraterone (+ Prednisone) Side Effects
fatigue
diarrhea
muscle aches
hot flashes
hypertension
adema
increased triglycerides
increased LFT
atrial fibrillation
hypokalemia
Cabazitaxel
Microtubule Disassembly Inhibitor
Poor affinity for MDR –> effective in resistant tumors
Cabazitaxel Side Effects
severe neutropenia & diarrhea
Radium 223
MOA: alpha particle isotope forming complexes with bone mineral in areas with increased bone turnover leading to DNA strand breaks and antitumor effects
Indication:
- M1CRPC
- bone metastases
- no known visceral metastatic disease
Radium 223 Side Effects
neutropenia
thrombocytopenia
anemia
SERM Side Effects
hot flashes
DVT
endometrial cancer
Aromatase Inhibitor Side Effects
osteoporosis
hot flashes
muscle aches/pains
Solubilzer for Paclitaxel
Crimafor
- causes hypersensitivity reactions associated with Paclitaxel
Pre-Medications for Paclitaxel
Dexamethasone
Diphenhydramine
H2 Antagonist
Why?
- prevent type I hypersensitivity reactions
Pre-Medications for Docetaxel
Dexamethasone
Trastuzumab/Deruxtecan Side Effect
Interstitial Lung Disease
Abemaciclib Side Effects & Monitoring
APPROVED IN EARLY, HIGH RISK
neutropenia
diarrhea
liver dysfunction
pneumonitis
DVT
Test –> CBC baseline then monthly
Palbociclib Side Effects & Monitoring
neutropenia
diarrhea
liver dysfunction
pneumonitis
Test –> CBC baseline then monthly
Ribociclib Side Effects & Monitoring
neutropenia
diarrhea
liver dysfunction
pneumonitis
Qtc prolongation
Test –> CBC baseline then monthly, EKG baseline then throughout first 2 cycles
5-FU Side Effects
myelosuppression
N/V/D
mucositis
Irinotecan Side Effects
Neutropenia
Diarrhea
- early onset
- late onset
Treatment of Irinotecan Early Onset Diarrhea
Atropine
Treatment of Irinotecan Late Onset Diarrhea
Loperamide 4 mg x 1 then 2 mg every 2 hours until normal bowel movement
Oxaliplatin Side Effects
neuropathy
COLD INTOLERANCES
shortness of breath
Capecitabine Side Effects
hand-foot syndrome
diarrhea
Cetuximab Side Effects
severe infusion reaction with 1st dose
rash
- premedicate with H1 antagonist
- combination with minocycline
hypomagnesemia
Bevacizumab Side Effects
bleeding
thromboembolism
proteinuria
- check urinary analysis
HYPERTENSION
- check B.P.
decreased wound healing
- wait a period before surgery
What 2 tests must you have with Bevacizumab?
urinary analysis
blood pressure
Cisplatin Side Effects
CINV
peripheral neuropathy
nephrotoxicity
ototoxicity
IF COMPLICATIONS –> try carboplatin
Carboplatin Side Effects
myelosuppression
Osimertinib Metabolism
CYP3A4 substrate
Osimertinib Side Effects
rash
diarrhea
nail changes
cardiomyopathy
Qtc prolongation
Dabrafenib Metabolism
CYP3A4 substrate
Dabrafenib Side Effects
fever
rash
secondary skin cancer
hyperglycemia
visual changes
TAKE ON EMPTY STOMACH
Trametinib
fever
rash
diarrhea
visual changes
retinal detachment
hand foot syndrome
hypertension
TAKE ON EMPTY STOMACH
STORE IN REFRIGERATOR
Sotorasib Metabolism
nonenzymatic conjugation and oxidative metabolism via CYP3A4
Sotorasib
N/V/D
rash
edema
decrease Hb
increase LFT
pneumonitis
Contraindication to Immunotherapy
autoimmune diseases
immunosuppression
- corticosteroids
- calcineurin inhibitors
- vaccines
Immunotherapy Side Effects
pneumonitis
colitis
hepatitis
nephritis
thyroiditis
Laboratory Values for Immunotherapy
CBC
CMP
TSH & T4
Amylase & Lipase
Vemurafenib Side Effects
squamous cell carcinoma
fever
rash
N/V/D
photosensitivity
edema
arthralgias
Combination: Cobimetinib
Encorafenib
Less fevers
rash
N/V
hand foot syndrome
anemia
increased Cr & transaminases
arthralgias
Combination: Binimetinib
Resources of Counseling a Patient
Chemocare.com
OralChemoEdSheets.com
Carboplatin Dosing
Calvert Equation
- Dose = AUC x (GFR + 25)
AUC = 5-7.5
When can Olaparib be used in Ovarian Treatment
- After Response if gBRCA or sBRCA or in combination with bevacizumab if HRD+
- After Relapse & BRCA not required
When can Niraparib be used in Overian Treatment
- After Response & BRCA not required
- After Relapse if gBRCA
When can Rucaparib be used in Ovarian Treatment
- After Relapse if gBRCA and sBRCA
Common Side Effect of -paribs
Anemia
Laboratory Monitoring for -Parib
CBC
SCr
Liver enzymes
cholesterol
Albumin
Allopurinol
MOA: xanthine oxidase inhibitor stopping the conversion of xanthine to uric acid
DOES NOT FACILITATE THE BREAKDOWN OF URIC ACID THAT IS ALREADY FORMED
Initiation: 12-24 hours before chemo
Duration: until normalization of uric acid or tumor burden decreases to low risk
Pearls:
- CrCl < 20 mL/min –> dose adjustment
- several days to see effects
- drug interactions with thioprines or methotrexate
Rasburicase
MOA: recombinant urate oxidase that converts uric acid to more soluble form, allantoin
BREAKS DOWN ALREADY FORMED URIC ACID
Initiation: 1 day before or day of chemotherapy
Duration: until normalization of uric acid
Pearls:
- see effects within 4 hours
- contraindicated in women pregnant or breast-feeding
- glucose-6-phosphate dehydrogenase deficiency can cause hemolysis
- degrades uric acid within blood samples (chilled tube + heparin, stored on ice, and evaluated within 4 hours)
- EXPENSIVE
Corrected Calcium Equation
Serum Calcium + 0.8 (4 - serum albumin)
Normal: 8.5-10 mg/dL
Phosphates
Indication: mild hypercalcemia with normal to low PO4
Pearls:
- use caution with moderate to severe hypercalcemia
- may induce metastatic calcification
- Nausea/diarrhea
Does Zoledronic acid or Pamidronate have a longer infusion time?
Pamidronate
Denosumab Pearls
correct hypocalcemia prior to initiation
supplement calcium and Vit D daily
Adverse Effects of Bone Therapy
Osteonecrosis of Jaw
- oral infection caused by invasive dental procedures and poor dental hygiene
monthly > year dosing
IV > PO
Zoledronic & Denosumab > Pamidronate
Treatment:
- pain control
- chlorhexidine rinse
- antibiotics
- surgery
DISCONTINUATION CAN IMPROVE BUT MAY NOT RETURN TO NORMAL
Hypocalcemia
- denosumab > zoledronic acid
- supplemented with calcium and Vit D daily
Bone pain
N/V/D
BiTE and CAR-T Toxicities
Cytokine Release Syndrome
- signs/symptoms: fever, tachycardia, hypotension (shock like)
- Treatment:
* Tocilizumab: Anti-IL6 –> grade 2 or higher
DOES NOT HAVE IMPACT ON CAR-T THERAPY
* Corticosteroids: grade 3 or higher
IMPAIRS T-CELL FUNCTION
Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS)
- risk factors: age, disease burden, product
- signs/symptoms: tremor, confusion, cerebral edema, seizures
- test/assessment: immune effector cell encephalopathy (ICE)
- Treatment:
* Corticosteroids
CANNOT USE TOCILIZUMAB BECAUSE IT DOES NOT CROSS BBB
TKI Toxicities
neutropenia
thrombocytopenia
anemia
abnormal liver enzymes
DECREASE AFTER 4 YEARS
Venetoclax
MOA: inhibits BCL2 resulting in release of BIM and PUMA
Drug Interactions:
- CYP3A4
* Inhibitors: Ritonavir, Azoles
* Inducers: Rifampin
- PgP
* Inhibitors: amiodarone, carvedilol, macrolides, azole, verapamil
* Inducers: Rifampin, Phenytoin, Carbamazepine, St. Johns Wort
