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PHRM 864 > Oncology Medications > Flashcards

Oncology Medications Flashcards

1
Q

Enzalutamide

A

Androgen Receptor Antagonist

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2
Q

Enzalutamide Drug Interactions

A

CYP2C8 substrate

CYP3A4, CYP2C9, CYP2C19 inhibitor
- decreases warfarin concentrations

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3
Q

Enzalutamide Side Effects

A

seizures (lowers seizure threshold)
fatigue
weakness
falls
diarrhea
hot flashes
musculoskeletal pain
hypertension
enzulatamide syndrome (foggy)

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4
Q

Apalutamide

A

Androgen Receptor Antagonist

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5
Q

Apalutamide Drug Interactions

A

CYP3A4 and CYP2C8 substrate

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6
Q

Apalutamide Side Effects

A

seizure
fatigue
falls
diarrhea
hypertension
increased:
- cholesterol
- glucose
- triglycerides
- TSH levels

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7
Q

Darolutamide

A

Androgen Receptor Antagonist

TAKE WITH FOOD

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8
Q

Darolutamide Drug Interactions

A

CYP3A4 substrate

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9
Q

Darolutamide Side Effects

A

less seizures, falls, fractures, weight loss

fatigue
diarrhea
musculoskeletal pain
hypertension
rash
anemia

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10
Q

Abiraterone + Prednisone

A

must be given with prednisone to prevent adrenal insufficiency

TAKE WITHOUT FOOD

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11
Q

Abiraterone (+ Prednisone) Drug Interactions

A

CYP3A4 substrate

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12
Q

Abiraterone (+ Prednisone) Side Effects

A

fatigue
diarrhea
muscle aches
hot flashes
hypertension
adema
increased triglycerides
increased LFT
atrial fibrillation
hypokalemia

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13
Q

Cabazitaxel

A

Microtubule Disassembly Inhibitor

Poor affinity for MDR –> effective in resistant tumors

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14
Q

Cabazitaxel Side Effects

A

severe neutropenia & diarrhea

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15
Q

Radium 223

A

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

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16
Q

Radium 223 Side Effects

A

neutropenia
thrombocytopenia
anemia

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17
Q

SERM Side Effects

A

hot flashes
DVT
endometrial cancer

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18
Q

Aromatase Inhibitor Side Effects

A

osteoporosis
hot flashes
muscle aches/pains

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19
Q

Solubilzer for Paclitaxel

A

Crimafor
- causes hypersensitivity reactions associated with Paclitaxel

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20
Q

Pre-Medications for Paclitaxel

A

Dexamethasone
Diphenhydramine
H2 Antagonist

Why?
- prevent type I hypersensitivity reactions

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21
Q

Pre-Medications for Docetaxel

A

Dexamethasone

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22
Q

Trastuzumab/Deruxtecan Side Effect

A

Interstitial Lung Disease

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23
Q

Abemaciclib Side Effects & Monitoring

A

APPROVED IN EARLY, HIGH RISK

neutropenia
diarrhea
liver dysfunction
pneumonitis
DVT

Test –> CBC baseline then monthly

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24
Q

Palbociclib Side Effects & Monitoring

A

neutropenia
diarrhea
liver dysfunction
pneumonitis

Test –> CBC baseline then monthly

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25
Ribociclib Side Effects & Monitoring
neutropenia diarrhea liver dysfunction pneumonitis Qtc prolongation Test --> CBC baseline then monthly, EKG baseline then throughout first 2 cycles
26
5-FU Side Effects
myelosuppression N/V/D mucositis
27
Irinotecan Side Effects
Neutropenia Diarrhea - early onset - late onset
28
Treatment of Irinotecan Early Onset Diarrhea
Atropine
29
Treatment of Irinotecan Late Onset Diarrhea
Loperamide 4 mg x 1 then 2 mg every 2 hours until normal bowel movement
30
Oxaliplatin Side Effects
neuropathy COLD INTOLERANCES shortness of breath
31
Capecitabine Side Effects
hand-foot syndrome diarrhea
32
Cetuximab Side Effects
severe infusion reaction with 1st dose rash - premedicate with H1 antagonist - combination with minocycline hypomagnesemia
33
Bevacizumab Side Effects
bleeding thromboembolism proteinuria - check urinary analysis HYPERTENSION - check B.P. decreased wound healing - wait a period before surgery
34
What 2 tests must you have with Bevacizumab?
urinary analysis blood pressure
35
Cisplatin Side Effects
CINV peripheral neuropathy nephrotoxicity ototoxicity IF COMPLICATIONS --> try carboplatin
36
Carboplatin Side Effects
myelosuppression
37
Osimertinib Metabolism
CYP3A4 substrate
38
Osimertinib Side Effects
rash diarrhea nail changes cardiomyopathy Qtc prolongation
39
Dabrafenib Metabolism
CYP3A4 substrate
40
Dabrafenib Side Effects
fever rash secondary skin cancer hyperglycemia visual changes TAKE ON EMPTY STOMACH
41
Trametinib
fever rash diarrhea visual changes retinal detachment hand foot syndrome hypertension TAKE ON EMPTY STOMACH STORE IN REFRIGERATOR
42
Sotorasib Metabolism
nonenzymatic conjugation and oxidative metabolism via CYP3A4
43
Sotorasib
N/V/D rash edema decrease Hb increase LFT pneumonitis
44
Contraindication to Immunotherapy
autoimmune diseases immunosuppression - corticosteroids - calcineurin inhibitors - vaccines
45
Immunotherapy Side Effects
pneumonitis colitis hepatitis nephritis thyroiditis
46
Laboratory Values for Immunotherapy
CBC CMP TSH & T4 Amylase & Lipase
47
Vemurafenib Side Effects
squamous cell carcinoma fever rash N/V/D photosensitivity edema arthralgias Combination: Cobimetinib
48
Encorafenib
Less fevers rash N/V hand foot syndrome anemia increased Cr & transaminases arthralgias Combination: Binimetinib
49
Resources of Counseling a Patient
Chemocare.com OralChemoEdSheets.com
50
Carboplatin Dosing
Calvert Equation - Dose = AUC x (GFR + 25) AUC = 5-7.5
51
When can Olaparib be used in Ovarian Treatment
1. After Response if gBRCA or sBRCA or in combination with bevacizumab if HRD+ 2. After Relapse & BRCA not required
52
When can Niraparib be used in Overian Treatment
1. After Response & BRCA not required 2. After Relapse if gBRCA
53
When can Rucaparib be used in Ovarian Treatment
1. After Relapse if gBRCA and sBRCA
54
Common Side Effect of -paribs
Anemia
55
Laboratory Monitoring for -Parib
CBC SCr Liver enzymes cholesterol Albumin
56
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
57
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
58
Corrected Calcium Equation
Serum Calcium + 0.8 (4 - serum albumin) Normal: 8.5-10 mg/dL
59
Phosphates
Indication: mild hypercalcemia with normal to low PO4 Pearls: - use caution with moderate to severe hypercalcemia - may induce metastatic calcification - Nausea/diarrhea
60
Does Zoledronic acid or Pamidronate have a longer infusion time?
Pamidronate
61
Denosumab Pearls
correct hypocalcemia prior to initiation supplement calcium and Vit D daily
62
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
63
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
64
TKI Toxicities
neutropenia thrombocytopenia anemia abnormal liver enzymes DECREASE AFTER 4 YEARS
65
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

PHRM 864 (4 decks)

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