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NAPLEX Review > Oncology Overview and Side Effect Management > Flashcards

Oncology Overview and Side Effect Management Flashcards

1
Q

What cancer is low-dose aspirin recommended to prevent against?

A

Colorectal

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2
Q

At what age should women begin yearly mammograms and and at what age should they get mammograms every other year?

A

45-54 - yearly

55 and up - every 2 years or yearly

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3
Q

At what age should women be screened for cervical cancer?

A

21-29 years - pap smear every 3 years

30-65 - pap smear + HPV test every 5 years

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4
Q

At what age should men and women be screened for colon cancer? How are they screened?

A

45 and up
Stool-based test - if positive f/u with colonoscopy
Colonoscopy every 10 years OR
Flexible sigmoidoscopy every 5 years

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5
Q

At what age should M/F be screened for lung cancer? How are they screened?

A

55-74 years

Annual CT scan if in good health, 30 ppy smoking hx, still smoking or quit smoking within the past 15 years

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6
Q

At what age should men be screened for prostate cancer?

A

50 and older

If opts out do a prostate specific antigen test +/- digital rectal exam

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7
Q

What is the max dose for bleomycin? Why?

A

Max lifetime cumulative dose: 400 units

Reason: pulmonary toxicity

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8
Q

What is the max dose for doxorubicin? Why?

A

Max lifetime cumulative dose: 450-550 units

Reason: cardiotoxicity

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9
Q

What is the max dose for cisplatin? Why?

A

Max dose per cycle: 100 mg/m2

Reason: nephrotoxicity

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10
Q

What is the max dose for vincristine?

A

Single dose capped at 2mg

Reason: neuropathy

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11
Q

What cancer meds commonly cause

myelosuppression

A

All except asparaginase, bleomycin, vincristine

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12
Q

What cancer meds commonly cause

N/V

A

Cisplatin, cyclophosphamide, ifosfamide

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13
Q

What cancer meds commonly cause

Mucositis

A

Fluorouracil, methotrexate

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14
Q

What cancer meds commonly cause

Diarrhea

A

Irinotecan, capeccitabine, fluorouracil, methotrexate

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15
Q

What cancer meds commonly cause

Constipation

A

Vincristine

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16
Q

What cancer meds commonly cause

Xerostomia

A

Radiation therapy to head or neck region

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17
Q

What cancer meds commonly cause

Cardiotoxicity

A

Cardiomyopathy: anthracyclines, HER2 inhibitors

QT prolongation: Arsenic trioxide, many TKIs

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18
Q

What cancer meds commonly cause

Pulmonary toxicity

A

Fibrosis: Bleomycin, busulfan, carmustine, lomustine
Pneumonitis: Methotrexate, immune therapy MAbs

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19
Q

What cancer meds commonly cause

Hepatotoxicity

A

Antiandrogens

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20
Q

What cancer meds commonly cause

Nephrotoxicity

A

Cisplatin, methotrexate

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21
Q

What cancer meds commonly cause

Hemarrhagic cystitis

A

Ifosfamide, cyclophosphamide

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22
Q

What cancer meds commonly cause

Neuropathy

A

Peripheral neuropathy: vinca alkaloids, platinums, taxanes

Autonomic neuropathy: vinca alkaloids

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23
Q 
What cancer meds commonly cause
Thromboembolic risk (clotting)
A

Aromatase inhibitors, SERMs

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24
Q

What medication is used to treat early onset diarrhea with irinotecan?

A

Atropine

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25
What medication is given with cisplatin to prevent nephrotoxicity
Amifostine
26
What medication is given with doxorubicin as prophylaxis for prevention of cardiomyopathy
Dexrazoxane (Zinecard)
27
What medication is given with doxorubicin as prophylaxis for treatment of extravasation
Dexrazoxane (Totect)
28
What medication is given with fluorouracil to enhance efficacy?
Leucovorin or levoleucovorin
29
What medication is an antidote for fluorouracil or capecitabine? When should it be given?
``` Uridine triacetate (Vistogard) Use within 96 hours for overdose or to treat severe toxicity ```
30
What medication is given with ifosfamide as prophylaxis to prevent hemorrhagic cystitis
Mesna (Mesnex)
31
What medication is given with irinotecan to treat delayed diarrhea?
Loperamide
32
What medication is given with methotrexate to decrease myelosuppression and mucositis in high-dose therapy?
Leucovorin or levoleucovorin (Fusilev)
33
What medication is an antidote for methotrexate to decrease excessive methotrexate levels due to acute renal failure
Glucarpidase (Voraxaze)
34
Nadir definition
lowest point that WBC and platelets reach | Occurs 7-14 days after chemo
35
What WBC level indicates neutropenia, severe neutropenia, and profound neutropenia
Neu: <1000 cells/mm3 Severe: <500 Profound: <100
36
What patients should receive growth colony stimulating factors to increase WBC count? What meds should they receive?
>20% risk (high risk) of developing chemotherapy-induced febrile neutropenia Filgrastim or pegfilgrastim
37
What medications are Colony stimulating factors (CSF)
Filgrastim (Neupogen) and pegfilgrastim (Neulasta) | Neulasta is pegylated and is given once per cycle while Neupogen is given daily
38
Pegfilgrastim/filgrastim SE and notes
SE: bone pain Notes: store in fridge, must have 12 days from pegfilgrastim to next chemo cycle
39
If patient is low risk with febrile neutropenia, what empiric abx should be started?
Oral anti-pseudomonal Cipro or levofloxacin PLUS Amox/clav or clindamycin
40
If patient is high risk with febrile neutropenia, what empiric abx should be started?
``` IV anti-pseudomal beta-lactams Cefepime or Ceftaz or Meropenem or Imipenem/Cilastatin or Pip/tazo ```
41
When to initiate ESA in anemic patients?
When non-myeloid malignancies where anemia is d/t effect of chemi Must have at least 2 months of additional chemo after initiation of ESA Hgb <10 Use lowest dose to avoid RBC transfusions
42
Risk factors for CINV
``` Female Age <50 Anxiety Depression Dehydration Hx of motion sickness Hx of N/V with chemo ```
43
How to treat acute CINV? When does it occur?
5HT3 receptor antagonists | Occurs within 24 hours after chemo
44
How to treat delayed CINV? When does it occur?
NK1-RA, corticosteroids, palonosetron and olanzapine | >24 hours after chemo
45
How to treat anticipatory CINV? When does it occur?
Benzos - start night before chemo | Before chemo
46
What medications are 5HT3-RA
Ondansetron Granisetron Dolasetron Palonosetron
47
What medications are NK1-RA?
Aprepitant | Rolapitant
48
Antiemetic regimen for high emetic risk
3 or 4 drugs NK1-RA + 5HT3-RA + Olanzapine + dexamethasone (preferred) Olanzapine + palonosetron + dexamethasone NK1-RA + 5HT3-RA + Dexamethasone
49
5HT-3 RA CI, warnings, and SE
``` CI: do not use with apomorphine (Apokyn) d/t hypotension Warnings: serotonin syndrome when used in combo with other serotonergic meds SE: HA, constipation ```
50
Dexamethasone SE
increased appetite, fluid retention, insomnia, increased BP and BG
51
NK1-RA MOA
``` inhibits substance P/NK1 receptor augmenting the antiemetic activity of 5HT3 RA and corticosteroids to inhibit acute and delayed phases of CINV ```
52
5HT-3 RA MOA
Blocks serotonin peripherally on vagal nerve terminals and centrally in chemo trigger zone
53
Dopamine receptor | antagonist MOA
Blocks dopamine receptor in CNS including chemo trigger zone
54
Dopamine receptor antagonists BBW and SE
BBW: promethazine - do not use in children <2 years, do not give IV; metoclopramide - tardive dyskinesia that can be irreversible; droperidol - QT prolongation SE: sedation, lethargy, acute EPS
55
Cannabinoids MOA
may work by activating cannabinoid receptors and inhibiting the vomiting control mechanism in the medulla oblongata
56
Cannabinoid SE
somnolence, euphoria, increased appetite
57
Benzodiazepine MOA
enhance GABA to decrease neuronal excitability
58
Chemo induced diarrhea drug therapies and max doses
Loperamide - 16 mg/d can be 24 if under medical supervision for chemo induced diarrhea Diphenoxylate + atropine
59
What medication is used for dry mouth?
Pilocarpine - cholinergic effects that cause salivation
60
What medications can cause hand-foot syndrome
Capecitabine, fluorouracil, cytarabine, liposomal doxorubicin and TKIs
61
How is hand-foot syndrome managed?
Cool compress Emollients Steroids Pain medications
62
How does tumor lysis syndrome cause Acute Renal Failure (ARF)
Cells are broken down and release nucleic acid, purines are catalyzed by xanthine oxidase enzyme to uric acid, hyperuricemia, crystalization of UA, ARF
63
What medications are used in tumor lysis syndrome to prevent hyperuricemia?
Allopurinol - use high doses (400-800mg/d for 10-14 days after chemo) Rasburicase - expensive but added to allopurinol when it fails or is unable to be used
64
How to treat mild hypercalcemia?
Hydration and loop diuretics
65
What is considered moderate to severe hypercalcemia? How to treat?
Calcium >12 | IV hydration with NS + calcitonin +/- IV bisphosphonates or denosumab
66
What brand name of zolendronic acid and denosumab is used for hypercalcemia of malignancy?
Zolendronic acid - zometa (NOT reclast) | Denosumab - Xgeva (NOT Prolia)
67
How to treat immunologic reactions to monoclonal antibodies?
APAP (650mg PO) | Diphenhydramine (IV or PO)
68
What cancer meds are vesicants?
Anthracyclines and vinca alkaloids
69
How to treat extravasation
Apply cold compresses (except vina alkaloids and etoposide - use warm) Give antidote
70
What is the antidote for anthracycline extravasation?
Dexrazoxane (Totect) or dimethylsulfoxide
71
What is the antidote for vinca alkaloids and etoposide extravasation
Hyaluronidase
72
When to give vaccines in relation to chemo
Avoid if possible or give 2 or more weeks before chemo Do not give live vaccines during chemo Can get inactivated flu vaccine

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