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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
Q

What medication is given with cisplatin to prevent nephrotoxicity

A

Amifostine

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26
Q

What medication is given with doxorubicin as prophylaxis for prevention of cardiomyopathy

A

Dexrazoxane (Zinecard)

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27
Q

What medication is given with doxorubicin as prophylaxis for treatment of extravasation

A

Dexrazoxane (Totect)

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28
Q

What medication is given with fluorouracil to enhance efficacy?

A

Leucovorin or levoleucovorin

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29
Q

What medication is an antidote for fluorouracil or capecitabine? When should it be given?

A 
Uridine triacetate (Vistogard)
Use within 96 hours for overdose or to treat severe toxicity
30
Q

What medication is given with ifosfamide as prophylaxis to prevent hemorrhagic cystitis

A

Mesna (Mesnex)

31
Q

What medication is given with irinotecan to treat delayed diarrhea?

A

Loperamide

32
Q

What medication is given with methotrexate to decrease myelosuppression and mucositis in high-dose therapy?

A

Leucovorin or levoleucovorin (Fusilev)

33
Q

What medication is an antidote for methotrexate to decrease excessive methotrexate levels due to acute renal failure

A

Glucarpidase (Voraxaze)

34
Q

Nadir definition

A

lowest point that WBC and platelets reach

Occurs 7-14 days after chemo

35
Q

What WBC level indicates neutropenia, severe neutropenia, and profound neutropenia

A

Neu: <1000 cells/mm3
Severe: <500
Profound: <100

36
Q

What patients should receive growth colony stimulating factors to increase WBC count? What meds should they receive?

A

> 20% risk (high risk) of developing chemotherapy-induced febrile neutropenia
Filgrastim or pegfilgrastim

37
Q

What medications are Colony stimulating factors (CSF)

A

Filgrastim (Neupogen) and pegfilgrastim (Neulasta)

Neulasta is pegylated and is given once per cycle while Neupogen is given daily

38
Q

Pegfilgrastim/filgrastim SE and notes

A

SE: bone pain
Notes: store in fridge, must have 12 days from pegfilgrastim to next chemo cycle

39
Q

If patient is low risk with febrile neutropenia, what empiric abx should be started?

A

Oral anti-pseudomonal
Cipro or levofloxacin PLUS
Amox/clav or clindamycin

40
Q

If patient is high risk with febrile neutropenia, what empiric abx should be started?

A 
IV anti-pseudomal beta-lactams
Cefepime or
Ceftaz or
Meropenem or
Imipenem/Cilastatin or 
Pip/tazo
41
Q

When to initiate ESA in anemic patients?

A

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
Q

Risk factors for CINV

A 
Female
Age <50
Anxiety
Depression
Dehydration
Hx of motion sickness
Hx of N/V with chemo
43
Q

How to treat acute CINV? When does it occur?

A

5HT3 receptor antagonists

Occurs within 24 hours after chemo

44
Q

How to treat delayed CINV? When does it occur?

A

NK1-RA, corticosteroids, palonosetron and olanzapine

>24 hours after chemo

45
Q

How to treat anticipatory CINV? When does it occur?

A

Benzos - start night before chemo

Before chemo

46
Q

What medications are 5HT3-RA

A

Ondansetron
Granisetron
Dolasetron
Palonosetron

47
Q

What medications are NK1-RA?

A

Aprepitant

Rolapitant

48
Q

Antiemetic regimen for high emetic risk

A

3 or 4 drugs
NK1-RA + 5HT3-RA + Olanzapine + dexamethasone (preferred)
Olanzapine + palonosetron + dexamethasone
NK1-RA + 5HT3-RA + Dexamethasone

49
Q

5HT-3 RA CI, warnings, and SE

A 
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
Q

Dexamethasone SE

A

increased appetite, fluid retention, insomnia, increased BP and BG

51
Q

NK1-RA MOA

A 
inhibits substance
P/NK1 receptor
augmenting the
antiemetic activity
of 5HT3 RA and
corticosteroids to inhibit acute and delayed phases of CINV
52
Q

5HT-3 RA MOA

A

Blocks serotonin peripherally on vagal nerve terminals and centrally in chemo trigger zone

53
Q

Dopamine receptor

antagonist MOA

A

Blocks dopamine receptor in CNS including chemo trigger zone

54
Q

Dopamine receptor antagonists BBW and SE

A

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
Q

Cannabinoids MOA

A

may work by activating
cannabinoid receptors and
inhibiting the vomiting control mechanism in the medulla oblongata

56
Q

Cannabinoid SE

A

somnolence, euphoria, increased appetite

57
Q

Benzodiazepine MOA

A

enhance GABA to decrease neuronal excitability

58
Q

Chemo induced diarrhea drug therapies and max doses

A

Loperamide - 16 mg/d can be 24 if under medical
supervision for chemo induced diarrhea
Diphenoxylate + atropine

59
Q

What medication is used for dry mouth?

A

Pilocarpine - cholinergic effects that cause salivation

60
Q

What medications can cause hand-foot syndrome

A

Capecitabine, fluorouracil, cytarabine, liposomal doxorubicin and TKIs

61
Q

How is hand-foot syndrome managed?

A

Cool compress
Emollients
Steroids
Pain medications

62
Q

How does tumor lysis syndrome cause Acute Renal Failure (ARF)

A

Cells are broken down and release nucleic acid, purines are catalyzed by xanthine oxidase enzyme to uric acid, hyperuricemia, crystalization of UA, ARF

63
Q

What medications are used in tumor lysis syndrome to prevent hyperuricemia?

A

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
Q

How to treat mild hypercalcemia?

A

Hydration and loop diuretics

65
Q

What is considered moderate to severe hypercalcemia? How to treat?

A

Calcium >12

IV hydration with NS + calcitonin +/- IV bisphosphonates or denosumab

66
Q

What brand name of zolendronic acid and denosumab is used for hypercalcemia of malignancy?

A

Zolendronic acid - zometa (NOT reclast)

Denosumab - Xgeva (NOT Prolia)

67
Q

How to treat immunologic reactions to monoclonal antibodies?

A

APAP (650mg PO)

Diphenhydramine (IV or PO)

68
Q

What cancer meds are vesicants?

A

Anthracyclines and vinca alkaloids

69
Q

How to treat extravasation

A

Apply cold compresses (except vina alkaloids and etoposide - use warm)
Give antidote

70
Q

What is the antidote for anthracycline extravasation?

A

Dexrazoxane (Totect) or dimethylsulfoxide

71
Q

What is the antidote for vinca alkaloids and etoposide extravasation

A

Hyaluronidase

72
Q

When to give vaccines in relation to chemo

A

Avoid if possible or give 2 or more weeks before chemo
Do not give live vaccines during chemo
Can get inactivated flu vaccine

NAPLEX Review (79 decks)

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