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NAPLEX Review UWorld > Oncology Part II > Flashcards

Oncology Part II Flashcards

1
Q

Trastuzumab (Herceptin)

Mechanism

A

Binds to human epidermal growth factor receptor 2 (HER2)

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2
Q

Trastuzumab (Herceptin)

Key Safety Concerns

A

Cardiotoxicity (eg, cardiomyopathy)

Monitor LVEF before & after treatment

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3
Q

Bevacizumab (Avastin)

Mechanism

A

Binds to vascular endothelial growth factor (VEGF)

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4
Q

Bevacizumab (Avastin

Key Safety Concerns

A

Impaired wound healing
* Avoid for 28 days before or after surgery

Thromboembolic events

Hemorrhage/fatal bleeding

Gl perforation

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5
Q

Programmed Death Receptor-1 (PD-1) inhibitors

Drugs

A

Pembrolizumab (Keytruda)

Nivolumab (Opdivo)

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6
Q

Cytotoxic T-Lymphocyte Antigen-4 (CTLA-4) Inhibitor

Drug

A

Ipilumumab (Yervoy)

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7
Q

Key Safety Concerns

PD-1 & CTLA-4

A

Immune-mediated toxicities (eg, endocrinopathies, colitis, hepatotoxicity)

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8
Q

Identifying Prostate Cancer

A

Abnormal DRE + PSA > 10 ng/mL

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9
Q

Gonadotropin-releasing hormone (GnRH) agonists

Common drugs

A

Leuprolide (Lupron Depot)

Goserelin (Zoladex)

Histrelin (Supprelin LA)
Triptorelin (Trelstar)

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10
Q

Gonadotropin-releasing hormone (GnRH) agonists

Safety concerns

A

↓ bone density
* Prevent with calcium & vitamin D

  • Tumor flare
  • Give with antiandrogen
  • Hot flashes
  • Impotence, gynecomastia
  • Bone pain
  • QT prolongation
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11
Q

Gonadotropin-releasing hormone (GnRH) antagonists

Common drugs

A

Degarelix (Firmagon)

Relugolix (Orgovyx)

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12
Q

Gonadotropin-releasing hormone (GnRH) antagonists

Safety concerns

A

Hot flashes

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13
Q

Antiandrogens

Common drugs

A

Bicalutamide (Casodex)

Flutamide

Nilutamide (Nilandron)

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14
Q

Antiandrogens

Safety concerns

A

Hot flashes

Gynecomastia

Hepatotoxicity

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15
Q

Vinca Alkaloids

Drugs

A

Vincristine

Vinblastine

Vinorelbine

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16
Q

Vinca Alkaloids

Side Effects

A

Peripheral sensory neuropathy (paresthesias)

Autonomic neuropathy (gastroparesis, constipation)

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17
Q

Vinca Alkaloids

Peripheral neuropathy

A

Monitor S/Sx (eg, numbness, paresthesia, pain)

Prevention: Limit single vincristine doses to 2 mg

Tx: Neuropathic pain medications (eg, gabapentin, duloxetine)

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18
Q

Vinca Alkaloids

Autonomic neuropathy

A

Monitor S/Sx (eg, Bowel movement frequency)

Prevention & Tx: Symptomatic care (eg, diet modifications, laxatives)

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19
Q

Vinca Alkaloids

Administration

A

Only IV

Prepare in a small IV bag

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20
Q

Tretinoin

Safety Concern

A

Differentiation syndrome (fever, dyspnea, pleural effusion)

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21
Q

Tretinoin

Management

A

Systemic steroids (eg, dexamethasone)

Interrupt therapy

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22
Q

Arsenic trioxide

Safety Concern

A

QT prolongation

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23
Q

Arsenic trioxide

Management

A

Maintain K > 4 and Mg > 1.8 mEq/L

Avoid QT-prolonging drugs

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24
Q

Bleomycin

Safety Concern

A

Pulmonary toxicity (eg, pulmonary fibrosis)

Hypersensitivity reactions

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25
Q

Bleomycin

Management

A

Limit lifetime cumulative dose to 400 units

Test dose and/or premedicate

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26
Q

Bortezomib & Carfilzomib

Safety Concern

Proteasome Inhibitors

A

Herpes reactivation

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27
Q

Bortezomib & Carfilzomib

Management

Proteasome Inhibitors

A

Antiviral agents (eg, acyclovir, valacyclovir)

28
Q

Immunomodulators Meds

A

Lenalidomide (Revlimid)
Pomalidomid (Pomlyst)
Thalidomide (Thalomid)

29
Q

Lenalidomide, Pomalidomid, & Thalidomide

Safety Concern

Immunomodulators

A

Sever birth defects (need 2 negative pregnancy tests)

Thrombosis (DVT/PE)

30
Q

Lenalidomide, Pomalidomid, & Thalidomide

Management

Immunomodulators

A

REMS program

2 form of contraception or abstain from sex

PPx anticoagulation

31
Q

Pegaspargase

Safety Concerns

Modified from of L-asparaginase conjugated w/ polyethylene glycol

A

Hypersensitivity Reactions

32
Q

Pegaspargase

Management

Modified from of L-asparaginase conjugated w/ polyethylene glycol

A

Premedication w/ APAP, diphenhydramine & an H2RA

33
Q

Whatdoes rituximab target?

A. EGFR

B. VEGF

C. CD20

D. HER2

E. PD-1

A

CD20

Brand (Rituxan)

Rituximab binds to the CD-20 antigen on the B-cells, so patients must be CD20 positive in order to use rituximab.

CD refers to the Leukocyte Cluster of Differentiation antigens.

34
Q

On day 5 of the chemotherapeutic regimen, he complains of tingling, numbness and pain in his fingers. Which of his chemotherapeutic medications is most likely causing these symptoms?

A. Rituximab

B. Cyclophosphamide

C. Doxorubicin

D. Vincristine

E. Prednisone

A

Vincristine

Vincristine is notable for causing peripheral neuropathies.

35
Q

Which agents are cell cycle independent?

A

Alkylating agents (eg, cyclophosphamide)

Anthracyclines (eg, doxorubicin)

Platinum compounds (eg, cisplatin)

36
Q

Which agents work on the S phase?

A

Antimetabolites (eg, methotrexate)

Topoisomerase I inhibitors (eg, irinotecan)

37
Q

Which agents works on the G2 phase?

A

Etoposide

Bleomycin

38
Q

Which agents works on the M phase?

A

Taxanes

Vinca alkaloids

39
Q

Pyrimidine analog antimetabolites

MOA

A

S phase

Incoporates into DNA by interfering w/ certain nucleotides in RNA & DNA

Flurorouracil inhibits thymidylate synthase

40
Q

Pyrimidine analog antimetabolites

Drugs

A

Fluorouracil

Capecitabine

Capecitabine is converted into Fluorouracil

41
Q

Pyrimidine analog antimetabolites

What is given w/ fluorouracil to ↑ efficacy?

A

Leucovorin or
Levoleucovorin

42
Q

Pyrimidine analog antimetabolites

Adverse Effects

A

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

GI Toxicities: Diarrhea, mucositis

Severe toxicities ↑ w/ dihydropyrimidine dehydrogenase (DPD) deficiency

DPD breaks down Fluorouracil

43
Q

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

Monitoring

A

S/Sx (eg, painful erythema, skin peeling)

44
Q

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

Management

A

Limit daily activities to reduce pressure to hands & feet

Avoid heat exposure

Apply cold compresses for temporary relief

Use emollients or topical steroids

Modify doses or interrupt therapy for severe cases

45
Q

Dihydropyrimidine dehydrogenase (DPD) deficiency

Prevention

A

Pharmacogenomic testing

46
Q

Dihydropyrimidine dehydrogenase (DPD) deficiency

Treatment of toxicities

A

Antidote: uridine triacetate for overdose or early-onset toxicity

Symptomatic care (specific to the toxicity)

47
Q

Pyrimidine analog antimetabolites

Drug intxn

A

Warfarin:
Monitor INR (↑) & S/Sx of bleeding

48
Q

Folate Antimetabolites

MOA

A

S phase

Inhibits dihydrofolate reductase → inhibits tetrahydrofolate activation → inhibiting purine & pyrimidines synthesis

49
Q

Folate Antimetabolites

Toxicities

A

Nephrotoxicity (w/ high doses ≥ 500 mg/m2)

GI toxicity (eg, diarrhea, mucositis)

50
Q

Folate Antimetabolites: Nephrotoxicity

Monitoring

A

Renal function (eg, BUN, SCr)

Wt gain

Urine pH (target ≥ 7)

Methotrexate levels

51
Q

Folate Antimetabolites: Nephrotoxicity

Prevention

A

Leucovorin or levoleucovorin “rescue”
IV sodium bicarbonate hydration to alkalinize the urine
Avoid interaction meds (eg, NSAIDs, salicylates)

52
Q

Folate Antimetabolites: Nephrotoxicity

Treatment

A

Antidote: glucarpidase rapidly lowers MTX levels

52
Q
A
53
Q
A
53
Q

Folate Antimetabolites: GI toxicity

Monitoring

A

S/Sx (eg, BM frequency, painful mouth ulcers)

54
Q

Folate Antimetabolites: GI toxicity

Prevention & Treatment

A

Diarrhea: antidiarrheals, hydration, electrolyte repletion
Mucositis: various
Leucovorin or levoleucovorin “rescue”

55
Q

Folate Antimetabolites: GI toxicity: Mucositis

Monitoring

A

S/Sx (eg, painful mouth ulcers, difficulty eating)
S/Sx of infections (eg, thrush)

56
Q

Folate Antimetabolites: GI toxicity: Mucositis

Prevention

A

Good oral hygiene (eg, brushing with a soft toothbrush)

Hold ice chips in the mouth

Frequent rinsing with bland rinses (eg, sodium bicarbonate solution)

57
Q

Folate Antimetabolites: GI toxicity: Mucositis

Treatment

A

Continue good oral hygiene and frequent rinsing

Symptomatic care (eg, viscous lidocaine 2%, magic mouthwash)

Parenteral nutrition or IV hydration in some cases

Thrush treatment (eg, nystatin oral suspension, clotrimazole troches) if indicated

58
Q

Tyrosine Kinase Inhibitors

Bind to BCR-ABL fusion gene

A

Imatinib (Gleevec)
Dasatinib (Sprycel)
Nilotinib (Tasigna)

59
Q

Tyrosine Kinase Inhibitors: Bind to BCR-ABL fusion gene

Safety Concerns

A

Fluid retention

QT prolongation (nilotinib [Tasigna] ← greatest risk)
* Assess QT interval with an ECG
* Correct electrolyte abnormalities
* Avoid concurrent QT-prolonging drugs & strong CYP3A4 inhibitors

Gl upset (eg, abdominal pain)
* Take imatinib with food

60
Q

Tyrosine Kinase Inhibitors

Bind to protein kinase BRAF

A

Dabrafenib (Tafinlar)
Vemurafenib (Zelboraf)

61
Q

Tyrosine Kinase Inhibitors: Bind to protein kinase BRAF

Safety Concerns

A

New malignancies

QT prolongation

62
Q

Tyrosine Kinase Inhibitors

Bind to mitogen-activated extracellular kinase (MEK)

A

Cobimetinib (Cotellic)
Trametinib

63
Q

Tyrosine Kinase Inhibitors: Bind to MEK

Safety Concerns

A

Retinopathy

Rhabdomyolysis

64
Q

Tyrosine Kinase Inhibitors

Bind to epidermal growth factor receptor (EGFR)

A

Afatinib (Gilotrif)

Erlotinib (Tarceva)

65
Q

Tyrosine Kinase Inhibitors: EGFR

Safety Concerns

A

Dermatologic toxicity (eg, acneiform rash)

Use general skin care (eg, sunscreen) & PPx measures (eg, antibiotics)

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