Oncology (Pt 1) Flashcards
Warning signs of cancer?
CAUTION C - change in bowel or bladder habits A - a sore that won't heal U - unusual bleeding or discharge T - thickening or lump in breast or elsewhere I - indigestion or difficulty swallowing O -obvious change in wart or mole N - nagging cough or hoarseness
Bleomycin has capped dosing due to _____ toxicity
pulmonary
Doxorubicin has capped dosing due to _____ toxicity
cardiotoxicity
Cisplatin has capped dosing due to _____ toxicity
nephrotoxicity
Vincristine has capped dosing due to _____ toxicity
neuropathy
Dose cap for bleomycin?
LIFETIME dose of 400 units
Dose cap for doxorubicin?
LIFETIME cumulative dose: 450 - 550 mg/m^2
Dose cap for cisplatin?
PER CYCLE do not exceed 100 mg/m^2
Dose cap for vincristine?
2 mg per single dose
Toxicities of Chemotherapy: MYLEOSUPPRESSION
— how to monitor?
CBC - complete blood count w/ differential
Temperature, bleeding, fatigue, shortness of breath
Most agents cause myleosuppression: except which ones?
- bleomycin
- vincristine
- TKIs
- monoclonal antibodies
what is the most emetogenic chemo agent?
cisplatin
what chemo agents very commonly cause mucositis?
- fluorouracil
- capecitabine (prodrug of 5-FU)
- irinotecan
- methotrexate
what cancer drugs cause cardiomyopathy?
- anthracyclines (doxorubicin)
- HER2 inhibitors (trastuzumab, pertuzumab)
what chemo agents very commonly cause diarrhea?
- fluorouracil
- capecitabine (prodrug of 5-FU)
- irinotecan
- many TKIs
what chemo agents very commonly cause constipation?
- vincristine
- pomalidomide
- thalidomide
what drug can be given to prophylactically prevent doxorubicin cardiomyopathy
dexrazoxane
what drugs cause QT prolongation?
mainly TKIs
what drugs commonly cause pulmonary fibrosis?
- bleomycin
- busulfan
- carmustine/lomustine
what drugs commonly cause nephrotoxicity?
- cisplatin
- methotrexate
what drugs cause hemorrhagic cystitis?
- ifosfamide (all doses)
- cyclophosphamide (high doses)
how to combat/prevent hemorrhagic cysitis?
give mesna and ensure adequate hydration
what drugs cause peripheral neuropathy?
- vinca alkaloids (vincristine, vinblastine)
- platinums (cisplatin, oxaliplatin)
- taxanes (paclitaxel, docetaxel)
what adjunctive medication should be given with cisplatin?
is is given to prevent ________
amifostine
prevent: nephrotoxicity
what adjunctive medication should be given with doxorubicin?
is is given to prevent ________
dexrazonxane
prevent: cardiomyopathy; treat extravasation
what adjunctive medication should be given with fluorouracil?
is is given to prevent ________
leucovorin
to enhance efficacy
what is the antidote for fluorouracil or capecitabine?
uridine triacetate
what adjunctive medication should be given with ifosfamide?
is is given to prevent ________
mesna
prevent hemorrhagic cystitis
what adjunctive medication should be given with irinotecan?
is is given to prevent ________
atropine or loperamide
prevent diarrhea
what adjunctive medication should be given with methotrexate?
is is given to prevent ________
leucovorin
to decrease myleosuppression, mucositis
what is the nadir?
lowest point of WBCs and platelets
usually about 7 - 14 days after chemo
examples of CSF? (colony stimulating factors)
filgrastim
pegfilgrastim (long acting)
sargramostim
when to give a CSF (in relation to chemo?)
wait at least 24 hours after chemo – then can administer
main side effect of CSF?
bone pain
ESAs _______ survival and _____ tumor progression
ESAs SHORTEN survival
and increase tumor progression
(do not use if treatment is for CURATIVE)
when should antiemetics be given in relation to chemotherapy?
30 minutes prior
what drugs are neurokinin receptor antagonists/substance P antagonists
the -pitants
aprepitant, fosaprepitant, netupitant
examples of 5-HT3 antagonists
-setrons
ondansetrons, granisetron, dolasetron
which 5-HT3 antagonists should not be given IV for CINV due to QT prolongation risk
dolasetron
common ADEs of ondansetron
fatigue, HA, constipation, dizziness
what drug can be used for xerostomia (other than artificial saliva substitutes)
pilocarpine
what dose adjustment is needed for pilocarpine
hepatic impairment
what is palmar-plantar erythrodysesthesia
hand foot syndrome (seen with fluorouracil and capecitabine most often)
how to deal with hand foot syndrome?
cooling/ice compresses (avoid hot water exposure for a long time)
avoid pressure on hand/and feets (jogging, tennis like sports, using knives/screwdrivers)
use emollients
what electrolyte is commonly elevated in malignancy conditions?
calcium
what are some possible treatment options for hypercalcemia?
oral/IV hydration + loop diuretics
or calcitonin
or IV bisphosphonates or denosumab
Expect calcium levels to drop within _______ when IV bisphosphonates or denosumab
1 - 3 days
Xgeva or Prolia is used for hypercalcemia in malignancy
Xgeva
Prolia is indicated for osteoporosis and dosing is different
which chemo agents are vesicants?
anthracyclines and vinca alkaloids causes tissues necrosis
Vincristine should not de dispensed as _________; why?
do not dispense as a SYRINGE —- if given intrathecally it is FATAL!
dispense in IVPB
vaccines and chemotherapy:
give vaccine at least ______ before starting chemo
give vaccine at least ______ after end of chemo
2 weeks before
at least 3 months after
what drugs are SERMs
tamoxifen
fulvestrant
raloxifene
toremifene
what drug is recommended to take with tamoxifen to help with hot flashes
venlafaxine
what are ADEs of SERMs
DVT/PE menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)
Examples of aromatase inhibitors?
anastrazole
letrozole
exemestane
Aromatase Inhibitors:
higher risk of ________ and ______ compared to SERMs
osteoporosis; CVD
^thus Ca2+/Vit D supplement
ADEs of AI’s?
DVT/PE, bone pain/osteoporosis menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)
hepatoxicity, dyslipidemia
Ibrance (palbociclib) is used with _______ or _______ for better outcomes
letrozole;
fulvestrant
boxed warning of tamoxifen?
risk of uterine/endometrial cancers
risk of thromboembolic events
need to discontinue _______ about 72 hours prior to/during prolonged immobilization
72 hours
drug classes used in prostate cancer?
GnRH/LHRH agonists
Antiandrogens
Androgen biosynthesis inhibitor
examples of GnRH/LHRH agonists?
Leuprolide (Lupron Depot or Eligard)
Goserelin (Zoladex)
GnRH/LHRH agonists have _______ risk
and they may cause tumor _______
have osteoporosis tumor flare (cause INITIAL raise in testosterone, then gradual reduction)
How to prevent tumor flare with GnRH/LHRH in prostate cancer patients?
antiandrogens
Examples of antiandrogens?
biclutamide
enzulatmide (Xtandi)
flutamide
Antiandrogens in prostate cancer: mono or dual therapy?
NEVER mono therapy (will just increase testosterone receptors)
always dual with GnRH agonists
what drug is a androgen biosynthesis inhibitor/inhibits CYP17 enzyme and is used in prostate cancer
abiraterone (Zytiga)
Side effects of LHRH agonists?
hot flashes impotence gynecomastia peripheral edema bone pain injection site pain QT prolongation dyslipidemia/hyperglycemia
which drug given for prostate cancer needs prednisone?
abiraterone (because of aldosterone feedback system – want to suppress hyperaldosteronism)
what cancer drugs work during the M phase?
vinca alkaloids
taxanes
(work on microtubules in different ways)
what cancer drugs are non-cell cycle specific?
alkylating agents
anthracyclines
platinum agents
what drugs are platinum based drugs?
cisplatin
oxaliplatin
carboplatin
what is the calvert formula?
just a formula used to dose carboplatin (uses AUC and GFR)
ADEs of platinum based compounds?
neuropathy
nephrotoxicity and ototoxicity
vinca alkaloids:
commonly cause diarrhea or constipation?
constipation (neuropathy issues related)
Vinca alkaloids:
_______ is related to CNS toxicity more (neuropathy)
______ and______ are more related to bone marrow suppression
vinCristine = CNS
vinBlastine and vinorelBine = bone marrow
Taxanes – what drugs are examples?
paclitaxel and docetaxel
Taxanes:
________ before infusions
premedicate (diphenhydramine, corticosteroid, H2RAs)
they commonly have infusion related reactions/anaphylaxis
Drug interaction with taxanes and platinum drugs?
taxane elimination is reduced if platinums are given first – thus give platinums first then taxanes
does Abaxane need premedication?
no the albumin form of paclitaxel does not premedication of steroids and diphenhydramine
