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NAPLEX Prep > Oncology (Pt 1) > Flashcards

Oncology (Pt 1) Flashcards

1
Q

Warning signs of cancer?

A 
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
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2
Q

Bleomycin has capped dosing due to _____ toxicity

A

pulmonary

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3
Q

Doxorubicin has capped dosing due to _____ toxicity

A

cardiotoxicity

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4
Q

Cisplatin has capped dosing due to _____ toxicity

A

nephrotoxicity

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5
Q

Vincristine has capped dosing due to _____ toxicity

A

neuropathy

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6
Q

Dose cap for bleomycin?

A

LIFETIME dose of 400 units

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7
Q

Dose cap for doxorubicin?

A

LIFETIME cumulative dose: 450 - 550 mg/m^2

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8
Q

Dose cap for cisplatin?

A

PER CYCLE do not exceed 100 mg/m^2

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9
Q

Dose cap for vincristine?

A

2 mg per single dose

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10
Q

Toxicities of Chemotherapy: MYLEOSUPPRESSION

— how to monitor?

A

CBC - complete blood count w/ differential

Temperature, bleeding, fatigue, shortness of breath

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11
Q

Most agents cause myleosuppression: except which ones?

A
  • bleomycin
  • vincristine
  • TKIs
  • monoclonal antibodies
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12
Q

what is the most emetogenic chemo agent?

A

cisplatin

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13
Q

what chemo agents very commonly cause mucositis?

A
  • fluorouracil
  • capecitabine (prodrug of 5-FU)
  • irinotecan
  • methotrexate
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14
Q

what cancer drugs cause cardiomyopathy?

A
  • anthracyclines (doxorubicin)

- HER2 inhibitors (trastuzumab, pertuzumab)

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15
Q

what chemo agents very commonly cause diarrhea?

A
  • fluorouracil
  • capecitabine (prodrug of 5-FU)
  • irinotecan
  • many TKIs
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16
Q

what chemo agents very commonly cause constipation?

A
  • vincristine
  • pomalidomide
  • thalidomide
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17
Q

what drug can be given to prophylactically prevent doxorubicin cardiomyopathy

A

dexrazoxane

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18
Q

what drugs cause QT prolongation?

A

mainly TKIs

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19
Q

what drugs commonly cause pulmonary fibrosis?

A
  • bleomycin
  • busulfan
  • carmustine/lomustine
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20
Q

what drugs commonly cause nephrotoxicity?

A
  • cisplatin

- methotrexate

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21
Q

what drugs cause hemorrhagic cystitis?

A
  • ifosfamide (all doses)

- cyclophosphamide (high doses)

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22
Q

how to combat/prevent hemorrhagic cysitis?

A

give mesna and ensure adequate hydration

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23
Q

what drugs cause peripheral neuropathy?

A
  • vinca alkaloids (vincristine, vinblastine)
  • platinums (cisplatin, oxaliplatin)
  • taxanes (paclitaxel, docetaxel)
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24
Q

what adjunctive medication should be given with cisplatin?

is is given to prevent ________

A

amifostine

prevent: nephrotoxicity

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25
Q

what adjunctive medication should be given with doxorubicin?

is is given to prevent ________

A

dexrazonxane

prevent: cardiomyopathy; treat extravasation

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26
Q

what adjunctive medication should be given with fluorouracil?
is is given to prevent ________

A

leucovorin

to enhance efficacy

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27
Q

what is the antidote for fluorouracil or capecitabine?

A

uridine triacetate

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28
Q

what adjunctive medication should be given with ifosfamide?

is is given to prevent ________

A

mesna

prevent hemorrhagic cystitis

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29
Q

what adjunctive medication should be given with irinotecan?

is is given to prevent ________

A

atropine or loperamide

prevent diarrhea

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30
Q

what adjunctive medication should be given with methotrexate?
is is given to prevent ________

A

leucovorin

to decrease myleosuppression, mucositis

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31
Q

what is the nadir?

A

lowest point of WBCs and platelets

usually about 7 - 14 days after chemo

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32
Q

examples of CSF? (colony stimulating factors)

A

filgrastim
pegfilgrastim (long acting)
sargramostim

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33
Q

when to give a CSF (in relation to chemo?)

A

wait at least 24 hours after chemo – then can administer

34
Q

main side effect of CSF?

A

bone pain

35
Q

ESAs _______ survival and _____ tumor progression

A

ESAs SHORTEN survival
and increase tumor progression

(do not use if treatment is for CURATIVE)

36
Q

when should antiemetics be given in relation to chemotherapy?

A

30 minutes prior

37
Q

what drugs are neurokinin receptor antagonists/substance P antagonists

A

the -pitants

aprepitant, fosaprepitant, netupitant

38
Q

examples of 5-HT3 antagonists

A

-setrons

ondansetrons, granisetron, dolasetron

39
Q

which 5-HT3 antagonists should not be given IV for CINV due to QT prolongation risk

A

dolasetron

40
Q

common ADEs of ondansetron

A

fatigue, HA, constipation, dizziness

41
Q

what drug can be used for xerostomia (other than artificial saliva substitutes)

A

pilocarpine

42
Q

what dose adjustment is needed for pilocarpine

A

hepatic impairment

43
Q

what is palmar-plantar erythrodysesthesia

A

hand foot syndrome (seen with fluorouracil and capecitabine most often)

44
Q

how to deal with hand foot syndrome?

A

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

45
Q

what electrolyte is commonly elevated in malignancy conditions?

A

calcium

46
Q

what are some possible treatment options for hypercalcemia?

A

oral/IV hydration + loop diuretics
or calcitonin
or IV bisphosphonates or denosumab

47
Q

Expect calcium levels to drop within _______ when IV bisphosphonates or denosumab

A

1 - 3 days

48
Q

Xgeva or Prolia is used for hypercalcemia in malignancy

A

Xgeva

Prolia is indicated for osteoporosis and dosing is different

49
Q

which chemo agents are vesicants?

A

anthracyclines and vinca alkaloids causes tissues necrosis

50
Q

Vincristine should not de dispensed as _________; why?

A

do not dispense as a SYRINGE —- if given intrathecally it is FATAL!

dispense in IVPB

51
Q

vaccines and chemotherapy:
give vaccine at least ______ before starting chemo

give vaccine at least ______ after end of chemo

A

2 weeks before

at least 3 months after

52
Q

what drugs are SERMs

A

tamoxifen
fulvestrant
raloxifene
toremifene

53
Q

what drug is recommended to take with tamoxifen to help with hot flashes

A

venlafaxine

54
Q

what are ADEs of SERMs

A 
DVT/PE
menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)
55
Q

Examples of aromatase inhibitors?

A

anastrazole
letrozole
exemestane

56
Q

Aromatase Inhibitors:

higher risk of ________ and ______ compared to SERMs

A

osteoporosis; CVD

^thus Ca2+/Vit D supplement

57
Q

ADEs of AI’s?

A 
DVT/PE, bone pain/osteoporosis
menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)

hepatoxicity, dyslipidemia

58
Q

Ibrance (palbociclib) is used with _______ or _______ for better outcomes

A

letrozole;

fulvestrant

59
Q

boxed warning of tamoxifen?

A

risk of uterine/endometrial cancers

risk of thromboembolic events

60
Q

need to discontinue _______ about 72 hours prior to/during prolonged immobilization

A

72 hours

61
Q

drug classes used in prostate cancer?

A

GnRH/LHRH agonists
Antiandrogens
Androgen biosynthesis inhibitor

62
Q

examples of GnRH/LHRH agonists?

A

Leuprolide (Lupron Depot or Eligard)

Goserelin (Zoladex)

63
Q

GnRH/LHRH agonists have _______ risk

and they may cause tumor _______

A 
have osteoporosis
tumor flare (cause INITIAL raise in testosterone, then gradual reduction)
64
Q

How to prevent tumor flare with GnRH/LHRH in prostate cancer patients?

A

antiandrogens

65
Q

Examples of antiandrogens?

A

biclutamide
enzulatmide (Xtandi)
flutamide

66
Q

Antiandrogens in prostate cancer: mono or dual therapy?

A

NEVER mono therapy (will just increase testosterone receptors)

always dual with GnRH agonists

67
Q

what drug is a androgen biosynthesis inhibitor/inhibits CYP17 enzyme and is used in prostate cancer

A

abiraterone (Zytiga)

68
Q

Side effects of LHRH agonists?

A 
hot flashes
impotence
gynecomastia
peripheral edema
bone pain 
injection site pain
QT prolongation 
dyslipidemia/hyperglycemia
69
Q

which drug given for prostate cancer needs prednisone?

A

abiraterone (because of aldosterone feedback system – want to suppress hyperaldosteronism)

70
Q

what cancer drugs work during the M phase?

A

vinca alkaloids
taxanes

(work on microtubules in different ways)

71
Q

what cancer drugs are non-cell cycle specific?

A

alkylating agents
anthracyclines
platinum agents

72
Q

what drugs are platinum based drugs?

A

cisplatin
oxaliplatin
carboplatin

73
Q

what is the calvert formula?

A

just a formula used to dose carboplatin (uses AUC and GFR)

74
Q

ADEs of platinum based compounds?

A

neuropathy

nephrotoxicity and ototoxicity

75
Q

vinca alkaloids:

commonly cause diarrhea or constipation?

A

constipation (neuropathy issues related)

76
Q

Vinca alkaloids:
_______ is related to CNS toxicity more (neuropathy)

______ and______ are more related to bone marrow suppression

A

vinCristine = CNS

vinBlastine and vinorelBine = bone marrow

77
Q

Taxanes – what drugs are examples?

A

paclitaxel and docetaxel

78
Q

Taxanes:

________ before infusions

A

premedicate (diphenhydramine, corticosteroid, H2RAs)

they commonly have infusion related reactions/anaphylaxis

79
Q

Drug interaction with taxanes and platinum drugs?

A

taxane elimination is reduced if platinums are given first – thus give platinums first then taxanes

80
Q

does Abaxane need premedication?

A

no the albumin form of paclitaxel does not premedication of steroids and diphenhydramine

NAPLEX Prep (19 decks)

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