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Pharmacy > Oncology Therapeutics > Flashcards

Oncology Therapeutics Flashcards

0
Q

Capecitabine

A

5-FU prodrug

Diarrhea, hand-foot syndrome

Give with food to decrease nausea
Avoid aluminum/magnesium antacids

Sun protection

CYP 2C9 interaction, warfarin concerns

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1
Q

Fluorouracil (5-FU)

A

Dihydropyrimidine dehydrogenase deficiency are more likely to experience toxicity

Mucositis, diarrhea,

Bolus - myelosuppression
Continuous - hand foot, mucositis, diarrhea

Need sun protection

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2
Q

Cytarabine

A

Ocular toxicity, profound myelosuppression, CNS toxicity if they start writing smaller and smaller

Vesicant

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3
Q

Vesicant cause tissue damage

Bendamustine 
CCC
DDD
MM
Taxanes
Vinca alkaloids
A 
Cytarabine
Vinca alkaloids (vincristine, vinblastine, vinorelbine)
Paclitaxel 
Carmustine (BCNU)
Mechlorethamine 
Bendamustine 
Cisplatin 
Doxorubicin, daunorubicin, mitoxantrone 
Dactinomycin
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4
Q

Gemcitabine

Yellow gem

A

Dose limiting myelosuppression
Dose reduce if elevated bilirubin
Elevated LFT enzymes

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5
Q

Azacitidine

Fresh AAA

A

Short stability, so fresh bags must be prepared every 2-3 hours

Fever

Hypoalbuminemia pts caution for hepatic coma

Acyclovir and antifungal prophylaxis

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6
Q

Decitabine

A

AE: thrombocytopenia, neutropenia

Antibiotic prophylaxis
Hematopoietic growth factors needed

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7
Q

Fludrabine

A

Fever
CNS toxicity: blindness, coma, death

Prophylaxis against opportunistic infections

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8
Q

Cladribine

A

Lymphopenia (myelosuppression)
Fever

Prophylaxis against opportunistic infections

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9
Q

Pentostatin

Pen Prophylaxis

A

Immunosuppression expected prophylaxis
Prophylaxis for opportunistic infections

Dose reduction in renal impairment

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10
Q

Methotrexate

A

For high doses of MTX, start sodium bicarbonate drip to alkinalize urine and prevent renal toxicity

Monitor hematology (myelosuppression), renal, hepatic, pulmonary function

DDI with protein bound drugs
NSAIDS decrease renal function and MTX clearance
Common interaction with Bactrim (trimethoprim is an antifolate)

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11
Q

Leucovorin

A

Reduced form of folic acid

Administer 24-48 hours after MTX doses >100mg/m2

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12
Q

Glucarpidase

A

Inactivates methotrexate useful if renal failure

Do not administer with leucovorin, wait 2 hours

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13
Q

Pemetrexed

Trex dex

A

Dose limiting neutropenia

Dexamethasone 4mg BID x 3 days to prevent/improve rash

Folate and Vit B supplement 1 week before and continue throughout therapy to decrease hematologic side effects, mucositis, and diarrhea

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14
Q

Plant derivatives

A

All are 3A4 substrates
affected by 3A4 inhibition

Vincalkaloids
Taxanes 
Epotholones
Camptothecans (irinotecan)
Podophyllotoxins
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15
Q

VinCristine

A

Constipation due to neurotoxicity
Dose limiting neurotoxicity
Do NOT administer intrathecally

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16
Q

VinBlastine

BlastM

A

Bronchospasm

Myelosuppression

Monitor CBC w/differential

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17
Q

Vinorelbine

A

Vinca alkaloids peripheral neuropathy

Myelosuppression

Monitor CBC

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18
Q

Paclitaxel

A

Alopecia, peripheral neuropathy, myalgia, cardiac toxicity, hypotension

Nano - more sensory neuropathy

Use non-PVC(polyvinyl chloride) tubing

Premedicate with diphenhydramine, H2RA, and dexamethasone

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19
Q

Docetaxel

Dose premedicate D C

A

Dose limiting myelosuppression
Mucositis
Increased Liver LFT enzymes
Fluid retention

Corticosteroid and diphenhydramine premedicate to prevent hypersensitivity reaction and fluid retention

Use non-PVC tubing and bags

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20
Q

Cabazitaxel

A

Do not use in hepatic impairment

Premedicate with diphenhydramine and corticosteroids
Muse non-PVC tubing and bags

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21
Q

Ixabepilone

A

Neuropathy

Use DEHP-free tubing/bags
Lactated ringers only

Premedicate with diphenhydramine and steroid

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22
Q

Etoposide

A

Dose limiting myelosuppression

Concentration dependent stability issues

Use non-PVC tubing

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23
Q

Irinotecan

A

Early onset Diarrhea within 24hrs (I ran to can)
And delayed onset

Prevent/Treat early diarrhea with IV atropine NOT lomotil

Treat delayed onset with loperamide 4mg and 2mg q 2h until no bowel movement in 12 hours

Dose limiting myelosuppression and diarrhea
Nausea and vomiting

D5W diluent

Dose reduce with elevated bilirubin

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24
Q

Topotecan

TT renal

A

Dose limiting myelosuppression

Anemia: 50% require blood transfusion

Dose reduce in renal impairment

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25
Q

Erbulin mesylate

A

Prolongs QT interval

NO dextrose in the tubing or lines
Use normal saline

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26
Q

Carmustine (BCNU)

A

High dose: severe N/V
Dose limiting hepatotoxicity and pulmonary toxicity
Neurotoxicity

Lifetime dose limit: 1400mg/m2

Non-PVC tubing

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27
Q

Lomustine

A

Delayed myelosuppression (nadir 24-60days)

Take on empty stomach

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28
Q

Cyclophosphamide

A

Dose limiting myelosuppression
Hemorrhagic cystitis (bladder toxicity)
Secondary neoplasm
Frequent urination due to acrolein

Adequate hydration (3L/day) needed 
Administer drug in morning

Monitor urine output and urinalysis

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29
Q

Ifosfamide

A

Dose-limiting hemorrhagic cystitis
CNS toxicity: hallucinations

Must be administered with Mesna and continued after ifosfamide

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30
Q

Mechlorethamine (nitrogen mustard)

A

Pain in injection

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31
Q

Melphalan

MM

A

Administer orally on empty stomach

Mucositis

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32
Q

Bendamustine

A

Lymphocytopenia

Metabolized through CYP1A2

Monitor renal function

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33
Q

Procarbazine

PP carbz food

A

Dose-limiting N/V
Administer with food or after a meal

Photo sensitivity

DDI: tyramine foods (beer, fermented cheese) SSRI, alcohol

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34
Q

Temozolamide

TE Time Empty

A

Take same time daily to decrease N/V
Take on empty stomach

Dose limiting myelosuppression

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35
Q

Thiotepa

A

Dose limiting cognitive impairment

Ocular toxicity, Fever

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36
Q

Cisplatin

A

SEVERE Nausea/Vomiting

Renal toxicity, ototoxicity, peripheral neuropathy, anemia

Mix in saline, cis saline

Decrease renal toxicity with amifostine

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37
Q

Carboplatin

A

Platelet myelosuppression
Ototoxicity, nephrotoxicity

Dose = AUC x (GFR+25) 25 is no renal Cl

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38
Q

Oxaliplatin

A

Dose limiting peripheral neuropathy
Cold sensitivity

Prevention with gabapentin

Dilute/flush with Dextrose!

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39
Q

Anthracene derivatives

A

-rubi - red urine
And mitoxantrone

Vesicant

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40
Q

Doxorubicin

A

Irreversible cardiac damage

Total lifetime dose 500mg/m2

Reduce cardio toxicity with dexrazoxane

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41
Q

Daunorubicin

A

Lifetime dose 500mg/m2

Red urine

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42
Q

Epirubicin

EpiHepiFree

A

Lines must be flushed with a heparin free solution

5-FU is incompatible with epirubicin

Total lifetime dose: 900mg/m2

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43
Q

Mitoxantrone

A

Blue green color majoring urine, sclera, skin,
increase CV toxicity

Lifetime dose 160mg/m2

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44
Q

Bleomycin

A

Irreversible pulmonary toxicity

Lifetime dose 400 units

Use test dose, Do not Premedicate

Monitor pulmonary function

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45
Q

Dactinomycin

A

Vesicant

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46
Q

Pegylated-Aspariginase

PegPro

A

PEG formulation decreases dose and frequency of administration (q2 weeks)

Prolonged Prothrombin time

Decrease in fibrinogen and clotting factors

Test dose recommended

Monitor coagulation parameters

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47
Q

Hydroxyurea

A

Discard white powder floating on top

Take with food to decrease N/V

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48
Q

Corticosteroids

A

Can kill your lymphocytes and result in opportunistic infections

Total WBC may increase

AE: GI irritation, hyperglycemia, mood change, muscle weakness, immunosuppression, appetite change, adrenal corticoid insufficiency

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49
Q

Tamoxifen, toremifene

A 
1st tamoxifen (also available for prevention)
2nd line toremifene

AE: DVT, elevated LFT, hot flashes, endometrial cancer

50
Q

Fulvestrant

A

For breast cancer resistant to tamoxifen

Administer in gluteal muscle monthly

51
Q

Anastrozole, letrozole, exemestane

A

Used in POSTmenopausal estrogen receptor positive breast cancer

AE: bone pain, muscle aches, osteoporosis

52
Q

Abiraterone

Inhibit CYP 17 testosterone synthesis

A

Take on empty stomach

10 fold increase with food
99% protein bound, caution phenytoin

AE: peripheral edema, joint pain, hypokalemia, hypertension

DDI: inhibitor of 1A2, 2D6, and Pgp

Monitor blood pressure, potassium monthly

53
Q

Flutamide, nilutamide

A

Flutamide- hepatotoxicity
Nilutamide - interstitial pneumonitis

Decreased libido, hot flashes, gynecomastia

54
Q

Enzalutamide

A

For castrate resistant Prostate cancer

Fatigue, asthenia, seizures

55
Q

GnRH agonists

A

Decrease LH/FSH to castration levels of testosterone (combo with flutamide)

56
Q

Megestrol

A

For weight gain

57
Q

Arsenic trioxide

A

Weight gain secondary to fluid retention
Dose-limiting peripheral neuropathy

Differentiation syndrome (30-50%), respiratory distress, pulmonary infiltrates, hypotension
Treat with steroids
58
Q

Retinoids (vitamin A)

A 
AE: headache
Differentiation syndrome (pulmonary infiltrate, pleural effusion, weight gain, hypotension ) treat with steroids
59
Q

Bortezomib

A

Severe diarrhea

Dose limiting peripheral neuropathy

60
Q

Thalidomide

A

Teratogenic use double contraception
Peripheral neuropathy

High rate of DVT with dexamethasone

61
Q

Lenalidomide

A

Teratogenic use 2 contraception. Condom

Dose limiting DVT (increases with dex)

Neuropathy

Prophylaxis with aspirin for renal function

62
Q

Pomalidomide

A

Take on empty stomach

Neuropathy, DVT

DDI: 3A4, pgp

63
Q

Imatinib

A

Take orally with food and glass of water (to reduce N/V)

Periorbital and lower limb edema

Severe increase in LFTs, hepatotoxicity

DDI: 3A4 metabolism

64
Q

Nilotinib

A

Take on empty stomach BID

QT prolongation

Monitor ECG

DDI: 3A4, 2C9, pgp

65
Q

Gefitinib

A

Diarrhea, mucositis
Acneform rash

Avoid sun

3A4 interactions

66
Q

Erlotinib

ER Empty Rash PPI

A

Take on empty stomach (2 hour buffer)

Rash

PPI contraindicated!

Avoid sun

67
Q

Afatinib

A

Take on empty stomach

Rash

DDI pgp

Avoid sun

68
Q

Sunitinib

A

VEGF - think vascular, cardiac, bleeding

Take baseline ejection fraction

Bleeding

Avoid sun

69
Q

VEGF

A

Sunitinib
Sorafenib
Pazopanib

Bevacizumab

Ziv-aflibercept

70
Q

Sorafenib

A

Take without food
Avoid sun

DDI: 3A4, UGT1A9 (increases irinotecan)

Bleeding, HTN, VEGF

71
Q

Lapatinib

LLVEF

A

Avoid in women with low LVEF ejection

Diarrhea
Plantar palmar erythrodysethesia
Rash
Anemia

3A4

Take on empty stomach

72
Q

Pazopanib

A

Diarrhea, hepatotoxicity

Hypertension, change in hair color

Take on empty stomach

73
Q

Crizotinib

A

Nausea/Vom/Diarrhea, vision changes

Resistance develops early

74
Q

Ceritinib

A

Replace if crizotinib resistance

Take on empty stomach

Hyperglycemia, diarrhea, increased LFT
N/V, increased creatinine, abdominal pain
QT prolongation

Monitor glucose, electrolytes, EKG

3A4, avoid with PPI, H2RA (decrease bioavailability)

75
Q

Vemurafenib and debrafenib

A

Arthralgia, rash, pyrexia (Fever)

Hyperglycemia (dabrafenib)

DDI: warfarin, 3A4

76
Q

Trametinib

TQT

A

Take on empty stomach

QT prolongation, peripheral edema

77
Q

Ibrutinib

IInfection

A

Take with glass of water at night to decrease diarrhea

Infections are common

Monitor CBC, infection

Avoid sun

78
Q

Indelalisib

A

Hyperglycemia

Monitor blood glucose, CBC, diarrhea/pulmonary symptoms

79
Q

Palbociclib

PPE

A

Neutropenia, pulmonary embolism

Take with food

Monitor CBC, PE, infection

3A4

80
Q

Everolimus

A

Hyperglycemia, infections, pneumonitis

High fat intake decreases absorption!

81
Q

Vismodegib

A

Muscle spasms, weight loss

Do not donate blood within 7 months of last dose

Men use condoms and spermicide
Women use contraception
Avoid pregnancy!

DDI: PPI, H2RA

82
Q

Olaparib

A

Thrombocytopenia, neutrocytopenia, increased SCr

Call MD for bleeding, muscle/joint pain

Monitor CBC, SCr, pulmonary function

83
Q

Bacillus Calmettr-Guerin

A

Patient must have competent immune system

Contraindication: those receiving immunosuppressants (chemo, radiation, steroids)

AE: flu symptoms: chills, fever, myalgia

84
Q

Interferons

A

Not absorbed orally

Flu-like syndrome
Dose limiting fatigue
Neurological and psych depression after several weeks (mental slowing, memory loss)

Dexamethasone contraindicated

85
Q

Interleukin 2

A

Proteins, not absorbed orally

Toxic, requires vigorous supportive care

Hypotension, fluid retention, renal dysfunction
Capillary leak syndrome , infections (staph)

Monitor renal, cardiac, edema, CBC, BP

AE reduced with corticosteroids but don’t use prophylactically or routinely (may interfere with IL-2 efficacy)

86
Q

Ziv-afilbercept

A

VEGF: HTN, bleeding

Proteinuria

Monitor Urine protein

87
Q

Mab nomenclature

A 
Li - immune
Tu - tumor
Os - bon
Vi - virus
Les - inflammation

O - mouse
U - human
Xi - chimera
Zu - humanized

88
Q

Alemtuzumab

HADP prophylaxis

A

Recognizes CD52 antigen

Use within 8 hours if diluting
Protect from light

Premedicate with 50mg diphenhydramine and 650mg acetaminophen to reduce infusion AE

Pneumocystis and HSV prophylaxis and continue until CD4 = 200 cells/liter

Avoid if active infection, immunodeficiency

89
Q

Brentuximab

A

Target CD30

Peripheral neuropathy, anemia, neutropenia, thrombocytopenia

Monitor CBC and for peripheral neuropathy

Contraindicated with bleomycin due to pulmonary toxicity

3A4

90
Q

Cetuximab

A

No efficacy in KRAS mutant tumors

Acneform, follicular rash, asthenia

Wear sunscreen and hat

Prophylaxis with antihistamine

Administer undiluted using 0.22 micron filter

91
Q

Panitimumab

A

Dermatologic reactions, ocular toxicity, diarrhea

Sunscreen, hat

92
Q

Rituximab

A

Targets CD20 antigen

Premedicate with diphenhydramine and acetaminophen for infusion reactions

93
Q

Tositumomab

TThyroid

A

Give sski the day prior to protect thyroid

Radiation mechanism

94
Q

Ibritumomab

A

A lot of radiation: need to avoid human contact

Prolonged neutrocytopenia, thrombocytopenia

Human anti-mouse antibody reactions

95
Q

Trastuzumab

A

Target HER-2

Pulmonary toxicity, cardio toxicity (contraindicated with doxorubicin)

No dextrose

96
Q

Trastuzumab emtansine (Kadcyla)

A

Antibody drug conjugate

Cardiopulmonary toxicity, Thrombocytopenia, increase LFTs

No dextrose

97
Q

Pertuzumab

A

LV dysfunction

Monitor LV ejection function

No dextrose

98
Q

Bevacizumab

A

VEGF: HTN, hemorrhage, DVT

GI perforations, proteinuria

Dilute with Normal saline NOT dextrose
Protect from light

Wait 28 days after surgery before starting

Monitor abdominal pain for GI lesions

99
Q

Gemtuzumab

A

Targets CD33

Last ditch effort

Premedicate with diphenhydramine and acetaminophen

Neutropenia, thrombocytopenia
Diarrhea, stomatitis, fever, chills

Protect from light, administer immediately after mixing

100
Q

Nivolumab

A

Increase LFTs, rash

AE related to immunity locations: GI, respiratory, skin, first pass

Monitor LFTs, symptoms of pneumonitis and colitis

101
Q

Ipilimumab

IIIimmuneitis

A

Immune mediated complications: colitis, hepatitis, dermatitis

Monitor LFTs, bowel changes, abdominal pain

102
Q

Pembrolizumab

A

Immune mediated reactions

GI, liver first pass, skin, respiratory

Monitor TSH, LFT

103
Q

Stipuleucel-T

A

Plasma dialysis, add antigen, boost immune response to Prostate cancer

Monitor for infusion reactions

104
Q

Chemo Man

A

Neurotoxic: nitrosourea (carmustine,lomustine)
Ototoxicity/nephrotoxic: CISplatin, carboplatin
Peripheral neuropathy: vinca alkaloids
Pulmonary fibrosis: bleomycin
Cardio toxic: doxorubicin, daunorubicin
Cystitis (bladder toxicity): cyclophosphamide
Myelosuppression: methotrexate, 5-FU

105
Q

Non-PVC tubing

TEC

A

Paclitaxel
Docetaxel
Cabazitaxel

Etoposide
Carmustine

106
Q

CNS toxicity

FIMP

A 
Cytarabine - write smaller
Fludrabine
Ifosfamide
Methotrexate 
Procarbazine
107
Q

Empty stomach

LMN TAPE CAPTinib

A 
Lomustine 
Melphalan 
Nilotinib 
Temozolamide 
Abiraterone 
Pomalidomide
Erlotinib
Ceritinib
Afatinib 
Pazopanib 
Trametinib
108
Q

Prolong QT interval

A

Ceritinib
Arsenic trioxide
Trametinib
Eribulin mesylate

109
Q

Premedicate diphenhydramine and dex

PIC DD

A

Paclitaxel
Ixabepilone
Cabazitaxel

110
Q

Premedicate with diphenhydramine and APAP

A

Alemtuzumab

Rituxamab

111
Q

Mix/dilute in saline

A

CISplatin

BevaCIZumab

112
Q

No dextrose

PET

A

Pertuzumab
Eribulin mesylate
Trastuzumab

113
Q

Antibiotic prophylaxis

A

Decitabine
Fludarabine
Cladribine
Pentostatin

114
Q

Antiviral prophylaxis

A

Azacitidine plus antifungal

Alemtuzumab (herpes)

115
Q

High risk emetogenic potential

CCDD

A

Cisplatin
Cyclophosphamide
Dacarbazine
Doxorubicin

116
Q

Chemo Mucositis

A 
5-FU
Capecitabine 
Doxorubicin 
Methotrexate 
Melphalan
117
Q

Chemo diarrhea

A

5-FU
Capecitabine
Irinotecan

118
Q

Premedicate antihistamine only

A

Cetuximab

119
Q

KRAS wild type

A

Can use EGFR targeted therapy

Cetuximab
Panitumumab

120
Q

Flush in dextrose

A

Oxaliplatin

Irinotecan

121
Q

Lacerated ringers solution

A

Ixabepilone

122
Q

With food

A

Capecitabine
Abiraterone
Procarbazine
Imatinib

Pharmacy (63 decks)

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