OncologyFC Flashcards
What are the seven warning signs for cancer?
CAUTION
C change in bowel or bladder habbits
A sore that does not heal
U unusual bleeding or discharge
T thickenin or lump in breast or anywhere
I indigestion or difficulty swallowing
O obvious change in wart or mole
N nagging cough or hoarseness
when should women get screening for breast cancer?
mammogram every year after 40
clinical breast exam every 3 years 20-39, then at 40 every year
selfe exam every year starting at 20 if they want
when should ppl start checking for colorectal cancer?
age 50 guys and girls
-sigmoidoscopy q 5y
-colonoscopy q 10 y
women to start cervical cancer screening?
at 21-29 have pap test q 3 years
30-65 pap test plus HPV test q 5 years or pap q 3years
-after age 65, if had normal results all her life, no more need to test
men to start to test for prostate cancer?
info to be provided at 50 yo but benefits have not been shown yet for routine testing. If AF am or family history can start at age 45 .
what test is for the prostate cancer?
PSA blood test with or without a digital rectal exam
what is the purpose of induction therapy (neoadjuvant)
to shrink the tumor initially
what is the purpose of adjuvatn therapy
given after the main treatment to eradicate the remaining disease tissue
what are the three main SE for oncology meds?
Hair loss, GI toxicity and myelosupresion \
know how to calculate ANC
WBC x [segments (decimal from percentage) + bands (same as for segments) ]
what is the g2 phse of replication and which agents work there?
here is where the cell is preparing to divide so It proudces topoisomerase and RNA. Agents
Topoisomerase inhibitors
what is the S phase of a cell and which agents hit it
S is where the cell is replicateing its DNA and duplicating Agent antimetabolits (MTX, SFU), capecitabine, gemcitabine, cytoraline
which anticancers are not specific?
alkylating agents, antrhacycline , platinum , antimitotic, vinca alkaloids, taxanes
what is the dubois equation for BSA?
BSA = 0.007184 x kg^0.425x ht cm ^0.725
MOA of alkylators
cross link DNA preventing cell replication
cyclophosphamide - Brand and major side effect
alkylators: Cytoxan - bladder toxicity = give with MESNA AND adequate hydration to protect against hemorrhagic cystitis.
Ifosfamide - Brand and major side effects
Ifex - bladder toxicity = give with MESNA AND adequate hydration to protect against hemorrhagic cystitis.
temozolomide - brand and MOA
Temodar - alyklator =cross link DNA
what is MESNA Brand and function
Mesnex given as an adjuvant in cancer chemotherapy that prevents the damage to the bladder. MOA thought to be antioxidant
bicalutamide - Brand and major side effect
Casodex - gynecomastia, hepatotoxicit, hot flashes- antiandrogen given po usually with LHRH for prostate cancer
flutamide - Brand and major side effects
Eulexin - gynecomastia, hepatotoxicit, hot flashes
more GI toxicity and visual disturbances
Goserelin - Brand and major side effects- antiandrogen anti estrogen LHRH
Zoladex - hot flashes, bone pain, impotence, QT prolongation, gynecomastia,
decreased bone density / consider calcium + vitamin D
Leuprolide - Brand and major adr - LHRH agonist
Lupron - hot flashes, bone pain, impotence, QT prolongation, gynecomastia,
decreased bone density / consider calcium + vitamin D
are the aromatase inhibitors approved for all women?
NO just post menopausal woemen and also not for men with breast cancer
anastrazole - Brand and major side effects-aromatase inhibits that prevents conversion to active estrogen, androgen cotincosteroid
Arimidex - fatigue, menopause symptoms, decrease bone density / consider calcium + vitamin D
exemestane - brand and major side effects aromatase inhibitor
Aromasin - fatigue, menopause symptoms, decrease bone density / consider calcium + vitamin D
increased cardiovascular disease risk compared to SERMs
letrozole - brand and major side effects
aromatase inhibtorFemara - fatigue, menopause symptoms, decrease bone density / consider calcium + vitamin D
increased cardiovascular disease risk compared to SERMs
fulvestrant - brand / major side effects / BBW
Faslodex / menopausal symptoms, hot flashes, flushing, weight gain
BBW - increase risk of DVT,PE,MI,stroke with all SERMs
raloxifene - brand / major side effects / BBW
SERM
Evista / menopausal symptoms, hot flashes, flushing, weight gain
BBW - increase risk of DVT,PE,MI,stroke with all SERMs
tamoxifen - brand / major side effects / BBW
SERM
Nolvadex / menopausal symptoms, hot flashes, flushing, weight gain
BBW - increase risk of DVT,PE,MI,stroke with all SERMs
doxorubicin - Brand / major side effects
Anthracycline- intercalation into DNA, inhibits topoisomeriase, creates oxygen free radicals
Adriamycin / radiation recall rection, hand foot syndrome, CARDIOTOXICITY (dec. risk by not exceeding max lifetime dose)
consider using cardioprotective dexrazoxane when doses continue beyond 300mg/m2
major side effects of anthracycline
cardiotoxicity and turnks the body fluids red such as the urine
epirubicin - brand / major side effects
Anthracyclines
ellence / Adriamycin / radiation recall rection, hand foot syndrome, CARDIOTOXICITY (dec. risk by not exceeding max lifetime dose)
mitoxantrone MOA and side effects
anthracycline Mitoxantrhone is an antracenedione similar to anthracyclines and turns body fluids into blue rather than red.
MOA of methorexate
inhibits folate metabolism leading to prevention of DNA sysnthesis
methotrexate - brand and major side effects
folate antimetabolite: prevents DNA synthesis:
MTX, Trexall, Folex, Mexate -
myelosuppression, mucositis, hepatic/renal toxicity, hand-foot syndrome,
High doses require leucovorin rescue
active transport elimination by decreasing aspirin, penicillins, probenacids and nsaids, resulting in toxicity so dont use together
Drink Fluids
lenalidomide - side effects
immuno modulators: decrease angiogenesis
Revlimid - severe birth defects (X) - risk of DVT/PE
available under restricted program revassist- pt prescriber and pharmacist have to be registered with this.
bevacizumab - Brand and major side effects
Avasstin - GI pain, impairs wound healing, thrombosis risk
angiogenesis inhibitor: limit tumor supply
rituximab - brand and major side effects- monoclonal antibody
Rituxan - Infusions must be given in hospital because reaction can be fatal.
another one: tostidumomab: iodine inducer. emmits gamma and ebta with radiation. thyroid protective regiment needed PRIOR to tositumomamb
cetuximab - Brand and major side effects
Erbitux - EGFR positive expression correlates with better response rates. Kras mutation indicates poor response.
pharmogenics: colorectal cancer does not respond to cetuximab if they have kras mutation
traztuzumab - Brand and targeted pt population - major side effects
Herceptin / Her2/neu+ gene/ cardiomyopathy
must be great than 2+ by immunohistochemical testing (IHC) to respond/use this.
cisplatin - Brand and major side effects
Platinol / nephrotoxicity-vigorous hydration , SEVERE N/V
sometimes mannitol used to avoid renal failure, electrolyte wasting requiring magnesium and potassium supplementation.
amifostine may be used prophylactically.
high risk of N/V needs prophylaxis
oxaliplatin - Brand and major side effects
Eloxatin - nuropathy exacerbated by exposure to COLD
capecitabine - brand / major side effect / administration
Xeloda / mucositis, hand foot syndrome, large increase in INR due to 2C9 inhibition
pharmacogenomic testing for DPD deficiency (increase risk of severe toxicity)
prodrug of 5-FU PO taken with meals
fluorouracil - brand / administration / testing
5-FU / given with leucovorin to increase efficacy /
pharmacogenics testing for DPD defieciey (dihydropyridimidine dehydrogenase deficiencty)
floxuridine - administration
given via intra-hepatic artery or portal vein infusion for isolated hepatic metastases. less systemic side effects
gemcitabine - brand
Gemzar
tretinoin - brand
ATRA (all trans retinoic acid) - preg cat X
Lots of side effects
docetaxel - brand and major side effects
Taxotere - cardiopulmonary: fluid retention
pretreat with dexamethasone
paclitaxel - brand / major side effect / administration
Taxol / anaphylaxis, hypersensitivity rxns,
PRETREAT with dexamethasone, diphenhydramine, and H2 blocker
irinotecan - brand / major side effects
topoisomerase 1 inhibitors
Camptosar / Acute diarrhea (treat with atropine / loperamide)
etoposide - brand / major side effects
VePesid - neurotoxicity/neuropathy
what is primary target of crizotinib?
ALK (anaplastic lymphoma kinase)
imatinib - brand and prior testing?
Gleevac - Philadelphia chromosome + (Ph+) or CML, or cKIT
erlotinib - brand, administration, major side effects.
Tarceva - PO 1 hr before or 2 hr after meal / hepatotoxicity
vinblastine - Brand / major side effects
Velban - cumulative dose dependent nerve damage, vesication occurs when extravasated, DO NOT administer intrathecally.
vincristine - brand / major side effects
Vincasar - cumulative dose dependent nerve damage, vesication occurs when extravasated, DO NOT administer intrathecally.
vinorelbine - brand / major side effects
Navelbine - cumulative dose dependent nerve damage, vesication occurs when extravasated, DO NOT administer intrathecally.
arsenic trioxide - brand and major side effects
Trisenox - QT prolongation: monitor ECG, keep Mg and K within normal range
bleomycin - brand and major side effects
Blenoxane - Pulmonary reactions - pneumonitis, hypersensitivity reactions
Max lifetime dose = 400 units
warning signs for cancer
CAUTION:
change in bowel habbits
a sore that does not heal
unusual bleeding
thickening or lump
indigestions
wart/mole
nagging cough
mammograms how often
yearly starting at age 40
clinical breast exam how often
every 3 years in 20s, every year after 40
colorectal cancer
at age 50 gets tested for sigmioidoscopy, colonoscopy, enema or CT scan and a yearly fecal occult blood test (FOBT) to screen for colon cancer
cervical cancer
3 years after sex and no later than 21 years old
screening should be done every year with the Pap test or every 2 years using liquid based pap test
most cancer will not relapse if pt remains cancer free for x time
5 years
primary treatment is usually
surgery, followed by chemo.
neaadjuvant or induction therapy
before start of primary treatment(chemo) such as riadiation
adjuvant therapy
is given after primary treatment (chemo) such as radiation or hormonal therapy
BSA equation use what type of weight
ACTUAL- adjust to obeseiy if > 130% of IBW
alkylators moa
cross link DNA- preventing replication: ex- benda mustin, chlorambucil (refrigerate)
procarbazine
MAOI- neurologic and cardiovascular toxicity.
antiandrogens which are they?
Bicalutamide, flutamide
antiandrogens moa
block andorgens at the receptor site. given PO daily usually with LHRH agononists for prostate cancer
antiandrogen GRH antagonist
Degarelex: gonadotoprin releasing hormon antognist used in prostate cancer
antiandrogen antiestrogen LHRH agonist
leuteinizing hormone releasing hormone
Goserelein (Zoladex) Leuprolide (lupron)
used for prostate cancer in males and for endometriosis, fibroids and breast cancer in females. inc production of andorgen and estrogen then decrease gonadotropin releast (LH, FSH).
aromatase inhibitors
anastrozole, exemestane, letrozole
prevents conversstion to active estrogen, androgen, corticosteroid, mineralcorticoid to reduce cell growth in breast cancer.
increased cardio vascular risk compared to serm
thalidomide
pregnancy category X - severe birth defects. prescribers must be enrolled in the STEPS program to dispense.
interferons adr
depression, suicidal ideation, flu like syndrome
mercaptopurine
6MP
xanthine oxidase which can be inhibited by allopurinol. requires dose reduction..
testing for TPMP and IPTA deficiency required before starting therapy to properly dose/avoid toxicituy
alitretinoin
pregnancy cateogry x. (retinoids?)
nadir
lowest point that cells (wbc, rbc) reach abt 10-14 days after chemotherapy. then recover then second round of chemo starts
ESA can
shorten survival and increase tumor progression in some cancers. SO dont use as much!.
Epoeitin alpha (procrit or epogen)
SC weekly
dRabepoitin
SC q 2-3 weeks
In order to prescribe ESA for cancer prescriber must be enrolled in
ESA APRISE oncology programs. pt needs to sign form that states they received counseling.
GET MED GUIDES
ESA should only be used if hemoglobin level is < 10
ANC less than X places pt at high risk
500,
< 100 screwed…severe risk
colony stimulatin factors name and side effects
sargramostin, filgrastim, epgfilgrastim.
can be given prophylatcially in pts at high risk of febril eneutropenia.
side effect: BONE PAIN
when do you start platelet trasnsfusions
BELOW 10,000
high and mod N/V
and what drugs to use?
cisplatin high, anthracyclines, carboplatin and oxaliplatin are moderate risk
use : dexamethasone, ondasetron and aprepitant in combo
dont really want to use prochlorperazine, diphyhydramine, or metoclopramide b/c of dopaimein blocking could wrsen movement disoder, sedating cause cognitive dysfunction etc.
diphydramine can cause anticholinergic side effects
dronabinol and nabilone can be used as 2nd line agents.
synthetic delta-9 tetrahydrocannabinol- naturally ocuring component of cannabis.
ondansetron
zofran
granisetron
kytril, sancuos transdermal patch
dolasetron
anzemet
palonsetron
aloxi
prochlorperazine
do not use in children < 2- EPS, sedation, NMS
aprepitant (Emend)
substance neurokinin 1 receptor antagonist
mucosistitis
magic mouth wash, chlorhexidine
hypercalcemia of malignancy
aggrestive hydration foreced diuretisis and IV bispohsphaonates used to treat. zoledronic acid and pamidronate are used to treat.
