Pharmacology - Chemotherapy

Question 1

Bendamustine dose adjustments/cautions for renal/hepatic impairment?

Answer 1

Renal: don’t use <30 ml/min
Hep: Don;t use AST/ALT >2.5x ULN or T bili >1.5x ULN

Question 2

Chlorambucil dose adjustments/cautions for renal/hepatic impairment?

Answer 2

Renal: CrCl 10-50: 75% of dose
CrCl <10: 50% of dose

Question 3

Common dose limiting toxicity in ifosfamide or cyclophosphamide?

Answer 3

Hemorrhagic cystitis

Question 4

Prevention for hemorrhagic cystitis in ifosfamide?

Answer 4

Mesna
Hydration

Question 5

Patient receiving RICE develops sedation, confusion, and hallucinations 12 hours after chemo. LIkely culprit?

Answer 5

Ifosfamide neurotoxicity

Question 6

Treatment of ifosfamide neurotoxicity? (2)

Answer 6

Methylene blue
Albumin

Question 7

Significant dose limiting toxicity of carmustine?

Answer 7

Interstitial pneumonitis
Myelosupperssion also super common

Question 8

Temozolomide dose adjustments/cautions for renal/hepatic impairment?

Answer 8

None

Question 9

Supportive care medication that should be given with concurrent temozolomide and radiation?

Answer 9

PJP prophylaxis

Question 10

Black box warning of dacarbazine (3)

Answer 10

Myelosuppression
Teratogen
Hepatic necrosis

Question 11

What chemotherapy can cause an disulfuram like reaction?

Answer 11

Dacarbazine

Question 12

Cisplatin dose adjustments/cautions for renal/hepatic impairment?

Answer 12

Adjust CrCl <60 ml/min

Question 13

Oxaliplatin dose adjustments/cautions for renal/hepatic impairment?

Answer 13

Adjust for CrCl <30 ml.min

Question 14

Common side effects of platinum

Answer 14

Myelosuppression
Nephrotoxicity
Ototoxicity

Question 15

Which platinum is most nephrotoxic?

Answer 15

Cisplatin

Question 16

Management of platinum hypersensitivty?

Answer 16

Pre-medicate
Prolong infusion time
Desensitization protocols

But this is a true drug allergy, not infusion reaction

Question 17

What is the difference between platinum hypersensitivity reaction and taxane hypersensitivity reactions?

Answer 17

Platinum is more a true drug allergy

Question 18

Trabectidin dose adjustments/cautions for renal/hepatic impairment?

Answer 18

Renal: none, but not studied in <30
Hepatic: Don’t give with Bili >3x ULN

Question 19

Prophylactic medications needed for high dose cytarabine

Answer 19

Steroids to prevent fever, rash, myalgias
Steroid eye drops to prevent conjunctivitis

Question 20

Gemcitabine dose adjustments/cautions for renal/hepatic impairment?

Answer 20

Hepatic: Adjust if Bili >1.6

Question 21

What two side effects of gemcitabine result in permanent DC?

Answer 21

Pneumonitis
HUS

Question 22

For high dose MTX, what two things do we do to prevent renal injury?

Answer 22

Urinary alkalinization
Hydration

Question 23

Pemetrexed dose adjustments/cautions for renal/hepatic impairment?

Answer 23

Renal: not recommended < 45

Question 24

What supportive care medications are needed when giving pemetrexed? (3)

Answer 24

Dexamethsone for pretreatment of rash
B12
Folate

Question 25

What commonly used supportive care medication interacts with 6-MP?

Answer 25

Allopurinol

Question 26

Black box warning of nelarabine (2)

Answer 26

Neurotoxicity Myelosuppression

Question 27

Capecitabine dose adjustments/cautions for renal/hepatic impairment?

Answer 27

Renal: CI in <30 Reduce by 75% for 30-50 Hepatic: none

Question 28

5-FU dose adjustments/cautions for renal/hepatic impairment?

Answer 28

Renal: None Hepatic: Reduce for severe impairment

Question 29

Difference in side effects between bolus and continuous 5-FU

Answer 29

Bolus: more myelosuppression CIV: More diarrhea, mucositis, cardiotoxic

Question 30

Patient receiving 5-FU has particularly severe diarrhea and neutropenia. What condition do you need to look for?

Answer 30

Dihydropyrimidine dehydrogenase (DPD) deficiency

Question 31

Nab-Paclitaxel dose adjustments/cautions for renal/hepatic impairment?

Answer 31

Renal: none Hepatic: AST <10xULN and Bili 1.5-3xULN

Question 32

Do taxanes need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 32

Hepatic

Question 33

What is the likely mechanism of taxane hypersensitivity reactions?

Answer 33

Due to the formulation vehicle, and not the drug itself. Cross reaction between paclitaxel and docetaxel

Question 34

Does Eribulin need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 34

Both

Question 35

Do Vinca alkaloids need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 35

Hepatic

Question 36

Does irinotecan need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 36

Hepatic

Question 37

Patient treated with FOLFIRINOX has severe diarrhea 48 hours after chemotherapy and is hard to treat. What do you need to text the patient for?

Answer 37

UGT1A1*28 allele

Question 38

MoA Sacituzumab govitecan

Answer 38

Trop-2 directed ADC with a topo I inhibitor

Question 39

Lifetime dose limit of doxorubicin?

Answer 39

450-500 mg/m2

Question 40

Do anthracyclines need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 40

Hepatic

Question 41

Antidote for anthracycline extravasation

Answer 41

Dexrazoxane

Question 42

does etoposide need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 42

Renal

Question 43

Does bleomycin need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 43

Renal

Question 44

What do you do for a patient's future treatment if they develop a hypersensitivity reaction to asparaginase?

Answer 44

Switch to Erwinia derived product

Question 45

Does ATRA need adjustment for renal dysfunction, hepatic dysfunction, both, or neither?

Answer 45

Hepatic

Question 46

for highly emetogenic chemotherapy regimens, what is the preferred anti=nausea prophylaxis?

Answer 46

1. Aprepitant (or fosaprepitant) 2. Ondansetron (or other trons) 3. Dexamethasone 4. Olanzapine