Pharmacology (Full Deck) Flashcards

Question

What is the class and MOA of Epirubicin?

Answer 1

This drug in the following class: - Anthracycline This drug's MOA is as follows: - Inhibits DNA and RNA synthesis via: - Intercalation (direct binding to DNA) - Inhibition of topoisomerase II (a repair enzyme) - Steric obstruction

Answer 2

This drug in the following class: - Anthracycline This drug's MOA is as follows: - Inhibits DNA and RNA synthesis via: - Intercalation (direct binding to DNA) - Inhibition of topoisomerase II (a repair enzyme) - Steric obstruction

Answer 3

The emetic potential of this drug is: - Moderate

Answer 4

The emetic potential of this drug is: - Low

Answer 5

The emetic potential of this drug is: - Moderate

Answer 6

The emetic potential of this drug is: - Moderate if <60 mg/m2 - High if >60 mg/m2

Answer 7

The emetic potential of this drug is: - Low

Answer 8

The emetic potential of this drug is: - Moderate

Answer 9

The emetic potential of this drug is: - Moderate (pediatrics and adults) - High when used in combination with cyclophosphamide (adults)

Answer 10

The emetic potential of this drug is: - Minimal

Answer 11

The emetic potential of this drug class is: - Mainly moderate (Daunorubicin, Doxorubicin (<60 mg/m2), Doxorubicin and Cytarabine, Idarubicin, Epirubicin) - High for Doxorucibin >60 mg/m2, and Epirubcin when used in combination with Cyclophosphamide (adults) - All the others are low (Daunorubicin Liposomal, Doxorubicin Liposomal) or minimal (Valrubicin)

Answer 12

Drugs in the class with a high emetic potential are: - Doxorucibin >60 mg/m2 - Epirubcin when used in combination with Cyclophosphamide (adults)

Answer 13

Drugs in the class with a moderate emetic potential are: - Daunorubicin - Doxorubicin (<60 mg/m2) - Doxorubicin and Cytarabine - Idarubicin - Epirubicin

Answer 14

Drugs in the class with a low emetic potential are: - Daunorubicin Liposomal - Doxorubicin Liposomal

Answer 15

Drugs in the class with a minimal emetic potential are: - Valrubicin

Answer 16

The main indications of this drug are: - ALL - AML - Kaposi sarcoma (Daunorubicin Liposomal)

Answer 17

The main indications of this drug are: - Kaposi sarcoma

Answer 18

The main indications of this drug are: - AML

Answer 19

The main indications of this drug are: - AML - Bladder Cancer - Breast Cancer - Hodkin Lymphoma - Non-Hodkin Lymphoma - Osteosarcoma - Soft Tissue Sarcomas

Answer 20

The main indications of this drug are: - Breast Cancer - Kasposi Sarcoma - Ovarian Cancer

Answer 21

The main indications of this drug are: - AML

Answer 22

The main indications of this drug are: - Breast Cancer - Bladder Cancer - Soft Tissue Sarcomas

Answer 23

The main indications of this drug are: - Bladder Cancer

Answer 24

The main/common indications of this drug class are: - Doxorubicin is the workhourse - AML - Bladder Cancer - Breast Cancer - Hodkin Lymphoma - Osteosarcoma - Soft Tissue Sarcomas

Answer 25

The notable/common monitoring parameters for this drug class are: - Echocardiogram to assess left ventricular ejection fraction (LVEF) prior to start of therapy, repeat if S/Sx of HF - History and cardiac exam prior to every cycle

Answer 26

Drug(s) requiring this monitoring are: - Anthracyclines

Answer 27

The extravasation risk and mangement strategies for this drug class are as follows: - All Anthracyclines are vesicants except for Valrubicin (intra-vesical) and liposomal products. - For intravenous administration only through a free flowing central IV line: not for intramuscular or subcutaneous administration. - If extravasation occurs, stop infusion, aspirate, give antidote (dexrazoxane [Totect] 1000 mg/m2 via remote IV site over 1-2 hours x 2 days or dimethyl sulfate [DMSO]), apply dry cold compresses.

Answer 28

The notable/common ADRs of this drug class are: - Cardiac toxicity (through reactive oxygen species, apoptosis, DNA damage (via topoisomerase II inhibition), and inhibition of protein synthesis - Body fluid discoloration (urine, tears, sweat, and saliva)

Answer 29

Risk factors for developing this ADR with this drug class are: - High cumulative exposure (most consistent risk factor) - Older age (>65 years) - Very young age (<4 years) - Female gender - Pre-existing cardiovascular disorders and comorbidities: - Hypertension - Smoking - Hyperlipidemia - Obesity - Diabetes

Answer 30

The recommended maximum lifetime dose of this class is: - 450-550 mg/m2 Doxorubicin equivalents

Answer 31

The strategy and rationale for management of this condition caused by this drug class are: - Limit lifetime exposure (<450-550 mg/m2 Doxorubicin equivalents) - Perform baseline testing (echocardiogram) - Dexrazoxane (Zinecard) can be used for prevention.

Answer 32

The use of this drug in the management of cardiac toxicity associated with this class is as follows: - Given IV in a 10:1 ratio of dexrazoxane:doxorubicin. - Doxorubicin must be administered within 30 minutes of the completion of the dexrazoxane infusion. - Its FDA labeled indication is in women with metastatic breast cancer with a cumulative doxorubicin dose exceeding 300 mg/m2. - May also be used off label and in some pediatric protocols. - It is not recommended for use with initial doxorubicin therapy. - Dexrazoxane is marketed under two different brand names (Totect and Zinecard), however they are not interchangeable. - Totect is indicated for Anthracycline extravasations. - Generic dexrazoxane and Zinecard are indicated for reducing doxorubicin-induced cardiomyopathy.

Answer 33

The strategy and rationale for management of this condition caused by this drug class are: - This discoloration is harmless and will resolve 1-2 days after the anthracycline dose - Patients should be counselled that urine discoloration from an anthracycline should be painless. If the discoloration (especially if red) is accompanied by symptoms such as urgency, frequency, or discomfort, they should be evaluated by their healthcare provider as these could be signs of blood in the urine.

Answer 34

The metabolism of this drug is as follows: - All drugs in this class are hepatically metabolized and generally require dose adjustments in patients with hepatic dysfunction

Answer 35

This nickname was given to this drug due to its bright red color, vesicant properties, and side-effect profile.

Answer 36

This drug was the nickname "the red devil" due to its bright red color, vesicant properties, and side-effect profile.

Answer 37

Drugs in this class are: - Bleomycin

Answer 38

The brand name of this generic drug is: - Blenoxane

Answer 39

The generic name of this brand name drug is: - Bleomycin

Answer 40

The main indications of this drug are: - Hodgin Lymphoma - Testicular Cancer - Ovarian Germ Cell Cancer

Answer 41

This drug in the following class: - Anti-tumor antibody This drug's MOA is as follows: - Inhibits synthesis of DNA by binding to DNA leading to single- and double-strand breaks.

Answer 42

The notable monitoring parameters for this drug are: - Pulmonary function tests before, during and after chemotherapy

Answer 43

Drug(s) requiring this monitoring are: - Bleomycin

Answer 44

The emetic potential of this drug is: - Minimal

Answer 45

The extravasation risk and mangement strategies for this drug are as follows: - None; N/A

Answer 46

The administration of this drug is described as follows: - Can be given IM, SubQ, and intrapleural - Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering test dose of 2 units or less before the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed. Monitor carefully, particularly following the first 2 doses.

Answer 47

The metabolism of this drug is as follows: - Metabolized by enzymatic inactivation by bleomycin hydrolase which is widely distributed in normal tissues (except for the skin and lungs) - Cleared/excreted in urine

Answer 48

The notable ADRs of this drug are: - Pulmonary toxicity (Bleomycin hydrolase is not found in the lungs). - Interstitial pneumonitis is the most common form of bleomycin pulmonary toxicity but it can also progress to pulmonary fibrosis which is irreversible and potentially fatal. - A severe idiosyncratic reaction consisting of HTN, mental confusion, fever, chills, and wheezing has been reported in approximately 1% of lymphoma patients treated with Bleomycin

Answer 49

The drugs notable for cause this condition are: - Bleomycin

Answer 50

The strategy and rationale for management of this condition caused by this drug are: - Routinely follow pulmonary function tests, including DLCO (diffusing capacity of the lung for carbon monoxide) during therapy and discontinue if there are significant changes in pulmonary function, including a decrease in DLCO of 40-60%.

Answer 51

Risk factors for developing this ADR with this drug/class are: - Age >70 years - Cumulative lifetime dose of >400 units - Use of GCSF

Answer 52

The threshold lifetime dose of this drug is: - 400 units - Beyond this, the risk of pulmonary toxicity increases

Answer 53

The half-life of the this drug is described as follows: - ~2 hours but increases exponentially as CrCl decreases

Answer 54

The clinical pearls of this drug are as follows: - Guidelines do not recommend the routine use of GCSF during bleomycin therapy when used for the treatment of lymphoma especially since ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine) can be safely given at full dose intensity without GCSF use. - No increased risk of pulmonary toxicity with GCSF + Bleomycin for the treatment of testicular cancer, thus use of GCSF is acceptable (although still not recommended as primary prophylaxis). - In patients on ABVD for Hodgkin lymphoma, bleomycin can be dropped if there is a positive response (Deauville 1 or 2) on interim PET scan after 2 cycles. In this situation, continuing with just AVD for the remaining cycles is safer (from a pulmonary toxicity standpoint) but no less effective. - Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering a test dose before the first 2 doses

Answer 55

Drugs in this class are: - Methotrexate - Pemetrexed

Answer 56

The main cancer-related indications of this drug are: - ALL - Non-Hodgkin Lymphoma - GVHD - Bladder Cancer - Head and Neck Cancer - Osteosarcoma - Soft Tissue Sarcoma

Answer 57

The main indications of this drug are: - Bladder Cancer - Mesothelioma - NSCLC

Answer 58

This drug in the following class: - Folate antagonist This drug's MOA is as follows: - Inhibits dihydrofolate reductase thus inhibiting the formation of reduced folates. - Inhibits thymidylate synthetase thus inhibiting synthesis of purines and thymidylic acid. - All this leads to inhibition of DNA synthesis, repair, and cellular replication

Answer 59

This drug in the following class: - Folate antagonist This drug's MOA is as follows: - Inhibits dihydrofolate reductase thus inhibiting the formation of reduced folates. - Inhibits thymidylate synthetase thus inhibiting synthesis of purines and thymidylic acid. - All this leads to inhibition of DNA synthesis, repair, and cellular replication

Answer 60

The notable monitoring parameters for this drug are: - Methotrexate levels with high dose (>500 mg/m2) - monitor daily until cleared - Urine pH with high dose

Answer 61

Drug(s) notably requiring this monitoring are: - Methotrexate

Answer 62

Drug(s) notably requiring this monitoring are: - Methotrexate

Answer 63

The administration of this drug is described as follows: - Most methotrexate protocols will require the urine pH to be >7 before starting methotrexate. - Alkalization protocols vary per institution but often include IV fluids, sodium bicarbonate (either IV or oral) and/or acetazolamide.

Answer 64

The emetic potential of this drug is: - Minimal with low lose (<50 mg/m2) - Low with low-moderate doses (50-250 mg/m2) - High with moderate-high doses (>250 mg/m2)

Answer 65

The emetic potential of this drug is: - Low

Answer 66

The extravasation risk and management strategies for this drug are as follows: - None; N/A

Answer 67

The extravasation risk and management strategies for this drug are as follows: - None; N/A

Answer 68

The metabolism of this drug is as follows: - Minimal metabolism; excreted primarily (90%) in the urine as unchanged drug - Urine clearance is pH dependant and improved when the urine is alkalized - High dose methotrexate may "third space" or accumulate in fluid collections leading to prolonged methotrexate clearance and increased toxicity. Patients with ascites. pericardial effusions. pleural effusions or other fluid collections should not receive high dose methotrexate until those have been drained.

Answer 69

The metabolism of this drug is as follows: - Minimal metabolism; excreted primarily (90%) in the urine as unchanged drug

Answer 70

The notable ADRs of this drug are: - Methotrexate toxicity - Renal dysfunction - Bone marrow suppression - Mucositis

Answer 71

The notable ADRs of this drug are: - Main one is that serious and occasionally fatal dermatologic toxicity may occur - Others are myelosuppression, renal dysfunction, and GI toxicities (especially with concomitant Ibuprofen use)

Answer 72

The strategy and rationale for management of this condition caused by this drug are: - Ensure urine is adequate alkalized before starting methotrexate - Administer leucovorin rescue with doses greater than >500 mg/m2 - Glucarpidase can be administered as an antidote.

Answer 73

This drug works as follows when used as a Methotrexate antidote: - Glucarpidase is an enzyme that hydrolyzes the methotrexate into inactive metabolites rapidly reducing the methotrexate concentration.

Answer 74

This drug is given as follows when use as a Methotrexate rescue: - The typical dose is 50 units/kg and it should ideally be given within 48-60 hours of methotrexate infusion (beyond this point, life threating toxicities may not be preventable).

Answer 75

The strategy and rationale for management of this condition caused by this drug are: - Pretreat with dexamethasone 4 mg orally twice daily for 3 days to reduce the incidence and severity of cutaneous reactions.

Answer 76

The clinical pearls of this drug are as follows: - Most methotrexate protocols will require the urine pH to be >7 before starting methotrexate - Doses >500 mg/m2 require leucovorin "rescue" and inpatient monitoring of levels to ensure appropriate methotrexate clearance - High dose methotrexate may "third space" or accumulate in fluid collections leading to prolonged methotrexate clearance and increased toxicity. Patients with ascites. pericardial effusions. pleural effusions or other fluid collections should not receive high dose methotrexate until those have been drained. - Methotrexate has many drug interactions which can cause delayed clearance. Medications that must be stopped prior to high dose methotrexate include: - Bactrim, PPIs, Penicillins, Salicylates, Probenecid, NSAIDs, Tetracyclines, and Ciprofloxacin. - Many of these agents can be stopped 1-2 days prior to high dose methotrexate and can be resumed after adequate clearance. - Intrathecal methotrexate or low oral doses of methotrexate do not have the same drug interaction concerns. - When checking doses on oral methotrexate, only oncologic indications will have daily dosing options. If a prescription for lupus, psoriasis, arthritis, etc. is written for daily (instead of weekly) it's likely an error!

Answer 77

Medications that must be stopped prior to administration of this drug include: - Bactrim - PPIs - Penicillins - Salicylates - Probenecid - NSAIDs - Tetracyclines - Ciprofloxacin

Answer 78

This drug works as follows when used as a Methotrexate rescue: - It is folinic acid (an active form of folate) that does not need to be processed by dihydrofolate reductase. It is given to rescue healthy cells from the toxicity of methotrexate and replenish the supply of folate metabolites depleted by methotrexate.

Answer 79

This drug is given as follows when use as a Methotrexate rescue: - Usually started 12-24 hours post high dose methotrexate and given until serum methotrexate levels are below a certain threshold (often 0.05 mM). - Dosing varies per protocol but oral absorption is saturable at doses >25 mg, so doses >25 mg are often given IV. - Typical dosing frequency is orally every 6 hours, although dose and frequency may be increased if a patient is experiencing methotrexate toxicity.

Answer 80

The clinical pearls of this drug are as follows: - Patients receiving pemetrexed require vitamin supplementation with folic acid and B12. - Give folic acid 400 to 1,000 mcg daily starting 7 days before initial pemetrexed dose and continue daily during treatment and for 21 days after last pemetrexed dose. - Give Vitamin B12 1,000 mcg IM starting 7 days prior to treatment initiation and then every 3 cycles. - To prevent dermatologic toxicity, pretreat with dexamethasone - Patients with a CrCl 45 to 79 mL/min must avoid ibuprofen for 2 days before, the day of, and for 2 days following a dose of pemetrexed. Monitor more frequently for myelosuppression, renal dysfunction, and GI toxicities if concomitant Ibuprofen administration cannot be avoided.

Answer 81

Drugs in this class are: - Azacitidine - Decitabine

Answer 82

The brand name of this generic drug is: - Vidaza (IV, SubQ) - Onureg (Oral)

Answer 83

The brand name of this generic drug is: - Dacogen

Answer 84

The generic name of this brand name drug is: - Azacitidine

Answer 85

The generic name of this brand name drug is: - Azacitidine

Answer 86

The generic name of this brand name drug is: - Decitabine

Answer 87

The main indications of this drug are: - AML - MDS

Answer 88

The main indications of this drug are: - AML - MDS

Answer 89

The main/common indications of this drug class are: - AML - MDS

Answer 90

This drug in the following class: - Hypomethylator This drug's MOA is as follows: - Methylation (via methyltransferase) of tumor suppressor genes can contribute to the growth and survival of the cancer. Hypomethylating agents prevent DNA methylation by inhibiting methyltransferase, thus allowing for tumor suppressor gene expression which thus inhibits cancer growth.

Answer 91

This drug in the following class: - Hypomethylator This drug's MOA is as follows: - Methylation (via methyltransferase) of tumor suppressor genes can contribute to the growth and survival of the cancer. Hypomethylating agents prevent DNA methylation by inhibiting methyltransferase, thus allowing for tumor suppressor gene expression which thus inhibits cancer growth.

Answer 92

The emetic potential of this drug is: - Moderate

Answer 93

The emetic potential of this drug is: - Minimal

Answer 94

Drugs in the class with a high emetic potential are: - None, N/A

Answer 95

Drugs in the class with a moderate emetic potential are: - Azacitidine

Answer 96

Drugs in the class with a low emetic potential are: - None, N/A

Answer 97

Drugs in the class with a minimal emetic potential are: - Decitabine

Answer 98

The extravasation risk and management strategies for this drug are as follows: - None, N/A

Answer 99

The extravasation risk and management strategies for this drug are as follows: - None, N/A

Answer 100

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 101

The distribution of this class is described as follows: - Hypomethylating agents do not cross the blood brain barrier and will have limited utility in treating patients with central nervous system disease.

Answer 102

The administration of this drug is described as follows: - Vidaza is given IV or SubQ - Onureg is given orally

Answer 103

The notable/common ADRs of this drug class are: - Bone marrow suppression

Answer 104

The strategy and rationale for management of this condition caused by this drug are: - This is the major side effect of the hypomethylators, however it can be difficult to determine if it is from the chemotherapy or the patient's disease. - In many cases, we will treat through it for the first few cycles of therapy (due to the long time to response of hypomethylators) but patients with this after 3-4 months of therapy may need a bone marrow biopsy to rule out relapsed disease.

Answer 105

The clinical pearls of this drug class are as follows: - When used as single agent therapy. hypomethylators have a median response time of 3-4 months. - These agents are typically well tolerated and are a good choice of therapy for older/frail patients who may not be able to tolerate intensive chemotherapy. - Recent data has shown that patients have improved response rates when combining hypomethylators with venetoclax (an oral BCL2 inhibitor). - This combination also increases toxicity but is preferentially used in patients who can tolerate it.

Answer 106

Drugs in this class are: - Carboplatin - Cisplatin - Oxaliplatin

Answer 107

The brand name of this generic drug is: - Paraplatin

Answer 108

The brand name of this generic drug is: - Platinol

Answer 109

The brand name of this generic drug is: - Eloxatin

Answer 110

The generic name of this brand name drug is: - Carboplatin

Answer 111

The generic name of this brand name drug is: - Cisplatin

Answer 112

The generic name of this brand name drug is: - Oxaliplatin

Answer 113

The main indications of this drug are: - Anal Cancer - Bladder Cancer - Breast Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancer - Hodgkin Lymphoma - Non-Hodgkin Lymphoma - NSCLC - SCLC - Gynecologic Cancer - Testicular Cancer

Answer 114

The main indications of this drug are: - Anal Cancer - Bladder Cancer - Breast Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancer - Hodgkin Lymphoma - Non-Hodgkin Lymphoma - NSCLC - SCLC - Gynecologic Cancer - Testicular Cancer

Answer 115

The main indications of this drug are: - Esophageal Cancer - Gastric Cancer - Non-Hodgkin Lymphoma - Testicular Cancer - Biliary Adencocarcinoma - Colorectal Cancer - Pancreatic Cancer

Answer 116

This drug in the following class: - Platinum Analogues This drug's MOA is as follows: - Alkylating agents which covalently binds to DNA and interfere with the function of DNA by producing interstrand DNA cross-links. - They preferentially bind to the N-7 position of guanine.

Answer 117

This drug in the following class: - Platinum Analogues This drug's MOA is as follows: - Alkylating agents which covalently binds to DNA and interfere with the function of DNA by producing interstrand DNA cross-links. - They preferentially bind to the N-7 position of guanine.

Answer 118

This drug in the following class: - Platinum Analogues This drug's MOA is as follows: - Alkylating agents which covalently binds to DNA and interfere with the function of DNA by producing interstrand DNA cross-links. - They preferentially bind to the N-7 position of guanine.

Answer 119

The notable monitoring parameters for this drug class are: - S/Sx of nephrotoxicity - renal panel - S/Sx of ototoxicity - consider audiometric and vestibular testing, particularly in all pediatric patients receiving cisplatin (pediatric patients should receive audiometric testing at baseline, prior to each dose, and for several years after discontinuing therapy). - S/Sx of neuropathy - neurologic evaluation prior to each dose and periodically thereafter

Answer 120

The emetic potential of this drug is: - High if AUC >4 - Moderate if AUC <4

Answer 121

The emetic potential of this drug is: - High (commonly regarded as the most emetogenic of all chemotherapies)

Answer 122

The emetic potential of this drug is: - Moderate

Answer 123

The emetic potential of this drug class is: - Moderate (Oxaliplatin, Carboplatin AUC <4) to High (Carboplatin AUC >4, Cisplatin)

Answer 124

Drugs in the class with a high emetic potential are: - Cisplatin (commonly regarded as the most emetogenic of all chemotherapies) - Carboplatin if AUC >4

Answer 125

Drugs in the class with a moderate emetic potential are: - Carboplatin if AUC <4 - Oxaliplatin

Answer 126

Drugs in the class with a low emetic potential are: - None, N/A

Answer 127

Drugs in the class with a minimal emetic potential are: - None, N/A

Answer 128

The extravasation risk and management strategies for this drug are as follows: - Irritant with vesicant- like properties - If extravasation occurs, stop infusion and aspirate. Data conflicts regarding use of warm or cold compresses - Cold compresses may reduce cellulary injury but could potentially precipitate or exacerbate peripheral neuropathy - Warm compresses may increase local drug removal but may increase cellular uptake and injury

Answer 129

The extravasation risk and management strategies for this drug class are as follows: - Carboplatin may be an irritant - Cisplatin is a vesicant at higher concentrations - Oxaliplatin is irritant with vesicant like properties

Answer 130

The metabolism of this drug is as follows: - Clearance is renal - The mean AUC of unbound platinum increases as renal function decreases - 40% increase with mild (CrCl 50 to 80 ml /minute) renal impairment - 95% increase with moderate (CrCl 30 to 49 ml /minute) renal impairment - 342% increase with severe (CrCl <30 ml /minute) renal impairment

Answer 131

The notable ADRs of this drug are: - Chronic Peripheral Neuropathy - Nephrotoxicity - Hypersensitivity Reactions

Answer 132

The notable ADRs of this drug are: - Ototoxicity - Chronic Peripheral Neuropathapy - Nephrotoxicity - Hypersensitivity Reactions

Answer 133

The notable ADRs of this drug are: - Chronic Peripheral Neuropathapy - Acute Peripheral Neuropathy (unique to oxaliplatin vs other platinums) - Nephrotoxicity - Hypersensitivity Reactions

Answer 134

The notable/common ADRs of this drug class are: - Chronic Peripheral Neuropathy (acute is unique to oxaliplatin) - Nephrotoxicity - Ototoxicity (cisplatin) - Hypersensitivity Reactions (especially carboplatin and oxaliplatin)

Answer 135

The drugs in this class notable for cause this condition are: - All can but it is especially notable for Cisplatin

Answer 136

The drugs in this class notable for cause this condition are: - Cisplatin (especially in children and even moreso in pediatrics)

Answer 137

The drugs in this class notable for cause this condition are: - Oxaliplatin

Answer 138

The drugs in this class notable for cause this condition are: - All can but it is especially notable for Carboplatin and Oxaliplatin

Answer 139

The strategy and rationale for management of this condition caused by this drug class are: - This can be broken down into two types: acute and chronic - Chronic mimics traditional peripheral neuropathy with numbness/tingling in the fingers and toes. - This can occur >14 days after the dose. - Can be persistent and interfere with daily activities like writing or walking. - Symptoms may improve in some patients upon discontinuing treatment. - Acute is unique to oxaliplatin and presents as cold-induced neuropathy. - Often occurs within hours of the oxaliplatin infusion and resolves within 7 days. - Symptoms may include transient paresthesia, dysesthesia, and hypoesthesia (in the hands, feet, perioral area, or throat), jaw spasm, abnormal tongue sensation, or a feeling of chest pressure. - Patients should be counseled to avoid ice chips, exposure to cold temperatures, and cold food/beverages during or within hours after oxaliplatin infusion.

Answer 140

The strategy and rationale for management of this condition caused by this drug class are: - All of the platinum agents have the potential to cause nephrotoxicity. - Patients should receive aggressive pre and post platinum hydration with normal saline, ideally targeting urine output of 100 ml/hour prior to the chemotherapy infusion. - Patients also should receive potassium and magnesium replacement as these agents (especially cisplatin) can cause electrolyte wasting.

Answer 141

The strategy and rationale for management of this condition caused by this drug class are: - Cisplatin may cause cumulative and severe ototoxicity. - Manifested by tinnitus, high-frequency (4,000 to 8,000 Hz) hearing loss, and/or decreased ability to hear normal conversational tones. - May occur during or after treatment and may be unilateral or bilateral. - More common in children and even moreso in pediatrics (40%-60%). - Consider audiometric and vestibular testing, particularly in all pediatric patients receiving cisplatin.

Answer 142

The strategy and rationale for management of this condition caused by this drug class are: - Platinum agents are the second most common source of hypersensitivity reactions among chemotherapy agents (following asparaginase products). - Especially common with Carboplatin and Oxaliplatin - For Carboplatin: - The incidence of carboplatin hypersensitivity reactions is between 1-44%. - Most common after 6 -8 doses - Patients with mild-moderate reactions can be desensitized and may continue to receive infusions - For Oxaliplatin: - The incidence of acute reactions is between 12-25% with up to 30% of those being severe infusion reactions. - Reactions may occur within minutes of drug administration and with any cycle - Similar to carboplatin, the risk of hypersensitivity reaction is higher with multiple cycles of therapy. - Patients with mild reactions may be re-challenged.

Answer 143

The clinical pearls of this drug are as follows: - Dosing is based off target AUC (usually 2-6)

Answer 144

This use of this formula is as follows: - Used to calculate Carboplatin dose using target AUC - Total dose (mg) = Target AUC x (GFR + 25) - If estimating instead of measuring GFR (as with Cockroft Gault), protocols typically cap GFR at a maximum of 125 ml/minute to avoid potential toxicity (although this does vary per indication)

Answer 145

The clinical pearls of this drug class are as follows: - They are the second most common source of hypersensitivity reactions among chemotherapy agents (following asparaginase products).

Answer 146

Drugs in this class are: - 6-Mercatopurine (6-MP) - Fludarabine - Cladribine - Clofarabine - Nelarabine - Pentostatin - Thioguanine

Answer 147

The brand name of this generic drug is: - Purixan

Answer 148

The brand name of this generic drug is: - Fludara

Answer 149

The brand name of this generic drug is: - Mavenclad - Leustatin

Answer 150

The brand name of this generic drug is: - Clolar - Clofarex

Answer 151

The brand name of this generic drug is: - Arranon

Answer 152

The brand name of this generic drug is: - Nipent

Answer 153

The brand name of this generic drug is: - Nipent

Answer 154

The generic name of this brand name drug is: - 6Mercatopurine

Answer 155

The generic name of this brand name drug is: - Fludarabine

Answer 156

The generic name of this brand name drug is: - Cladribine

Answer 157

The generic name of this brand name drug is: - Clofarabine

Answer 158

The generic name of this brand name drug is: - Nelarabine

Answer 159

The generic name of this brand name drug is: - Pentostatin

Answer 160

The generic name of this brand name drug is: - Thioguanine

Answer 161

The main indications of this drug are: - ALL

Answer 162

The main indications of this drug are: - CLL - AML - HSCT - Non-Hodkin Lymphoma

Answer 163

The main/common indications of this drug class are: - Leukemias with Fludarabine - Non-Hodgkin Lymphoma with 6MP

Answer 164

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 165

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 166

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 167

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 168

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 169

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 170

This drug in the following class: - Purine Antagonist This drug's MOA is as follows: - Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite. - The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis. - They are specific for the S phase of the cell cycle.

Answer 171

The emetic potential of this drug is: - Minimal to Low

Answer 172

The emetic potential of this drug is: - Minimal

Answer 173

The emetic potential of this drug class is: - Minimal to Low except for Clofarabine (Moderate)

Answer 174

Drugs in the class with a high emetic potential are: - None, N/A

Answer 175

Drugs in the class with a moderate emetic potential are: - Clofarabine

Answer 176

Drugs in the class with a low emetic potential are: - All are Minimal to Low except for: - Fludarabine and Cladribine (Minimal) - Clofarabine (Moderate)

Answer 177

Drugs in the class with a minimal emetic potential are: - Fludarabine - Cladribine - All the rest are "Minimal to Low" except for Clofarabine (Moderate)

Answer 178

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 179

The metabolism of this drug is as follows: - Total body clearance of the principal metabolite correlates with creatinine clearance

Answer 180

The metabolism of this drug is as follows: - Renal impairment may result in slower elimination of parent drug and metabolite, and a greater cumulative effect

Answer 181

The clinical pearls of this drug are as follows: - Doses for ALL are typically titrated to maintain an ANC between 500-1500 cells/mcL. Methods of dose titration will vary per protocol but typically involve adjusting doses every 4-8 weeks. - In patients intolerant to this drug (abnormally low CBC unresponsive to dose reduction, severe bone marrow toxicities, or repeated myelosuppressive episodes), consider genotyping of NUDT15 and TPMT. - NUDT15 and TPMT genotyping or phenotyping may assist in identifying patients at risk for developing toxicity and those who may needs empiric dose reductions due to decreased metabolism of 6-MP.

Answer 182

Drugs in this class are: - Gemcitabine - 5Fluorouracil (5FU) - Capecitabine - Cytarabine - Floxuridine

Answer 183

The brand name of this generic drug is: - Infugem - Gemzar

Answer 184

The brand name of this generic drug is: - Adrucil

Answer 185

The brand name of this generic drug is: - Xeloda

Answer 186

The brand name of this generic drug is: - AraC - Cytosar

Answer 187

The brand name of this generic drug is: - Fluorouridine deoxyribose

Answer 188

The generic name of this brand name drug is: - Gemcitabine

Answer 189

The generic name of this brand name drug is: - Gemcitabine

Answer 190

The generic name of this brand name drug is: - 5Fluorouracil

Answer 191

The generic name of this brand name drug is: - Capecitabine

Answer 192

The generic name of this brand name drug is: - Cytarabine

Answer 193

The generic name of this brand name drug is: - Cytarabine

Answer 194

The generic name of this brand name drug is: - Floxuridine

Answer 195

The main indications of this drug are: - Breast Cancer - Head and Neck Cancers - Pancreatic Cancer - Bladder Cancer - Hodgkin Lymphoma - Non-Hodgkin Lymphoma - Small Cell Lung Cancer - Non-Small Cell Lung Cancer

Answer 196

The main indications of this drug are: - Anal Cancer - Breast Cancer - Colorectal Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancers - Pancreatic Cancer

Answer 197

The main indications of this drug are: - Anal Cancer - Breast Cancer - Colorectal Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancers - Pancreatic Cancer

Answer 198

This drug in the following class: - Pyrimidine Antagonist This drug's MOA is as follows: - It interferes with DNA and RNA synthesis due to structural similarity to pyrimidine. - The antimetabolite is substituted for normal building blocks of RNA/DNA and interferes with enzyme activity causing cell death.

Answer 199

This drug in the following class: - Pyrimidine Antagonist This drug's MOA is as follows: - It interferes with DNA and RNA synthesis due to structural similarity to pyrimidine. - The antimetabolite is substituted for normal building blocks of RNA/DNA and interferes with enzyme activity causing cell death. - After activation, F-UMP (an active metabolite) is incorporated into RNA to replace uracil and inhibit cell growth - The active metabolite F-dUMP inhibits thymidylate synthetase

Answer 200

This drug in the following class: - Pyrimidine Antagonist This drug's MOA is as follows: - Capecitabine is a prodrug of fluorouracil. - It interferes with DNA and RNA synthesis due to structural similarity to pyrimidine. - The antimetabolite is substituted for normal building blocks of RNA/DNA and interferes with enzyme activity causing cell death. - After activation of Fluorouracil, F-UMP (an active metabolite) is incorporated into RNA to replace uracil and inhibit cell growth - The active metabolite F-dUMP inhibits thymidylate synthetase

Answer 201

This drug in the following class: - Pyrimidine Antagonist This drug's MOA is as follows: - Cytarabine is a pyrimidine analog and is incorporated into DNA; however, the primary action is inhibition of DNA polymerase resulting in decreased DNA synthesis and repair.

Answer 202

This drug in the following class: - Pyrimidine Antagonist This drug's MOA is as follows: - It is catabolized to fluorouracil after intra-arterial administration, resulting in activity similar to fluorouracil - It inhibits thymidylate synthetase - It interferes with DNA and RNA synthesis due to structural similarity to pyrimidine. - The antimetabolite is substituted for normal building blocks of RNA/DNA and interferes with enzyme activity causing cell death.

Answer 203

The notable monitoring parameters for this drug are: - Monitor INR closely if patients are receiving concomitant warfarin therapy due to a drug-drug interaction.

Answer 204

The notable monitoring parameters for this drug are: - Monitor INR closely if patients are receiving concomitant warfarin therapy due to a drug-drug interaction.

Answer 205

The notable/common monitoring parameters for this drug class are: - Monitor INR closely if patients are receiving concomitant warfarin therapy and 5Fluorouracil or Capecitabine due to a drug-drug interaction.

Answer 206

Drug(s) notably requiring this monitoring are: - 5Fluorouracil - Capecitabine

Answer 207

The emetic potential of this drug is: - Low

Answer 208

The emetic potential of this drug is: - Low

Answer 209

The emetic potential of this drug is: - Low

Answer 210

The emetic potential of this drug is: - Adults: - Moderate if >1,000 mg/m2 - Low if ≤1,000 mg/m2 - Pediatrics: - High if ≥3,000 mg/m2/day: High (>90%). - Moderate for 75 mg/m2/dose.

Answer 211

The emetic potential of this drug class is: - Low (except for Cytarabine*)

Answer 212

The extravasation risk and management strategies for this drug class are as follows: - Fluorouracil may be an irritant. avoid extravasation.

Answer 213

The administration of this drug is described as follows: - 5-FU is given as a 46-hour continuous infusion with some chemotherapy regimens. - In these cases, leucovorin is often given to enhance the mechanism of 5-FU by adding additional inhibition of thymidylate synthase. This leads to increased cancer cell death but can also cause increased toxicities.

Answer 214

The administration of this drug is described as follows: - It is given orally often in divided doses, 12 hours apart, for 2 weeks on and 1 week off. - It should be taken with food. - Oral administration is similar to continuous infusion 5-FU in terms of toxicity.

Answer 215

The administration of this drug is described as follows: - Administered as a continuous hepatic intra-arterial infusion using an infusion pump.

Answer 216

The metabolism of this drug is as follows: - HEPATICALLY metabolized to form active metabolites. 5-fluoroxyuridine monophosphate (F-UMP) and 5-5-fluoro- 2'-deoxyuridine-5'-0 -monophosphate (F-dUMP)

Answer 217

The metabolism of this drug is as follows: - Enzymatically metabolized to fluorouracil.

Answer 218

The metabolism of this drug is as follows: - Metabolized intracellularly by nucleoside kinases to the active diphosphate (dFdCDP) and triphosphate (dFdCTP) nucleoside metabolites

Answer 219

The metabolism of this drug is as follows: - Primarily hepatic - Metabolized by deoxycytidine kinase to aracytidine triphosphate (active) - ~90% of dose is metabolized to inactive uracil arabinoside (ARA-U); intrathecal administration results in little conversion to ARA-U due to the low levels of deaminase in the cerebral spinal fluid.

Answer 220

The notable ADRs of this drug are: - Hand-foot syndrome, also called palmar-plantar erythrodysesthesia. Patients can experience redness, swelling, and pain on the palms of the hands and/or the soles of the feet. - A bolus dose of 5-FU is associated with myelosuppression while the continuous infusion 5-FU/capecitabine is more likely to cause diarrhea and hand/foot syndrome.

Answer 221

The notable ADRs of this drug are: - Hand-foot syndrome, also called palmar-plantar erythrodysesthesia. Patients can experience redness, swelling, and pain on the palms of the hands and/or the soles of the feet.

Answer 222

The notable ADRs of this drug are: - Cytarabine syndrome which is almost flu-like and is characterized by fever, myalgia, bone pain, chest pain (occasionally), maculopapular rash, conjunctivitis, and malaise. - Occurs in up to 1/3rd of patients receiving Cytarabine for AML (most of whom have had prior exposure to the drug) - It generally occurs 6 to 12 hours following administration.

Answer 223

The notable/common ADRs of this drug class are: - Hand/Foot Syndrome (especially 5Fluorouracil and Capecitabine)

Answer 224

The drugs in this class notable for cause this condition are: - 5Fluorouracil and Capecitabine (and to a lesser degree Cytarabine)

Answer 225

The strategy and rationale for management of this condition caused by this drug are: - Leucovorin is often given to enhance the mechanisam of 5-FU by adding additional inhibition of thymidylate synthase. This leads to increased cancer cell death but can also cause increased toxicities. - In patients who are poorly tolerating their 5-FU/leucovorin containing regimens. you may consider omitting the leucovorin (instead of decreasing the 5-FU dose)

Answer 226

The strategy and rationale for management of this condition caused by this drug are: - It is thought to be caused by damage to the deep capillaries, leading to COX inflammatory-type reactions or related to enzymes involved in 5-FU metabolism - It can be prevented by avoiding friction causing activities (lifting weights, running), avoiding hot water or other sources of heat, and using lotions or creams to keep skin moist. - It is treated by holding chemotherapy, and applying topical or oral anti-inflammatory agents and analgesics.

Answer 227

The strategy and rationale for management of this condition caused by this drug are: - While the etiology is unclear, it is probably related to cytokine release rather than immune-mediated - Acetaminophen before and after dose may reduce the frequency of the cytarabine syndrome. - Glucocorticoids may also be beneficial for both treatment and prevention of the cytarabine syndrome. - Retreatment after Cytarabine syndrome can usually be safely accomplished with increased premedication, even in patients with multiple reactions

Answer 228

The clinical pearls of this drug are as follows: - Oral capecitabine has many drug interactions to be aware of including: - PPIs (which can decrease efficacy) - Warfarin (increased INR)

Answer 229

Drugs in this class are: - Docetaxel - Cabazitaxel - Paclitaxel - NabPaclitaxel

Answer 230

The brand name of this generic drug is: - Taxotere

Answer 231

The brand name of this generic drug is: - Jevtana

Answer 232

The brand name of this generic drug is: - Taxol

Answer 233

The brand name of this generic drug is: - Abraxane

Answer 234

The generic name of this brand name drug is: - Docetaxel

Answer 235

The generic name of this brand name drug is: - Cabazitaxel

Answer 236

The generic name of this brand name drug is: - Paclitaxel

Answer 237

The generic name of this brand name drug is: - NabPaclitaxel

Answer 238

The main indications of this drug are: - Breast Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancer - Non-Small Cell Lung Cancer - Ovarian Cancer - Prostate Cancer - Small Cell Lung Cancer

Answer 239

The main indications of this drug are: - Breast Cancer - Esophageal Cancer - Gastric Cancer - Head and Neck Cancer - Non-Small Cell Lung Cancer - Ovarian Cancer - Small Cell Lung Cancer - Anal Cancer - Bladder Cancer - Cervical Cancer - Endometrial Cancer - Kaposi Sarcoma

Answer 240

The main indications of this drug are: - Breast Cancer - Non-Small Cell Lung Cancer - Ovarian Cancer - Bladder Cancer - Cervical Cancer - Biliary Cancer - Pancreatic Cancer

Answer 241

This drug in the following class: - Taxanes This drug's MOA is as follows: - Taxanes inhibit the mitotic spindle. - They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process. - These drugs are cell-cycle specific in the M-phase.

Answer 242

This drug in the following class: - Taxanes This drug's MOA is as follows: - Taxanes inhibit the mitotic spindle. - They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process. - These drugs are cell-cycle specific in the M-phase - Unlike other taxanes, this drug has a poor affinity for multidrug resistance (MDR) proteins, therefore conferring activity in resistant tumors.

Answer 243

This drug in the following class: - Taxanes This drug's MOA is as follows: - Taxanes inhibit the mitotic spindle. - They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process. - These drugs are cell-cycle specific in the M-phase.

Answer 244

This drug in the following class: - Taxanes This drug's MOA is as follows: - Taxanes inhibit the mitotic spindle. - They bind to tubulin and prevent microtubule depolymerization - therefore inhibiting mitosis and inducing apoptosis in cells undergoing the division process. - These drugs are cell-cycle specific in the M-phase.

Answer 245

The emetic potential of this drug class is: - Low (all agents)

Answer 246

The extravasation risk and management strategies for this drug are as follows: - Irritant with vesicant-like properties - Consider the use of hyaluronidase - Administer 1 to 6 ml (150 units/ml) into existing IV line: usual dose is 1 ml for each 1 ml of extravasated drug.

Answer 247

The extravasation risk and management strategies for this drug are as follows: - Irritant with vesicant-like properties

Answer 248

The extravasation risk and management strategies for this drug class are as follows: - Paclitaxel and Docetaxel are irritants with vesicant-like properties - NabPaclitaxel may be an irritant

Answer 249

The administration of this drug is described as follows: - Use Low-sorb tubing BUT NO IN-LINE FILTER

Answer 250

The administration of this drug is described as follows: - Use Low-sorb tubing with an in-line filter

Answer 251

The administration of this drug is described as follows: - Use Low-sorb tubing with an in-line filter

Answer 252

The general techniques for administration of this drug class is described as follows: - Paclitaxel and Cabazitaxel require low-sorb tubing and in-line filter - Docetaxel requires low-sorb tubing BUT NO IN-LINE FILTER

Answer 253

The metabolism of this drug is as follows: - Primarily hepatic metabolism by CYP3A4 (CYP2C8 minor). - Dose adjustments are recommended in patients with hepatic impairment.

Answer 254

The metabolism of this drug is as follows: - Primarily hepatic metabolism by CYP3A4/3A5 (CYP2C8 minor). - Dose adjustments are recommended in patients with hepatic impairment.

Answer 255

The metabolism of this drug is as follows: - Primarily hepatic metabolism by CYP2C8 (CYP3A4 minor). - Dose adjustments are recommended in patients with hepatic impairment.

Answer 256

The metabolism of this drug is as follows: - Primarily hepatic metabolism by CYP2C8 (CYP3A4 minor). - Dose adjustments are recommended in patients with hepatic impairment.

Answer 257

The notable ADRs of this drug are: - Infusion reactions

Answer 258

The notable ADRs of this drug are: - Peripheral edema (black box warning)

Answer 259

The strategy and rationale for management of this condition caused by this drug are: - This drug has poor water solubility and is thus formulated with a polyethoxylated castor oil (Cremophor). - This viscous solution is likely to cause hypersensitivity reactions, but these reactions are due to the Cremophor (not the drug itself). - In order to prevent these reactions, patients should be premedicated with antihistamines and corticosteroids. Typically, patients receive dexamethasone 10-20 mg oral 12 and 6 hours prior to the infusion, plus diphenhydramine 50 mg IV and ranitidine 50 mg IV 30 minutes prior to the infusion.

Answer 260

The strategy and rationale for management of this condition caused by this drug are: - Characterized by pleural effusions (requiring immediate drainage), ascites with pronounced abdominal distention, peripheral edema, dyspnea at rest, cardiac tamponade, and/or generalized edema. - Premedication with corticosteroids for 3 days, beginning the day before drug administration, is recommended to prevent pulmonary/peripheral edema. - Patients typically receive dexamethasone 8mg oral twice daily 1 day prior to drug and continuing for 2 days after.

Answer 261

The clinical pearls of this drug are as follows: - Not interchangeable with other paclitaxel formulations and cannot be substituted for conventional paclitaxel.

Answer 262

The history of this drug class is as follows: - Discovered in 1971 by NCI researchers during a plant screening program when a crude extract with anti-tumor activity was isolated from the bark of the Pacific Yew, Taxus brevifolia. - But the amount of paclitaxel in yew bark was small and extracting it was complicated and expensive and the collection of Pacific Yew bark also became restricted for environmental reasons. - This led to production of semi-synthetic form of paclitaxel derived from the needles of the Himalayan yew tree, Taxus bacatta.

Answer 263

The drugs in this class notable for cause this condition are: - Docetaxel

Answer 264

The drugs in this class notable for cause this condition are: - Paclitaxel (due to Cremophor)

Answer 265

Drugs in this class are: - lrinotecan - Topotecan - Etoposide - Teniposide - Mitoxantrone

Answer 266

The brand name of this generic drug is: - Camptosar

Answer 267

The brand name of this generic drug is: - Hycamtin

Answer 268

The brand name of this generic drug is: - Toposar, Vepesid, VP16

Answer 269

The brand name of this generic drug is: - VM26

Answer 270

The brand name of this generic drug is: - Novantrone

Answer 271

The generic name of this brand name drug is: - lrinotecan

Answer 272

The generic name of this brand name drug is: - Topotecan

Answer 273

The generic name of this brand name drug is: - Etoposide

Answer 274

The generic name of this brand name drug is: - Etoposide

Answer 275

The generic name of this brand name drug is: - Etoposide

Answer 276

The generic name of this brand name drug is: - Teniposide

Answer 277

The generic name of this brand name drug is: - Mitoxantrone

Answer 278

The main indications of this drug are: - Non-Small Cell Lung Cancer - Small Cell Lung Cancer - Colorectal Cancer - Esophageal Cancer - Gastric Cancer - Pancreatic Cancer

Answer 279

The main indications of this drug are: - Small Cell Lung Cancer - Cervical Cancer - CNS Malignancy - Ewing Sarcoma - Ovarian Cancer - Rhabdomyosarcoma

Answer 280

The main indications of this drug are: - Breast Cancer - Hematopoietic Stem Cell Transplant - Hemophagocytic Lymphohistiocytosis - Hodgkin Lymphoma - Non-Hodgkin Lymphoma - Non-Small Cell Lung Cancer - Small Cell Lung Cancer - Testicular Cancer

Answer 281

This drug in the following class: - Topoisomerase I Inhibitors This drug's MOA is as follows: - Topoisomerase is an essential enzyme found in all nucleated cells and is responsible for the regulation of DNA topology. - DNA is wound around basic proteins called histones and supercoiled however, DNA must be relaxed before it can be copied. Topoisomerase I introduces single stranded nicks into DNA to allow DNA relaxation. - In the presence of topoisomerase inhibitors, these nicks remain and the DNA is damaged causing cell death.

Answer 282

This drug in the following class: - Topoisomerase I Inhibitors This drug's MOA is as follows: - Topoisomerase is an essential enzyme found in all nucleated cells and is responsible for the regulation of DNA topology. - DNA is wound around basic proteins called histones and supercoiled however, DNA must be relaxed before it can be copied. Topoisomerase I introduces single stranded nicks into DNA to allow DNA relaxation. - In the presence of topoisomerase inhibitors, these nicks remain and the DNA is damaged causing cell death.

Answer 283

This drug in the following class: - Topoisomerase II Inhibitors (Podophyllotoxin Derivative) This drug's MOA is as follows: - Topoisomerase is an essential enzyme found in all nucleated cells and is responsible for the regulation of DNA topology. - DNA is wound around basic proteins called histones and supercoiled however, DNA must be relaxed before it can be copied. Topoisomerase II introduces double stranded nicks into DNA to allow DNA relaxation. - In the presence of topoisomerase inhibitors, these nicks remain and the DNA is damaged causing cell death.

Answer 284

This drug in the following class: - Topoisomerase II Inhibitors (Podophyllotoxin Derivative) This drug's MOA is as follows: - Topoisomerase is an essential enzyme found in all nucleated cells and is responsible for the regulation of DNA topology. - DNA is wound around basic proteins called histones and supercoiled however, DNA must be relaxed before it can be copied. Topoisomerase II introduces double stranded nicks into DNA to allow DNA relaxation. - In the presence of topoisomerase inhibitors, these nicks remain and the DNA is damaged causing cell death.

Answer 285

This drug in the following class: - Topoisomerase II Inhibitors (Anthracenedione) This drug's MOA is as follows: - Topoisomerase is an essential enzyme found in all nucleated cells and is responsible for the regulation of DNA topology. - DNA is wound around basic proteins called histones and supercoiled however, DNA must be relaxed before it can be copied. Topoisomerase II introduces double stranded nicks into DNA to allow DNA relaxation. - In the presence of topoisomerase inhibitors, these nicks remain and the DNA is damaged causing cell death.

Answer 286

The emetic potential of this drug is: - Low

Answer 287

The emetic potential of this drug is: - Low

Answer 288

The emetic potential of this drug is: - Moderate

Answer 289

The emetic potential of this drug is: - Low

Answer 290

The emetic potential of this drug is: - Low

Answer 291

The emetic potential of this drug class is: - All low except for topotecan (moderate)

Answer 292

The extravasation risk and management strategies for this drug class are as follows: - All irritants except for mitoxantrone (irritant with vesicant like properties)

Answer 293

The metabolism of this drug is as follows: - In patients with hepatic dysfunction, clearance is decreased and exposure to the active metabolite (SN-38) is increased proportional to the degree of hepatic impairment.

Answer 294

The metabolism of this drug is as follows: - In renal function impairment, total body clearance is reduced, AUC is increased, and Vd is lower.

Answer 295

The metabolism of this drug is as follows: - AUC after oral administration is 30% higher in Asian patients as compared to white patients.

Answer 296

The notable ADRs of this drug are: - Diarrhea - Neutropenia if homozygous for the UGT1A1*28 allele

Answer 297

The drugs in this class notable for cause this condition are: - Irinotecan

Answer 298

The strategy and rationale for management of this condition caused by this drug are: - Early-onset diarrhea occurs during or within 24 hours of infusion. - This is caused by direct inhibition of acetylcholinesterase by the drug and is accompanied with cholinergic symptoms such as cramps, diaphoresis, flushing, salivation, visual disturbances, and lacrimation. - Acute diarrhea is treated with atropine 0.25-1 mg SO or IV. Patients may also be given atropine as secondary prophylaxis after experiencing acute diarrhea in previous chemotherapy cycles.

Answer 299

The strategy and rationale for management of this condition caused by this drug are: - Late-onset diarrhea is the dose limiting toxicity of this drug and typically occurs >24 hours after drug administration (median time to onset is 6 days). - This is thought to occur due to secretory processes caused by the active metabolite of the drug. - Late onset diarrhea is treated with high dose loperamide and supportive care including fluids if needed. - Patient should be instructed to take loperamide 4 mg at first sign of diarrhea, followed by 2 mg every 2 hours (4 mg every 4 hours at night) until 12 hours following last bowel movement up to 24 mg/day. Exceeding the daily limit of loperamide 16 mg/day is recommended for treatment of irinotecan-associated diarrhea in adults. - Atropine has no role in the treatment of late onset diarrhea.

Answer 300

The strategy and rationale for management of this condition caused by this drug are: - A test is available for genotyping of UGT1A1, however, use of the test is not widely accepted as dose reductions are already recommended in patients who have experienced toxicity regardless of genotype.

Answer 301

Risk factors for developing this ADR with this drug/class are: - Homozygous for the UGT1A1*28 allele are at increased risk. - Heterozygous carriers may also be at increased neutropenic risk, however, most patients have tolerated normal starting doses

Answer 302

Drugs in this class are: - Vincristine - Vinorelbine - Vinblastine

Answer 303

The brand name of this generic drug is: - Oncovin

Answer 304

The brand name of this generic drug is: - Navelbine

Answer 305

The brand name of this generic drug is: - Velban

Answer 306

The generic name of this brand name drug is: - Vincristine

Answer 307

The generic name of this brand name drug is: - Vinorelbine

Answer 308

The generic name of this brand name drug is: - Vinblastine

Answer 309

The main indications of this drug are: - Acute Lymphoblastic Leukemia - Non-Hodgkin Lymphoma - Rhabdomyosarcoma - Central nervous system tumors - Chronic lymphocytic leukemia/small lymphocytic leukemia - Ewing sarcoma - Hodgkin Lymphoma

Answer 310

The main indications of this drug are: - Hodgkin Lymphoma - Soft Tissue Sarcoma - Non-small cell Lung cancer - Small-cell Lung cancer - Breast Cancer - Cervical Cancer - Ovarian cancer - Mesothelioma

Answer 311

The main indications of this drug are: - Hodgkin Lymphoma - Soft Tissue Sarcoma - Testicular cancer - Kaposi Sarcoma - Bladder cancer - Non-small cell Lung cancer

Answer 312

This drug in the following class: - Vinca Alkaloids This drug's MOA is as follows: - Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Answer 313

This drug in the following class: - Vinca Alkaloids This drug's MOA is as follows: - Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Answer 314

This drug in the following class: - Vinca Alkaloids This drug's MOA is as follows: - Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Answer 315

The emetic potential of this drug is: - Minimal

Answer 316

The emetic potential of this drug is: - Minimal

Answer 317

The emetic potential of this drug is: - Minimal

Answer 318

The emetic potential of this drug class is: - All are minimal

Answer 319

The extravasation risk and management strategies for this drug class are as follows: - All are vesicants - If extravasation occurs, stop infusion immediately and gently aspirate extravasated solution (do not flush the line). - Initiate hyaluronidase antidote and apply warm dry compresses for 20 minutes four times a day for 1-2 days.

Answer 320

The general techniques for administration of this drug class is described as follows: - These agents are for IV use only and are FATAL if administered intrathecally - The Institute for Safe Mediation Practices (ISMP) recommends dispensing vinca alkaloids in a mini-bag (not a syringe) to prevent inadvertent intrathecal administration. - Vincristine is commonly used in the treatment of adult and pediatric ALL which also includes frequent administration of intrathecal chemotherapy. ISMP has reported 135 fatalities worldwide due to inadvertent intrathecal administration of vincristine. all of which were dispensed in a syringe.

Answer 321

The metabolism of this drug is as follows: - Extensively hepatic metabolism, mostly via CYP3A4

Answer 322

The notable ADRs of this drug are: - When used as a single agent, this drug does not typically cause myelosuppression - Neuropathy (peripheral and autonomic [constipation])

Answer 323

The notable ADRs of this drug are: - This drug can typically cause cytopenias - Neuropathy (peripheral and autonomic [constipation])

Answer 324

The notable ADRs of this drug are: - This drug can typically cause cytopenias - Neuropathy (peripheral and autonomic [constipation])

Answer 325

The notable/common ADRs of this drug class are: - When used as a single agent, Vincristine does not typically cause myelosuppression. Vinorelbine and vinblastine however can both cause cytopenias. - Neuropathy (most common dose limiting side effect of this drug class)

Answer 326

The strategy and rationale for management of this condition caused by this drug class are: - This is the most common dose limiting side effect of this drug class. - This can not only affect the peripheral nerves (leading to numbness and tingling in the extremities) but it can also affect the autonomic nerves leading to constipation. - Patients should be on an aggressive bowel regimen while receiving drugs in this class and be evaluated for neuropathy at every visit. - The presence of peripheral neuropathy may require a dose reduction or omission of the vinca alkaloid.

Answer 327

The strategy and rationale for management of this condition caused by this drug class are: - All of the vinca alkaloids are hepatically metabolized and require hepatic dose adjustments. - The only exception is based on clinical judgement if the liver dysfunction is known to be due to the disease.

Answer 328

The history of this drug class is as follows: - They are derived from the Madagascar periwinkle plant, Vinca rosea. - This plant was said to be useful in the treatment of diabetes. Attempts to verify the antidiabetic properties of the plants extracts in the 1950's led instead to the discovery and isolation of vinblastine. - Scientists first observed vinblastine's anticancer properties in a lab in 1962 with the observation of regression of lymphocytic leukemia in rats.

Answer 329

Drugs in this class are: - Anastrozole - Exemestane - Letrozole

Answer 330

The brand name of this generic drug is: - Arimidex

Answer 331

The brand name of this generic drug is: - Aromasin

Answer 332

The brand name of this generic drug is: - Femara

Answer 333

The generic name of this brand name drug is: - Anastrozole

Answer 334

The generic name of this brand name drug is: - Exemestane

Answer 335

The generic name of this brand name drug is: - Letrozole

Answer 336

The main/common indications of this drug class are: - Breast Cancer

Answer 337

This drug in the following class: - Aromatase Inhibitors This drug's MOA is as follows: - Inhibits aromatase which is the enzyme responsible for the conversion of androgens to estrogens, this leads to a significant decrease in circulating estrogen. - This thus reduces estrogen mediated stimulation of breast cancer tissue - This one is a non-steroidal aromatase inhibitor - it decreases estrogen synthesis without compromising adrenal steroid synthesis

Answer 338

This drug in the following class: - Aromatase Inhibitors This drug's MOA is as follows: - Inhibits aromatase which is the enzyme responsible for the conversion of androgens to estrogens, this leads to a significant decrease in circulating estrogen. - This thus reduces estrogen mediated stimulation of breast cancer tissue - This one is a steroidal aromatase inhibitor - it has a similar structure to androgen and irreversibly binds to aromatase

Answer 339

This drug in the following class: - Aromatase Inhibitors This drug's MOA is as follows: - Inhibits aromatase which is the enzyme responsible for the conversion of androgens to estrogens, this leads to a significant decrease in circulating estrogen. - This thus reduces estrogen mediated stimulation of breast cancer tissue - This one is a non-steroidal aromatase inhibitor - it decreases estrogen synthesis without compromising adrenal steroid synthesis

Answer 340

The notable/common monitoring parameters for this drug class are: - Baseline and periodic bone mineral density screening (every 1 to 2 years). - Cholesterol and hepatic function tests at baseline and periodically during therapy.

Answer 341

The emetic potential of this drug class is: - None, N/A

Answer 342

The extravasation risk and management strategies for this drug class are as follows: - None, N/A (all are oral)

Answer 343

The metabolism of this drug class is as follows: - Extensively hepatic

Answer 344

The notable/common ADRs of this drug class are: - Musculoskeletal side effects including carpal tunnel. arthralgias. joint stiffness. and/or bone pain

Answer 345

The strategy and rationale for management of this condition caused by these drugs are: - This includes carpal tunnel, arthralgias, joint stiffness, and/or bone pain. - In up to 1/3 of patients these symptoms can be severe and may be the cause of treatment discontinuation in 10-20% of patients on Als. - The best strategy for managing these adverse effects includes exercise and nonsteroidal anti-inflammatory drugs.

Answer 346

The clinical pearls of this drug class are as follows: - 70% estradiol reduction after 24 hours; 80% after 2 weeks of therapy - Aromatase inhibitors work in the peripheral fat to decrease estrogen synthesis. - In pre-menopausal women, estrogen is also produced by the ovaries so aromatase inhibitors are NOT effective therapy as monotherapy for pre-menopausal women. Some sort of ovarian suppression must be used in pre-menopausal women receiving Als. - An Al is the preferred adjuvant treatment of post-menopausal women, although tamoxifen is an acceptable alternative for women who are intolerant of Als. - Data shows similar clinical outcomes and tolerability between the AIs. Individuals may tolerate one of these agents better than another. Consider switching to an alternative Al if the initial Al is poorly tolerated and strategies to manage the side effects have been ineffective. - ASCO recommends a maximum duration of 5 years of AI therapy for postmenopausal women. Als may be combined with tamoxifen for a total duration of up to 10 years of endocrine therapy. - Aromatase inhibitors are currently being studied as risk reduction agents in post-menopausal women at a high risk for breast cancer

Answer 347

Drugs in this class are: - Tamoxifen - Fulvestrant - Elacestrant - Toremifene

Answer 348

The brand name of this generic drug is: - Soltamox - Nolvadex

Answer 349

The brand name of this generic drug is: - Faslodex

Answer 350

The brand name of this generic drug is: - Orserdu

Answer 351

The brand name of this generic drug is: - Fareston

Answer 352

The generic name of this brand name drug is: - Tamoxifen

Answer 353

The generic name of this brand name drug is: - Tamoxifen

Answer 354

The generic name of this brand name drug is: - Fulvestrant

Answer 355

The generic name of this brand name drug is: - Elacestrant

Answer 356

The generic name of this brand name drug is: - Toremifene

Answer 357

The main/common indications of this drug class are: - Breast Cancer

Answer 358

This drug in the following class: - Estrogen Receptor Antagonists This drug's MOA is as follows: - Binds to estrogen receptors on tumors and other tissue targets inhibiting estrogens effects and thus tumor growth

Answer 359

This drug in the following class: - Estrogen Receptor Antagonists This drug's MOA is as follows: - Binds to estrogen receptors on tumors and other tissue targets inhibiting estrogens effects and thus tumor growth

Answer 360

This drug in the following class: - Estrogen Receptor Antagonists - Selective estrogen receptor degrader (SERD) This drug's MOA is as follows: - Elacestrant is an estrogen receptor antagonist and nonsteroidal selective estrogen receptor degrader (SERD), which degrades estrogen receptor alpha in a dose-dependent manner, and inhibits estradiol-dependent estrogen-receptor directed gene transcription and tumor growth.

Answer 361

This drug in the following class: - Estrogen Receptor Antagonists This drug's MOA is as follows: - Binds to estrogen receptors on tumors and other tissue targets inhibiting estrogens effects and thus tumor growth

Answer 362

The notable/common monitoring parameters for this drug class are: - Bone mineral density at baseline and periodically during treatment (every 1-2 years) - Gynecologic exam (baseline and annually, continuing after discontinuation of therapy) - Liver function tests periodically during therapy

Answer 363

The emetic potential of this drug class is: - None, N/A

Answer 364

The extravasation risk and management strategies for this drug class are as follows: - None, N/A (all are oral)

Answer 365

The metabolism of this drug class is as follows: - Primarily hepatic (mainly CYP2D6 for tamoxifen, mainly CYP3A4 for the others)

Answer 366

The notable ADRs of this drug are: - Hot flashes - Thromboembolism - Endometrial malignancies

Answer 367

The notable/common ADRs of this drug class are: - See tamoxifen (possible class effect?)

Answer 368

The drugs in this class notable for cause this condition are: - Tamoxifen (possible class effect?)

Answer 369

The drugs in this class notable for cause this condition are: - Tamoxifen (possible class effect?)

Answer 370

The drugs in this class notable for cause this condition are: - Tamoxifen (possible class effect?)

Answer 371

The strategy and rationale for management of this condition caused by this drug are: - Chemotherapy + this drug can cause more frequent and severe hot flashes than natural menopause, which often results in decreased quality of life and may affect medication adherence. - This is thought to be due to a central nervous system antiestrogenic effects causing thermoregulatory dysfunction. - 80% of women prescribed this drug complain of hot flashes, with 30% of those having severe symptoms. - Venlafaxine 75 mg orally daily has been shown to be more effective in managing hot flashes when compared to placebo, clonidine and gabapentin. - Data also supports the use of paroxetine*, fluoxetine*, sertraline, and citalopram to manage hot flashes. - *Drug interaction with CYP2D6

Answer 372

The strategy and rationale for management of this condition caused by this drug are: - There is a significant procoagulant effect when this drug is added to chemotherapy.

Answer 373

The strategy and rationale for management of this condition caused by this drug are: - Women taking tamoxifen should be informed about the risks of endometrial proliferation, endometrial hyperplasia, endometrial cancer, and uterine sarcomas. - The risk of developing endometrial cancer from tamoxifen is about 1 in 500. - Any abnormal vaginal bleeding, bloody vaginal discharge, or spotting should be investigated in post-menopausal women. - Premenopausal women treated with tamoxifen have no known increased risk of uterine cancer and require no additional monitoring beyond routine gynecologic care.

Answer 374

Risk factors for developing this ADR with this drug/class are: - Coadministration with chemotherapy? - Premenopausal women - Polymorphisms in drug metabolizing enzymes - Coadministration of drugs that inhibit the activity of CYP2D6 - Specific estrogen receptor genotypes

Answer 375

Risk factors for developing this ADR with this drug/class are: - Coadministration with chemotherapy? - The relative risks of venous thromboembolism are increased 2-3-fold in older women receiving tamoxifen and this elevated risk continues as long as the patient takes the drug.

Answer 376

The clinical pearls of this drug are as follows: - Oral solution is bioequivalent to tamoxifen tablets - It is the endocrine agent of choice for the adjuvant treatment of premenopausal women with breast cancer and for postmenopausal women who are not candidates for an aromatase inhibitor for whatever reason. - Converted to its active metabolites by CYP2D6 and UGT2B7 - drugs that inhibit CYP2D6 (fluoxetine and paroxetine) may potentially alter the metabolism of tamoxifen. - Unlike the aromatase inhibitors, this drug may help prevent bone loss and lowers total cholesterol

Answer 377

The clinical pearls of this drug class are as follows: - See tamoxifen (possible class effect?)

Answer 378

Drugs in this class are: - Triptorelin - Goserelin - Leuprolide - Histrelin

Answer 379

The brand name of this generic drug is: - Trelstar Mixject - Triptodur

Answer 380

The brand name of this generic drug is: - Zoladex

Answer 381

The brand name of this generic drug is: - Camcevi - Eligard - Fensolvi - Lupron

Answer 382

The brand name of this generic drug is: - Vantas

Answer 383

The generic name of this brand name drug is: - Triptorelin

Answer 384

The generic name of this brand name drug is: - Triptorelin

Answer 385

The generic name of this brand name drug is: - Goserelin

Answer 386

The generic name of this brand name drug is: - Leuprolide

Answer 387

The generic name of this brand name drug is: - Leuprolide

Answer 388

The generic name of this brand name drug is: - Leuprolide

Answer 389

The generic name of this brand name drug is: - Leuprolide

Answer 390

The generic name of this brand name drug is: - Histrelin

Answer 391

The main indications of this drug are: - Prostate Cancer - Endometrial stromal sarcoma

Answer 392

The main indications of this drug are: - Prostate Cancer - Breast Cancer - Prevention of early menopause during chemotherapy

Answer 393

The main indications of this drug are: - Prostate Cancer - Breast Cancer - Prevention of early menopause during chemotherapy

Answer 394

The main/common indications of this drug class are: - Prostate Cancer (primary) - Breast Cancer

Answer 395

This drug in the following class: - GNRH Agonists This drug's MOA is as follows: - Agonist analog of gonadotropin releasing hormone (GnRH) and causes suppression of ovarian and testicular steroidogenesis due to decreased levels of LH and FSH (after initial increase during initiation phase) with subsequent decrease in testosterone (male) and estrogen (female) levels.

Answer 396

This drug in the following class: - GNRH Agonists This drug's MOA is as follows: - Agonist analog of gonadotropin releasing hormone (GnRH) and causes suppression of ovarian and testicular steroidogenesis due to decreased levels of LH and FSH (after initial increase during initiation phase) with subsequent decrease in testosterone (male) and estrogen (female) levels.

Answer 397

This drug in the following class: - GNRH Agonists This drug's MOA is as follows: - Agonist analog of gonadotropin releasing hormone (GnRH) and causes suppression of ovarian and testicular steroidogenesis due to decreased levels of LH and FSH (after initial increase during initiation phase) with subsequent decrease in testosterone (male) and estrogen (female) levels.

Answer 398

This drug in the following class: - GNRH Agonists This drug's MOA is as follows: - Agonist analog of gonadotropin releasing hormone (GnRH) and causes suppression of ovarian and testicular steroidogenesis due to decreased levels of LH and FSH (after initial increase during initiation phase) with subsequent decrease in testosterone (male) and estrogen (female) levels.

Answer 399

The notable/common monitoring parameters for this drug class are: - Serum testosterone levels - Prostate-specific antigen to monitor response to therapy

Answer 400

The emetic potential of this drug class is: - None, N/A

Answer 401

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 402

The administration of this drug is described as follows: - Given IM by a healthcare provider - Canadian product can be given SubQ

Answer 403

The administration of this drug is described as follows: - This drug is an implant that is administered/implanted SubQ

Answer 404

The administration of this drug is described as follows: - Administered SubQ expect for depot formulations (IM)

Answer 405

The administration of this drug is described as follows: - This drug is an implant that is surgically implanted SubQ

Answer 406

The notable/common ADRs of this drug class are: - Long term use can cause ADRs related to decreased testosterone levels including osteoporosis, bone fractures. obesity, insulin resistance, hyperlipidemia, and increased risk of diabetes/cardiovascular events. - Disease flare - Gynecomastia - Hot flashes - Erectile dysfunction - Edema - Injection site reactions

Answer 407

The strategy and rationale for management of this condition caused by this drug are: - This is thought to be caused by initial induction of luteinizing hormone (LH) and follicte stimulating hormone (FSH) by the GNRH agonist. - This can manifest as increased bone pain or increased urinary symptoms. - Antiandrogen therapy should be started before beginning a GNRH agonist and be continued in combination for at least 7 days for patients with metastases to help reduce tumor flare. - This flare reaction usually resolves after 2 weeks and has a similar onset and duration pattern between the depot and regular acting GNRH agonists.

Answer 408

The onset of drugs in this class is described as follows: - Following a transient increase, testosterone suppression occurs at ~2 to 4 weeks of continued therapy

Answer 409

The clinical pearls of this drug class are as follows: - Also referred to as luteinizing hormone-releasing hormone (LHRH) agonists - GnRH agonists are a reversible method of androgen ablation and are as effective as orchiectomy in treating prostate cancer - In the context of prostate cancer, goal is to induce castrate levels of testosterone. - This can be accomplished by surgical castration (orchiectomy) or medical/chemical castration (GNRH agonists or antagonists). - When using GNRH agonists, the goal serum testosterone level is <50 ng/dl after 1 month of therapy. - Use in combination with antiandrogen to reduce disease flare

Answer 410

Drugs in this class are: - Lenalidomide - Pomalidomide - Thalidomide

Answer 411

The brand name of this generic drug is: - Revlimid

Answer 412

The brand name of this generic drug is: - Pomalyst

Answer 413

The brand name of this generic drug is: - Thalomid

Answer 414

The generic name of this brand name drug is: - Lenalidomide

Answer 415

The generic name of this brand name drug is: - Pomalidomide

Answer 416

The generic name of this brand name drug is: - Thalidomide

Answer 417

The main indications of this drug are: - Multiple Myeloma - Non-Hodgkin Lymphoma - Myelodysplastic Syndrome - CLL

Answer 418

The main indications of this drug are: - Multiple Myeloma - Pomalidomide - Kaposi Sarcoma

Answer 419

The main indications of this drug are: - Multiple Myeloma

Answer 420

The main/common indications of this drug class are: - Multiple Myeloma

Answer 421

This drug in the following class: - Immune Modulators (IMiDs) This drug's MOA is as follows: - The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Answer 422

This drug in the following class: - Immune Modulators (IMiDs) This drug's MOA is as follows: - The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Answer 423

This drug in the following class: - Immune Modulators (IMiDs) This drug's MOA is as follows: - The mechanism of action is still under investigation but it is believed to exert direct cytotoxic effects on the tumor cells causing apoptosis

Answer 424

The notable/common monitoring parameters for this drug class are: - Females of reproductive potential should receive a pregnancy test 10 to 14 days and 24 hours prior to initiating therapy, weekly during the first 4 weeks of treatment, then every 2 to 4 weeks through 4 weeks after therapy discontinued.

Answer 425

The emetic potential of this drug class is: - Minimal-Low

Answer 426

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 427

The metabolism of this drug is as follows: - Excreted primarily as unchanged drug in the urine (70-90%)

Answer 428

The notable/common ADRs of this drug class are: - Risk of birth defects (fetal death; limb (seal-like), eye, urinary tract, and heart problems). - Thromboembolism

Answer 429

The strategy and rationale for management of this condition caused by drugs in this class are: - Women of childbearing potential need to be on effective contraception for at least 4 weeks prior to starting therapy, during therapy, and for at least 4 weeks after discontinuing therapy. - Pregnancy screening should be done prior to initiating therapy and pregnancy must be excluded by 2 negative pregnancy tests. - During the first month of therapy patients are required to undergo weekly pregnancy tests, then monthly thereafter in women with regular menstrual cycles or every 2 weeks for women with irregular menstrual cycles while on treatment. - If pregnancy does occur, therapy must be discontinued. - Drug is present in semen so male patients are required to use condoms during any sexual contact with females of childbearing potential while on treatment and for up to 28 days after receiving therapy and must not donate sperm.

Answer 430

The strategy and rationale for management of this condition caused by drugs in this class are: - All patients receiving these drugs need some sort of VTE prophylaxis. - The SAVED score can estimate VTE risk and takes into account: recent surgeries, race, VTE history, age, and dexamethasone dosing to estimate VTE risk while taking these drugs. - Patients at low risk for VTE (per the SAVED score) can receive aspirin 81 mg once daily. - High risk patients should receive full dose warfarin (target INR 2-3), enoxaparin 40 mg daily, Dalteparin 5,000 units daily, or apixaban 2-5 mg every 12 hours. - Patient can also receive full dose anticoagulation if indicated for another medical condition.

Answer 431

The clinical pearls of this drug class are as follows: - All of these drugs have a REMS program with restrictions for prescribing and dispensing due to the risk of fetal toxicity. - If patients are deemed transplant eligible, collect stem cells within first 4 cycles of lenalidomide as this increases the likelihood of a successful collection.

Answer 432

The history of this is as follows: - This drug was first marketed in 1957 in Europe as an over the counter medication. It was said to help with anxiety, trouble sleeping, and morning sickness. - While it was initially thought to be safe in pregnancy, concerns regarding birth defects arose in 1961 and the medication was removed from the market. - It is estimated that 10,000 embryos were affected by the use of thalidomide during pregnancy - of which 40% died at the time of birth. Those who survived had limb (seal-like), eye, urinary tract, and heart problems. - This led to public support for stronger drug laws in the United States and the creation of the Kefauver-Harris drug amendment.

Answer 433

Drugs in this class are: - Nivolumab - Pembrolizumab - Cemiplimab - Dostarlimab - Retifanlimab - Nivolumab+Relatlimab

Answer 434

Drugs in this class are: - Atezolizumab - Avelumab - Durvalumab

Answer 435

Drugs in this class are: - lpilimumab - Tremelimumab

Answer 436

The brand name of this generic drug is: - Opdivo

Answer 437

The brand name of this generic drug is: - Keytruda

Answer 438

The brand name of this generic drug is: - Libtayo

Answer 439

The brand name of this generic drug is: - Jemperli

Answer 440

The brand name of this generic drug is: - Zynyz

Answer 441

The brand name of this generic drug is: - Opdualag

Answer 442

The brand name of this generic drug is: - Tecentriq

Answer 443

The brand name of this generic drug is: - Bavencio

Answer 444

The brand name of this generic drug is: - Imfinzi

Answer 445

The brand name of this generic drug is: - Yervoy

Answer 446

The brand name of this generic drug is: - Imjudo

Answer 447

The generic name of this brand name drug is: - Nivolumab

Answer 448

The generic name of this brand name drug is: - Pembrolizumab

Answer 449

The generic name of this brand name drug is: - Cemiplimab

Answer 450

The generic name of this brand name drug is: - Dostarlimab

Answer 451

The generic name of this brand name drug is: - Retifanlimab

Answer 452

The generic name of this brand name drug is: - Nivolumab+Relatlimab

Answer 453

The generic name of this brand name drug is: - Atezolizumab

Answer 454

The generic name of this brand name drug is: - Avelumab

Answer 455

The generic name of this brand name drug is: - Durvalumab

Answer 456

The generic name of this brand name drug is: - lpilimumab

Answer 457

The generic name of this brand name drug is: - Tremelimumab

Answer 458

This drug in the following class: - Immunotherapy - Anti-PD-1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 459

This drug in the following class: - Immunotherapy - Anti-PD-1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 460

This drug in the following class: - Immunotherapy - Anti-PD-1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 461

This drug in the following class: - Immunotherapy - Anti-PD-1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 462

This drug in the following class: - Immunotherapy - Anti-PD-1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 463

This drug in the following class: - Immunotherapy - Anti-PD-1 + Anti-LAG-3 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 464

This drug in the following class: - Immunotherapy - Anti-PD-L1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 465

This drug in the following class: - Immunotherapy - Anti-PD-L1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 466

This drug in the following class: - Immunotherapy - Anti-PD-L1 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 467

This drug in the following class: - Immunotherapy - Anti-CTLA4 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 468

This drug in the following class: - Immunotherapy - Anti-CTLA4 This drug's MOA is as follows: - Immune checkpoint inhibitors remove inhibitory signals of T-cell activation, which enables tumor- reactive T-cells to overcome regulatory mechanisms and mount an effective antitumor response.

Answer 469

The notable/common monitoring parameters for this drug class are: - TSH/T4 at baseline and every 4-6 weeks - LFTs (AST, ALT, and bilirubin) at baseline and periodically during treatment - Serum creatinine at baseline and periodically during treatment

Answer 470

The emetic potential of this drug class is: - Minimal

Answer 471

The emetic potential of this drug class is: - Minimal

Answer 472

The emetic potential of this drug class is: - Minimal

Answer 473

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 474

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 475

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 476

The notable/common ADRs of this drug class are: - Immune related adverse events (irAEs) - These irAEs can affect any organ/tissue in the body (skin, GI tract lungs, liver, thyroid, etc.). - The most common irAEs with these agents are rash, pruritus, diarrhea, colitis, elevated liver enzymes/ bilirubin, hepatitis, hypophysitis, and hypothyroidism.

Answer 477

The strategy and rationale for management of this condition caused by this drug are: - Patients should be educated on the mechanism of action of immunotherapy and when a new side effect occurs, there should be a high suspicion for it being treatment-related. - Though treatment interruption may be needed for some irAEs depending on severity, dose adjustments are not recommended after restarting therapy following toxicity. - Toxicity Management (except hypothyroidism): - Grade 1 toxicity: Continue immunotherapy with close monitoring - Grade 2 toxicity: Hold immunotherapy (may resume when toxicity< grade 1). Prednisone 0.5-1 mg/kg/day or equivalent may be administered - Grade 3 toxicity: Hold immunotherapy (may resume when toxicity< grade 1). Start prednisone 1-2 mg/ kg/ day or methylprednisolone IV 1-2 mg/kg/day with taper over > 4-6 weeks. If no improvement after 48-72 hours, then consider infliximab - Grade 4 toxicity: Permanently discontinue immunotherapy

Answer 478

The strategy and rationale for management of this condition caused by this drug are: - Thyroid supplementation in symptomatic patients with TSH levels> 10 mIU/L, monitor every 6-8 weeks while titrating

Answer 479

The half-life of the this drug is described as follows: - The typical half-life of these agents ranges from 15-27 days - This leads to a longer time to tumor response compared to traditional cytotoxic chemotherapy

Answer 480

The clinical pearls of this drug class are as follows: - Drug interactions - As steroids are known to reduce the immune response (and are used to treat immune related adverse events), they may diminish the therapeutic effect of Immune Checkpoint Inhibitors. - Carefully consider the need for corticosteroids during the initiation of Immune Checkpoint inhibitor therapy. - Generally, doses of a prednisone-equivalent of 10 mg or less per day are permitted. - Combining nivolumab (anti-PD-1) with ipilimumab (anti-CTLA-4) results in enhanced T-cell function that is greater than that of either antibody alone, resulting in improved anti-tumor responses in metastatic melanoma and advanced renal cell carcinoma.

Answer 481

The clinical pearls of this drug are as follows: - It was one of the first oncology drugs approved for a specific genetic marker (tumors with high microsatellite instability) regardless of cancer type or tissue diagnosis. - This means that any patient whose tumor is MSI high is eligible to receive this drug.

Answer 482

The brand name of this generic drug is: - Herceptin

Answer 483

The brand name of this generic drug is: - Erbitux

Answer 484

The brand name of this generic drug is: - Vectibix

Answer 485

The brand name of this generic drug is: - Perjeta

Answer 486

The brand name of this generic drug is: - Avastin

Answer 487

The brand name of this generic drug is: - Darzalex

Answer 488

The brand name of this generic drug is: - Rituxan

Answer 489

The generic name of this brand name drug is: - Trastuzumab

Answer 490

The generic name of this brand name drug is: - Cetuximab

Answer 491

The generic name of this brand name drug is: - Panitumumab

Answer 492

The generic name of this brand name drug is: - Pertuzumab

Answer 493

The generic name of this brand name drug is: - Bevacizumab

Answer 494

The generic name of this brand name drug is: - Daratumumab

Answer 495

The generic name of this brand name drug is: - Rituximab

Answer 496

The MOA of this drug class is as follows: - Bind to specific targets (immune cells. cell receptors. tumor molecules. etc.) to exert anti-tumor effects, the specific target varies per antibody. - This leads to very specific anti-tumor effects using biologic agents.

Answer 497

The notable monitoring parameters for this drug are: - Type and screen prior to starting therapy (this drug can affect the ability to determine a patient's blood type if a transfusion is needed)

Answer 498

The notable monitoring parameters for this drug are: - Blood pressure and urine protein prior to starting therapy and periodically during treatment

Answer 499

The notable monitoring parameters for this drug are: - Assess left ventricular ejection fraction at baseline, every 3 months during therapy, every 4 weeks if therapy is withheld for significant left ventricular cardiac dysfunction, and every 6 months for at least 2 years following completion of therapy

Answer 500

The notable monitoring parameters for this drug are: - Assess left ventricular ejection fraction at baseline, every 3 months during therapy, every 4 weeks if therapy is withheld for significant left ventricular cardiac dysfunction, and every 6 months for at least 2 years following completion of therapy

Answer 501

The notable/common monitoring parameters for this drug class are: - Hepatitis B screening prior to starting therapy (patients may need hepatitis B prophylaxis if positive)

Answer 502

The emetic potential of this drug class is: - Minimal

Answer 503

The extravasation risk and management strategies for this drug class are as follows: - None, N/A

Answer 504

The metabolism of drugs in this class is as follows: - Generally, agents undergo intracellular lysosomal degradation

Answer 505

The notable/common ADRs of this drug class are: - Infusion Reactions

Answer 506

The strategy and rationale for management of this condition caused by this drug are: - Infusion reactions occur due to the immunogenicity of these agents, this can lead to the development of anti-monoclonal antibodies, which can cause acute hypersensitivity reactions. - The risk of reaction varies depending on the species whose proteins form the base of the molecule. Even fully humanized antibodies can cause allergic reactions. - Infusion reactions typically occur in the first 1-2 hours of starting an infusion. They can affect any organ system and range from mildly irritating injection-site reactions, fever or itching/rash to potentially life-threatening anaphylaxis. - Mild reactions are common. Many patients will receive premedication with acetaminophen and diphenhydramine prior to their infusion. - In the event of an infusion reaction, always stop the infusion as soon as possible. From there, treatment depends on the severity of the reaction. - After a mild reaction (slight rash or itching), the infusion can often be continued after temporarily stopping it with a slower infusion rate or additional doses of antipyretics or antihistamines. - More severe reactions (like anaphylaxis) can be managed with epinephrine and may require permeant discontinuation of the drug. - Humanized antibodies are produced by merging the DNA that encodes the binding protein of a monoclonal mouse antibody with human antibody producing DNA. This can reduce the risk of hypersensitivity reactions.

Answer 507

The half-life of the this drug class is described as follows: - These agents typically have a long half-life (many are >15 days) - This often leads to a slower onset of actions (many antibodies can take at least a several weeks before a meaningful effect is achieved)

Answer 508

The clinical pearls of this drug class are as follows: - These agents are very large proteins (molecular weight of ~146,000 Dal and therefore have poor CNS penetration

Answer 509

The naming conventions of this drug class are as follows: - Chimeric monoclonal antibodies contain "-xi-" (ex. Cetuximab) - Humanized monoclonal antibodies contain "-zu-" (ex. Trastuzumab) - Fully human antibodies contain "-u-" (ex. Panitumumab)

Answer 510

The brand name of this generic drug is: - Hydrea

Answer 511

The brand name of this generic drug is: - Vesanoid

Answer 512

The brand name of this generic drug is: - Trisenox

Answer 513

The generic name of this brand name drug is: - Hydroxyurea

Answer 514

The generic name of this brand name drug is: - All-Trans Retinoic Acid (ATRA, Tretinoin)

Answer 515

The generic name of this brand name drug is: - Arsenic Trioxide (ATO)

Answer 516

This drug's MOA is as follows: - Binds one or more nuclear receptors and decreases proliferation and induces differentiation of APL cells

Answer 517

This drug's MOA is as follows: - Induces apoptosis in APL cells via DNA fragmentation and damages the fusion protein: promyelocytic leukemia (PML)-retinoic acid receptor (RAR) alpha

Answer 518

This drug's MOA is as follows: - Antimetabolite that selectively inhibits ribonucleoside diphosphate reductase and interferes with DNA repair. - In sickle cell anemia, this drug increases hemoglobin F levels.

Answer 519

The main indications of this drug are: - Cytoreduction in hematologic malignancies - CML - Head and Neck Cancer - Sickle Cell Anemia - Essential Thrombocythemia - Polycythemia Vera

Answer 520

The main indications of this drug are: - Acute Promyelocytic Leukemia

Answer 521

The main indications of this drug are: - Acute Promyelocytic Leukemia

Answer 522

The notable monitoring parameters for this drug are: - Confirm t(15:17) translocation or the presence of the PML/RAR-alpha fusion protein (confirming diagnosis of acute promyelocytic leukemia). - Monitor patient multiple times daily during the initiation of therapy for signs of APL differentiation syndrome (monitor volume status, pulmonary status, temperature, respiration). - Coagulation parameters at baseline then at least 2 to 3 times a week during induction and at least weekly during consolidation. - Pregnancy test

Answer 523

The notable monitoring parameters for this drug are: - Confirm t(15:17) translocation or the presence of the PML/RAR-alpha fusion protein (confirming diagnosis of acute promyelocytic leukemia). - Monitor patient multiple times daily during the initiation of therapy for signs of APL differentiation syndrome (monitor volume status, pulmonary status, temperature, respiration). - Coagulation parameters at baseline then at least 2 to 3 times a week during induction and at least weekly during consolidation. - QTc via 12-lead EKG at baseline then weekly or twice weekly

Answer 524

The notable monitoring parameters for this drug are: - CBC with differential and platelets (once weekly for antineoplastic indications, every 2 weeks initially for sickle cell anemia)

Answer 525

The emetic potential of this drug is: - Minimal to Low

Answer 526

The emetic potential of this drug is: - Minimal to Low

Answer 527

The emetic potential of this drug is: - Low

Answer 528

The extravasation risk and management strategies for this drug are as follows: - None

Answer 529

The extravasation risk and management strategies for this drug are as follows: - None

Answer 530

The extravasation risk and management strategies for this drug are as follows: - None

Answer 531

The administration of this drug is described as follows: - Hydroxyurea can be used for cytoreduction (urgently bringing down a high white blood cell count) in newly diagnosed hematologic malignancy patients or as maintenance therapy for patients with essential thrombocythemia, sickle cell disease, and chronic myeloid leukemia. - Regardless of indication, doses are typically titrated to specific white blood cell or platelet counts (that vary depending on indication). - When titrating doses for cytoreduction, doses are typically adjusted every few days. - When used for maintenance indications, doses are typically titrated every few weeks.

Answer 532

The metabolism of this drug is as follows: - Exposure is higher in patients with CrCl <60 mL/minute or end-stage renal disease

Answer 533

The metabolism of this drug is as follows: - Systemic exposure to metabolites may also be increased in patients with renal impairment

Answer 534

The notable ADRs of this drug are: - Differentiation Syndrome (DS) - Pregnancy risk/fetal deformity

Answer 535

The notable ADRs of this drug are: - Differentiation Syndrome (DS) - QTc Prolongation

Answer 536

The notable ADRs of this drug are: - Myelosuppression - Hair Thinning - Skin/Nail Changes - Birth Defects

Answer 537

The drugs in this class notable for cause this condition are: - Tretinoin - Arsenic Trioxide

Answer 538

The drugs in this class notable for cause this condition are: - Arsenic Trioxide

Answer 539

The drugs in this class notable for cause this condition are: - Tretinoin

Answer 540

The strategy and rationale for management of this condition caused by this drug are: - While acute promyelocytic leukemia (APL) is highly treatable, this is a potentially fatal complication of APL treatment. - It occurs in approximately 25% of patients who are treated for APL and typically presents in the first 7-12 days of treatment. - The pathogenesis of DS is incompletely understood, but in APL, treatment can induce maturation of promyelocytes and promote tissue infiltration which is linked to the production of inflammatory cytokines. - Patients are started on APL induction therapy in the hospital to closely monitor for DS. - Typical clinical findings of DS include dyspnea, fever, peripheral edema, hypotension, weight gain, pleuro-pericardial effusion, acute renal failure, musculoskeletal pain, and hyperbilirubinemia - Treatment of DS includes prompt steroid treatment and holding agents that can cause DS (ATRA and ATO) until signs and symptoms resolve. (Both ATRA and ATO have black boxed warnings for DS). - These agents are typically restarted at a lower dose before slowly titrating back up to full dose.

Answer 541

The strategy and rationale for management of this condition caused by this drug are: - This drug has a black box warning for QTc interval prolongation, complete atrioventricular block, and torsade de pointes, which can be fatal. - Before administering this drug, assess the OTc interval, correct pre-existing electrolyte abnormalities (Potassium >4 and magnesium >2), and consider discontinuing drugs known to prolong OTc interval. - EKGs should be checked at baseline and 1-2 times per week during therapy. - QTc is calculated using the Framingham formula (QTc = QT interval + 154 * (1 - RR interval)) and QTc elevation is considered to be >450-500 msec. - Withhold arsenic trioxide until resolution and resume at reduced dose for QTc prolongation.

Answer 542

The strategy and rationale for management of this condition caused by this drug are: - There is a high risk that a severely deformed infant will result if this drug is administered during pregnancy. - Within 1 week prior to starting tretinoin therapy, collect blood or urine from the patient for a serum or urine pregnancy test with a sensitivity of at least 50 milliunits/mL. - When possible, delay therapy until a negative result from this test is obtained.

Answer 543

The history of this drug is as follows: - Hydroxyurea was the first drug FDA approved for the treatment of sickle cell disease back in 1998. - It was nearly 20 years before another drug was approved for sickle cell disease in 2017! - Since then, there have been 3 new drug approvals and more therapies are being investigated.

Answer 544

Drugs in this class are: - Octreotide - Lanreotide

Answer 545

The brand name of this generic drug is: - SandoSTATIN/LAR Depot

Answer 546

The brand name of this generic drug is: - Somatuline Depot

Answer 547

The generic name of this brand name drug is: - Octreotide

Answer 548

The generic name of this brand name drug is: - Lanreotide

Answer 549

The main/common indications of this drug class are: - Carcinoid Crisis/Syndrome - Neuroendocrine Tumors

Answer 550

This drug in the following class: - Somatostatin Analogs This drug's MOA is as follows: - Mimics natural somatostatin by inhibiting serotonin release and the secretion of gastrin, VIP, insulin, glucagon, secretin, motilin, and pancreatic polypeptide - Control symptoms that result from release of peptides and neuroamines from neuroendocrine tumors and help control the disease itself

Answer 551

This drug in the following class: - Somatostatin Analogs This drug's MOA is as follows: - Mimics natural somatostatin by inhibiting serotonin release and the secretion of gastrin, VIP, insulin, glucagon, secretin, motilin, and pancreatic polypeptide - Control symptoms that result from release of peptides and neuroamines from neuroendocrine tumors and help control the disease itself

Answer 552

The notable/common ADRs of this drug class are: - Bradycardia - Edema - Hyperglycemia

Answer 553

The half-life of this drug is described as follows: - Duration of action: - SubQ: 6 to 12 hours - IM (LAR depot suspension): Following a single injection, a steady concentration is achieved within 2 to 3 weeks and maintained for an additional 2 to 3 weeks; steady-state levels are achieved after 3 injections administered at 4-week intervals.

Answer 554

The clinical pearls of this drug class are as follows: - Carcinoid syndrome primary occurs in patients with well differentiated metastatic neuroendocrine tumors. - Signs and symptoms include diarrhea and flushing. - Serotonin is thought to be the most important factor in the etiology of carcinoid syndrome diarrhea. - Long acting somatostatin analogs are highly active for the control of flushing/diarrhea as well as long term disease control. - Short acting analogs can be used for immediate effect in patients with uncontrolled carcinoid syndrome. - Short-acting octreotide can also be added to octreotide long-acting release for the treatment of breakthrough symptoms.

Answer 555

Drugs in this class are: - Bosutinib - Dasatinib - lmatinib - Nilotinib - Ponatinib - Asciminib

Answer 556

The brand name of this generic drug is: - Bosulif

Answer 557

The brand name of this generic drug is: - Sprycel

Answer 558

The brand name of this generic drug is: - Gleevec

Answer 559

The brand name of this generic drug is: - Tasigna

Answer 560

The brand name of this generic drug is: - Iclusig

Answer 561

The brand name of this generic drug is: - Scemblix

Answer 562

The generic name of this brand name drug is: - Bosutinib

Answer 563

The generic name of this brand name drug is: - Dasatinib

Answer 564

The generic name of this brand name drug is: - lmatinib

Answer 565

The generic name of this brand name drug is: - Nilotinib

Answer 566

The generic name of this brand name drug is: - Ponatinib

Answer 567

The generic name of this brand name drug is: - Asciminib

Answer 568

The main indications of this drug are: - Chronic Myeloid Leukemia

Answer 569

The main indications of this drug are: - Chronic Myeloid Leukemia - Acute lymphoblastic Leukemia - Gastrointestinal stromal tumors

Answer 570

The main indications of this drug are: - Chronic Myeloid Leukemia - Acute lymphoblastic Leukemia - Gastrointestinal stromal tumors

Answer 571

The main indications of this drug are: - Chronic Myeloid Leukemia - Acute lymphoblastic Leukemia - Gastrointestinal stromal tumors

Answer 572

The main indications of this drug are: - Chronic Myeloid Leukemia - Acute lymphoblastic Leukemia

Answer 573

The main indications of this drug are: - Chronic Myeloid Leukemia

Answer 574

The main/common indications of this drug class are: - Chronic Myeloid Leukemia - Acute lymphoblastic Leukemia - Gastrointestinal stromal tumors

Answer 575

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia

Answer 576

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia

Answer 577

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia

Answer 578

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia

Answer 579

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia

Answer 580

This drug in the following class: - BCR-ABL TKIs This drug's MOA is as follows: - Inhibits BCR-ABL tyrosine kinase - the abnormal gene product of the Philadelphia chromosome in chronic myeloid leukemia - This drug is a novel first in class STAMP (Specifically Targeting the ASL Myristoyl Pocket) inhibitor. This drug potently inhibits ABL1 kinase activity of the BCR-ABL1 fusion protein via allosteric binding to the ASL myristoyl pocket.

Answer 581

The notable/common monitoring parameters for this drug class are: - CBC weekly for first month, biweekly for the second month, then periodically thereafter - Liver function tests (at baseline and monthly) - In patients who discontinue therapy after a sustained molecular response, monitor BCR-ABL transcript levels and CBC with differential monthly for 1 year, then every 6 weeks for the second year, and every 12 weeks thereafter

Answer 582

The emetic potential of this drug is: - Minimal-Low if <400 mg/day - Moderate-High if >400 mg/day

Answer 583

The emetic potential of this drug is: - Minimal-Low

Answer 584

The emetic potential of this drug is: - Minimal-Low if <400 mg/day - Moderate-High if >400 mg/day

Answer 585

The emetic potential of this drug is: - Minimal-Low

Answer 586

The emetic potential of this drug is: - Minimal-Low

Answer 587

The emetic potential of this drug is: - Minimal-Low

Answer 588

The emetic potential of this drug class is: - Most are Minimal-Low - Bosutinib and Imatinib are Moderate-High if >400 mg/day

Answer 589

Drugs in the class with a moderate-high emetic potential are: - Bosutinib and Imatinib if >400 mg/day

Answer 590

Drugs in the class with a low emetic potential are: - All of them except if >400 mg/day for Bosutinib and Imatinib (Moderate-High)

Answer 591

The administration of this drug is described as follows: - Once Daily

Answer 592

The administration of this drug is described as follows: - Once Daily

Answer 593

The administration of this drug is described as follows: - Usually Once Daily - select regimens are Twice Daily

Answer 594

The administration of this drug is described as follows: - Twice Daily (may influence adherence)

Answer 595

The administration of this drug is described as follows: - Once Daily

Answer 596

The administration of this drug is described as follows: - Usually Once Daily - select regimens are Twice Daily

Answer 597

The general techniques for administration of this drug class is described as follows: - All are once daily except for Nilotinib and select regimens of Imatinib and Asciminib (twice daily)

Answer 598

The notable/common ADRs of this drug class are: - Edema - Thrombocytopenia - Neutropenia - Bleeding

Answer 599

The clinical pearls of this drug class are as follows: - Food and/or medications may enhance or decrease absorption - Neither dasatinib, nilotinib or bosutinib have shown improved overall survival or progression free survival rates compared to imatinib, so choice of first-line therapy should be individualized. - The following should be considered when choosing an agent: - toxicity profile - patient's age and ability to tolerate therapy - adherence/ease of administration - comorbid conditions - drug interactions - cost - feasibility of treatment discontinuation - In patients with disease progression, the selection of an alternative agent in this class is based on prior therapy, concurrent disease states, and/or mutational testing.

Answer 600

Considerations for discontinuation of agents in this class are as follows: - The management of CML as a chronic disease requires long-term therapy which can cause both adverse effects and a financial burden. - Discontinuation of TKI may be feasible in selected patients and with careful monitoring. - Discontinuation of TKI therapy may be considered only in patients who met all of the following criteria: - Chronic phase -CML with no history of accelerated phase or blast crisis - Have been on TKI therapy for at least 3 years with no history of resistance - Had stable molecular response for >2 years on at least 4 tests performed at least 3 months apart - Patients who do quality for TKI discontinuation must have monthly molecular monitoring for the first year following discontinuation, then every 6 weeks during the second year, and quarterly thereafter if still in a major molecular response. - If a patient loses their molecular response, they must have prompt resumption of therapy within 4 weeks.

Answer 601

Considerations for resistence to agents in this class are as follows: - Point mutations in the ABL kinase domain are the most frequent mechanism of secondary resistance to these drugs. - Among mutations in the ABL domain, the presence of the T315i mutation is the most common and displays resistance to all currently available agents except ponatinib and asciminib. - T315i mutation is also associated with disease progression and poorer survival. - Asciminib binds allosterically to the ABL pocket and is less susceptible to mutations that drive resistance. It has demonstrated activity against wild-type BCR-ABL1 and several mutant forms (including T315i), even showing activity in heavily pretreated patients. - Consider performing BCR-ABL kinase domain mutational analysis in patients who fail to achieve the response milestones, patients with any loss of response, or patients who experience disease progression to accelerated phase-CML or blast crisis-CML.

Answer 602

Considerations for interactions with agents in this class are as follows: - Dasatinib, Bosutinib, and Ponatinib require an acidic environment for absorption. - Avoid the use of proton pump inhibitors and separate H2-antagonists by at least two hours.

Answer 603

Considerations for CNS penetration of agents in this class are as follows: - Of the available agents, dasatinib crosses blood-brain barrier to the greatest extent.

Answer 604

Drugs in this class are: - Dabrafenib - Vemurafenib - Encorafenib

Answer 605

The brand name of this generic drug is: - Tafinlar

Answer 606

The brand name of this generic drug is: - Zelboraf

Answer 607

The brand name of this generic drug is: - Braftovi

Answer 608

The generic name of this brand name drug is: - Dabrafenib

Answer 609

The generic name of this brand name drug is: - Vemurafenib

Answer 610

The generic name of this brand name drug is: - Encorafenib

Answer 611

The main indications of this drug are: - Melanoma (with BRAFV6ooE or BRAFV6ooK mutation) - Non-small cell lung cancer (with BRAF V6ooE mutation) - Thyroid cancer (with BRAF V6ooE mutation)

Answer 612

The main indications of this drug are: - Melanoma (with BRAFV6ooE or BRAFV6ooK mutation) - Non-small cell lung cancer (with BRAF V6ooE mutation) - Erdheim-Chester disease (with BRAF V6oo mutation)

Answer 613

The main indications of this drug are: - Melanoma (with BRAFV6ooE or BRAFV6ooK mutation) - Colorectal cancer (with BRAF V6ooE mutation)

Answer 614

This drug in the following class: - BRAF Inhibitors This drug's MOA is as follows: - Selectively targets mutated forms BRAF kinase (V600-) and interferes with the mitogen-activated protein kinase (MAPK) signaling pathway that regulates the proliferation and survival of melanoma cells.

Answer 615

This drug in the following class: - BRAF Inhibitors This drug's MOA is as follows: - Selectively targets mutated forms BRAF kinase (V600-) and interferes with the mitogen-activated protein kinase (MAPK) signaling pathway that regulates the proliferation and survival of melanoma cells.

Answer 616

This drug in the following class: - BRAF Inhibitors This drug's MOA is as follows: - Selectively targets mutated forms BRAF kinase (V600-) and interferes with the mitogen-activated protein kinase (MAPK) signaling pathway that regulates the proliferation and survival of melanoma cells.

Answer 617

The notable monitoring parameters for this drug are: - See common parameters for class - EKG at baseline. 15 days after initiation. then monthly for 3 months. then every 3 months thereafter (more frequently if clinically appropriate) and with dosage adjustments.

Answer 618

The notable/common monitoring parameters for this drug class are: - BRAFV6ooK or V6ooE mutation status prior to treatment - Dermatologic evaluations prior to initiation, every 2 months during therapy, and for up to 6 months following discontinuation to assess for new cutaneous malignancies

Answer 619

The emetic potential of this drug is: - Moderate - High

Answer 620

The emetic potential of this drug is: - Minimal - Low

Answer 621

The emetic potential of this drug is: - Moderate - High

Answer 622

The emetic potential of this drug class is: - All moderate-high except for Vemurafenib (minimal-low)

Answer 623

Drugs in the class with a moderate-high emetic potential are: - Dabrafenib - Encorafenib

Answer 624

Drugs in the class with a minimal-low emetic potential are: - Vemurafenib

Answer 625

The administration of this drug is described as follows: - Oral: Absorption decreased with a high fat meal (-1,000 calories: 58 to 75 grams of fat)

Answer 626

The administration of this drug is described as follows: - Oral

Answer 627

The administration of this drug is described as follows: - Oral

Answer 628

The metabolism of this drug is as follows: - Patients with moderate (bilirubin >1,5 to 3 times ULN and any AST) or severe (bilirubin >3 to 10 times ULN and any AST) hepatic impairment may have increased exposure to this drug

Answer 629

The notable ADRs of this drug are: - Secondary skin cancers - QT prolongation

Answer 630

The notable/common ADRs of this drug class are: - Secondary skin cancers - QT prolongation with Vemurafenib

Answer 631

The strategy and rationale for management of this condition caused by this drug class are: - Secondary cutaneous squamous cell cancers and keratoacanthomas are the result of compensatory RAF signaling seen with BRAF inhibition. - The risk of these additional cancers is decreased with the addition of a MEK inhibitor. - These cancers are typically localized and easily treated with surgical excision or topical fluorouracil cream. - Regular skin assessments should be done throughout therapy with BRAF inhibitors.

Answer 632

The half-life of this drug is described as follows: - This drug has a longer dissociation half-life than other BRAF inhibitors, allowing for sustained inhibition of BRAF (and thus tumor growth)

Answer 633

The clinical pearls of this drug class are as follows: - Though the BRAF inhibitors were initially evaluated as single agents, combination therapy with a MEK inhibitor (ex: Trametinib) is now the recommended treatment regimen.

Answer 634

The therapy selection process for this drug class is as follows: - All metastatic tumors should be evaluated for the V6oo mutation. - In V6ooE or V6ooK mutated tumors, the initial selection between BRAF inhibitors and immunotherapy is commonly done based on the aggressive nature of the tumor. - Rapidly growing tumors that are symptomatic are treated with BRAF-directed therapy because it generates a higher rate of response that occurs quicker, while asymptomatic or more indolent tumors may be treated with immunotherapy.

Answer 635

Resistance to this drug class is as follows: - Though the BRAF inhibitors were initially evaluated as single agents, combination therapy with a MEK inhibitor (example: Trametinib) is now the recommended treatment regimen. - This is due to the development of resistance to the single agent BRAF inhibitors after 6-7 months - Combination therapy with both BRAF and MEK inhibitors may suppress the downstream resistance mechanism

Answer 636

Symptoms of this condition are: - ABCDE: asymmetry, border, color, diameter, and evolving - A: Asymmetry - melanomas are often asymmetrical - B: Border - melanomas often have an irregular border - C: Color - melanomas often have more than one color or shade in the mole - D: Diameter: melanomas are often larger than 6mm, or the size of a pencil eraser - E: Evolving: melanomas tend to change over time while benign moles do not

Answer 637

Drugs in this class are (not all inclusive): - Gefitinib - Erlotinib - Osimertinib - Afatinib

Answer 638

The brand name of this generic drug is: - Iressa

Answer 639

The brand name of this generic drug is: - Tarceva

Answer 640

The brand name of this generic drug is: - Tagrisso

Answer 641

The brand name of this generic drug is: - Gilotrif

Answer 642

The generic name of this brand name drug is: - Gefitinib

Answer 643

The generic name of this brand name drug is: - Erlotinib

Answer 644

The generic name of this brand name drug is: - Osimertinib

Answer 645

The generic name of this brand name drug is: - Afatinib

Answer 646

The main indications of this drug are: - Non-Small Cell Lung Cancer with EGFR mutation

Answer 647

The main indications of this drug are: - Non-Small Cell Lung Cancer with EGFR mutation - Pancreatic Cancer with EGFR mutation

Answer 648

The main indications of this drug are: - Non-Small Cell Lung Cancer with EGFR mutation, T790M EGFR-mutation positive, or brain/leptomeningeal metastases

Answer 649

The main indications of this drug are: - Non-Small Cell Lung Cancer with EGFR mutation

Answer 650

The main/common indications of this drug class are: - Certain cancers (such as Non-Small Cell Lung Cancer) with EGFR mutation

Answer 651

This drug in the following class: - EGFR Inhibitors This drug's MOA is as follows: - EGFR inhibitors are highly selective tyrosine kinase inhibitors that covalently bind to epidermal growth factor receptors and irreversibly inhibit tyrosine kinase phosphorylation and downregulate EGFR signaling preventing cell growth.

Answer 652

This drug in the following class: - EGFR Inhibitors This drug's MOA is as follows: - EGFR inhibitors are highly selective tyrosine kinase inhibitors that covalently bind to epidermal growth factor receptors and irreversibly inhibit tyrosine kinase phosphorylation and downregulate EGFR signaling preventing cell growth.

Answer 653

This drug in the following class: - EGFR Inhibitors This drug's MOA is as follows: - EGFR inhibitors are highly selective tyrosine kinase inhibitors that covalently bind to epidermal growth factor receptors and irreversibly inhibit tyrosine kinase phosphorylation and downregulate EGFR signaling preventing cell growth.

Answer 654

This drug in the following class: - EGFR Inhibitors This drug's MOA is as follows: - EGFR inhibitors are highly selective tyrosine kinase inhibitors that covalently bind to epidermal growth factor receptors and irreversibly inhibit tyrosine kinase phosphorylation and downregulate EGFR signaling preventing cell growth.

Answer 655

The notable/common monitoring parameters for this drug class are: - Confirm EGFR mutation positive before beginning therapy

Answer 656

The emetic potential of this drug class is: - Minimal-Low

Answer 657

The administration of this drug is described as follows: - Oral

Answer 658

The administration of this drug is described as follows: - Oral - Absorption is ~60% on an empty stomach, increases to ~100% with food

Answer 659

The administration of this drug is described as follows: - Oral

Answer 660

The administration of this drug is described as follows: - Oral - Absorption is decreased with high-fat meals

Answer 661

The metabolism of this drug class is as follows: - Primarily hepatic with the exception of Afatinib (minimal enzymatic metabolism)

Answer 662

The notable/common ADRs of this drug class are: - Acneiform Rash - N/V/D - Skin/nail changes - Dry mouth - Decreased appetite - Hepatic dysfunction - Disease flare (after discontinuation)

Answer 663

The strategy and rationale for management of this condition caused by this drug are: - This is a common side effect of this class. - EGFR is expressed in many different tissues, including epithelial tissue, skin, hair follicles, and the gastrointestinal tract. - During treatment with EGFR inhibitors cutaneous adverse events occur in 65-90% of patients. This rash usually develops in the first 1-2 weeks, peaks at 3-4 weeks of therapy, and its intensity decreases after 2 weeks but can often persist over some months. - Management: - Mild Rash: patients may not require any form of intervention. Consider topical hydrocortisone cream or clindamycin gel. - Moderate Rash: hydrocortisone cream or clindamycin gel plus doxycycline 100 mg oral twice daily or minocycline 100 mg oral twice daily. - Studies have found that the development of a rash seems to be associated with an increased likelihood of tumor response and/or survival in NSCLC.

Answer 664

The clinical pearls of this drug class are as follows: - For patients with asymptomatic progression on a TKI, continuation of EGFR-TKI therapy can be considered - For patients who have not received osimertinib, recommend testing for the T790M mutation at time of progression. - If positive, osimertinib therapy is indicated. - For patients with symptomatic progression on a TKI, options include: - Continuing with an EGFR inhibitor - Switching to osimertinib if T790M mutation positive - Switching to systemic chemotherapy - EGFR mutations are present in 10-15% of non-small cell lung cancers and typically occur more commonly in women, Asian ethnicities, and never-smokers. - K-RAS and EGFR mutations are mutually exclusive. Meaning that if a patient has a K-RAS mutation, they will not respond to EGFR inhibitors.

Answer 665

Resistance to this drug class is as follows: - The T790M mutation is the most common EGFR resistance mechanism (seen in 50-60% of patients) and can be present at diagnosis or develop during treatment. - This mutation increases affinity of kinase to ATP and decreases affinity to erlotinib and gefitinib. - Patients with the T790M mutation should be switched to osimertinib as is a third-generation EGFR-TKI that is selective for both EGFR-TKI-sensitizing and T790M resistance mutations.

Answer 666

Drugs in this class are: - Axitinib - Cabozantinib - Lenvatinib - Vandetanib - Pazopanib - Regorafenib - Sorafenib - Sunitinib

Answer 667

The brand name of this generic drug is: - Inlyta

Answer 668

The brand name of this generic drug is: - Cabometyx - Cometriq

Answer 669

The brand name of this generic drug is: - Lenvima

Answer 670

The brand name of this generic drug is: - Caprelsa

Answer 671

The brand name of this generic drug is: - Votrient

Answer 672

The brand name of this generic drug is: - Stivarga

Answer 673

The brand name of this generic drug is: - NexAVAR

Answer 674

The brand name of this generic drug is: - Sutent

Answer 675

The generic name of this brand name drug is: - Axitinib

Answer 676

The generic name of this brand name drug is: - Cabozantinib

Answer 677

The generic name of this brand name drug is: - Cabozantinib

Answer 678

The generic name of this brand name drug is: - Lenvatinib

Answer 679

The generic name of this brand name drug is: - Vandetanib

Answer 680

The generic name of this brand name drug is: - Pazopanib

Answer 681

The generic name of this brand name drug is: - Regorafenib

Answer 682

The generic name of this brand name drug is: - Sorafenib

Answer 683

The generic name of this brand name drug is: - Sunitinib

Answer 684

The main/common indications of this drug class are: - Endometrial cancer - Hepatocellular carcinoma - Renal cell carcinoma - Thyroid cancer

Answer 685

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 686

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 687

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 688

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 689

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 690

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 691

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 692

This drug in the following class: - VEGF Inhibitors This drug's MOA is as follows: - Binds to VEGF and other endothelial growth factors receptors on endothelial cells blocking signals that promote the growth and survival of new blood vessels

Answer 693

The notable/common monitoring parameters for this drug class are: - Blood pressure after 1 week, then every 2 weeks for 2 months, and at least monthly thereafter - Check urine for proteinuria at baseline and periodically during treatment (frequency depends on institutional standards, likely every 1-2 cycles) - TSH at baseline, then monthly for 4 months, then every 2 to 3 months - Baseline echocardiogram (sunitinib, pazopanib)

Answer 694

The emetic potential of this drug class is: - Minimal-Low for all except cabozantinib and high dose Lenvatinib (>12 mg/day - Moderate-High)

Answer 695

The emetic potential of this drug is: - Minimal-Low

Answer 696

The emetic potential of this drug is: - Moderate-High

Answer 697

The emetic potential of this drug is: - Minimal-Low if low dose <12 mg/day - Moderate-High if high dose >12 mg/day

Answer 698

The emetic potential of this drug is: - Minimal-Low

Answer 699

The emetic potential of this drug is: - Minimal-Low

Answer 700

The emetic potential of this drug is: - Minimal-Low

Answer 701

The emetic potential of this drug is: - Minimal-Low

Answer 702

The emetic potential of this drug is: - Minimal-Low

Answer 703

Drugs in the class with a high emetic potential are: - Cabozantinib - High dose Lenvatinib (>12 mg/day)

Answer 704

Drugs in the class with a moderate emetic potential are: - All except for Cabozantinib and high dose Lenvatinib (>12 mg/day) - Axitinib - Lenvatinib (low dose <12 mg/day) - Vandetanib - Pazopanib - Regorafenib - Sorafenib - Sunitinib

Answer 705

The metabolism of this drug class is as follows: - Hepatic (primarily metabolized by CYP3A4)

Answer 706

The notable ADRs of this drug are: - This drug can cause yellowing of the skin and hair - Think "shine like the sun" to help you remember

Answer 707

The notable/common ADRs of this drug class are: - Hypertension - Proteinuria - Bleeding/Thrombotic Events - Impaired Wound Healing - Hepatotoxicity

Answer 708

The strategy and rationale for management of this condition caused by this drug class are: - VEGF plays a role in nitric oxide production and vasodilation. When the VEGF-signaling pathway is inhibited, hypertension may occur secondary to the decrease in nitric oxide production. - Hypertension associated with drug class should be managed similarly to hypertension in the general population (JNC guidelines). - A common BP goal is <140/90 mmHg. - Patients should have their BP monitored (and well controlled) prior to starting therapy and then checked at least every 2 to 3 weeks for the duration of treatment.

Answer 709

The strategy and rationale for management of this condition caused by this drug class are: - Proteinuria is a common adverse side effect of any anti-angiogenic agent. - VEGF is critical to the maintenance of normal renal function - Under-expression of VEGF can disrupt normal glomerular function leading to proteinuria. - Patients should have their urine checked for protein on a regular basis during VEGF inhibitor therapy. Frequency may vary per institutional protocol but it is often checked every 1-2 cycles of chemotherapy. - The presence of protein typically requires interruption of anti-VEGF therapy. - In the majority of cases, proteinuria resolves or significantly improves with removal of VEGF inhibitors.

Answer 710

The strategy and rationale for management of this condition caused by this drug class are: - These agents are associated with bleeding events sich as: - Epistaxis - Hemoptysis - Hematemesis - Gastrointestinal bleeding (including GI perforation which is infrequent but potentially life-threatening) - These agents are associated with arterial thromboembolic events such as: - Stroke/transient ischemic attack - Myocardial infarction - This predisposition to thrombosis and bleeding after inhibition ofVEGF signaling reflects the multitude of actions VEGF has on vascular walls and the coagulation system.

Answer 711

The strategy and rationale for management of this condition caused by this drug class are: - VEGF receptor inhibitors are associated with impaired wound healing due to decreased angiogenesis. - Therapy should typically be held for at least 1 month prior to surgery and only resumed when adequate wound healing has occurred.

Answer 712

The strategy and rationale for management of this condition caused by this drug class are: - The VEGF inhibitors undergo hepatic metabolism and many of them can cause hepatotoxicity. In fact, many of the TKls have a black boxed warning for hepatotoxicity - Depending on the level of AST/ALT elevations, you may need to hold or reduce the dose of the VEGF inhibitor.

Answer 713

Risk factors for developing this ADR with this drug/class are: - Pre-existing hypertension - Obesity - Older age

Answer 714

Risk factors for developing this ADR with this drug/class are: - Age greater than 65 years - Pre-existing history of thromboembolic events

Answer 715

The clinical pearls of this drug are as follows: - Cabozantinib is used to treat multiple disease states. However, the tablets and capsules are NOT interchangeable. - The tablets are used for renal cell carcinoma and the capsules are used for thyroid cancer.

Answer 716

Drugs in this class are: - Flutamide - Abiraterone acetate - Apalutamide - Bicalutamide - Enzalutamide - Nilutamide - Darolutamide

Answer 717

The brand name of this generic drug is: - Eulexin

Answer 718

The brand name of this generic drug is: - Yonsa - Zytiga

Answer 719

The brand name of this generic drug is: - Erleada

Answer 720

The brand name of this generic drug is: - Casodex

Answer 721

The brand name of this generic drug is: - Xtandi

Answer 722

The brand name of this generic drug is: - Nilandron

Answer 723

The brand name of this generic drug is: - Nubeqa

Answer 724

The generic name of this brand name drug is: - Flutamide

Answer 725

The generic name of this brand name drug is: - Abiraterone acetate

Answer 726

The generic name of this brand name drug is: - Abiraterone acetate

Answer 727

The generic name of this brand name drug is: - Apalutamide

Answer 728

The generic name of this brand name drug is: - Bicalutamide

Answer 729

The generic name of this brand name drug is: - Enzalutamide

Answer 730

The generic name of this brand name drug is: - Nilutamide

Answer 731

The generic name of this brand name drug is: - Darolutamide

Answer 732

The main/common indications of this drug class are: - Prostate cancer

Answer 733

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Non-steroidal anti-androgen that inhibits androgen uptake and inhibits binding of androgen in target tissues

Answer 734

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Selectively and irreversibly inhibits CYP17 an enzyme required for biosynthesis and inhibits the formation of testosterone

Answer 735

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Nonsteroidal androgen receptor antagonist

Answer 736

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Selectively and irreversibly inhibits CYP17 an enzyme required for biosynthesis and inhibits the formation of testosterone

Answer 737

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Pure androgen receptor signaling inhibitor

Answer 738

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Non-steroidal anti-androgen that inhibits androgen uptake and inhibits binding of androgen in target tissues

Answer 739

This drug in the following class: - Anti-Androgens This drug's MOA is as follows: - Competitive androgen receptor inhibitor, also inhibits androgen receptor translocation and androgen receptor-mediated transcription

Answer 740

The notable/common monitoring parameters for this drug class are: - Serum transaminases at baseline, monthly for 4 months. and periodically thereafter: monitor liver function tests at the first sign or symptom of liver dysfunction - Prostate specific antigen (PSA) to monitor response to therapy

Answer 741

The emetic potential of this drug class is: - N/A (minimal)

Answer 742

The metabolism of this drug class is as follows: - Extensively hepatic

Answer 743

The notable/common ADRs of this drug class are: - Headache - Peripheral edema - Hot flashes - Gynecomastia - Secondary infections

Answer 744

The clinical pearls of this drug are as follows: - See common pearls for class - Used in combination with a GNRH agonist - Response rate = 50-87%

Answer 745

The clinical pearls of this drug are as follows: - See common pearls for class - Approved for metastatic, castration-resistant prostate cancer in combination with a steroid BID. - Co-administration with the recommended dose of steroid compensates for drug-induced reductions in serum cortisol and blocks the compensatory increase in adrenocorticotropic hormone seen with this drug

Answer 746

The clinical pearls of this drug are as follows: - See common pearls for class - Used in combination with a GNRH agonist - Response rate = 54-70%

Answer 747

The clinical pearls of this drug are as follows: - See common pearls for class - Requires dose adjustments for strong CYP2C8 inhibitors and CYP3A4 inducers

Answer 748

The clinical pearls of this drug are as follows: - See common pearls for class - Used in combination with orchiectomy - Response rate = 40%

Answer 749

The clinical pearls of this drug class are as follows: - Monotherapy is less effective than GNRH agonist therapy and is not currently recommended to be used alone (unless patient had orchiectomy) - Therefore, used in combination with androgen ablation therapy - Overall efficacy is similar, but bicalutamide is generally preferred due to better toxicity profile

Answer 750

Dosing schedule and administration for drug class: - All are given PO - All are given once daily except: - Flutamide (TID) - Abiraterone acetate (BID) - Darolutamide (BID)

Answer 751

Dosing schedule and administration for this drug: - PO TID

Answer 752

Dosing schedule and administration for this drug: - PO BID

Answer 753

Dosing schedule and administration for this drug: - PO once daily

Answer 754

Dosing schedule and administration for this drug: - PO once daily

Answer 755

Dosing schedule and administration for this drug: - PO once daily

Answer 756

Dosing schedule and administration for this drug: - PO once daily

Answer 757

Dosing schedule and administration for this drug: - PO BID

Answer 758

Drugs in this class are: - Cyclophosphamide - lfosfamide - Busulfan - Melphalan - Bendamustine

Answer 759

The brand name of this generic drug is: - Cytoxan

Answer 760

The brand name of this generic drug is: - Ifex

Answer 761

The brand name of this generic drug is: - Busulfex - Myleran

Answer 762

The brand name of this generic drug is: - Alkeran - Evomela

Answer 763

The brand name of this generic drug is: - Belrapzo - Bendeka - Treanda - Vivimusta

Answer 764

The generic name of this brand name drug is: - Cyclophosphamide

Answer 765

The generic name of this brand name drug is: - lfosfamide

Answer 766

The generic name of this brand name drug is: - Busulfan

Answer 767

The generic name of this brand name drug is: - Busulfan

Answer 768

The generic name of this brand name drug is: - Melphalan

Answer 769

The generic name of this brand name drug is: - Melphalan

Answer 770

The generic name of this brand name drug is: - Bendamustine

Answer 771

The generic name of this brand name drug is: - Bendamustine

Answer 772

The generic name of this brand name drug is: - Bendamustine

Answer 773

The generic name of this brand name drug is: - Bendamustine

Answer 774

The main indications of this drug are: - Non-Hodgkin lymphoma - Hodgkin lymphoma - Hematopoietic stem cell transplant - Acute lymphoblastic leukemia - Breast cancer - Ewing sarcoma - Graft-vs-host disease prophylaxis - Multiple myeloma - Osteosarcoma - Rhabdomyosarcoma - Small cell lung cancer

Answer 775

The main indications of this drug are: - Non-Hodgkin lymphoma - Hodgkin lymphoma - Ewing sarcoma - Osteosarcoma - Testicular cancer - Bladder cancer - Cervical cancer - Ovarian cancer - Soft tissue sarcoma

Answer 776

The main indications of this drug are: - Hematopoietic stem cell transplant - Polycythemia vera - Essential thrombocythemia

Answer 777

The main indications of this drug are: - Hematopoietic stem cell transplant - Multiple myeloma

Answer 778

The main indications of this drug are: - Chronic lymphocytic leukemia - Non-Hodgkin lymphoma - Hodgkin lymphoma

Answer 779

This drug in the following class: - Alkylating Agents This drug's MOA is as follows: - Alkylates and cross-links DNA preventing DNA synthesis and cell division

Answer 780

This drug in the following class: - Alkylating Agents This drug's MOA is as follows: - Alkylates and cross-links DNA preventing DNA synthesis and cell division

Answer 781

This drug in the following class: - Alkylating Agents This drug's MOA is as follows: - Alkylates and cross-links DNA preventing DNA synthesis and cell division

Answer 782

This drug in the following class: - Alkylating Agents This drug's MOA is as follows: - Alkylates and cross-links DNA preventing DNA synthesis and cell division

Answer 783

This drug in the following class: - Alkylating Agents This drug's MOA is as follows: - Alkylates and cross-links DNA preventing DNA synthesis and cell division

Answer 784

The notable monitoring parameters for this drug are: - Monitor for blood in urine (either through patient report or urine dipstick depending on protocol)

Answer 785

The notable monitoring parameters for this drug are: - Monitor for blood in urine (either through patient report or urine dipstick depending on protocol)

Answer 786

The notable monitoring parameters for this drug are: - Monitor hepatic function for signs of veno-occlusive disease - Monitor pharmacokinetics when giving high dose for stem cell transplant

Answer 787

The emetic potential of this drug is: - High if >1500 mg/m2 - Moderate if <1500 mg/m2

Answer 788

The emetic potential of this drug is: - High if >2 g/m2 - Moderate if <2 g/m2

Answer 789

The emetic potential of this drug is: - Moderate

Answer 790

The emetic potential of this drug is: - High if >140 mg/m2 - Moderate if <140 mg/m2

Answer 791

The emetic potential of this drug is: - Moderate

Answer 792

The emetic potential of this drug class is: - All are either moderate or high

Answer 793

Drugs in the class with a high emetic potential are: - Cyclophosphamide >1500 mg/m2 - Ifosfamide >2 g/m2 - Melphalan >140 mg/m2

Answer 794

Drugs in the class with a moderate emetic potential are: - Cyclophosphamide <1500 mg/m2 - Ifosfamide <2 g/m2 - Melphalan <140 mg/m2 - Busulfan - Bendamustine

Answer 795

Drugs in the class with a low emetic potential are: - None (all are moderate or higher)

Answer 796

Drugs in the class with a minimal emetic potential are: - None (all are moderate or higher)

Answer 797

The extravasation risk and management strategies for this drug are as follows: - Carries risk as it is an irritant with vesicant like properties. - If extravasation occurs: - Stop infusion - Aspirate extravasated solution - Elevate extremity - Apply cold compress for 20 minutes 4 times daily - Consider sodium thiosulfate (2 mL SQ for each mg of drug suspected to have extravasated)

Answer 798

The extravasation risk and management strategies for this drug class are as follows: - Bendamustine carries extravasation risk as it is an irritant with vesicant like properties.

Answer 799

The metabolism of this drug class is as follows: - All agents are hepatically metabolized - lfosfamide/cyclophosphamide are converted into active metabolites and acrolein

Answer 800

This metabolite is what cyclophosphamide and ifosfamide are converted into. It is toxic and causes bladder irritation and hemorrhagic cystitis.

Answer 801

Of the agents in this drug class, this ADR is most notable with melphalan.

Answer 802

The notable ADRs of this drug are: - Mucositis ranging from mouth sores to irritation of the GI tract leading to severe diarrhea.

Answer 803

The notable ADRs of this drug are: - Hemorrhagic cystitis (irritation and bleeding of the bladder) due to accumulation of the toxic metabolite acrolein in the bladder. - Rare cases of neurotoxicity (<15%) with symptoms developing hours to days after the dose (typical onset is 48-72 hours)

Answer 804

The notable ADRs of this drug are: - Hemorrhagic cystitis (irritation and bleeding of the bladder) due to accumulation of the toxic metabolite acrolein in the bladder.

Answer 805

The notable ADRs of this drug are: - Veno-occlusive disease (VOD)/Sinusoidal Obstructive Syndrome (SOS) (when used in high doses for bone marrow transplantation)

Answer 806

Of the agents in this drug class, this ADR is most notable with busulfan (high dose as is used in stem cell transplant).

Answer 807

Of the agents in this drug class, this ADR is most notable with cyclophosphamide and ifosfamide.

Answer 808

The notable/common ADRs of this drug class are: - Mucositis - Hemorrhagic cystitis - Neurotoxicity - Hepatic veno-occlusive disease/sinusoidal obstructive syndrome

Answer 809

The strategy and rationale for management of this condition caused by this drug are: - Oral mucositis can be prevented with cryotherapy. Due to short half-life, patients can chew on ice chips during and shortly after infusion causing vasoconstriction in the mouth and preventing chemotherapy from reaching the mucous membranes. - GI mucositis is managed with anti-motility agents after ruling out infectious causes of diarrhea

Answer 810

The strategy and rationale for management of this condition caused by this drug are: - Mesna is used as a chemoprotectant. - Hemorrhagic cystitis is caused by accumulation of the toxic metabolite acrolein in the bladder. - Mesna is oxidized to dimesna which in turn is reduced back to mesna in the kidneys supplying a free thiol group which binds and inactivates acrolein. - Mesna is always given with ifosfamide and if often given with high dose cyclophosphamide. - Mesna dose if typically 20% of the total daily ifosfamide/cyclophosphamide dose and is given for 3 doses - Vigorous hydration is also used as both prevention and treatment of hemorrhagic cystitis. - Additional treatments include bladder irrigation, hyperbaric oxygen, prostaglandin E2, and cystectomy for refractory cases.

Answer 811

The strategy and rationale for management of this condition caused by this drug are: - Patients should monitor for S/Sx with a daily signature log. - Symptoms generally resolve within 3 days of treatment discontinuation and can be managed with supportive care or methylene blue.

Answer 812

The strategy and rationale for management of this condition caused by this drug are: - Also called sinusoidal obstructive syndrome (SOS) - Most commonly seen with high dose regimens use for stem cell conditioning - Risk increases with higher areas under the curve - Thus, pharmacokinetics measurements are often monitored, and doses are adjusted to target a specific AUC - Patient should be monitored for hepatic dysfunction, unexplained weight gain, edema, abdominal pain, and jaundice - Treatment options range from supportive care to defibrotide

Answer 813

The half-life of drugs in this class is described as follows: - All are relatively short, ranging from 40 minutes with Bendamustine to 15 hours with ifosfamide - This becomes especially important when managing adverse effects of melphalan with cryotherapy

Answer 814

The history of this drug class is as follows: - These drugs were the first anti-cancer drugs and remain a cornerstone of anti-cancer therapy. - The utility was discovered during World War I when researchers at Yale noticed that soldiers affected by mustard gas had low WBCs. They speculated that if mustard gas could destroy healthy WBCs, that it could destroy cancerous WBCs - this led to the use of alkylating agent as chemotherapy.