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12. Chemotherapy > Prostate Cancer > Flashcards

Prostate Cancer Flashcards

1
Q

Prostate Specific Antigen (PSA) blood test

  • Normal range
  • Closer monitor
  • Suspicious for malignancy
A
  • Normal range: 0-4 ng/mL
  • Closer monitor: 2.5-4ng/mL
  • Suspicious for malignancy > 10 ng/mL
  • PSA > normal range, biopsy is performed to confirm diagnosis
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2
Q

Rec age for baseline PSA

A
  • Men after age 40 y.o
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3
Q

Zoladex

  • Form
  • Dose
A

GOSerelin - GOE se rel in

  • Form: SC

Dose

  • 3.6 mg SC Q1M
  • 10.8mg SC Q3M
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4
Q

Lupron

  • Form
  • Dose
A

Leuprolide - Loo PROE lide

  • Form: IM

Dose:

  • 7.5 mg IM Q1M
  • 22.5 mg IM Q3M
  • 30mg IM Q4M
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5
Q

Trelstar

  • Form
  • Dose
A

Triptorelin

Dose

  • 3.75mg IM Q1M
  • 11.25mg Q3M
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6
Q

LH-RH or GnRH stands for

A

Leutenizing hormone- Releasing hormones

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7
Q

Firmagon

  • Form
  • Dose
A

Degarelix

  • Form: SC
  • Dose: 80 mg SC Q28D
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8
Q

Plenaxis Depot

  • Indication:
  • Form:
  • Dose
A

Abarelix

  • Indication: palliative treatment in advanced sx PC
  • Form: IM
  • Dose: IM Q2W x 1M, then Q4W
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9
Q

Casodex

A

BIClutamide

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10
Q

Eulexin

A

FLUtamide

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11
Q

Nilandron

A

NILutamide

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12
Q

Xtandi

  • Indications
A

Enzalutamide

  • Indication: Prostate cancer not responding to other treatments
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13
Q

Zytiga

  • Indication
A

Abiraterone - A bi ra ter one

  • I: Used w/ prednisone in men with castration-resistant prostate cancer
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14
Q

Nizoral

  • Indication:
A

Ketoconazole

  • Prostate cancer Salvage Hormone Therapy (off-label)
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15
Q

Proscar

  • Indication
A

Finasteride

Indication:

  • BPH
  • Prevention of prostate cancer risk
  • Baldness
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16
Q

Avodart

  • Indication:
A

Dutasteride

Indication:

  • BPH
  • Prevention of prostate cancer risk
17
Q

Provenge

  • Indication
A

Sipuleucel-T - si pu LOO sel

  • I: tx advance PC
18
Q

LH-RH analogs

  • Drugs in this class
  • MOA
  • Other indications:
A

Goserelin - Zoladex
Leuprolide - Lupron
Triptorelin - Trelstar

  • MOA: LH and FSH increase = increase testosterone => stop releasing LH & FSH.
  • It works by negative feedback: First gets worse b/c there is a surge increase in testosterone then when negative feedback kicks in, it gets better

Indication

  • Prostate cancer
  • Endometriosis
  • Pre-Menopausal hormone positive breast cancer
19
Q

LH-RH analogs

  • SEs
  • How to prevent tumor flares
A

SEs

  • Tumore flare: bone pain, inc tumor size, urinary sx
  • Hot flashes, impotence, decr libido, decrease bone density, gynecomastia, pain @ injection site
  • Ischemia 19%
  • Thrombosis/PE/MI
  • Peripheral edema 12%

Prevent tumor flares

  • Use anti-androgen therapy
  • Flutamide, Biclutamide, Nilutamide
  • Starts 2-4 wks prior to LHRH agonist, continue 1 week after the start
20
Q

LH-RH analogs
Route of administration

  • Goseline - Zoladex
  • Leuprolide - Lupron
  • Triptorelin - Trelstar
A

Goseline - Zoladex

  • 3.6 mg SC Q1m
  • 10.8 mg SC 3mo, upper abdomen

Leuprolide - Lupron

  • 7.5 mg IM Q1mo
  • 22.5mg IM Q3mo
  • 30 mg IM Q4mo

Triptorelin - Trelstar

  • 3.75 mg IM Q1m
  • 11.25 mg IM Q3m
21
Q

Firmagon(R)

  • MOA
  • Route of administration
  • SEs:
A

Degarelix

  • MOA: LHRH antagonist => rapid suppression of testosterone and a rapid PSA reduction w/o the need for additional PO anti-androgen therapy
  • Dose: 80 mg SC Q28D

SEs
- Hot flashes, wt gain, LFT elevation

22
Q

Plenaxis Depot

  • MOA
  • Indication
  • Route of Administration
A

Abarelix

  • MOA: GnRH antagonist => Suppresses LH and FSH secretion thus reducing the secretion of testosterone from the testes. Direct inhibition of LH => no tumor flare
  • Use as palliative tx in adv symptomatic prostate cancer in pts who are NOT candidate for LHRH agonists and refuse surgical castration

Dose

  • 100 mg deep IM intragluteally Q2W x 1 mo
  • Then Q4 wks thereafter
23
Q

Anti-androgens

FLutamide - Eulexin
Biclutamide - Casodex
Nilutamide - Nilandron = night
Enzalutamide - Xtandi

  • Special problems
A

Flutamide - Eulexin

  • D: 250 mg Q8H
  • SP: worse diarrhea, yellow green discoloration of urine, and liver dysfxn has been fatal

Biclutamide - Casodex

  • D: 50mg QD
  • SP: Interact w/ warfarin (protein binding) inc INR
  • Diarrhea

Nilutamide - Nilandron

  • D: 150 mg QD
  • Do not drink EtOH = disulfiram rxn
  • Diminished rx to darkness => cause delay adaption to the dark
  • Constipation

Enzalutamide - Xtandi

  • D: 160 mg PO QD
  • SP: Sz
  • SP: Avoid CYP3A4 and 2C8 inducers/inhibitors
24
Q

Anti-androgens

  • MOA
  • Class SE
  • Which cause diarrhea
  • Which cause constipation
A

MOAs

  • Block testosterone production
  • Use w/ LHRH/GnRH analogues

SEs

  • Gynecomastia, libido decr
  • Hot flashes
  • Liver enzyme increase => monitor LFT

Diarrhea

  • Flutamide
  • Biclutamide

Constipation
- Nilutamide

25
Q

Zytiga

Xtandi

  • Indication
A

Abiraterone - (PO)

Enzalutamide

  • Prostate cancer not responding to other tx
  • Used along with prednisone tx men w/ castration resistant prostate cancer (prostate cancer that is resistant to medical or surgical tx) that has spread to other parts of the body
26
Q

Salvage Hormone Therapy
Nizoral

  • MOA
  • SEs
  • DDI
A

Ketoconazole

  • MOA: reduce levels of testosterone & cortisol
  • SEs: haptic dysfxn, gynecomastia, N/V, rash
  • DDI: requires acidic environment, inhibit 3A4 = lot of DDI
27
Q

Proscar
Avodart

  • Indication
  • MOA
A

Finasteride
Dutasteride

  • Indication: Use for PREVENTION of prostate cancer
  • MOA: inhibits 5-alpha-reductase, the enzyme that converts testosterone to the more potent androgen dihydrostestosterone
28
Q

Sipuleucel-T (Provenge)

  • Indication
A
  • Vaccine to tx advanced prostate cancer

- Use pt immune system to fight against the cancer

29
Q

Eligard

A

Leuprolide Depot SC

30
Q

Viadur

A

Leuprolide Implant 120mcg QD over 12 months

31
Q

Lupaneta Pack

  • Indications
A

Leuprolide deport IM + norethindrone oral tab

  • Indications: endometriosis

12. Chemotherapy (6 decks)

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