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Pharmacology > Systemic Anticancer Agents > Flashcards

Systemic Anticancer Agents Flashcards

1
Q

What is the PBS criteria for vismodegib?

A

Metastatic or locally advanced BCC
Inappropriate for sugary
Inappropriate for curative radiotherapy
Must not have failed another hedgehog inhibitor

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2
Q

What are the contraindications to vismodegib?

A

Hypersensitivity
Pregnancy/lactation
Women of child bearing potential
Children <18 years (premature fusion of epiphyses)

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3
Q

What are the side effects of vismodegib?

A

Skin: alopecia, SCC
MSK: arthralgia, muscle spasm
GI: dysgeusia, n/v/d/a
Other: fatigue, weight loss

Serious: Hepatotoxicity, pneumonia

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4
Q

What contraception advice is given to patients started on vismodegib?

A

Females: 2 methods of contraception during and at least 2 years after cessation

Males: contraception during and at least 2 months after cessation

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5
Q

What baseline and ongoing monitoring is required for vismodegib?

A

Baseline:
Full exam incl. lymph nodes (SCC risk)
FBC, UEC, LFT, CPK, BhCG

Ongoing:
Monthly BhCG
3 monthly FBC, UEC, LFT

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6
Q

What BRAF inhibitors are used in dermatology?

A

Dabrafenib
Vemurafenib

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7
Q

What are the contraindications to BRAF inhibitors?

A

Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease

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8
Q

What other drugs do BRAF inhibitors interact with?

A

CYP3A4 & 2C8 drugs
Warfarin
OCP
Dexamethasone

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9
Q

What are the adverse effects of BRAF inhibitors?

A

Skin: SCC, BCC, melanoma, warty keratosis, xerosis, vitiligo, photosensitivity, MP eruptions

Extracutaneous: fever, headache, fatigue, arthralgia, GI effects, hepatotoxicity, QT prolongation, hyperglycaemia

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10
Q

What baseline and ongoing monitoring is required for BRAF inhibitors?

A

Full hx and exam, incl. skin

FBC, UEC, LFT, BhCG, urinalysis, ECG

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11
Q

What PD1 inhibitors are used in dermatology?

A

Nivolumab
Pembrolizumab

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12
Q

What are the contraindications to PD1 inhibitors?

A

Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease

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13
Q

What are the adverse effects of PD1 inhibitors?

A

Skin: morbilliform rash, pruritus, lichenoid eruption, psoriasis, eczema, vitiligo, bullous pemphigoid, panniculitis, SJS/TEN

Infusion reactions

Autoimmune: encephalitis, conjunctivitis/uveitis, hypophysitis, thyroiditis, pneumonitis, myocarditis, hepatitis, colitis, nephritis, diabetes mellitus, neuropathies

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14
Q

What baseline and ongoing monitoring is required for PD1 inhibitors?

A

Full Hx and exam

FBC, UEC, CMP, LFT, glucose, TFT, BhCG
Sex hormones, prolactin, cortisol/ACTH
Urinalysis
Immunosuppression screen
Cardiac markers, ECG

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15
Q

What are the contraindications to ipilimumab?

A

Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease

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16
Q

What are the adverse effects to ipilumumab?

A

Skin: morbilliform rash, pruritus, lichenoid eruption, psoriasis, eczema, vitiligo, bullous pemphigoid, panniculitis, SJS/TEN

Infusion reactions

Autoimmune: encephalitis, conjunctivitis/uveitis, hypophysitis, thyroiditis, pneumonitis, myocarditis, hepatitis, colitis, nephritis, diabetes mellitus, neuropathies

17
Q

What baseline and ongoing monitoring is required for ipilumumab?

A

Full Hx and exam

FBC, UEC, CMP, LFT, glucose, TFT, BhCG
Sex hormones, prolactin, cortisol/ACTH
Urinalysis
Immunosuppression screen
Cardiac markers, ECG

18
Q

What is the MOA and dermatology Indications for imatinib?

A

Tyrosine kinase inhibitor

Systemic mastocytosis
Unresectable/metastatic DFSP

19
Q

What are the contraindications to imatinib?

A

Hypersensitivity
Pregnancy/lactation
Children <18 years
Severe cardiac/hepatic/renal disease

20
Q

What drugs interact with imatinib?

A

CYP3A4 drugs

21
Q

What are the adverse effects of Imatinib?

A

Skin: EM/SJS/TEN, alopecia
Haem: cytopaenias, tumour lysis syndrome
CVS: hypereosinophilic cardiac disease, peripheral oedema
GI: n/v/d/a/p, hepatotoxicity, hypoalbuminaemia, deranged LFTs, GI haemorrhage/perforation
Resp: URTI/nasopharyngitis, cough, influenza, dyspnoea, pneumonia
Endo: hypothyrodism, hypokalemia
MSK: arthralgia/myalgia, bone pain
CNS: headache, dizziness, low mood, insomnia
GUS: renotoxicity, high creatinine
Embryofoetal toxicity, growth retardation

22
Q

What baseline and ongoing monitoring is done for imatinib?

A

Full Hx & exam (cardiac, renal and GI)
Growth parameters (children)
FBC, UEC, LFT, TFT, CPK, LDH, BhCG, urinalysis

23
Q

Vismodegib, true / false
A. overall response rate is around 60%
B. SCC is an adverse effect
C. High rates of adverse effects
D. May be loss of efficacy over time / with subsequent treatments

A

All true

Pharmacology (13 decks)

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