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NAPLEX Study Time > Oncology > Flashcards

Oncology Flashcards

1
Q

What do the letters in TNM staging stand for?

A

T - tumor size and extent
N - spread of cancer to lymph nodes
M - metastasis

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2
Q

What are the CAUTION warning signs for cancer?

A

C - Change in bowel/bladder habits
A - A sore that does not heal
U - Unusual bleeding/discharge
T - Thickening or lump in breast or elsewhere
I - Indigestion or difficulty swallowing
O - Obvious change in wart/mole
N - Nagging cough or hoarseness

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3
Q

What drug is recommended for prevention of colorectal cancer?

A

Low dose ASA

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4
Q

What is the maximum lifetime dose for bleomycin?

A

400 units

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5
Q

What is the maximum lifetime dose for doxorubicin?

A

450-550 mg/m2

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6
Q

What is the maximum cycle dose for cisplatin?

A

Not to exceed 100 mg/m2 per cycle

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7
Q

What is the maximum single dose for vincristine?

A

2 mg

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8
Q

What is the major toxicity of bleomycin?

A

Pulmonary toxicity

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9
Q

What is the major toxicity of doxorubicin?

A

Cardiotoxicity

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10
Q

What is the major toxicity of cisplatin?

A

Nephrotoxicity

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11
Q

What is the major toxicity of vincristine?

A

Neuropathy

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12
Q

Which chemo agents do not cause myelosuppression?
Hint - 5

A

Asparaginase
Bleomycin
Vincristine
MABs
TKIs

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13
Q

Which chemo agents cause severe N/V
Hint - 5

A

Cisplatin
Cyclophosphamide
Ifosfamide
Doxorubicin
Epirubicin

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14
Q

Which chemo agents cause mucositis?
Hint - 5

A

Methotrexate
Fluorouracil
Capecitabine
Irinotecan
TKIs

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15
Q

Which chemo agents cause diarrhea?
Hint - 5

A

Irinotecan
Methotrexate
Fluorouracil
Capecitabine
TKIs

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16
Q

Which chemo agents cause constipation?
Hint - 3

A

Vincristine
Thalidomide
Pomalidomide

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17
Q

Which chemo agents cause cardiomyopathy?
Hint - 3

A

Anthracyclines
HER2 inhibitors
Fluorouracil

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18
Q

Which chemo agents cause QT prolongation?
Hint - 3

A

Arsenic trioxide
TKIs
Leuprolide

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19
Q

What drug can be given alongside an anthracycline to prevent toxicity?

A

Dexrazoxane

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20
Q

Which chemo agents cause pulmonary fibrosis?
Hint - 4

A

Bleomycin
Busulfan
Carmustine
Lomustine

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21
Q

Which chemo agents cause pneumonitis?
Hint- 2

A

Methotrexate (long term use)
MABs targeting CLTA-4 or PD-1

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22
Q

Which chemo agents cause hepatotoxicity?
Hint - 5

A

Antiandrogens (bicalutamide)
Folate antimetabolites (methotrexate)
Pyrimidine analogs (cytarabine)
TKIs
Some MABs

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23
Q

Which chemo agents cause nephrotoxicity?
Hint - 5

A

Cisplatin
Methotrexate (high doses)
Pemetrexed
Pralatrexate
Some MABs

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24
Q

What drug can be given with cisplatin to reduce toxicity?

A

Amifostine

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25
Q

Which chemo agents cause hemorrhagic cystitis?
Hint - 2

A

Ifosfamide
Cyclophosphamide (high doses)

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26
Q

What drug can be given with isosfamide/cyclophosphamide to reduce toxicity?

A

Mesna (Mesnex)

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27
Q

Which chemo agents cause neuropathy?
Hint - 7

A

Vinca alkaloids
Platinums
Taxanes
Proteasome inhibitors (-zomibs)
Thalidomide
Cytarabine
Brentuximab

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28
Q

What type of neuropathy occurs with oxaplatin?

A

Cold-mediated sensory neuropathy
Counsel pts to avoid cold temps/beverages

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29
Q

Which chemo agents have an increased risk of thromboembolic/clotting events?
Hint - 3

A

Aromatase inhibitors (anastrozole)
SERMs (tamoxifen)
Immunomodulators (-lidomides)

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30
Q

What drug(s) are given with fluorouracil to enhance efficacy?

A

Leucovorin or levoleucovorin

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31
Q

What drug is an antidote to fluorouracil and capecitabine?

A

Uridine triacetate
To be used within 96 hrs of OD/toxicity

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32
Q

What drug can be used to prevent/treat acute diarrhea associated with irinotecan?

A

Atropine

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33
Q

What drug can be used to treat delayed diarrhea associated with irinotecan?

A

Loperamide

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34
Q

What drug can be given prophylactically with high dose methotrexate to decrease myelosuppression and mucositis?

A

Leucovorin or levoleucovorin

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35
Q

What drug is an antidote to methotrexate?

A

Glucarpidase

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36
Q

What drugs can be used to treat neutropenia?

A

Colony-stimulating factors
(Filgrastim and Pegfilgrastim)
Given prophylactically after chemotherapy

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37
Q

What is the lowest point that WBCs and platelets reach called?

A

Nadir

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38
Q

How long does it take for WBCs/platelets to recover post treatment?

A

3-4 weeks
Must wait for cells to recover before giving next round of treatment

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39
Q

When does the nadir occur for platelets/WBCs?

A

~7-14 days post treatment

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40
Q

What are the cell counts for neutropenia?

A

Neutropenia: ANC <1,000
Severe neutropenia: ANC <500
Profound neutropenia: ANC <100

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41
Q

Key points for CSFs

A

Main SE: Bone pain
Filgrastim = qd
Pegfilgrastim = once per cycle, at least 12 days before next cycle
Must store in fridge
Administered 24-96 hrs after chemo
Must monitor for enlarged spleen and resp distress syndrome

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42
Q

Febrile neutropenia diagnosis criteria

A

Temp >38.3 C x1 reading OR >38.0 C sustained for 1 hr
PLUS
ANC <500 (or expected to be <500 within next 48 hrs)

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43
Q

What bug must be covered when empirically treating febrile neutropenia?

A

Pseudomonas

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44
Q

When is it acceptable to use an ESA for anemia in a cancer pt?

A

Only if it is being used with palliative intent and Hgb <10
ESAs can increase tumor progression and should not be used with curative intent

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45
Q

When is platelet infusion indicated?

A

Plts <10,000 (<30,000 w/ active bleed)

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46
Q

What antiemetics are used for acute CINV?
(<24 hrs after chemo)

A

5HT-3 RAs (1st line, can add on others)
NK1 RAs
Dexamethasone
Olanzapine

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47
Q

What antiemetics are used for delayed CINV?
(>24 hrs after chemo)

A

NK1-RAs + steroids + 5HT RA + olanzapine

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48
Q

What antiemetics are used for anticipatory CINV?

A

BZD (given evening prior to chemo)

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49
Q

How many agents should be used for each class of emetic risk?

A

High risk: 3-4 agents (NK1-RAs + dexamethasone + 5HT RA + olanzapine)
Mod risk: 2-3 agents (NK1-RAs + steroids + 5HT RA)
Low risk: 1 agent (any but NK1-RAs)

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50
Q

When are antiemetics given in relation to chemo infusion time?

A

Given at least 30 minutes before chemo

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51
Q

What should acute dystonic rxns be treated with?

A

Anticholinergics (ex. benztropine, benadryl)

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52
Q

Examples of 5HT3-RAs

A

-setrons

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53
Q

Examples of dopamine antagonists

A

Prochlorperazine
Promethazine
Metoclopramide
Olanzapine
Droperidol

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54
Q

Examples of NK1-RAs

A

Aprepitant
Fosaprepitant

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55
Q

What enzyme are aprepitant/fosaprepitant metabolized via?

A

CYP3A4
May need to reduce dexamethasone dose due to interaction

56
Q

Key points for 5HT3-RAs (-setrons)

A

CI with apomorphine
Prolongs QT
Risk of serotonin syndrome
SE: HA, constipation
Minimal sedation

57
Q

Key points for dopamine receptor antagonists

A

Only give promethazine IM
Metoclopramide: Can cause irreversible tardive dyskinesia; needs dose adjustment if CrCl <40
Avoid in parkinsons disease
Droperidol: can prolong QT
SE: Acute EPS, sedation, decreased seizure threshold

58
Q

SE of cannabinoids (dronabinol, nabilone)

A

Somnolence
Euphoria
Increased appetite

59
Q

What is the max daily dose for loperamide?

A

16 mg/day

60
Q

What is hand-foot syndrome?

A

Occurs when small amounts of chemo drug leaks out of capillaries and into palms or hands and soles of feet causing tenderness, pain, inflammation, and skin peeling

61
Q

What chemo agents can cause hand-foot syndrome?

A

Capecitabine
Fluorouracil
Cytarabine
Liposomal doxorubicin
Sorafenib/sunitinib

62
Q

What electrolyte abnormalities are associated with tumor lysis syndrome?

A

Hyperkalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia

63
Q

What agent is 1st line for severe cancer-related hypercalcemia?

A

IV bisphosphonates +/- calcitonin
Can also use denosumab (different dose than prolia)

64
Q

What premedications must be given with a MAB?

A

APAP 650 mg PO
Diphenhydramine IV or PO

65
Q

What 2 chemo agents are major vesicants?

A

Anthracyclines
Vinca alkaloids

66
Q

What is the antidote for vinca alkaloids and etoposide in the event of extravasation?

A

Hyaluronidase + warm compress
for all other drugs, use cold compress

67
Q

What chemo agent cannot be given intrathecally?

A

Vincristine (fatal)

68
Q

Complete response

A

Treatment has destroyed all known tumors

69
Q

Partial response

A

Treatment eliminated at least 30% of the tumor

70
Q

Neoadjuvant therapy

A

Treatment given before surgery to reduce the size of a tumor

71
Q

Adjuvant therapy

A

Treatment given after surgery to eradicate residual disease

72
Q

3 types of lung cancer

A

1) Non-small cell (most common)
2) Small cell
3) Carcinoid

73
Q

Most common cause of lung cancer

A

Smoking

74
Q

Risk factors for skin cancer

A

UV exposure
Light skin/hair/eyes
Immunosuppressant therapy
Hx of skin cancer

75
Q

3 types of skin cancer

A

1) Basal cell
2) Squamous cell
3) Melanoma (rare, but deadly)

76
Q

What are the ABCDEs of skin cancer?

A

A - Asymmetry
B - Borders that are irregular/notched
C - Color is not same all over
D - Diameter >6 mm
E - Evolving

77
Q

Klinefelter syndrome

A

Males with XXY chromosomes

78
Q

Treatment duration for hormone sensitive (ER+/PR+) breast cancer

A

5-10 years

79
Q

1st line treatment for premenopausal females w/ hormone sensitive breast cancer

A

SERM (tamoxifen)

80
Q

Aromatase inhibitor MOA

A

Blocks the conversion of androgens to estrogen; only effective in post-menopausal pts

81
Q

Which medication is a SERM indicated only for breast cancer prophylaxis?

A

Raloxifene
Increases bone density and is also used for osteoporosis treatment/prevention

82
Q

Examples of SERMs

A

Tamoxifen
Raloxifene
Toremifene

83
Q

Which drug is a SERD (selective estrogen receptor degrader)?

A

Fulvestrant

84
Q

SERM key points

A

Warnings: increased risk of uterine/endometrial cancer and thrombotic events
Tamoxifen CI w/ warfarin
SE: hot flashes, night sweats, vaginal bleeding/spotting/discharge/dryness, decreased libido
Venlafaxine preferred drug for SE treatment
Tamoxifen: teratogenic, can decrease bone density - needs vit D/Ca supplementation

85
Q

Tamoxifen is a prodrug metabolized via what enzyme?

A

CYP2D6

86
Q

SERD SE

A

Increased LFTs
Injection site rxns
Hot flashes

87
Q

Examples of aromatase inhibitors

A

Anastrozole (arimidex)
Letrozole (Femara)
Exemestane (Aromasin)

88
Q

Aromatase inhibitor key points

A

Higher risk of osteoporosis and CVD vs SERMS
CI w/ pregnancy
SE: Hot flashes, night sweats, arthralgias, myalgias

89
Q

Examples of cyclin-dependent kinase (CDK4/6) inhibitors

A

Palbociclib (Ibrance)
Abemaciclib (Verzenio)
Ribociclib (Kisquali)

90
Q

HER2 inhibitor for breast cancer

A

Trastuzumab

91
Q

2 options for androgen deprivation therapy

A

GnRH antagonist
or
GNRH agonist + antiandrogen

92
Q

Examples of GnRH agonists

A

Leuprolide
Goserelin
Histrelin
Triptorelin

93
Q

GnRH agonist key points

A

Decrease testosterone via negative feedback mechanism
Can decrease bone density - supplement w/ vit D and Ca
Will cause tumor flare at therapy initiation so must be paired with an antiandrogen
SE: hot flashes, impotence, gynecomastia, bone pain, QTc prolongation, difficulty urinating
CI w/ pregnancy/breastfeeding

94
Q

Examples of GnRH antagonists

A

Degarelix (Firmagon)
Relugolix (Orgovyx)

95
Q

GnRH antagonist key points

A

Directly block GnRH receptors
Osteoporosis risk
No tumor flare, can be used as monotherapy

96
Q

Examples of 1st gen antiandrogens

A

Bicalutamide
Flutamide
Nilutamide

97
Q

Antiandrogen key points

A

Competitively inhibit testosterone from binding to prostate cancer cells
Disulfiram rxns w/ nilutamide
QTc prolongation w/ apalutamide
SE: hot flashes, gynecomastia

98
Q

Examples of 2nd gen antiandrogens

A

Apalutamide
Darolutamide
Enzalutamide

99
Q

Androgen biosynthesis inhibitor

A

Abiraterone
Interferes w/ CYP17 to decrease testosterone production

100
Q

What weight is used in the BSA calculation?

A

Actual body weight

101
Q

Examples of alkylating agents (chemo)

A

Cyclophosphamide
Isosfamide
Carmustine
Dacarbazine
Busulfan
Melphan

102
Q

Examples of platinum-based agents (chemo)

A

Cisplatin
Carboplatin
Oxaplatin

103
Q

Examples of anthracyclines (chemo)

A

Doxorubicin
Daunorubicin
Epirubicin
Mitoxantrone (anthracenedione)

104
Q

Mitoxantrone will discolor body fluids what color?

A

Blue

105
Q

Doxorubicin will discolor body fluids what color?

A

Red

106
Q

Examples of topoisomerase I inhibitors (chemo)

A

Irinotecan
Topotecan

107
Q

Examples of topoisomerase II inhibitors (chemo)

A

Etoposide
Bleomycin

108
Q

Storage/admin points for etoposide

A

IV must be given in non-PVC bag/tubing
Capsules must be stored in fridge

109
Q

Examples of vinca alkaloids

A

Vincristine - more CNS tox
Vinblastine - more bone tox
Vinblastine - more bone tox

B for Bone, C for CNS

110
Q

Examples of taxanes

A

Paclitaxel
Docetaxel
Cabazitaxel

111
Q

Key points for taxanes

A

High risk of severe/fatal hypersensitivity rxns
Must premedicate prior to infusion (usually with steroids + benadryl)
Must be in non-PVC bag
Requires 0.22 micron filter

112
Q

Examples of pyrimidine analogues

A

Fluorouracil
Capecitabine (FU prodrug)
Cytarabine
Gemcitabine

113
Q

Examples of folate antimetabolites

A

Methotrexate
Pemetrexed
Pralatrexate

114
Q

What should be given with methotrexate to decrease risk of nephrotoxicity?

A

Hydration + bicarb (alkalinizes the urine)

115
Q

What meds should not be given with methotrexate?

A

NSAIDs, salicylates, probenecid
Anything that decreases renal clearance

116
Q

What is a main risk/SE of bortezomib?

A

Herpes reactivation
Can be prevented w/ acyclovir/valacyclovir
Also peripheral neuropathy

117
Q

Which MABs target vascular endothelial growth factors (VEGF)?

A

Bevacizumab
Ramucirumab

“ci” = circulatory/vascular

118
Q

Which MABs target epidermal growth factor receptors (EGFR)?

A

Cetuximab
Panitumumab

119
Q

Which MABs target human epidermal growth factor 2 (HER2)?

A

Trastuzumab
Pertuzumab

“tuz” = 2

120
Q

Which MABs target CD antigens?

A

Rituximab
Brentuzimab

121
Q

Which MABs target the immune system (PD-1, PDL-1, CTLA-4)?

A

Ipilimumab
Pembrolizumab

122
Q

What are VEGF inhibitors used to treat?

A

Colon cancer, NSCLC

123
Q

What are EGFR inhibitors used to treat?

A

Colon cancer

124
Q

What are HER2 inhibitors used to treat?

A

Breast cancer

125
Q

What are CD inhibitors used to treat?

A

Hematologic cancers (lymphoma, myeloma)

126
Q

What are immune inhibitors used to treat?

A

NSCLC, melanoma

127
Q

Key points for VEGF inhibitors

A

Impairs wound healing, cannot be used for 28 days before/after surgery
Warnings for severe bleeding, GI perforation

128
Q

Key points for HER2 inhibitors

A

Must be HER2+ to use
Monitor LVEF at baseline and during treatment

129
Q

Key points for EGFR inhibitors

A

Must use 0.22 filter
Must be EGFR+, KRAS- to use
SE: Acneiform rash - occurs during 1st 2 weeks, predictor of better response to drug; can treat with topical steroids/abx

130
Q

Key points for CD inhibitors

A

Must premedicate with APAP, benadryl, and steroid
Must be CD20+ for rituxumab
Warning for hepB reactivation - must check for hepB prior to initiating

131
Q

Examples of BCR-ABL inhibitors

A

Imatinib
Dasatinib
Nilotinib

132
Q

Key points for BCR-ABL inhibitors

A

Must be BCR-ABL+ to use
SE: fluid retention, QT prolongation
Used in chronic myelogenous leukemia (CML)

133
Q

Examples of BRAF inhibitors

A

Vemurafenib
Dabrafenib

134
Q

Key points for BRAF inhibitors

A

Must be V600E or V600K + to use
Warnings for new malignancies and QT prolongation
Used in melanoma

135
Q

Which drugs must be taken with food?
Hint - 4

A

Imatinib
Capecitabine
Thalidomide
Exemestane

136
Q

Which drugs must be taken on empty stomach?
Hint - 5

A

Nilotinib
Erlotinib
Pomalidomide
Abiraterone
Temozolomide

NAPLEX Study Time (8 decks)

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