Atineoplastic

Question 1

BSA formula

Answer 1

square root of kg x cm /3600

Question 2

which drugs are the intrathecal route absolutely contraindicated

Answer 2

vinca alkaloids

Question 3

alkylating agents MOA

Answer 3

inhibit dna replication by causing cross linking and abnormal base pairing of the dna strands
reactive alkyl groups form a highly electrophilic immonium ion which can bind covalently to any nucloephilic compound

Question 4

resistance mechanisms to alkylating agents

Answer 4

increased ability to repair dna lesion
decreased permeability to the agents
increased production of glutathione which reacts with the alkylating agent

Question 5

adverse effects of alkylating agents

Answer 5

myelosupression
NV
alopecia

Question 6

what results of myelosuppression (bone marrow suppression)

Answer 6

neutropenia (decreased WBC)

thrombocytopenia (decreased platelets), anemia (decreased RBC) - not as common due to long lifespan

Question 7

examples of alkylating agents

Answer 7

nitrogen mustards
alkl sulfonates
nitrosoureas
triazenes

Question 8

antimetabolites MOA

Answer 8

structural analogues of naturally occuring substrates for biochemical reactions
act as false substitues in the production of nucleic acids

Question 9

examples of antimetabolites

Answer 9

folic acid analogs - methotrexate
purine analogs - mercaptopurine
pyrimidine analogs - 5FU

Question 10

antibiotics MOA

Answer 10

intercalation of sliding between DNA base pairs and inhibiting DNA synthesis

Question 11

examples of antibiotics

Answer 11

anthracyclines

Question 12

examples of plant alkaloids

Answer 12

vinca alkaloids
podophyllotoxins
taxanes

Question 13

onset and recovery of myelosuppression

Answer 13

onset 7-10day
lowest counts seen 10-14d after tx
recovery takes 2-3 wks

Question 14

what is filgrastim

Answer 14

growth factor that increases the rate neutrophil count recovers
may prevent febrile neutropenia and allow chemo to continue

Question 15

what is erythropoietin

Answer 15

promotes production of RBC

Question 16

acute nausea

Answer 16

symptoms begin in 1-2 hrs, peak in 4-6 and subside after 12-24

Question 17

cause of acute nausea

Answer 17

stimulation of chemoreceptor trigger zone through serotonin release

Question 18

treatment of acute nausea

Answer 18

ondansetron combined with dexamethasone

Question 19

anticipitory nausea

Answer 19

triggered by stimuli associaated with the therapy

conditioned response

Question 20

management of anticipatory nausea

Answer 20

erlexation techniques
aromatherapy
lorazepam
ensure good acute phase control to prevent

Question 21

delayed nausea

Answer 21

begins 24hr post chemo
persist for 2-5d
usually with highly emetogenic drugs like cisplatin

Question 22

3 effects due to the mucous membranes containing rapidly dividing cells

Answer 22

diarrhea
mucositis
extravasation

Question 23

timeline of alopecia

Answer 23

begins 7-10d after tx
peaks in 1-2 mon
regrows about a month after tx stopped
often new hair is diff in color and texture

Question 24

signs and sx of pulmonary toxicity

Answer 24

SOB

non productive cough

Question 25

agent causing pulmonary toxicity

Answer 25

bleomycin

Question 26

cause of pulmonary toxicity

Answer 26

direct cytotoxic effects on pul monary epithelium and subsequent fibrosis

Question 27

cause of cardiac toxicity

Answer 27

tissue damage from teh generation of free radicals while also suppression of the enzymes which protect the cells from free radical damage

Question 28

acute vs chronic cardiac toxicity

Answer 28

acute - transient electrocardiograph abnormalities | chronic - irreversible congestive heart failure

Question 29

drugs associated with cardiac toxicity

Answer 29

anthrycycline doxorubicin increased with increasing cumulative lifetime dose

Question 30

cadioprotective drug

Answer 30

dexrazoxane

Question 31

neurological effects with vinca alkaloids is related to

Answer 31

total cumulative dose | age >40

Question 32

agents associated with neurotoxic adverse effects

Answer 32

vinca alkaloids | cisplatin, carboplatin

Question 33

neurotoxic adverse effects

Answer 33

numbness of hands and feet gait disturbance severe motor weakness maybe reversibile if drug stopped early enough

Question 34

ototoxicity seen with

Answer 34

cisplatin

Question 35

neurotoxicity of platinum compounds due to

Answer 35

demyelination

Question 36

drugs causing nephrotoxicity

Answer 36

cisplatin ifosfamide methotrexate

Question 37

hwo to reduce nephrotoxicity

Answer 37

aggressively hydrating tha patient prior to treatemtn IV admin of annitol an osmotic diuretic will make pt pee more so drug not in kidney

Question 38

hemorrhagic cystitis associated wiht

Answer 38

cyclophosphamide | ifosfamide

Question 39

prevention of hemorrhagic cystitis

Answer 39

aggressive hydration prior to treatment | admin of mensa which binds to the active metabolite acrolein

Question 40

permanent or temporary infertility associated with

Answer 40

cyclophosphamide chlorambucil mechlorethamine melphlan

Question 41

category X in pregnancy

Answer 41

methotrexate

Question 42

sources of medication errors

Answer 42

prescription and ordering process compounding/dispensing storage and administration