Chapter 61: Oncology Flashcards
(228 cards)
1
Q
What characterizes cancer?
A
Abnormal cell proliferation and uncontrolled cell division
2
Q
What is a tumor?
A
A mass of cells that can be benign or malignant
3
Q
What is the difference between benign and malignant tumors?
A
- Benign tumors are non-cancerous and stay in their primary location
- Malignant tumors can invade other tissues and spread
4
Q
What does metastasis refer to?
A
The spread of cancer to a different part of the body
Metastasis involves cancer cells traveling through the lymphatic system or blood.
5
Q
Where can malignant tumors travel through to invade other tissues?
A
- Lymphatic system
- Blood
6
Q
Fill in the blank: Malignant tumors can form a secondary tumor with the same _______ as the primary tumor.
A
cancerous cells
7
Q
What causes cancer?
A
Genetic mutations
8
Q
What are the main types od genes involved in cancer?
A
- Proto-oncogene
- DNA repair gene
- Tumor suppressor gene
9
Q
What are proto-oncogenes?
A
Genes involved in normal cell division that can become mutated to form oncogenes.
10
Q
What are oncogenes?
A
Mutated forms of proto-oncogenes that promote cancer cell growth.
Examples of oncogenes include HER2 and EGFR.
11
Q
What role do DNA repair genes play in cancer?
A
They usually fix mistakes in DNA during replication, and mutations in these genes prevent cell repair.
12
Q
What role do Tumor suppressor genes play in cancer?
A
They normally regulate cell division; when mutated, cells can grow uncontrollably
13
Q
What are external factors causing mutations?
A
- Chemicals
- Radiation
- Sunlight exposure
- Tabacco and alcohol
- Bacteria and viruses
14
Q
What are internal factors causing mutations?
A
- Hormones
- BRCA genes
- Older age
15
Q
What type of cancer is commonly associated with sun or UV light exposure?
A
Skin cancer
16
Q
What type of skin cancer is less prevalent but more likely to spread?
A
Melanoma
17
Q
What are the ABCDE warning signs of melanoma stand for?
A
- Asymmetry
- Border irregularity
- Color variation
- Diameter larger than 6 mm
- Evolving changes in size, color, or shape
18
Q
What are the screening guidelines for breast cancer?
A
Annual mammogram after age 45 yo and can switch to every 2 years after 55 yo
19
Q
What are the screening guidelines for cervical cancer?
A
Start at the age of 25:
* pap smear every 3 years
* HPV DNA test every 5 years
20
Q
What are the screening guidelines for Colorectal cancer?
A
- Starts at the age 45 years
- Stool based test every 3 years
- Colonoscopy every 10 years
- Sigmoidoscopy every 5 years
21
Q
What are the screening guidelines for Lung cancer?
A
At the age of 50 years,
annual CT of the chest if:
* >= 20 pack-year smoking history
* still smoking or quit smoking within the past 15 years
22
Q
What are the screening guidelines for Prostate cancer?
A
If patients choose to test:
Prostate specific antigen blood test +/- digital rectal exam
23
Q
What are the warning signs of cancer?
CAUTION
A
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in the breast or elsewhere
- Indigestion or difficulty swollowing
- Obvious change in a wart or mole
- Nagging cough or hoarseness
24
Q
What are the core elements of diagnosis for all cancer types?
A
- Biopsy
- Imaging
- Lab test such as metabolic panel, tumor markers and genetic testing
25
What factors influence cancer treatment decisions?
* Cancer type and characteristics
* Cancer stage
* Patient characteristics
* Risks and benefits of each treatment option
26
What is the goal of treatment options with curative intent?
To eradicate cancerous cells and prevent recurrence
27
What is palliative treatment?
Treatment that helps control symptoms and provide comfort
28
What is neoadjuvant therapy?
Treatment (e.g., radiation, chemotherapy) used before surgery to shrink the tumor
29
What is adjuvant therapy?
Additional cancer treatment given after the primary treatment to eradicate residual disease
30
Define complete response in cancer treatment.
The cancer responded to treatment and cannot be detected
31
Define partial response in cancer treatment.
There is a substantial reduction in the cancer burden, but it is still present
32
What is the primary mechanism by which traditional chemotherapy drugs kill cancer cells?
They are cytotoxic by interfering with cell division and DNA replication.
33
Which types of cells are more susceptible to the effects of traditional cytotoxic cancer drugs?
Actively dividing cancer cells and noncancerous rapidly dividing cells such as those in the gastrointestinal tract, hair follicles, and bone marrow.
34
What are common side effects of chemotherapy?
* Diarrhea
* Mucositis
* Nausea/Vomiting
* Alopecia
* Myelosuppression
35
What supportive care measures are often used with chemotherapy?
An antiemetic regimen.
36
What occurs during the M Phase of the cell cycle?
Mitosis, where the cell divides into 2 daughter cells.
37
Which drug classes effect M phase (mitosis)?
* Taxanes
* Vinca Alkaloids
38
Name two drugs classified as Taxanes.
* Paclitaxel
* Docetaxel
39
Name two Vinca Alkaloids.
* Vincristine
* Vinblastine
40
What are some examples of cell cycle nonspecific agents?
* Cyclophosphamide
* Ifosfamide
* Doxorubicin
* Daunorubicin
* Cisplatin
* Carboplatin
* Oxaliplatin
41
What is the G0 phase of the cell cycle?
A resting phase after mitosis has occurred.
42
What occurs during the G1 and G2 phases of the cell cycle?
Growth phases to prepare DNA/RNA/proteins for cell division.
43
Which drug effects G1 phase?
Pegaspargase
44
Which drug class effect S phase?
* Antimetabolites
* Topoisomerase I inhibitors
45
What drugs are classified under Antimetabolites?
* Methotrexate
* Pemetrexed
* Fluorouracil (5-FU)
* Capecitabine
46
What are Topoisomerase I Inhibitors?
* Irinotecan
* Topotecan
47
What is the significance of the S Phase in the cell cycle?
DNA replication occurs during this phase.
48
Which drugs effect G2 phase of cell cycle?
* Etoposide
* Bleomycin
49
Chemotherapy regimens typically include a combination of drugs to increase efficacy via _______.
[synergistic effects]
50
How long are chemotherapy regimens usually administered?
In 2 - 6 week cycles.
51
What is an example of a breast cancer chemotherapy regimen?
AC regimen, which includes Doxorubicin and Cyclophosphamide.
52
Which drugs are cell cycle non-specific?
1. Alkylating agents
2. Anthracyclines
3. Platinum compunds
53
List Anthracycline agents
* Doxorubicin
* Daunorubicin
54
List platinum compound agents
* Cisplatin
* Carboplatin
* Oxaliplatin
55
Mosteller Equation
56
Du Bois Equation
57
Calvert formula for carboplatin dosing
58
What is the MOA of alkylating agents?
Work by cross-linking DNA strands which inhibits DNA and protein synthesis.
59
List common alkylating agents
* Cyclophosphamide & Ifosfamide
* Busulfan
* Carmustine
60
What is a key safety concern associated with cyclophosphamide and ifosfamide?
Hemorrhagic cystitis caused by the toxic metabolite acrolein, which concentrates in the bladder
61
What monitoring is required for patients on cyclophosphamide and ifosfamide?
**Hematuria**, urinalysis (for RBCs), lower urinary tract symptoms (e.g., urinary urgency, **dysuria**, incomplete bladder emptying)
62
What is the management strategy for preventing hemorrhagic cystitis for cyclophosphamide and ifosfamide?
* Adequate hydration
* Mesna (a chemoprotectant) with all ifosfamide doses and high doses of cyclophosphamide
63
What is the safety concern with busulfan?
pulmonary toxicity like pulmonary fibrosis,
64
What is a potential toxic effect of carmustine?
* Neurotoxicity such as seizures, cerebral edema
* Pulmonary toxicity
65
What are platinum-based compounds classified as?
Alkylating agents
66
What is the primary mechanism of action for platinum-based compounds?
Cross-link DNA, interfering with DNA synthesis and cell replication
67
Name common platinum-based compound agents
* Cisplatin
* Carboplatin
* Oxaliplatin
68
What are safety concerns associated with platinum-based compounds?
* Nephrotoxicity
* Hypersensitivity reaction
* Ototoxicity
* Peripheral neuropathy
69
What is a safety concern associated specifically with oxaliplatin?
acute sensory neuropathy exacerbated by cold
70
What should be monitored in patients receiving platinum-based compounds?
* Anaphylaxis symptoms
* Renal function
* S/sx of hearing loss, tinntius
* Numbness, pain
* abnormal sensation
71
How can nephrotoxicity be prevented with cisplatin?
* Adequate hydration
* Limiting cisplatin dose per cycle to ≤ 100 mg/m
* Amifostine (Ethyol)
72
Which drug has the greatest incidence of side effects associated with which platinum-based compound?
Cisplatin
73
What are the mechanisms of action for anthracyclines?
Anthracyclines work by several mechanisms, including:
* intercalation into DNA
* **inhibition of topoisomerase II **
* creation of oxygen-free radicals that damage cells
74
Name a key drug in the anthracycline class.
Doxo**rubi**cin (Adriamycin)
75
What is a common safety concern associated with anthracyclines?
* Cardiotoxicity
* Red discoloration of bodily fluid
76
What should be monitored to assess cardiotoxicity in patients receiving doxorubicin?
Left ventricular ejection fraction (LVEF) and signs/symptoms of heart failure
77
What is the key safety concern associated with mitoxantrone?
Blue discoloration of sclera and bodily fluids
78
How to prevent cardiotoxicity of doxorubicin?
* Limit total lifetime cumulative dose to 450-550 mg/m2
* Administer Dexrezoxane
## Footnote
This limit is important to prevent cardiotoxicity.
79
How can doxorubicin cardiotoxicity be reduced?
1. Keep track of the lifetime cumulative doxorubicin dose
2. Consider dexrazoxane if cumulative dose ≥ 300 mg/m2
3. Stop treatment at cumulative dose of 450-550 mg/m2
4. Monitor LVEF before and after treatment
80
What do topoisomerase I inhibitors block during the cell cycle?
The coiling and uncoiling of the double-stranded DNA helix during the S phase
81
Name a specific topoisomerase I inhibitor.
Irinotecan (Camptosar)
82
What are common safety concerns associated with Irinotecan?
* Acute diarrhea,
* cholinergic symptoms (e.g., abdominal cramping, lacrimation, salivation)
* Delayed Diarrhea
## Footnote
Mnemonic: 'I run to the can'.
83
What is the prevention and treatment for acute diarrhea caused by Irinotecan?
Atropine (an anticholinergic)
84
What is the treatment for delayed diarrhea (> 24 hours after infusion) caused by Irinotecan?
Antidiarrheal agent (e.g., loperamide)
85
During which phase of the cell cycle do topoisomerase II inhibitors act?
G2 phase
86
Name a specific topoisomerase II inhibitor.
Etoposide
87
What do vinca alkaloids inhibit during the cell cycle?
Microtubule formation during the M phase
88
Which vinca alkaloid causes more CNS toxicity?
Vincristine
89
Which vinca alkaloids cause more bone marrow suppression?
Vinblastine and Vinorelbine
90
What are common safety concerns associated with vinca alkaloids?
* Peripheral neuropathy,
* autonomic neuropathy (constipation),
* paralysis, and death if given intrathecally
91
What should be monitored when administering vincristine?
Signs and symptoms of neuropathy (e.g., extremity numbness, paresthesia, pain)
92
What is the prevention measure for vincristine associated peripheral neuropathy?
Limit single vincristine doses to 2 mg
93
What is a critical safety measure for vincristine administration?
For intravenous use only; fatal if given by other routes
94
What do taxanes inhibit during the cell cycle?
Depolymerization of tubulin during the M phase
95
Name three taxane drugs.
* Paclitaxel
* Cabazitaxel (Jevtana)
* Docetaxel
96
What are common safety concerns associated with taxanes?
* Peripheral neuropathy
* Hypersensitivity reactions
97
What precaution should be taken when administering paclitaxel and cabazitaxel?
* Use non-PVC bag and tubing
* Use 0.22 micron filter
98
What severe side effect is associated with docetaxel?
Severe fluid retention
99
What is recommended to prevent hypersensitivity reactions to taxanes?
premedication with:
* Systemic steroid (e.g., dexamethasone)
* Diphenhydramine
* H2RA (e.g., famotidine)
100
Fill in the blank: Use a _______ filter for cabazitaxel and paclitaxel.
0.22 micron
## Footnote
This helps to prevent complications during drug administration.
101
What do pyrimidine analog antimetabolites inhibit during the cell cycle?
Pyrimidine DNA synthesis during the S phase
102
Which agent is given with fluorouracil to increase efficacy?
Leucovorin or its L-isomer (levoleucovorin)
103
What is fluorouracil also referred to as?
5-FU
104
What are the signs and symptoms of hand-foot syndrome?
Painful erythema, skin peeling
105
What is capecitabine?
Oral prodrug of fluorouracil
106
What are common side effects of pyrimidine analog antimetabolites?
* Hand-foot syndrome
* Diarrhea
* Mucositis
107
What deficiency increases the risk of toxicities associated with pyrimidine analog antimetabolites?
dihydropyrimidine dehydrogenase (DPD) deficiency
108
What is the antidote for fluorouracil overdose or early-onset toxicity?
Uridine triacetate (Vistogard)
109
What should be monitored frequently in patients on pyrimidine analogs and warfarin?
INR
110
What is a significant drug interaction with fluorouracil?
Warfarin (can significantly increase INR)
111
What are some management strategies for hand-foot syndrome?
* Limit or modify daily activities
* Avoid heat exposure
* Use emollients (e.g., ammonium lactate, urea cream)
* Topical steroids (e.g., clobetasol)
* Pain medications
* Dose modifications or therapy interruptions for severe cases
112
What do folate antimetabolites interfere with?
Enzymes involved in the folic acid cycle. They block purine and pyrimidine biosynthesis during the S phase of the cell cycle.
113
What is the primary drug mentioned for folate antimetabolites?
Methotrexate
## Footnote
Other drugs in the class include pemetrexed and pralatrexate.
114
What is a major safety concern associated with high doses of methotrexate?
Nephrotoxicity
(High doses are considered to be ≥ 500 mg/m².)
115
Which parameters should be monitored for methotrexate safety?
Renal function, weight gain, urine pH, methotrexate levels
116
What are the methods to prevent nephrotoxicity when using methotrexate?
* Leucovorin or levoleucovorin 'rescue'
* hydration with IV sodium bicarbonate to alkalinize the urine
* Avoid NSAIDs
117
Name two types of gastrointestinal toxicity associated with methotrexate.
Diarrhea, mucositis
118
What is the antidote for methotrexate-induced acute kidney injury?
Glucarpidase (Voraxaze)
119
What is a key aspect of mucositis prevention?
* Good oral hygiene
* Frequent bland rinses
120
What is one treatment option for mucositis?
Viscous lidocaine 2% or magic mouthwash
121
What should be done to manage thrush in patients with mucositis?
Nystatin oral suspension or clotrimazole troches
122
What is the recommended dose of folic acid for patients on low-dose methotrexate?
1-5 mg daily
123
What is the safety concern with tretinoin?
differentiation syndrome
124
What is the prevention/treatment for differentiation syndrome?
* Systemic steroids (e.g., dexamethasone)
* Interrupt therapy for severe cases
125
What is a safety concern associated with arsenic trioxide?
QT prolongation
126
What measures are taken to prevent QT prolongation when using arsenic trioxide?
* Maintain K > 4 mEq/L
* Maintain Mg > 1.8 mEq/L
* Avoid concurrent QT-prolonging drugs
127
What is a boxed warning. for bleomycin?
Pulmonary toxicity
128
What is the recommended lifetime cumulative dose limit for bleomycin?
400 units
129
What is the purpose of premedication before administering bleomycin?
To prevent hypersensitivity reactions
130
What are the side effects associated with bortezomib?
Herpes reactivation (zoster and simplex)
131
What is the prevention/treatment for herpes reactivation when using bortezomib?
Antiviral agents (e.g., acyclovir, valacyclovir)
132
What are the risks associated with lenalidomide and other immunomodulators?
* Severe birth defects
* Thrombosis (DVT/PE)
133
What is required before initiating treatment with thalidomide?
Two negative pregnancy test results
134
What is the prevention strategy for thalidomide-related birth defects?
* Restricted distribution program
* Two forms of contraception or abstain from sex
135
What are the symptoms of hypersensitivity reactions to pegaspargase?
* Dyspnea
* Angioedema
* Urticaria
136
What is the recommended premedication for pegaspargase to prevent hypersensitivity?
* Acetaminophen
* Antihistamine (e.g., diphenhydramine)
* H2RA (e.g., famotidine)
137
Which Chemotherapy causes Neurotoxicity?
Carmustine
138
What are Cisplatin toxicities?
* Ototoxicity
* N/V
* Nephrotoxicity
139
Which chemotherapy agents cause Mucositis?
* Methotrexate
* Fluorouracil
* Capecitabine
140
Which chemotherapy agents cause pulmonary toxicity?
* Bleomycin
* Busulfan
* Carmustine
141
Which Chemotherapy agents can cause peripheral neuropathy?
1. **P**: platinum based compounds
2. **V**: vinca alkaloids
3. **T**: taxanes
142
What is myelosuppression?
Bone marrow suppression characterized by a decrease in blood cell production. Myelosuppression results in fewer WBCs (neutropenia), platelets (thrombocytopenia), and RBCs (anemia)
143
Which chemotherapy drugs are exceptions that do not cause myelosuppression?
* Bleomycin
* Pegaspargase
* Vincristine
144
What is the nadir in the context of myelosuppression?
The lowest point that WBCs and platelets reach, typically occurring 7 - 14 days after chemotherapy
145
When does the greatest risk of complications from myelosuppression occur?
During the nadir period, which lasts 5-7 days
146
How long does it generally take for WBCs and platelets to recover after chemotherapy?
3 - 4 weeks after treatment
147
What is neutropenia?
A low neutrophil count, assessed by calculating an absolute neutrophil count (ANC)
148
What is the absolute neutrophil count (ANC) threshold for neutropenia?
≤ 1,000 cells/mm³
149
What is the absolute neutrophil count (ANC) formula?
150
What do Granulocyte Colony-Stimulating Factors (G-CSFs) stimulate?
WBC production in the bone marrow
151
When are G-CSFs given to patients?
Prophylactically after chemotherapy
152
What is the purpose of administering G-CSFs after chemotherapy?
To reduce the duration and severity of neutropenia and the risk of infection
153
Who should receive G-CSF prior to their first cycle of chemotherapy?
Patients at high risk of developing febrile neutropenia
154
Name two commom G-CSF drugs.
* Filgrastim (Neupogen)
* Pegfilgrastim (Neulasta, Neulasta OnPro)
155
how often is the Filgrastim dosed?
Daily until post-nadir recovery
156
What is Pegfilgrastim?
A pegylated form of filgrastim with extended half-life
157
How often is Pegfilgrastim dosed?
once per chemotherapy cycle
158
When should the first dose of G-CSFs be administered after chemotherapy?
No sooner than 24 hours after chemotherapy
159
What are common side effects of G-CSFs?
* Bone pain
* Rash
* Hypersensitivity/allergic reaction
* Glomerulonephritis
* Splenic rupture
* Respiratory distress syndrome
160
What should be monitored when administering G-CSFs?
CBC with differential, vital signs, upper abdominal pain
161
What is a key storage requirement for G-CSFs?
Store in refrigerator; protect vials and syringes from light
162
What is the diagnostic criteria for febrile neutropenia?
Oral temperature ≥ 38.3°C (101°F) x 1 reading, or oral temperature ≥ 38.0°C (100.4°F) sustained for > 1 hour
PLUS
ANC < 500 cells/mm³, or ANC < 1,000 cells/mm³ and expected to fall to < 500 cells/mm³ over the next 48 hours
163
What should be done if a fever occurs in a neutropenic patient?
Start empiric antibiotics immediately
164
What must the initial empiric antibiotic regimen provide activity against?
Gram-negative bacteria, including Pseudomonas aeruginosa
165
What are the criteria to be at high risk of Febrile neutropenia?
ANC =< 100 for more that 7 days
Comorbidities
166
What is the empiric therapy for high risk patients to febrile neutropenia?
IV anti-pseudomonal beta-lactams
* Cefepime or ceftazidime
* Imipenem/cilastatin or meropenem
* Piperacillin/tazobactam
167
What is thrombocytopenia?
Low platelets leading to spontaneous, uncontrolled bleeding
168
What platelet count indicates a high risk for spontaneous bleeding?
< 10,000 cells/mm³
169
Define anemia.
Decrease in RBCs and hemoglobin (Hgb)
170
What is the management of anemia?
* Observation
* RBC transfusion
* Erythropoiesis-stimulating agents (ESAs)
171
What are erythropoiesis-stimulating agents (ESAs)?
Drugs like epoetin alfa and darbepoetin alfa used to treat anemia
172
Under what conditions can ESAs be considered for use?
* Patient has a non-myeloid malignancy
* Hgb is < 10 g/dL
* Minimum of two additional months of planned chemotherapy
* Lowest dose needed to maintain Hgb is used
* ESA is discontinued after chemotherapy
## Footnote
ESAs are not recommended in patients receiving chemotherapy with curative intent
173
What is chemotherapy-induced nausea and vomiting (CINV)?
CINV is one of the most common adverse effects associated with cancer treatment.
174
Which chemotherapeutic agents are most commonly associated with CINV?
**Cisplatin**, carboplatin, cyclophosphamide, and anthracyclines.
175
What is acute CINV?
Acute CINV occurs within 24 hours after chemotherapy and peaks around 5 - 6 hours.
176
What is delayed CINV?
Delayed CINV occurs more than 24 hours after chemotherapy.
177
What is anticipatory CINV?
Anticipatory CINV occurs before treatment and develops as a conditioned response from a previous negative experience.
178
What is breakthrough CINV?
Breakthrough CINV occurs at any time after chemotherapy, despite the use of prophylaxis, and requires rescue antiemetics.
179
What is refractory CINV?
Refractory CINV occurs when prophylaxis and/or rescue treatment is not effective.
180
What is the primary goal of antiemetic therapy?
To prevent nausea and vomiting (emesis)
181
When should antiemetic regimens be administered in relation to chemotherapy?
At least 30 minutes before chemotherapy and continued for the full period of emetic risk.
182
What can be added to the antiemetic regimen for anticipatory nausea and/or vomiting?
Lorazepam
183
Which IV chemotherapies have high emetic risk percentage for acute emesis?
This includes drugs such as cisplatin and regimens containing both an anthracycline and cyclophosphamide.
184
What is the preferred antiemetic regimen for high emetic risk on Day 1?
* NK1 RA + 5-HT3 RA + olanzapine + dexamethasone
* NK1 RA + 5-HT3 RA + dexamethasone.
* Palonosetron + olanzapine + dexamethasone
## Footnote
Alternative regimens can also be used, such as
185
What is the drug of choice for breakthrough CINV?
Based on assessment of current prophylaxis regimen, It typically involves adding one or more drugs with a different mechanism of action. q4-6h prn
186
Which medications may be beneficial for breakthrough CINV?
* 5-HT3 RAs (except palonosetron)
* Dopamine receptor antagonists (e.g., prochlorperazine, promethazine, metoclopramide, haloperidol, olanzapine)
* Cannabinoids
* Dexamethasone
* Lorazepam
* Scopolamine
## Footnote
These medications can provide relief from breakthrough nausea and vomiting.
187
What do Substance P/Neurokinin-1 Receptor Antagonists (NK1 RAs) do?
Inhibit the substance P/neurokinin-1 receptor, augmenting the antiemetic activity of 5-HT3 receptor antagonists and corticosteroids.
188
What are common agents in NK1RAs class?
* Aprepitant (Emend)
* Fosaprepitant (Emend)
189
What are the common antiemetic 5-HT3 RAs?
* Ondansetron (Zofran)
* Granisetron (Sancuso)
* Palonosteron
190
What are the contraindications for Ondansetron?
Do not use with apomorphine due to severe hypotension.
191
What is a warning associated with 5-HT3 receptor antagonists?
Dose-dependent QT prolongation (Torsades de Pointes) - more common with IV administration.
192
List short-term side effects of Dexamethasone.
* Appetite/weight gain
* Fluid retention
* Emotional instability
* Insomnia
* GI upset/dyspepsia
193
When should Lorazepam be started if used for anticipatory N/V?
The evening prior to chemotherapy.
194
What significant effect does Lorazepam have on the nervous system?
Enhances GABA, decreasing neuronal excitability.
195
What should the IV dose of Ondansetron be limited to?
16 mg
196
What do dopamine receptor antagonists block?
Dopamine receptors in the CNS, including in the chemoreceptor trigger zone.
197
Which dopamine receptor antagonists are used for CINV?
* Olanzapine (Zyprexa)
* Prochlorperazone
* Promethazine
* Metoclopramide (Reglan)
* Haloperidol
198
What age group should not use Promethazine?
Children < 2 years of age.
199
What risk is associated with Promethazine if administered incorrectly?
Serious tissue injury due to extravasation.
200
What condition is Metoclopramide associated with?
Tardive dyskinesia (TD) that can be irreversible.
201
What adjustment should be made for Metoclopramide in patients with CrCl < 60 mL/min?
Decrease dose by 50%.
202
What are some side effects of dopamine receptor antagonists?
* Sedation
* Lethargy
* Acute EPS
* QT prolongation
203
What is a side effect of Dronabinol?
* Somnolence
* Euphoria
* Increased appetite
* Seizure
204
What is a key risk associated with chemotherapy during pregnancy?
Most chemotherapy is highly teratogenic and all patients must avoid conceiving during treatment.
205
What type of contraception should be used during chemotherapy?
Barrier methods to prevent a partner from having contact with body fluids
206
Why all chemotherapy drugs fall under Hazardous?
They are carcinogenic, genotoxic, or teratogenic.
207
What can happen if intravenous chemotherapy agents leak from the vein?
Tissue necrosis (extravasation)
208
What is the recommended treatment for extravasation of anthracyclines?
Apply cold compresses and administer dexrazoxane or topical dimethyl sulfoxide (DMSO)
## Footnote
Essential for minimizing tissue damage.
209
What should be done for extravasation of vinca alkaloids?
Apply warm compresses and administer hyaluronidase
210
What type of chemotherapy agents can be given intrathecally?
Limited number of agents that must be preservative-free
211
What is the timing recommendation for vaccinations in relation to chemotherapy?
* Vaccination should precede chemotherapy by ≥ 2 weeks
* All vaccinations should be avoided during chemotherapy.
212
Can patients receiving chemotherapy have the seasonal influenza vaccine?
Yes, between chemotherapy cycles
213
# z
When can live vaccines be administered to immunocompromised patients?
≥ 4 weeks prior or at least three months after discontinuation of chemotherapy
## Footnote
Live vaccines should not be given during chemotherapy.
214
What do targeted therapies recognize?
Specific biomarkers and molecular targets present on cancer cells
215
What premedications are commonly required for mAb administration to prevent hypersensitivity?
* Acetaminophen (usually 650 mg PO)
* Diphenhydramine (IV or PO) or another antihistamine
216
What is the function of pharmacogenomic testing in targeted therapies?
To identify patients likely to respond to these therapies
217
What is the target of Rituximab (Rituxan)?
CD20
218
What is the safety concern with Rituximab?
Rituximab is associated with the risk of hepatitis B reactivation.
219
What safety concern is associated with Cetuximab (Erbitux)?
Dermatologic toxicity (e.g., acneiform rash)
## Footnote
This occurs within the first two weeks of treatment and correlates with response to therapy.
220
What does the KRAS mutation predict in patients receiving anti-EGFR drugs?
Lack of response
## Footnote
Anti-EGFR drugs can still be used if the KRAS is wild type.
221
What is the MOA of Trastuzumab?
Binds to human epidermal growth factor receptor 2 (HER2)
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Trastuzumab brand name
Herceptin
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What are the key safety concerns for Trastuzumab?
Cardiotoxicity
224
What is the MOA of Bevacizumab?
Binds to and blocks vascular endothelial growth factor (VEGF)
225
What is Bevacizumab brand name
Avastin
226
What are the safety concerns with Bevacizumab?
* Impaired wound healing
* Thromboembolic events
* Fatal bleeding
* GI perforation
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What are the 2 classes of medications that are immunotherapy?
* Pembrolizumab & Nivolumab
* Ipilumumab
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What are the safety concerns with immunotherapies?
Immune mediated toxicities
