FINAL EXAM CUMULATIVE PORTION

Question 1

MOA of Alkylating Agents

Answer 1

Bind covalently to the DNA molecule

Question 2

Alkylating Agents inhibit what phase of DNA Synthesis?

Answer 2

S Phase

Question 3

List the Alkylating Agents

Answer 3

1. Cyclophosphamide
2. Ifosfamide
3. Cisplatin
4. Carboplatin
5. Oxaliplatin
6. Temozolmide

Question 4

What is the MOA of Anthracyclines?

Answer 4

Intercalation + Topoisomerase II

Question 5

List the Anthracyclines

Answer 5

“RUBICIN”
1. Doxorubicin
2. Daunorubicin
3. Epirubicin
4. Idarubicin

Question 6

What is the MOA of Bleomycin?

Answer 6

DNA Strand Breaks

Question 7

What is the MOA of Antimetabolites?

Answer 7

Block the biosynthesis or use of normal cellular metabolites

Question 8

List the Pyrimidine Analogues Antimetabolites

Answer 8

1. 5-FU
2. Gemcitabine
3. Capcetiabine
4. Azacitdine

Question 9

List the Purine Analogues Antimetabolites

Answer 9

1. 6-MU
2. Vidarabine
3. Cladribine
4. Fludarabine

Question 10

What is the MOA of Vinca Alkaloids?

Answer 10

Arrest cell division by preventing the formation of mitotic spindle

Question 11

List the Vinca Alkaloids

Answer 11

1. Vincristine
2. Vinblastine
3. Vinorelbine

Question 12

What is the MOA to Etoposide?

Answer 12

Inhibit Topoisomerase II

Question 13

What is the MOA of Tecans?

Answer 13

Inhibit Topoisomerase I

Question 14

List the Tecans

Answer 14

1. Irinotecan
2. Topotecan

Question 15

What is the MOA of Taxenes?

Answer 15

Stabilize microtubules

Question 16

List the Taxenes

Answer 16

1. Paclitaxel
2. Docetaxel

Question 17

What is the MOA of Ixabepilone?

Answer 17

Microtubule Stabilization

Question 18

What is the MOA of Eribulin?

Answer 18

Binds and blocks plus ends of microtubules

Question 19

What is the MOA of Anti-Androgens?

Answer 19

Inhibit/degrade the androgen receptor

Question 20

List the Anti-Androgens

Answer 20

“TAMIDE”

Question 21

What is the MOA of Anti-Estrogens?

Answer 21

Inhbit/degrade the estrogen receptor

Question 22

List the Anti-Estrogens

Answer 22

1. Tamoxifen
2. Fluvestrant

Question 23

What is the MOA of Aromatase Inhibitors?

Answer 23

Block the rate-limiting step in estrogen synthesis

Question 24

List the Aromatase Inhibitors

Answer 24

“OZOLE”

Question 25

What is the MOA of Arsenic Trioxide?

Answer 25

Induces apoptosis through reactive oxygen species

Question 26

What is the MOA of BCG Vaccine?

Answer 26

Enhances immune system to remove tumor cells

Question 27

What is the MOA of CDK4/6 Inhibitors?

Answer 27

Arrest cells in G1/S Phase

Question 28

List the CDK4/6 Inhibitors

Answer 28

"CICLIB"

Question 29

What is the MOA of PARP Inhibitors?

Answer 29

Block PARP DNA Repair Enzyme = DNA strand breaks

Question 30

List the PARP Inhibitors

Answer 30

"PARIB"

Question 31

What is the MOA of Vitamin A Derivatives?

Answer 31

Induce tumor cell differentiation to become more mature, less malignant cells

Question 32

List the Vitamin A Derivatives

Answer 32

1. Tretinoin 2. Bexarotene

Question 33

What is the MOA of Differentiating Agents?

Answer 33

Sonic Hedgehog

Question 34

List the Differentiating Agents

Answer 34

"DEGIB"

Question 35

What is the MOA of Proteasome Inhibitors?

Answer 35

Block proteasome 26S and 20S

Question 36

List the Proteasome Inhibitors

Answer 36

"ZOMIB"

Question 37

What is the MOA of Selinexor?

Answer 37

Blocks Exportin-1

Question 38

What is the MOA of Venetoclax?

Answer 38

Blocks BCL-2

Question 39

What is the MOA of Trastuzumab?

Answer 39

Blocks EGF binding to HER2/NEU

Question 40

What is the MOA of Pertuzumab?

Answer 40

Blocks HER2/NEU Dimerization

Question 41

What is the MOA of Lapatinib?

Answer 41

Blocks HER2/NEU Activity

Question 42

What is the MOA of EGFR-1 Tyrosine Kinase Inhibitors TKIs?

Answer 42

Block EGFR

Question 43

List the EGFR TKIs

Answer 43

1. Erlotinib 2. Afatinib

Question 44

What is the MOA of Cetuximab?

Answer 44

Anti EGFR Monoclonal Antibody ONLY works on Wild Type KRAS

Question 45

What is the MOA of Imatinib?

Answer 45

Inhibit BCR Kinase

Question 46

What is the MOA of Crizotinib?

Answer 46

Inhibits ALK Kinase

Question 47

What is the MOA of Imbrutinib?

Answer 47

Inhibits Bruton tyrosine kinase

Question 48

What is the target of Sotorasib and Asagrasib RAS?

Answer 48

Mutant KRAS

Question 49

What is the target of Vemurafenib and Dabrafenib RAF?

Answer 49

B-Raf

Question 50

What is the target of Trametinib, Cobimetinib, Binimetinib MET?

Answer 50

MEK 1/2

Question 51

What is the target of Idelisib, Copanlisib, Pelisib, and Umbrolisib LISIB?

Answer 51

PI-3 Kinase

Question 52

What is the target of Everolimus and Temsirolimus LIMUS?

Answer 52

mTOR

Question 53

What is the MOA of Midostaurin?

Answer 53

Smalle molecule inhibitor of multiple signaling kinases

Question 54

What is the MOA of Bevacizumab?

Answer 54

Anti VEGF

Question 55

What is the MOA of Pomalidomide and Lenalidomide OMIDE?

Answer 55

Blocks VEGF and bFGF

Question 56

What is the MOA of Sorafenib and Sunitinib?

Answer 56

Blocks VEGFR2 and PDGFR

Question 57

What is the MOA of Ipilmumab?

Answer 57

CTLA4 Inhibitor

Question 58

What is the MOA Pembrolizumab and Nivolumab?

Answer 58

PD1 Inhibitor

Question 59

What is the target for Rituximab and Obunutuzumab?

Answer 59

CD20

Question 60

What is the MOA of Blinatumomab?

Answer 60

BiTES

Question 61

What is the target of Denileukin?

Answer 61

Interleukin 2

Question 62

What is the target of Intotuzumab?

Answer 62

CD22

Question 63

What is the MOA of T-VEC?

Answer 63

Virus

Question 64

What is the MOA of Tisagenlecleucel LEUCEL?

Answer 64

CART

Question 65

Define Neutropenia

Answer 65

Neutrophils <1500

Question 66

Define Normal Platelet Range

Answer 66

140,000-440,000

Question 67

Define Thrombocytopenia

Answer 67

<140,000 platelets

Question 68

What decreases platelet PRODUCTION?

Answer 68

Chemotherapy

Question 69

What increases platelet DESTRUCTION?

Answer 69

Heparin and Penicllin

Question 70

What decreases platelet FUNCTION?

Answer 70

NSAIDs/ASA

Question 71

Substance P = ____ CINV

Answer 71

Delayed

Question 72

Serotonin 5HT = ____ CINV

Answer 72

Acute

Question 73

Minimal Acute CINV give what?

Answer 73

No prophylaxis

Question 74

Low Acute CINV give what?

Answer 74

Dexamethasone

Question 75

Moderate Acute CINV give what?

Answer 75

3 Drug Regimen 1. 5HT3: Ondansetron 2. Dexamethasone 3. +/- NK Antagonist: Aprepitant/Fosaprepitant

Question 76

High Acute CINV give what?

Answer 76

3-4 Drug Regimen 1. 5HT3: Ondansetron 2. Dexamethasone 3. NK Antagonist: Aprepitant/Fosaprepitant 4. +/- Olanzapine (breakthrough/refractory CINV)

Question 77

Minimal/Low Delayed CINV give what?

Answer 77

No prophylaxis needed

Question 78

Moderate Delayed CINV give what?

Answer 78

1. NK Aprepitant +/- Dexamethasone OR 2. Dexamethasone alone OR 3. 5HT3 alone

Question 79

High Delayed CINV give what?

Answer 79

Aprepitant + Dexamethasone +/- Olanzapine

Question 80

Low Emetic Agents use what?

Answer 80

NO NK1 antagonists Use 1 agent

Question 81

Moderate Emetic Agents use what?

Answer 81

1. 5HT3 + Dexamethasone +/- NK1 Antagonist OR 2. Palonesetron + Dexamethasone + Olanzapine

Question 82

High Emetic Agents use what?

Answer 82

5HT3 + NK Antagonist + Dexamethasone +/- Olanzapine

Question 83

Define Palliative Care

Answer 83

1. Begins at time of disease 2. Provided over many years to all patients w/serious illness 3. Specialist

Question 84

Define Hospice

Answer 84

1. Begins after of treatment of disease is stopped 2. ONLY for patients with lifespan <6 months 3. Hospice Clinicians

Question 85

Define Hyperuricemia

Answer 85

Uric Acid >8

Question 86

Define Hyperkalemia

Answer 86

Potassium >6

Question 87

Define Hyperphosphatemia

Answer 87

Phosphorous >6.5

Question 88

Define Hypocalemia

Answer 88

Calcium <7

Question 89

Antihyperuricemic Agents are used in TLS, name the 2 agents.

Answer 89

1. Allopurinol 2. Rasburicase

Question 90

What is used to stabilize the heart in TLS?

Answer 90

Calcium Gluconate

Question 91

What happens in TLS?

Answer 91

1. Hyperurecemia 2. Hyperkalemia 3. Hyperphosphatemia 4. Hypocalcemia

Question 92

T/F: You can give Calcium Gluconate in symptomatic hypocalcemia.

Answer 92

True

Question 93

Decreased Calcium triggers PTH to what?

Answer 93

Increase calcium

Question 94

Increased PTH trigger Calcitriol to do what?

Answer 94

Increase calcium

Question 95

Increased calcium triggers Calcitonin to do what?

Answer 95

Decrease Calcium

Question 96

Formula for Corrected Calcium

Answer 96

Measured Calcium + [0.8 x (4-Albumin)]

Question 97

When do you treat Hypercalcemia?

Answer 97

1. Moderate 12-13.9 corrected Ca with symptoms 2. Severe >14 corrected Ca

Question 98

What are the symptoms of Hypercalcemia?

Answer 98

1. Painful Bones 2. Renal Stones 3. Abdominal Groans 4. Psychic Moans

Question 99

Treatment of Hypercalcemia

Answer 99

1. Hydration 2. Loops 3. IV Bisphosphonate (moderate and up) 4. Calcitonin (severe)

Question 100

Define Neutropenic Fever

Answer 100

1. Single temp >38.3/101 2. Temp >38/100.4 sustained over 1 hour

Question 101

Define Neutropenia

Answer 101

1. ANC <500 2. ANC <1000 and predicted to decline to <500 over next 48 hours

Question 102

Absolute Neutrophil Count ANC Formula

Answer 102

[(WBC) x (seg % + band %)] / 100

Question 103

What Gram Pos Bugs are a concern in Neutropenic Fevers?

Answer 103

1. Staph Aur MRSA 2. Strep Pneumo

Question 104

What Gram Neg Bugs are a concern in Neutropenic Fevers?

Answer 104

Pseudomonas Aeru

Question 105

What is outpatient therapy of Neutropenic Fever?

Answer 105

Cipro or Levo + Augmentin

Question 106

What is inpatient therapy of Neutropenic Fever?

Answer 106

Monotherapy Cefepime or Zosyn

Question 107

What is the preferred prophylaxis therapy for Antibacterial Neutropenic Fever?

Answer 107

Levofloxacin

Question 108

What is the most common DLT?

Answer 108

Myelosuppression

Question 109

What is the most common site of toxicity?

Answer 109

Bone Marrow

Question 110

What drugs do NOT cause Bone Marrow Toxicity?

Answer 110

1. Bleomycin 2. Vincristine 3. Hormones 4. Corticosteroids 5. L-Asparaginase 6. Interferons 7. Methotrexate + Leucovorin Rescue

Question 111

What chemotherapy is renal toxic?

Answer 111

Cisplatin

Question 112

When does Nadir occur?

Answer 112

7-14 days

Question 113

What is the primary prevention of Neutropenia?

Answer 113

G-CSF

Question 114

Pegfilgrastim is given when?

Answer 114

Start 1-2 days after completion of chemo, SINGLE DOSE

Question 115

Fligrastim is given when?

Answer 115

Start 1-3 days after completion of chemo, given DAILY

Question 116

What agents are known to cause Thrombocytopenia?

Answer 116

1. Toptecan 2. Carboplatin 3. Gemcitabine 4. Bortezombi

Question 117

ESAs should only be used to treat chemotherapy induced anemia and DC when chemo is complete, but they should NOT be used when intent is ______.

Answer 117

CURATIVE

Question 118

What agents are known to cause Mucositis?

Answer 118

1. 5-FU 2. Methotrexate 3. Doxorubicin 4. Pemtrexed 5. Stem Cell Transplant

Question 119

What is indicated for prevention of mukositits and is a human keratinocyte growth factor?

Answer 119

Palifermin

Question 120

What agents are known to cause Diarrhea?

Answer 120

1. 5-FU 2. Immunotherapy 3. Irinotecan

Question 121

What is used for treatment of Diarrhea?

Answer 121

1. Atropine - irinotecan only 2. Loperamide - AVOID in immunotherapy 3. Octreotide - SEVERE only

Question 122

What agent is known to cause Constipation?

Answer 122

Vincristine

Question 123

T/F: Anthracyclines are NOT cardiac toxic?

Answer 123

False

Question 124

Give ______ to protect from Anthracycline Cardiomyopathy?

Answer 124

Dexrazoxane

Question 125

What agent is Pulmonary Toxic?

Answer 125

Bleomycin

Question 126

What agents are Bladder Toxic?

Answer 126

1. Cyclophosphamide 2. Ifosfamide

Question 127

Administer what to aid in Bladder Toxicity?

Answer 127

Mensa

Question 128

What agents have Neurotoxicities?

Answer 128

1. Oxaliplatin = acute/chronic neuropathies 2. Taxanes = peripheral neuropathy

Question 129

What are the Vesicants?

Answer 129

1. Anthracyclines = HOT/DMSO 2. Vinca = COLD/Hyaluronidase 3. Nitrogen Mustard = HOT/Sodium Thiosulfate

Question 130

What agents need test doses?

Answer 130

1. Bleomycin 2. Cetuximab

Question 131

What agents need premedications?

Answer 131

1. Paclitaxel 2. Cetuximab

Question 132

What is the premedication regimen for Paclitaxel?

Answer 132

1. Dexamethasone 2. Famotidine 3. Diphenhydramine

Question 133

What are the irAEs of Ipilimumab?

Answer 133

Diarrhea/Colitis

Question 134

What are the irAEs of PD1 Inhibits (Nivolumab/Pembrolizumab/Atezolizumab)?

Answer 134

"itis" + endocrinopathies

Question 135

BSA Formula

Answer 135

Square Root [ (height cm x weight kg)/3600]

Question 136

Diffuse Large B cell Lymphoma DLBCL is the most common ____.

Answer 136

NHL

Question 137

What is therapy for DLBCL?

Answer 137

RCHOP

Question 138

Define RCHOP

Answer 138

R = rituximab C = cyclophosphamide H = doxorubicin O = vincristine P = prednisone

Question 139

What do you pretreat with for Rituxumab?

Answer 139

APAP + Diphenhydramine

Question 140

T/F: Do NOT administer Vincristine Intrathecally.

Answer 140

True

Question 141

Therapy Options for R/R DLBCL

Answer 141

1. RGemOx -preferred 2. RICE -preferred 3. Polatuzumab Vedotin - 2nd line/bridge 4. Tafasitmab + Lenalidomide -2nd line/bridge for patients not suitable for intense therapy 5. Loncastuximab - 3rd line for patients not sutiable for intense therapy 6. CART

Question 142

Define RICE

Answer 142

Rituximab, Ifosfamide, Carboplatin, Etoposide

Question 143

Define RGemOx

Answer 143

Rituximab, Gemcitabine, Oxaliplatin

Question 144

Polatuzumab Vedotin is used in combo with what for 2nd line therapy of R/R DLBCL?

Answer 144

Bendamustine + Rituximab

Question 145

Lenalidomide requires _____ QD?

Answer 145

ASA 81 mg

Question 146

Loncastixumab Tesirine requires ______ to prevent edema?

Answer 146

Dexamethasone

Question 147

Define CLL

Answer 147

Chronic Lymphocytic Leukemia

Question 148

What agent requires dexamethasone eye drops to prevent conjunctivitis?

Answer 148

Cytarabine (used in AML)

Question 149

What is the toxicity concern with daunorubicin + cytarabine combo?

Answer 149

Prolonged Cytopenia

Question 150

What agent is Liver Toxic?

Answer 150

Gemtuzumab Ozogamicin (AML)

Question 151

What class requires Bactrim prophylaxis due to PJP Infection toxicity?

Answer 151

Corticosteroids Prednisone/Dexamethsone (ALL)

Question 152

Blinatumomab used in CLL can cause what AE?

Answer 152

Cytokine Release Syndrome

Question 153

CLL Upfront Therapy with/without 17p deletion

Answer 153

1. Acalabrutinib 2. Obinutuzumab 3. Ventoclax 4. +/- Rituxumab (+frail/old >65)

Question 154

CLL R/R Therapy for 17p deletion

Answer 154

1. Acalabrutinib 2. Ventoclax 3. Rituximab

Question 155

Optimal Therapy for SCLC LIMITED Stage (small cell lung cancer)

Answer 155

1. Cisplatin 2. Etoposide Can switch to carboplatin if cisplatin not tolerated

Question 156

Optimal Therapy SCLC EXTENSIVE Stage

Answer 156

1. Atezolizumab 2. Carboplatin 3. Etoposide

Question 157

What do you give with Pemetrexed?

Answer 157

Folic Acid and Vitamin B12

Question 158

Do you pretreat with Pemetrexed?

Answer 158

YES, dexamethasone for cutaneous reactions

Question 159

Therapy Stage IA NSCLC

Answer 159

Surgery

Question 160

Therapy Stage IB, II, IIA NSCLC

Answer 160

1. Surgery 2A. EGFR IF ex19del/L858R + Osimertinib 2B. Adjuvant Cisplatin 3. (ONLY IF 2B was done) IF PD1.1 + Adjuvant Atezolizumab

Question 161

Therapy Stage IIIA, IIIB, IIIC NSCLC

Answer 161

1. CRT 2. Durvalumab

Question 162

Therapy Metastatic NSCLC Adenocarcinoma NON-Squamous

Answer 162

1A = EGFR Inhibitor 1B = ALK Inhibitor

Question 163

Therapy Metastatic NSCLC SQUAMOUS Carcinoma

Answer 163

1A. EGFR 20 = Osimertinib 1B. KRAS G12C = Sotosanib

Question 164

If the patient received immunotherapy monotherapy for NSCLC, what can they receive 2nd line?

Answer 164

Platinum Doublet = carboplatin + pemetrexed

Question 165

If the patient progressed on immunotherapy + chemotherapy combo NSCLC, what can they receive 2nd line?

Answer 165

Docetaxel +/- Reamucirumab

Question 166

If a patient had EGFR 20 or KRAS G12C what can they receive on 2nd line setting?

Answer 166

Targeted Therapy = Osimertinib or Sotorasib

Question 167

If a patient progressed on Osimertinib NSCLC, what can they received next?

Answer 167

Platinum Doublet = carboplatin + pemetrexed

Question 168

If a patient progressed on Alectinib NSCLC, what can they received next?

Answer 168

Lorlatinib

Question 169

AVOID what agents with Squamous Cell Carcinoma?

Answer 169

1. Bevacizumab 2. Pemetrexed

Question 170

What is first line therapy for patients with NO targetable mutations NSCLC (KRAS G12C or EXON 20)?

Answer 170

Squamous = Pembro + Carbo + Paclitaxel Nonsquamous = Pembro + Carbo + Pemetrexed