Lung Cancer 1: Drugs

Question 1

What are the drug classes used in lung cancer

Answer 1

Alkylating drugs, antimicrotubules, antimetabolites, Topoisomerase inhibitors, and novel agents

Question 2

What are is the dose limiting toxicity of alkylating agents, other side effects

Answer 2

Myelosuppresion/ Nausea and vomitting, secondary leukemias

Question 3

What are the two classes of alkylating drugs

Answer 3

Platinum derivatives and nitrogen mustards

Question 4

What are the platinum derivatives, nitrogen mustards

Answer 4

Cisplatin, Carboplatin, Oxaliplatin/ Ifosfamide and cyclophosphamide

Question 5

T/F: Cisplatin is only reconstituted in NaCl, oxaliplatin is only reconstituted in D5W, and carboplatin can be reconstituted in both

Answer 5

True

Question 6

`Which platinum derivates are most known for causing myelosuppresion

Answer 6

Oxaliplatin and carboplatin

Question 7

What dose limiting toxicity is cisplatin most known for

Answer 7

Nephrotoxicity

Question 8

What labs should be monitored for all three platinum derivates/ just cisplatin and carboplatin

Answer 8

SCr, CBC with differential/ Mg K Phos

Question 9

How is nephrotoxicity avoided for these patients taking cisplatin

Answer 9

Vigourous hydration

Question 10

How is neurotoxicity caused by cisplatin, risk factors

Answer 10

Damage to dorsal root ganglia and peripheral nerves causing slowing or reduction in nerve conductions (slow and reversible), DM and alcohol use

Question 11

T/F: Oxaliplatin causes loss of hearing by damaging hairy cells in the cochlea and it is irreversible

Answer 11

True: Cisplatin causes loss of hearing by damaging hairy cells in the cochlea and it is irreversible

Question 12

What is given for electrolyte disturbances due to cisplatin

Answer 12

Administer IV magnesium 2 to 4 grams, Replace K and Phos as needed

Question 13

Cisplatin causes mostly anemia due to its myelosuppression instead of thrombocytopenia and neutropenia

Answer 13

True

Question 14

Which platinum agent needs to be dosed using an equation due to being based on AUC and GFR

Answer 14

Carboplatin, Calvert Equation: Dose (mg) = Target AUC X (GFR + 25) (Cap CrCl is 125 ml/min)

Question 15

What type of myelosuppresion is seen with Carboplatin,nadir

Answer 15

Thrombocytopenia, 17-21 days

Question 16

What are parameters of acute neuropathy caused by oxaliplatin, delayed

Answer 16

Cold induced, minutes to hours after infusion/ over time (chronic)

Question 17

What drugs can be given for delayed neuropathy caused by oxaliplatin

Answer 17

Tramadol, TCAs, gabapentin, SNRIs

Question 18

What is the BBW for platinum agents,most likely causes, management

Answer 18

Type 1 hypersensitivity (IgE mediated) (carboplatin and oxaliplatin)/ antihistamines, corticosteroids, epinephrine

Question 19

Which platinum agent is most likely to cause peripheral neuropathy

Answer 19

Oxaliplatin

Question 20

What are the two classes of antimicrotubules that are used to treat lung cancer

Answer 20

Vinca alkaloids (destabilizing) and Taxanes (stabilizing)

Question 21

What are the vinaca alkaloids

Answer 21

Vincristine, vinblastine, Vinorebline

Question 22

T/F: Vinca alkaloids is IV only and highly protein bound

Answer 22

True

Question 23

What enzyme metabolizes vinca alkaloids, what causes dose adjustements

Answer 23

CYP3A4/ bilirubin and AST/ALT

Question 24

Which vinca alkaloid causes the most neurotoxicity, myelosuppresson, other side effects from all three

Answer 24

Vinicristine,Vinorebline then vinblastine/ constipation and alopecia

Question 25

T/F: Vinicristine neuortoxicity that is irreversible includes foot drop ataxia, upper and lower extremity weakness,

Answer 25

True

Question 26

What is the most recommended drug for vinicristine neurotoxicity

Answer 26

Duloxetine

Question 27

What are the prefered methods to give vinca alkaloids , how can it never be administered

Answer 27

IVPB and IVP/ Intrathecally (caused ascending myeloencephelopathy)

Question 28

What are extravastation side effects due to vinca alkaloids/ management

Answer 28

blistering, tissue damage, and necrosis/ Stop infusion, Apply warm packs to site, Hyaluronidase to the site of extravastation

Question 29

T/F: Vinicristine causes more neurotoxicity while vinorelbine and vinablastine causes neutropenia (myleosuppression)

Answer 29

True

Question 30

What are the taxanes

Answer 30

Paclitaxel (camaphor), nab-placlitaxel, docetaxel (tween 80), cabizitaxel (tween 80)

Question 31

T/F: Taxanes also have dose adjustments due to bilirubin and AST/ALT

Answer 31

True

Question 32

What are the paclitaxel drug-drug interactions

Answer 32

Doxorubicin: increases doxorubicin increasing toxicity (separate 24 hours), Carboplatin: decreased paclitaxel clearance and increased myelosuppresion (paclitaxel 24 hours before carboplatin, phenytoid: increased paclitaxel metabolism (potentially increase paclitaxel dose)

Question 33

What liver enzyme metabolizes the taxanes

Answer 33

CYP3A4

Question 34

What pre-medications should be given before paclitaxel is given to a patient

Answer 34

Diphenhydramine 50 IV PLUS Famotidine 20 mg IV PLUS Dexemethasone 20 mg PO or IV 30-60 min prior (or 10 mg PO/IV for two doses 6 and 12 hours before chemo)

Question 35

What adverse effects does paclitaxel have

Answer 35

Myelosuppresion (incidence higher if infused longer), peripheral neuropathy, alopecia all over``

Question 36

Which topoisomerases are used in lung cancer

Answer 36

Etoposide, Irinotecan, and tepotican

Question 37

What is the prodrug for etoposide

Answer 37

Etoposide phosphate

Question 38

T/F: IV Etoposide is half the oral dose

Answer 38

True