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Naplex Oncology Notes Flashcards

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1
Q

Positive Reed-Sternberg cells in the lymph node biopsy indicates what kind of diagnosis?

A

Hodgkin’s Lymphoma

Epstein Barr virus acquired thru HIV also increases risk of HD

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2
Q

Good recommendations to prevent colorectal cancer

A

Increase calcium intake, as well as fiber and antioxidants, and decrease fats

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3
Q

What are indications for a poor prognosis of breast cancer

A

Young (<35 yo); premenopausal, African American, and

HER2/neu overexpression

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4
Q

Primary side effects of Cyclophosphamide?

A

Hemorrhagic cystitis (inflammation of bladder - may see blood in urine); high N/V; mucositis

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5
Q

What can be used to help minimize the side effects of Cyclophosphamide?

A

Maintain adequate hydration to avoid inflammation of bladder, and Mensa

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6
Q

What is the side effect profile of Chlorambucil (Leukeran)?

A

Bone marrow suppression, infertility, secondary leukemias, SJS, hepatotoxicity

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7
Q

Should Leukeran be taken with food or on an empty stomach?

A

Empty stomach

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8
Q

Side effect profile of Carmustine?

A

Severe N/V profile, pulmonary fibrosis, HoTN, secondary leukemias (w/ long term use), reversible increase in LFTs

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9
Q

What is the side effect profile for the -Platin’s: cisplatin, carboplatin, oxaliplatin (Eloxin)

A

Dose-related myelosuppression, Nephrotoxicity!, peripheral neuropathy, rhabdomyolysis (oxaliplatin)

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10
Q

What a side effect special for cisplatin? And Level of emetogenic potential

A

Ototoxicity, high emetogenic potential

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11
Q

What is the max dose for cisplatin?

A

Do not administer doses exceeding 100mg/m^2 every 3 weeks

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12
Q

Of the 3 platin chemotherapies (cisplatin, carboplatin, and oxaliplatin) which 2 are renally dose adjusted?

A

Carboplatin and oxaliplatin

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13
Q

What is the MOA of Cyclophosphamide, Chlorambucil, and Carmustine? Hint all are in the same class.

A

Alkylate DNA, make it more prone to breakage, most effective against rapidly dividing cells

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14
Q

What is the MOA of the platin drugs? (Cisplatin, carboplatin, oxaliplatin)

A

Crosslink DNA, causing it to break

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15
Q

What is the MOA of Irinotecan and Etoposide? (Same drug class)

A

Target enzymes responsible for DNA replication and repair

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16
Q

What is the brand name for Irinotecan and Irinotecan liposomal?

A

Irinotecan = Camptosar

Irinotecan liposomal = Onivyde

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17
Q

What is the major side effect of Irinotecan?

A

Diarrhea, severe and life-threatening

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18
Q

How would you treat the major side effect of Irinotecan?

A

Atropine in early-onset OR loperamide for late-onset diarrhea

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19
Q

How should you administer Etoposide?

A

IV, NOT IV push!

and NOT IM - cases NECROSIS!

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20
Q

What is the MOA of Vincristine, Vinblastine, Paclitaxel, Paclitaxel, and Docetaxel? (Same drug class)

A

Spindle poisons; interfere with mitotic spindle; prevent chromosome segregation and lead to cell death

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21
Q

What are major side effects of Vincristine?

A

Constipation!, Peripheral neuropathy

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22
Q

How do you administer Vincristine?

A

IV, do NOT give intrathecally, AVOID extravasation (vesicant)
Pt should be on a prophylactic bowel management regimen (SE: constipation)

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23
Q

What are major side effects of Paclitaxel (protein bound particles) [Abraxane]?

A

Bone marrow suppression (dose-limiting), peripheral neuropathy, cardiac rhythm abnormalities, MUCOSITIS, STOMATITIS (SEVERE!!)

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24
Q

Max dose for Vincristine?

A

do NOT exceed 2mg/dose

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25
Max dose for Docetaxel?
AVOID doses > 100 mg/m^2
26
Taxotere and Docefrez are the brand names for what chemo-drug?
Docetaxel
27
What is the MOA of antimetabolites (Cytarabine and 5FU)
Nucleoside analogs
28
MOA of Trexall (MTX)?
Folic acid antagonist
29
What can be used as a rescue for patients treated with MTX?
Leucovorin - can be highly toxic Give 24hrs after MTX to limit toxicities; Can enhance 5FU effects
30
What is the side effect profile of Methotrexate (MTX)
Nephrotoxicity, BMS, SJS, severe diarrhea and ulcerative stomatitis, neurotoxicity, hepatotoxicity, pneumonitis, TLS
31
Side effects of Daunorubicin (Cerubidine) and Doxorubicin (liposomal - Doxil)
Cardiotoxicity!! (Dose-related), severe bone marrow suppression, secondary leukemias, red colorations of body fluids!!! Vesicant
32
What is the MOA of anthracyclines? (Daunorubicin and Doxorubicin)
Intercalated DNA and desecrate reactive oxygen species
33
What is the life-time cumulative dose of anthracyclines? And why is there a life-time max?
Greatest risk of irreversible myocardial damage at cumulative dose > 550 mg/m^2
34
What can be used to prevent doxorubicin induced cardiotoxicity or to treat anthracycline-induced extravasation?
Dexrazoxane
35
What 3 types of cancers can Liposomal doxorubicin be used for?
1. Kaposi's sarcoma, 2. multiple myeloma, and 3. ovarian cancer
36
Which 3 anti-hormonal drugs can be used for postmenopausal women?
Anastrozole (Arimidex), Exmestane (Aromasin), Letrozole (Femara)
37
What are the major contraindications for Tamoxifen anti-cancer therapy?
Concurrent warfarin therapy, Hx of DVT or PE
38
What are the major side effects of Leuprolide (Eligard, Lupron Depot)?
Abnormal menses, exacerbation of endometriosis, hot flashes/sweats, decreased BMD (if used > 6 mon), tumor flare, depression, mood disturbances!!
39
How do you administer Lupron aka Eligard?
SQ inj daily or IM injection Q 1-6 mon depending on dosage | Rotate inj sites!!
40
What may seem like a side effect, but may be an indication of a good therapeutic response of Tamoxifen? And how can it be managed?
Bone pain, | Can be managed with mild analgesic
41
What is the side effect profile of tamoxifen?
Thromboembolic events, increased risk of endometrial cancer (duration dep on menopausal status), hot flashes, altered menses, mood disturbances/depression, decreased BMD
42
Which chemotherapy drugs have the common side effect of Cardiotoxicity? (7)
Doxorubicin, Daunorubicin, Idarubicin, Lapatinib, Mitoxantrone, Pertuzumab, Trastuzumab
43
Which chemotherapy drugs have the common side effect of N/V? (5)
Cisplatin, Carboplatin, Cytarabine, Doxorubicin, Cyclophosphamide
44
Which chemotherapy drugs have the common side effect of Mucositis? (4)
Cytarabine, Cyclophosphamide, 5FU, MTX
45
Which chemotherapy drugs have the common side effect of Neuropathy? (4)
Vincristine, Vinblastine, Oxaliplatin, Paclitaxel
46
Which chemotherapy drugs have the common side effect of renal impairment? (3)
Cisplatin, Cyclophosphamide, Ifosfamide
47
Which chemotherapy drugs have the common side effect of pulmonary fibrosis? (2)
Cleomycin, Busulfan
48
Which chemotherapy drugs have the common side effect of Infusion reactions? (2)
Monoclonal antibodies and Paclitaxel
49
Which 4 chemo drugs have a MOA/Target of the CD20 antigen?
Ibritumomab tiuxetan (Zevalin), Obinutuzumab (Gazyva), Ofatumumab (Arzerra), and Rituximab (Rituxan) Do NOT administer live vaccines in these patients!!
50
Which monoclonal antibody chemo drugs would you want to pre-treat with antihyperuricemics and hydration in patients at high risk of TLS? As well as screen for HBV prior to treatment? *Same drugs
Gazyva, Arzerra, and Rituxan
51
What are the major EGFR inhibitors used for chemotherapy? (11)
Afatinib (Gilotrif), Cetuximab (Erbitux), Erlotinib (Tarceva), Gefitinib (Iressa), Lapatinib (Tykerb), Necitumumab (Portrazza), Osimertinib (Tagrisso), Panitumumab (Vectibix), Pertuzumab (Perjeta), Trastuzumab (Herceptin), and Ado-Trastuzumab emtansine (Kadcyla)
52
Of the 11 EGFR inhibitors, which ones are PO? (5)
Gilotrif, Tarceva, Iressa, Tykerb, and Tagrisso
53
Which EGFR inhibitors are used for HER2 positive metastatic breast cancer? (4)
Lapatinib (Tykerb), Pertuzumab (Perjeta), Trastuzumab (Herceptin - also used for gastric cancer), and Ado-Trastuzumab emtansine (Kadcyla)
54
What are major side effects specific for Cetuximab (Erbitux)?
Sudden cardiac death, electrolyte abnormalities
55
Major side effects specific for Erlotinib (Tarceva)?
Renal failure, GI perforation, MI, Rash
56
Which chemo drugs are VEGF inhibitors? (6)
Axitinib (Inlyta), Bevacizumab (Avastin), Cabozantinib (Cabometyx), Ramucirumab (Cyramza), Sorafenib (Nexavar), Sunitinib (Sutent)
57
Which of the VEGF inhibitors are Oral?
Inlyta, Nexavar, and Sutent
58
What are common side effects of EGFRs?
Diarrhea, Rash, Interstitial Lung Disease (ILD), Hepatotoxicity
59
What are common side effects for VEGF inhibitors?
Thromboembolic events (except Sorafenib and Sunitinib), Hemorrhage, Diarrhea, increased LFTs, Rash, impaired healing, HTN
60
Which VEGF inhibitor can affect thyroid function?
Axitinib (Inlyta)
61
Which VEGF inhibitor can be used for metastatic colorectal cancer?
Bevacizumab (Avastin) - infusion related rxns
62
Which chemo drugs are Tyrosine Kinase Inhibitors? (5) | MOA: halt proliferation of tumor cells by inhibiting TK
Bosutinib (Bosulif), Dasatinib (Sprycel), Imatinib (Gleevec), Lenvatinib (Lenvima), Nilotinib (Tasigna)
63
Of all the Oral Tyrosine Kinase Inhibitors, which ones are used for Philadelphia-positive CML and ALL? (4)
Bosulif, Sprycel, Gleevec, and Tasigna | All TKI's are oral
64
What are common side effects of Tyrosine Kinase Inhibitors?
Myelosuppression, rash, TLS, HTN,hemorrhage
65
Which TKI's can cause Hypothyroidism? (2)
Gleevec and Lenvima
66
``` Which TKI's are 3A4 substrates? (4) 3A4 Inhibitors (3)? ```
Bosutinib, Sprycel (inhibitor), Gleevec (inhibitor), Tasigna (inhibitor)
67
Which TKI increases risk of TdP with other drugs that prolong QT interval?
Lenvatinib (Lenvima)
68
Which chemo drugs are Anaplastic Lymphoma Kinase inhibitors? (3) ALK inhibitors - and which are PO?
Alectinib (Alecensa), Ceritinib (Zykadia, Crizotinib (Xalkori) ALL are PO!
69
What are ALK inhibitors used in cancer therapy?
Mainly for ALK-positive metastatic NSCLC
70
Which chemo drug contains radioactive isotopes which require handling?
Zevalin
71
Which anti-nausea drugs would you use for anticipatory nausea?
Benzodiazepines
72
Which anti-emetic would you use for delayed (N/V)? - such seen with cisplatin, Cyclophosphamide, and doxorubicin
Aprepitant
73
Which anti-emetics would you use for less severe cases of N/V with chemotherapy?
Prochlorperazine or metoclopramide
74
Which CYP enzyme is use by Aprepitant?
3A4, substrate and inhibitor
75
Which anti-emetic class should be avoided with serotonergic agents due to increased risk of serotonin syndrome?
5HT3 antagonists such as ondansetron (Zofran), other brand names of 5HT3 antags are Sancuso, Anzemet, Suplenz, Aloxi
76
Which 5HT3 antagonist can be effective in preventing acute and delayed N/V?
Palonosetron (Aloxi)
77
What is a major contraindication of Metoclopramide?
Seizure disorders
78
What is a major side effect specific for Reglan?
Extrapyramidal Symptoms (EPS)
79
What are the 3 CSFs?
Filgrastim (Grantix, Neupogen, Zarxio), PEG-Filgrastim (longer t1/2) (Neulasta), and Sargramostim (Leukine)

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