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NAPLEX STUDY > Oncology > Flashcards

Oncology Flashcards

(65 cards)

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1
Q

bleomycin lifetime cumulative dose

A

400 units (pulmonary toxicity)

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2
Q

doxorubicin lifetime cumulative dose

A

450-550 mg/m3 (cardiotoxicity)

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3
Q

cisplatin lifetime cumulative dose

A

dose per cycle not to exceed 100 mg/m3 (nephrotoxicity)

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4
Q

vincristine lifetime cumulative dose

A

single dose capped at 2 mg (neuropathy)

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5
Q

Neurotoxicity

A

Nitrosoureas: Lomustine, Carmustine

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6
Q

Nephrotoxic/Otoxic

A

Platinum-Based: Cisplatin, Carboplatin
-amifostine can be given prior to cisplatin to prevent nephrotoxicity

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7
Q

Mucositis

A

methotrexate and flurouracil
-lidocaine viscous
-if candida infection occurs due to incr risk: nystatin suspension, clomitrazole troche

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8
Q

Pulmonary fibrosis

A

Bleomycin, Busulfan, Carmustine, Lomustine

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9
Q

Cardiotoxic

A

Doxorubicin and other anthracyclines
HER2 inhibitors, fluorouracil
-do not exceed cumulative dose, and give dexraoxane to select patients before doxorubicin

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10
Q

Autoimmune syndromes (widespread)

A

immunotherapy targeting CTL-4 or PDL-1: ipillmumab, atezolizumab, durvalumab, nivolumab, pembrolizumab

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11
Q

Hemorrhagic cystitis

A

ifosfamide and cyclophosphamide
-Mesna can be given prophylactically (almost always) with Ifosfamide (sometimes cyclophosphamide) to reduce the risk

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12
Q

Peripheral neuropathy

A

vinca alkaloids (vincristine, vinblastine, vinorelbine) and taxanes (paclitaxel, docetaxel), platinums (cisplatin, oxaliplatin)

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13
Q

myelosuppression

A

almost all chemotherapy drugs except: asparaginase, bleomycin, vincristine, most mAb, and many TKis

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14
Q

Nausea and vomiting

A

cisplatin, cyclophosphamide, ifosfamide

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15
Q

diarrhea

A

irinotecan, capecitabine, fluoruracil, methotrexate
-IV/PO fluid hydration, anti motility medications
-irinotecan: atropine

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16
Q

constipation

A

vincristine

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17
Q

oxaliplatin

A

cold-mediated sensory neuropathy - avoid cold temperatures and cold beverages

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18
Q

leucovorin

A

-given with fluorouracil to enhance efficacy
-given with Methotrexate after high doses to decrease myelosuppression and mucositis

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19
Q

Uridine triacetate

A

antidote for flurouracil or capecitabine
-use within 96 hours for an overdose or to treat severe, life threatening or early onset toxicity

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20
Q

Glucarpidase

A

antidote to decrease excessive methotrexate levels due to acute renal failure

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21
Q

CSFs

A

-Filgrastim (Neupogen), Pegfligrastim (Neulasta)
-bone pain

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22
Q

dx of febrile neutropenia

A

oral temp of 101 (38.3) x 1 reading or oral temperature of 100.4 (38) sustained for > 1 hr

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23
Q

Low-risk ( ANC < 500 for < 7 days)

A

oral antipseudomonal abx
-ciprofloxacin or levofloxacin + augmentin or clindamycin if allergic to penicillins

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24
Q

High risk (ANC < 100 for > 7 days, presence of comorbidities, evidence of renal or hepatic impairment)

A

intravenous anti-pseudomonal beta-lactams
-cefepime, ceftazidime, meropenem, imipenem/cilstatin, zosyn

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25
ESAs
shorten survival and increase tumor progression -palliation only and not for curative intent -only for patients with non-myeloid malignancies where anemia is due to chemo -must be a minimum of two additional months of planned chemotherapy -initiate only when Hgb < 10 g/dL -use the lowest dose needed to avoid RBC transfusions
26
acute CINV
5-HT3-RA NK1 receptor antagonists dexamethasone olanzipine
27
Delayed CINV
NK1-RA, corticosteroids, palonosetron, olanzapine
28
anticipatory CINV
benzos: start the evening prior to chemo to alleviate anxiety and n/v
29
5-HT3 RA
-setron ondansetron, granisetron, palonosetron
30
NK1-RA
aprepitant, fosaprepitant, rolapitant
31
high emetic risk
3 or 4 drugs -NK1-RA + 5HT3 RA + olanzapine + dexamethasone -palonosetron + olanzapine + dexamethasone -NK1-RA + 5HT3 RA + dexamethasone
32
moderate emetic risk
2 or 3 drugs
33
low emetic risk
1 drug (any except NK1-RA)
34
Irinotecan
causes cholinergic excess, including acute diarrhea with abdominal cramping -atropine: prevent acute diarrhea -pilocarpine: for dry mouth
35
Hand-foot syndrome
occurs following treatment with capecitabine and fluorouracil -cooling hands/feet with cold compress -aquaphor
36
TLS
allopurinol or rasburicase (do not use in G6PD deficiency)
37
Hypercalcemia of malignancy
-hydration with normal saline and loop diuretic -calcitonin (Miacalcin) -IV bisphosphonates: Zoledronic acid (Zometa) -Denosumab (Xgeva)
38
treatment of immunologic reactions
acetaminophen (650 mg PO) and diphenhydramine (IV or PO)
39
major vesicants
anthracyclines (dexrazoxane) and vinca alkaloids (hyaluronidase) -apply cold compresses (except for vinca alkaloids or etoposide use warm compress)
40
Breast Cancer: Hormone-sensitive
Premenopausal women: - tamoxifen (SERM) Postmenopausal women: - anastrozole
41
HER2
-trastuzumab (herceptin)
42
prostate cancer
1. GnRH agonists (Leuprolide, Goserelin) -dcr bone density: supplement calcium/vitamin D -tumor flare > prevent with concurrent use of antiandrogen -hot flashes, impotence, gynecomastia, bone pain 2. GnRH antagonist -osteoporosis risk -no tumor flare 3. antiandrogens
43
BSA
square root of (ht in cm) * (wt in kg)/3600
44
alkylating agents (hemorrhagic cystitis)
cyclophosphamide , ifosfamide, busulfan, carmustine
45
platinum-based compounds (nephrotoxicity and high emetic)
cisplatin, carboplatin, oxaliplatin -anaphylactic reactions - risk increases with repeated doses
46
anthracyclines (cardiotoxicity)
doxorubicin and mitoxantrone
47
topoisomerase I inhibitors (diarrhea)
irinotecan
48
topoisomerase II inhibitors (pulmonary fibrosis)
bleomycin
49
Vinca Alkaloids (peripheral sensory and autonomic neuropathies - constipation)
-Vincristine (CNS toxicity than others) -Vinblastine and vinorelbine (myelosupression) -vesicants --> use warm compress and hyaluronidase
50
Taxanes (peripheral sensory neuropathies)
-severe infusion-related hypersensitivity reactions -paclitaxel, docetaxal -use non-PVC bag (except abraxane) with 0.22 micron flter
51
Pyrimidine analog antimetabolites
-5-FU > given with leucovorin to help increase efficacy -capecitabine (Xeldoa) > oral prodrug of 5-FU, DPD deficiency -hand-foot syndrome, diarrhea, mucositis
52
DPD deficiency
-capecitabine -increases the risk of severe toxicity
53
folate antimetabolites
-methotrexate -with high doses leucovorin must be given as a rescue -hydration and IV sodium bicarb must be given to alkalinize the urine and decrease the risk of nephrotoxicity -glucarpidase is an antidote that works quickly to lower methotrexate levels -do not give with NSAIDs or salicylates
54
VEGF receptor inhibitor (-ci)
bevacizumab and ramucirumab -HTN, proteinuria -thrombosis or hemorrhage -imapired wound healing
55
EGFR inhibitor (-tu)
cetuximab and panitumumab -skin toxicity -rash
56
HER2 receptor inhibitors (-tu)
Traztuzumab and pertuzumab -cardiotoxicity and teratogenic
57
Antigen-specific binding (-tu)
Rituximab and Brentuximab (ADC) -bone marrow suppression -reactivation of dormant viruses
58
immune system agents (-li)
ipilimumab and pembrolizumab -immune mediated reactions, colitis, hepatic toxicity, thyroid dysfunction, myocarditis
59
TKi: CML
Imatinib (Gleevec) -must be BCR-ABL positive to use (Philadelphia chromosome)
60
TKi: melenoma/BRAF inhibitors
must be V600E or V600K positive to use
61
TKi: NSCLC/EGFR inhibitors
must be EGFR mutation-positive to use (exon 19 or 21)
62
TKi: NSCLC/ALK inhibitors
must be ALK positive to use
63
common toxicities of TKi
hypothyroidism, QT prolongation, hepatotoxicity, diarrhea
64
Gleevec and Xeloda
take with food or 1 hour after a meal
65
Arimidex and tamoxifen
take without regards to food

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