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NAPLEX STUDY > Oncology > Flashcards

Oncology Flashcards

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
Q

ESAs

A

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

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26
Q

acute CINV

A

5-HT3-RA
NK1 receptor antagonists
dexamethasone
olanzipine

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27
Q

Delayed CINV

A

NK1-RA, corticosteroids, palonosetron, olanzapine

28
Q

anticipatory CINV

A

benzos: start the evening prior to chemo to alleviate anxiety and n/v

29
Q

5-HT3 RA

A

-setron
ondansetron, granisetron, palonosetron

30
Q

NK1-RA

A

aprepitant, fosaprepitant, rolapitant

31
Q

high emetic risk

A

3 or 4 drugs
-NK1-RA + 5HT3 RA + olanzapine + dexamethasone
-palonosetron + olanzapine + dexamethasone
-NK1-RA + 5HT3 RA + dexamethasone

32
Q

moderate emetic risk

A

2 or 3 drugs

33
Q

low emetic risk

A

1 drug (any except NK1-RA)

34
Q

Irinotecan

A

causes cholinergic excess, including acute diarrhea with abdominal cramping
-atropine: prevent acute diarrhea
-pilocarpine: for dry mouth

35
Q

Hand-foot syndrome

A

occurs following treatment with capecitabine and fluorouracil
-cooling hands/feet with cold compress
-aquaphor

36
Q

TLS

A

allopurinol or rasburicase (do not use in G6PD deficiency)

37
Q

Hypercalcemia of malignancy

A

-hydration with normal saline and loop diuretic
-calcitonin (Miacalcin)
-IV bisphosphonates: Zoledronic acid (Zometa)
-Denosumab (Xgeva)

38
Q

treatment of immunologic reactions

A

acetaminophen (650 mg PO) and diphenhydramine (IV or PO)

39
Q

major vesicants

A

anthracyclines (dexrazoxane) and vinca alkaloids (hyaluronidase)
-apply cold compresses (except for vinca alkaloids or etoposide use warm compress)

40
Q

Breast Cancer: Hormone-sensitive

A

Premenopausal women:
- tamoxifen (SERM)

Postmenopausal women:
- anastrozole

41
Q

HER2

A

-trastuzumab (herceptin)

42
Q

prostate cancer

A
  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
Q

BSA

A

square root of (ht in cm) * (wt in kg)/3600

44
Q

alkylating agents (hemorrhagic cystitis)

A

cyclophosphamide , ifosfamide, busulfan, carmustine

45
Q

platinum-based compounds (nephrotoxicity and high emetic)

A

cisplatin, carboplatin, oxaliplatin
-anaphylactic reactions - risk increases with repeated doses

46
Q

anthracyclines (cardiotoxicity)

A

doxorubicin and mitoxantrone

47
Q

topoisomerase I inhibitors (diarrhea)

A

irinotecan

48
Q

topoisomerase II inhibitors (pulmonary fibrosis)

A

bleomycin

49
Q

Vinca Alkaloids (peripheral sensory and autonomic neuropathies - constipation)

A

-Vincristine (CNS toxicity than others)
-Vinblastine and vinorelbine (myelosupression)
-vesicants –> use warm compress and hyaluronidase

50
Q

Taxanes (peripheral sensory neuropathies)

A

-severe infusion-related hypersensitivity reactions
-paclitaxel, docetaxal
-use non-PVC bag (except abraxane) with 0.22 micron flter

51
Q

Pyrimidine analog antimetabolites

A

-5-FU > given with leucovorin to help increase efficacy
-capecitabine (Xeldoa) > oral prodrug of 5-FU, DPD deficiency
-hand-foot syndrome, diarrhea, mucositis

52
Q

DPD deficiency

A

-capecitabine
-increases the risk of severe toxicity

53
Q

folate antimetabolites

A

-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
Q

VEGF receptor inhibitor (-ci)

A

bevacizumab and ramucirumab
-HTN, proteinuria
-thrombosis or hemorrhage
-imapired wound healing

55
Q

EGFR inhibitor (-tu)

A

cetuximab and panitumumab
-skin toxicity
-rash

56
Q

HER2 receptor inhibitors (-tu)

A

Traztuzumab and pertuzumab
-cardiotoxicity and teratogenic

57
Q

Antigen-specific binding (-tu)

A

Rituximab and Brentuximab (ADC)
-bone marrow suppression
-reactivation of dormant viruses

58
Q

immune system agents (-li)

A

ipilimumab and pembrolizumab
-immune mediated reactions, colitis, hepatic toxicity, thyroid dysfunction, myocarditis

59
Q

TKi: CML

A

Imatinib (Gleevec)
-must be BCR-ABL positive to use (Philadelphia chromosome)

60
Q

TKi: melenoma/BRAF inhibitors

A

must be V600E or V600K positive to use

61
Q

TKi: NSCLC/EGFR inhibitors

A

must be EGFR mutation-positive to use (exon 19 or 21)

62
Q

TKi: NSCLC/ALK inhibitors

A

must be ALK positive to use

63
Q

common toxicities of TKi

A

hypothyroidism, QT prolongation, hepatotoxicity, diarrhea

64
Q

Gleevec and Xeloda

A

take with food or 1 hour after a meal

65
Q

Arimidex and tamoxifen

A

take without regards to food

NAPLEX STUDY (25 decks)

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