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NAPLEX Review UWorld > Oncology > Flashcards

Oncology Flashcards

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1
Q

Which of the following should be preparedin a non-PVC container and infused with non-PVC tubing? (SelectALLthat apply.)

A. Docetaxel

B. Doxorubicin

C. Vinblastine

D. Paclitaxel

E. Vincristine

A

Docetaxel

Paclitaxel

These can cause leaching of DEHP when placed in PVC containers.

Also use 0.22 micron filter

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2
Q

Taxanes

What phase of the cell cycle does Taxanes work in?

A

M phase

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3
Q

Taxanes

MOA

A

Inhibit depolymerization (which stabilizes microtubules)

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4
Q

Taxanes

Meds

A

Paclitaxel

Docetaxel

Cabazitaxel (Jevtana)

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5
Q

Taxanes

Safety Concern

A

Peripheral neuropathy

Hypersensitivity rxn

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6
Q

Taxanes: Safety Concern

Peripheral neuropathy

Monitoring & Management

A

Monitoring: Neuropathy S/S (eg, numbness, paresthesia)

Management: Symptomatic care (eg, neuropathic pain medications)

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7
Q

Taxanes: Safety Concern

Hypersensitivity rxn

Monitoring & Management

A

Monitoring:
* Anaphylaxis S/S
* Vital signs (eg, BP, HR)

Management:
* Premedications w/ a systemic steroid, diphenhydramine & an H2RA
* Stop therapy
* Symptomatic care (eg, O2, bronchodilators)

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8
Q

Taxanes: Safety Concern

Docetaxel

Monitoring & Management

A

Severe fluid retention

Monitoring: Fluid retention S/S (eg, edema)

Management:
* Premedication w/ a systemic steroid
* Symptomatic care (eg, diuretics)

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9
Q

A pharmacist has filled a prescription for exemestane (Aromasin). She should include the following points in her counseling to the patient: (Select ALL that apply.)

A. Ensure adequate calcium intake.

B. Ensure adequate vitamin D supplementation.

C. Ensure adequate iron intake.

D. Get immediate help if the patient notices any new or worsening chest pain or becomes short of breath.

E. The patient may experience weakness, extreme fatigue and a desire to eat non-food substances such as paper. If this happens, report these symptoms immediately to a physician.

A

Ensure adequate calcium intake.

Ensure adequate vitamin D supplementation.

Get immediate help if the patient notices any new or worsening chest pain or becomes short of breath.

Aromasin (exemestane) is an aromatase inhibitor that decreases bone mineral density and has an increased risk for cardiovascularevents.

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10
Q

Breast Cancer Risk

A

Female sex

Family History

Genetics
* BRCA1 & BRCA2 gene mutations
* Klinefelter syndrome

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11
Q

Breast Cancer Prevention

A

Surgery (eg, mastectomy)

Risk-reducing medications

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12
Q

Breast Cancer Prevention: Risk-reducing medications

Premenopausal

A

SERM: Tamoxifen (Soltamox)

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13
Q

Breast Cancer Prevention: Risk-reducing medications

Postmenopausal

A

SERM: Tamoxifen, Raloxifene

AI: Exemestane, Anastrozole

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14
Q

Breast Cancer Tx

A

Surgery

Radiation

Chemotherapy

Hormone Receptor-Positive Tx (Endocrine Therapy)

HER2-Positive Tx

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15
Q

Hormone Receptor-Positive Tx (Endocrine Therapy)

Premenopausal

A

SERM: tamoxifen

AI + ovarian ablation/suppression

Ovarian ablation/suppression: Surgery, radiation, or a gonadotropin-release hormone agonist (eg, goserelin, leuprolide)

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16
Q

Hormone Receptor-Positive Tx (Endocrine Therapy)

Postmenopausal

A

SERM: tamoxifen (Soltamax)

AI (eg, anastrozole [Arimidex])

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17
Q

Tamoxifen Safety Concerns

A

Vasomotor Symptoms (eg, hot flashes, night sweats)

↑ risk of thromboembolic events

↑ risk of uterine or endometrial cancer

Vaginal bleeding/discharge

↓ bone density

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18
Q

Tamoxifen

Box Warnings

A

↑ risk of thromboembolic events

↑ risk of uterine or endometrial cancer

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19
Q

Tamoxifen drug intxn

A

Is a prodrug converted via CYP2D6 to endoxifen

Don’t take w/ most antidepressants except venlafaxine

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20
Q

Tamoxifen

What is the preferred antidepressant for hot flashes?

A

Venlafaxine

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21
Q

What supplements should be taken w/ Tamoxifen?

A

Calcium & Vit D

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22
Q

Selective Estrogen Receptor Degrader

Fulvestrant (Faslodex)

A

↑ LFTs

Injection site pain (IM)

Hot flashes

For advance breast cancer

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23
Q

Aromatase inhibitors meds

A

Anastrozole

Letrozole

Exemestane

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24
Q

AI Safety Concerns

A

Osteoporosis
* Calcium & vitamin D supplementation
* Wt bearing exercise
* DEXA screening

↑ risk of cardiovascular disease

Hot flashes/night sweats

Arthralgia/myalgia

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25
HER2-Positive Tx
trastuzumab (Herceptin)
26
A pharmacist receives a prescription for Aloxi. Which drug should be dispensed?  A. Ondansetron  B. Granisetron  C. Dolasetron  D. Palonosetron  E. Netupitant
Palonosetron ## Footnote The generic name of Aloxi is palonosetron. It is available only in an IV preparation, but is available as PO formulation when in combination with netupitant (Akynzeo).
27
# Chemotherapy-Induced N/V (CINV) Classfication
Anticipatory Acute Delayed Breakthrough Refractory
28
# Chemotherapy-Induced N/V (CINV) Anticipatory
**Before** chemo
29
# Chemotherapy-Induced N/V (CINV) Acute
W/in **24 hrs** after chemo
30
# Chemotherapy-Induced N/V (CINV) Delayed
**> 24 hrs** after chemo
31
# Chemotherapy-Induced N/V (CINV) Breakthrough
**Any time** after chemo despite antiemetic PPx
32
# Chemotherapy-Induced N/V (CINV) Refractory
When antiemetic PPx and/or rescue **Tx is ineffective**
33
# Chemotherapy-Induced N/V (CINV) Types of Antiemetics
Neurokinin-1 receptor antagonists (NK1 RAs) Serotonin receptor antagonists (5-HT3 RAS) Dopamine receptor antagonists Other
34
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Neurokinin-1 receptor antagonists (NK1 RAS) | Common Drugs
**Aprepitant** (**Emend**, Cinvanti) **Fosaprepitant** (**Emend**) Rolapitant (Varubi
35
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Neurokinin-1 receptor antagonists (NK1 RAS) | Safety concerns
Generally well tolerated | Can cause abdominal pain or dizziness
36
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Dopamine receptor antagonists | Common Drugs
**Olanzapine** (**Zyprexa**) **Prochlorperazine** (Compro) **Promethazine** **Metoclopramide** (**Reglan**) **Haloperidol**
37
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Dopamine receptor antagonists | Safety Concerns
Acute extrapyramidal Symptoms QT prolongation
38
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Serotonin receptor antagonists (5-HT3 RAS) | Common Drugs
**Ondansetron** (**Zofran**) **Granisetron** (**Sancuso**, Sustol) **Palonosetron** (Aloxi) Dolasetron (Anzemet)
39
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Serotonin receptor antagonists (5-HT3 RAS) | Safety Concerns
QT prolongation (limit IV ondasetron to 16 mg) Serotonin syndrome
40
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Other
**Dexamethasone** **Dronabinol** (**Marinol**) **Lorazepam** (**Ativan**)
41
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Dexamethasone | Safety Concerns
↑ appetite Insomnia
42
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Dronabinol (Marinol) | Safety Concerns
Somnolence Euphoria ↑ appetite
43
# Chemotherapy-Induced N/V (CINV): Types of Antiemetics Lorazepam (Ativan) | Safety Concerns
Anterograde amnesia
44
# Chemotherapy-Induced N/V (CINV): Antiemetic Regimens Goals: Prevent N/V | How?
Give at least 30 minutes before chemotherapy Continue for the full period of emetic risk Add lorazepam for anticipatory nausea and vomiting Have breakthrough agents available
45
# Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk High emetic risk:
**3 or 4 drugs** NK1 RA + 5-HT3 RA + olanzapine + dexamethasone NK1 RA + 5-HT3 RA + dexamethasone Palonsetron + olanzapine + dexamethasone | 90% frequency of acute emesis ## Footnote eg, cisplatin, regimen w/ anthracycline + cyclophosphamide
46
# Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk Moderate emetic risk:
**2 or 3 drugs** NK1 RA + 5-HT3 RA + dexamethasone 5-HT3 RA + dexamethasone Palonsetron + olanzapine + dexamethasone | 30-90% frequency of acute emesis
47
# Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk Low emetic risk:
**1 drug** 5-HT3 RA Dexamethasone Metoclopramide Prochlorperazine | 10-30% frequency of acute emesis
48
# Chemotherapy-Induced N/V (CINV): Antiemetic Regimens: IV Chemo Risk Minimal emetic risk:
No routine PPX | < 10% frequency of acute emesis
49
# Generic Akynzeo
Palonosetron + netupitant
50
During treatment, ST develops an ANC of 326 cells/mm3 and a temperature of 39 degrees Celsius. Which of the following is an appropriate treatment based on these findings?  A. Start a 5HT-3 receptor antagonist until the temperature returns to normal  B. Start an erythropoiesis-stimulating agent  C. Monitor for symptoms of an infection; start antibiotics if symptoms develop  D. Start a colony stimulating factor daily until the ANC recovers  E. Start broad-spectrum antibiotics 
Monitor for symptoms of an infection; start antibiotics if symptoms develop ## Footnote Patients with neutropenia are at risk of death due to sepsis. For febrile neutropenia, broad-spectrum antibiotics should be started immediately and should include activity against Gram-negatives, including Pseudomonas. A colony stimulating factor would be considered for the next cycle of chemotherapy to prevent neutropenia recurrence.
51
Absolute Neutrophil Count
WBC x (%segs + %bands)/100 ## Footnote Segs can also be neutrophils, polys, or polymorphonuclear leukocytes.
52
# Neutropenia Category Neutropenia
< 1,000
53
# Neutropenia Category Sever Neutropenia
< 500
54
# Neutropenia Category Profound Neutropenia
< 100
55
Granulocyte Colony-Stimulating Factors (G-CSFs) | Effects
Stimulate production of white blood cells Shorten duration of neutropenia and reduce mortality from infections Given prophylactically after chemotherapy in high-risk patients
56
# Granulocyte Colony-Stimulating Factors (G-CSFs) Drugs
Filgrastim (Neupogen) Pegilgrastim (Neulast, Neulast OnPro)
57
# Granulocyte Colony-Stimulating Factors (G-CSFs) Pegilgrastim | Dose
Pegylated form of filgrastim → extended half-life 6 mg SC **once per chemo cycle**
58
# Granulocyte Colony-Stimulating Factors (G-CSFs) Filgrastim | Dose
5 mcg/kg IV/SC **QD** Treat through post-nadir recovery
59
# Granulocyte Colony-Stimulating Factors (G-CSFs) When to administor?
No sooner than 24 hrs after chemo
60
# Granulocyte Colony-Stimulating Factors (G-CSFs) Side effects
Bone pain Splenic rupture Rash Hypersensitivity/Allergic reaction
61
# Granulocyte Colony-Stimulating Factors (G-CSFs) Monitoring
CBC w/ differential Vital Signs Upper abdominal pain
62
# Granulocyte Colony-Stimulating Factors (G-CSFs) Storage
Refrigerate Protect vials & syringes from light
63
# Febrile Neutropenia Diagnosis Fever
Single oral temp ≥ 101 F (38.3 C) OR ≥ 100.4 F (38 C) for > 1 hr ## Footnote iFever and Neutropenia meet creteria
64
# Febrile Neutropenia Diagnosis Neutropenia
ANC < 500 OR ANC < 1000 & likely to decline to < 500 over the next 48 hrs ## Footnote Fever and Neutropenia meet criteria
65
What to do if Febrile Neutropenia occurs?
Start empiric antibiotics immediately w/ antipseudomonal coverage
66
# Febrile Neutropenia High risk | Criteria
ANC ≤ 100 for ≥ 7 days, comorbidities
67
# Febrile Neutropenia Tx High risk
IV anti-pseudomonal beta-lactams Cefepime or ceftazidime Imipenem/cilastatin or meropenem Piperacillin/tazobactam
68
# Febrile Neutropenia Low risk | Criteria
ANC ≤ 100 for < 7 days, no comorbidities
69
# Febrile Neutropenia Tx Low risk
Oral anti-pseudomonal antibiotics Ciprofloxacin or levofloxacin + amoxicillin/clavulanate or clindamycin (if penicillin allergy)
70
Thrombocytopenia
↓ in platelets result in uncontrollable bleeding Platelets < 10,000 Platelet transfusion
71
Anemia Management
Observation RBC transfusion Erythropoiesis-stimulating agent (ESA)
72
# Anemia Erythropoiesis-stimulating agent (ESA)
Epoetin alfa (Epogen, Procrit) Darbepoetin alfa (Aranesp)
73
# Anemia Which ESA is short acting?
Epoetin alfa (Epogen, Procrit)
74
# Anemia Which ESA is long acting?
Darbepoetin alfa (Aranesp)
75
# Anemia ESA Benefits
Improved quality of life ↓ Blood transfusions
76
# Anemia ESA Risks
Shortened survival Tumor progression Thrombotic events ↑ All-cause mortality | Do not use w/ chemo for curative intent
77
ESA Admin
Initiate only when hemoglobin < 10 g/dL Use lowest dose needed to avoid RBC transfusions Assess serum ferritin, transferrin saturation, and total iron binding capacity ESAs work optimally in patients with adequate iron stores
78
Anthracyclines MOA
inhibits DNA & RNA synthesis: * Intercalation into DNA * Inhibition of Topoisomerase II Creation of oxygen-free radicals
79
What part of the cell cycle does anthracyclines work on?
The entire cycle
80
# Anthracyclines Side Effect
Cardiotoxicity ## Footnote Main Side Effect
81
# Anthracyclines Doxorubicin (Adriamycin) Dosing
Max lifetime cumulative dose: 450-500 mg/m2 | To prevent Cardiotoxicity
82
Next step if doxorubicin therapy is reached?
Doxorubicin ≥ 300 mg/m2 → Consider dexrazoxane (if continuing Tx) ## Footnote dexrazoxane (Totect, Zinecard)
83
# Anthracyclines Doxorubicin (Adriamycin) Monitoring
LVEF before & after Tx (w/ an ECG or MUGA scan) HF S/Sx (eg, edema, SOB) during Tx
84
What medications related to anthracyclines turns the pt blue?
Mitoxantrone
85
What SPF spectrum should be use to prevention skin cancer?
SPF 30 | Reapply ever 2 hrs
86
Warnings Signs of Melanoma | Mnemonic
ABCDE **A**symmetry **B**order **C**olor **D**iameter > 6 mm **E**volving
87
# Breast Cancer Screening Age & Freq
Start ≥ 45 y/o Annually ≥ 55 y/o can switch to q 2 yrs
88
# Cervical Cancer Age & Freq
Age 25-65 Pap smear q 3 yrs HPV DNA test q 5 yrs Combo q 3 yrs
89
# Colorectal Cancer Age & Freq
≥ 45 y/o Stool-based tests q 3 yrs Visual exams * Colonoscopy q 10 yrs * CT colonography or flexible sigmoidoscopy q 5 yrs
90
# Lung Cancer Age & Freq
≥ 50 y/o Annual CT if: * ≥ 20 pack-year smoking history * Still smoking or quit smoking w/in the past 15 yrs
91
Prostate Cancer
Prostat-specific antigen blood test ± digital rectal exam
92
Monoclonal Antibodies are use for:
Targeted Therapy | For specific biomarkers & proteins
93
Targeted Therapy Actions
Enhances immune system's ability to destroy cancer cells (eg, immunotherapy) Interrupts signals that cause cancer growth Inhibits angiogenesis Induces apoptosis Starves cancer cells of hormones needed to grow (eg, hormone or endocrine therapy
94
# Monoclonal Antibodies Infusion-related Reactions Monitoring
Signs & symptoms (eg, fever, flushing, dyspnea, rash, anaphylaxis) Vital signs (eg, BP, HR)
95
# Monoclonal Antibodies Infusion-related Reactions Prevention
Premedication with acetaminophen & an antihistamine (eg, diphenhydramine)
96
# Monoclonal Antibodies Infusion-related Reactions Treatment
Symptomatic care (eg, oxygen, bronchodilators)
97
# Rituximab (Rituxan) Mechanism
Binds to CD20 antigen
98
# Rituximab (Rituxan) Key Safety Concerns
Hepatitis B reactivation Check hepatitis B panel before starting
99
# Cetuximab (Erbitux) Mechanism
Binds to epidermal growth factor receptor (EGFR)
100
# Cetuximab (Erbitux) Key Safety Concerns
Dermatologic toxicity (eg, acneiform rash) Use general skin care (eg, sunscreen) & prophylactic measures (eg, antibiotics)

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