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ONCOLOGY Flashcards

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1
Q

What are some of the non-specific cell cycle agents used in cancer chemotherapy?

A
  • Alkylating Agents
  • Platinum-based compounds
  • Anthracyclines
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2
Q

What is the MOA for the **Alkylating Agents **used in Chemotherapy?

A

Cross links DNA strands to inhibit DNA/Protein synthesis = cell death

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3
Q

What are some of the Alkylating Agents what are used in Chemotherapy?

A
  • Cyclophosphamide
  • Ifosfamide (Ifex)
  • Busulfan (Busulfex, Myleran)
  • Carmustine (BiCNU, Gliadel Wafer)
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4
Q

What are some of the Safety concerns for Cyclophosphamide & Ifosfamide?

A

Hemorrhagic Cystitis [caused by acrolein in the bladder]

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5
Q

What are some of the Monitoring for Cyclophosphamide & Ifosfamide?

A

Hematuria, Urinalysis (for RBCs), Dysuria

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6
Q

What are Management for Cyclophosphamide & Ifosfamide?

A
  • Prevent: Hydration
  • Treat: MESNA [for all Ifosfamide and High Cyclo doses > 1 gram/m2]
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7
Q

What are some of the Safety concerns for Busulfan?

A
  1. Pulmonary Toxicity (pulmonary fibrosis)
  2. Seizures
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8
Q

What are some of the Monitoring for Bulsulfan?

A
  1. Signs/symptoms of **Pulmonary Toxicities **(dyspnea, cough, PFTs)
  2. Signs/symptoms of Seizures (tonic-clonic movements, lack of awareness)
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9
Q

What are management for Busulfan?

A
  • Oxygen or supportive care
  • Antiseziure medication (Keppra)
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9
Q

What are Safety Concerns for Carmustine?

A
  1. Signs/symptoms of **Pulmonary Toxicities **(dyspnea, cough, PFTs)
  2. Signs/symptoms of Seizures (tonic-clonic movements, lack of awareness)
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10
Q

What are some of the Monitoring for Carmustine?

A
  1. **Seizures, Headache **
  2. Signs/symptoms of Pulmonary issues, PFTs
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11
Q

What are Management for Carmustine?

A
  1. Oxygen or supportive care
  2. Antiseziure medication
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12
Q

What is the MOA for the Platinum Based Compounds?

A

Cross link DNA, that interfere with DNA Synthesis & cell replication = cell death

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13
Q

What are the Platinum Based Compounds that are used in Chemotherapy?

A
  • Cisplatin
  • Carboplatin (Paraplatin)
  • Oxaliplatin
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14
Q

What are some of the** Safety Concerns** for Platinum Based Compounds?

A
  • Hypersensitivity Reactions
  • Nephrotoxicity
  • Ototoxcity
  • Peripheral Neuropathy
  • Oxaliplatin: Cold exacerbation
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15
Q

What are some of the monitoring for Platinum Based Compounds?

A
  • Signs/Symptoms of Anaphylaxis [Hypersensitivity Rx]
  • Renal Function [Nephrotoxcity]
  • Hearing Loss or Tinnitus [Ototoxicity]
  • Numbness, Pain [Neuropathy]
  • Oxaliplatin: Abnormal sensations in hands, feet, perioral area, throat, jaw spasm, chest pressure
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16
Q

What are some of the management for Platinum Based Compounds?

A
  • Symptomatic Care [Hypersensitivity Rx]
  • Hydration, Amifostine [for renal toxcity], LIMIT CISPLATIN TO < 100 mg/m2 [Nephrotoxicity]
  • Avoid other ototoxic meds such as aminoglycosides [Ototoxicity]
  • Avoid cold exposure with Oxaliplatin
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17
Q

What is the MOA for the Anthracyclines?

A

Intercalate DNA (insert into DNA), Inhibition of topoisomerase II, Creation of oxygen-free radicals that damage cells

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18
Q

What are the Anthracyclines that are used in Chemotherapy?

A
  • DoxoRUBIcin (Adriamycin)
  • Danorubicin
  • Mitoxantrone (anthracenedione related to anthracyclines)

All have -RUBI-

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19
Q

What are some of the safety concerns for Doxorubicin?

A
  • Cardiotoxicity
  • Red Discoloration of body fluids

Remember -RUBI- red body fluids

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20
Q

What are some of the safety concerns for Mitoxantrone?

A
  • Blue discoloration of sclera and bodily fluids
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21
Q

What are some of the monitoring parameters for Doxorubicin?

A
  • Left Ventricular Ejection Fraction, s/sx of heart failure
  • Red Urine
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22
Q

What are the Management for Doxorubicin?

Study These Flashcards
A
  • Limit total lifetime dose to 450 - 550 mg/m2
  • Dexrazoxane is a protectant

When doxorubicin cumulative dose >/= 300 mg/m2 with planned continued treatment, consider Dexrazoxane

23
Q

What is the MOA for the Topoisomerase I Inhibitors?

Study These Flashcards
A

Topoisomerase I inhibitors block coiling/uncoiling of double stranded DNA helix during the S PHASE = preventing DNA from sealing up

23
What are some of the **Cell Cycle Specific** drug classes in oncology?
* Topoisomerase I Inhibitors * Topoisomerase II Inhibitors * Vinca Alkaloids * Taxanes * Pyrimidine Analog Antimetabolites * Folate Antimetabolites
24
What are the **Topo I Inhibitors** that are used?
Irinotencan (Camptosar)
25
What are some of the **safety concerns** for the **Topo I Inhibitors**?
* **Acute diarrhea** plus **chonlinergic symptoms** (Salivation, lamcrimation, abdominal cramping) * **Delayed Diarrhea** (> 24 hours after infusion)
26
What are some **monitoring** parameters with the **Topo I Inhibitors**?
* Bowel Movements (how many) * Eletrolytes (K, Mg) * Dehydration (from all the diarrhea)
27
What are the **management** options for the **Topo I Inhibitors**?
* Prevent: **Atropine** * Treat: Acute = **Atropine**; Delayed = **Loperamide** * Symptomatic: Hydration or electrolyte replacement
28
What is the **MOA** for the **Topoisomerase II Inhibitors**?
Topo II **blocks** the coiling/uncoiling of **double stranded DNA **during the **G2 PHASE** = preventing DNA from sealing up
29
What are some of the **Topo II Inhibitors** that are used?
Etoposide
30
What are some **safety concerns** for the **Topo II Inhibitors**?
Infusion related **Hypo**tension
31
What are some **monitoring** parameters with the **Topo II Inhibitors**?
Vitals (BP)
32
What are some **management** options for **Topo II Inhibitors**?
* Prevent: **Infuse over 30 - 60 mins** * Treat: **IV Hydration**, **decrease** infusion rate
33
What is the **MOA** for the **Vinca Alkaloids**?
Inhibit **microtubule formation** during **M PHASE** ## Footnote Microtubules play a role in axonal transport, which is why neuropathies are a common side effect in Vincas
34
What are some of the **Vinca Alkaloids** that are used?
* **Vincristine** * Vinblastine * Vinorelbine
35
What are some of the** safety concerns** for the **Vincas**?
* **Peripheral Neuropathy** * **Autonomic Neuropathy** (Constipation) * **Paralysis**/**Death** if **given intrathecally** ## Footnote Vincas are **ONLY** given as **IV**
36
37
What are the **monitoring** parameters for with the **Vincas**?
* S/sx of neuropathy (**extremity numbness, pain, paresthesia**) * S/sx of constipation (bowel movement frequency, hard stools) * **Make sure to give it IV**
38
What are some of the **management** options for **Vincas**?
* Neuropathy: Prevent - **Limit single vincristine dose to 2 mg**; Treat - Neuropathic meds (gabapentin) * Constipation: Prevent/Treat - diet changes or laxatives * **IV ONLY** - Prepare a **small IV Bag **(**piggyback**) that cannot be used intrathecally, label products
39
What is the **MOA** for the **Taxanes**?
**Inhibits** the **depolymerization** of **tubulin** during the **M PHASE** ## Footnote Destabilizes the microtubules
40
What are some of the **Taxanes** that are used?
* **Paclitaxel** * Cabazitacel (*Jevtana*) * Docetaxel ## Footnote use **NON-PVC** bags and **0.22 micron filters**
41
What are some **safety concerns** for the **Taxanes**?
* **Peripheral Neuropathy** * **Hypersensitivity Reactions** * *Doxetaxel*: **Severe Fluid Retention**
42
What are some **monitoring** parameters with **Taxanes**?
* S/sx of **Neuropathy** (extremity numbness, pain, paresthesia) * S/sx of **Anaphylaxis** * *Docetaxel*: S/sx of **Fluid retention** (edema, dyspnea at rest, abdominal distension)
43
What are some **management** options for the **Taxanes**?
* Neuropathy: Treat - Neuropathic Meds (gabapentin) * Anaphylaxis: Prevent - **Premedication** with **systemic steroid** (dexamethasone), **diphenhydramine**, and **H2RA** (famotidine) Treat - STOP therapy, symptomatic care * Fluid Retention: Prevent - **Premedication** with **systemic steroid** (dexamethasone) Treat - Diuretics
44
What is the **MOA** for the **Pyrimidine Antimetabolites**?
Inhibit Pyrimidine synthesis during **S PHASE** ## Footnote **Leucovorin** is given with 5-FU to **increase** efficacy
45
What are the **Pyrimidine Antimetabolites** that are used?
* **Flurouracil** (*5-FU*) * **Capecitabine** (Oral *prodrug* for 5-FU)
46
What are some **safety** concerns for the **Pyrimidine Antimetabolites**?
* **Hand-and-Foot syndrome** (palmar plantar erythrodysesthesia) * **Diarrhea** * **Mucositis** * **DPD Deficiency**: increase risk of toxicities * Drug interactions with **warfarin** (can significantly **increase INR**)
47
What are some **monitoring** parameters with **Pyrimidine antimetabolites**?
* S/sx of **Hand-foot syndrome** (**peeling of skin, redness**, pain) * Frequency of bowel movements, electrolytes, dehydration * S/sx of Mucositis (**painful mouth ulcers**, difficulty eating or drinking) * S/sx of Toxicities * INR, Bleeding (drug interactions with Warfarin)
48
What are some **management** options for **Pyrimidine Antimetabolites**?
* Hand-foot syndrome: Prevent/Treat - Avoid heat, do cold compresses, **emollients** (urea cream, aquaphor, ammonium lactate), **topical steroids** (clobetasol) and **pain medications** to help inflammation and pain * Diarrhea: Treat - **Loperamide**, hydration, electrolyte replacement * Mucositis: Prevent - **Good oral hygiene**, ice chips, **frequent rinsing** with **bland rinses** (sodium bicarbonate or sodium chloride solutions) Treat - Continue good oral hygiene and frequent rinsing, symptomatic care (**viscous lidocaine 2%, magic mouthwash**), thrush care (**nystatin oral suspension, clotimazole troches**) * Toxicities: Treat - **Uridine Triacetate** (*Antidote used within 96 hours*)
49
What is the **MOA** for the **Folate Antimetabolites**?
**Interferes** with enzymes in the **folic acid cycle**, blocking purine and pyrimidine synthesis during **S PHASE**
50
What are the **Folate Antimetabolites** that are used?
Methotrexate
51
What are some **safety concerns** for the **folate antimetabolites**?
* **Nephrotoxicity** (with **high doses** **> 500 mg/m2**) * **GI toxicities** (**Diarrhea, Mucositis**)
52
What are some **monitoring parameters** with **folate antimetabolites**?
* **Renal Function** (BUN, SCr, Urine Output) * Frequency of bowel movements, electrolytes, dehydration * S/sx of Mucositis (**painful mouth ulcers**, difficulty eating or drinking)
53
What are some of the **management** options for the **folate antimetabolites**?
* Nephrotoxicity: Prevent - **Leucovorin** (increases efficacy), **Hydration** with IV sodium bicarbonate to alkalinize the urine (improves methotrexate solubility), Avoid Drug interactions (NSAIDs, salicylates, beta-lactams, PPIs, sulfonamide antibiotics, probenecid) Treat - **Glucarpidase** (*Antidote* that lowers MTX levels) * Mucositis: Prevent - **Good oral hygiene**, ice chips, **frequent rinsing** with **bland rinses** (sodium bicarbonate or sodium chloride solutions) Treat - Continue good oral hygiene and frequent rinsing, symptomatic care (**viscous lidocaine 2%, magic mouthwash**), thrush care (**nystatin oral suspension, clotimazole troches**)
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