Oncology

Question 1

Bleomycin

Answer 1

Lifetime cumulative dose: 400 units–> pulmonary toxicity

Question 2

Doxorubicin

Answer 2

lifetime cumulative dose: 450-550mg/m2–> cardiotoxicity

Question 3

Cisplatin

Answer 3

dose per cycle not to exceed 100mg/m2–> nephrotoxicity

Question 4

vincristine

Answer 4

single dose “capped” at 2mg–> neuropathy

Question 5

Drugs that commonly cause myelosuppression

Answer 5

Almost all except: Asparaginase, bleomycin, vincristine

Question 6

Drugs that commonly cause nausea/vomiting

Answer 6

Cisplatin, cyclophosphamide, ifosfamide

Question 7

Drugs that commonly cause Mucositis

Answer 7

Fluorouracil and methotrexate

Question 8

Drugs that commonly cause Diarrhea

Answer 8

Irinotecan, capecitabine, fluorouracil, and methotrexate

Question 9

Drugs that commonly cause constipation

Answer 9

Vincristine

Question 10

Common causes of Xerostomia

Answer 10

Caused by radiation to the head or neck region

Question 11

Drugs that commonly cause cardio toxicity

Answer 11

Cardio myopathy: Anthrcyclines

QT prolongation: arsenic, trioxide, many TKIs

Question 12

Drugs that commonly cause pulmonary toxicity

Answer 12

Pulmonary fibrosis: bleomycin, busulfan, carmustine, lomustine
Pneumonitis:methotrexate and MABs

Question 13

Drugs that commonly cause hepatotoxicity

Answer 13

Antiandrogens (bicalutamide, flutamide, nilutamide)

Question 14

Drugs that commonly cause nephrotoxicity

Answer 14

Cisplatin and methotrexate (in high doses)

Question 15

Drugs that commonly cause hemorrhagic cystitis

Answer 15

Ifosfamide (all doses) cyclophosphamide (higher doses)

Question 16

Drugs that commonly cause neuropathy

Answer 16

Peripheral neuropathy:
Vinca alkaloids (vincristine, vinblastine, vinorelbine)
platinums (cisplatin, oxaliplatin)
Taxanes (paclitaxel, docetaxel, cabazitaxel)
Autonomic neuropathy: Vinca alkaloids

Question 17

Drugs that commonly cause thromboembolic risks

Answer 17

Aromatase inhibitors (anastrazole and letrazole), SERMs (tamoxifen, raloxifene

Question 18

Screening for breast cancer

Answer 18

Female age 40-44yrs–> screening optional
45-54yrs–> yearly mammograms
55 and older–> mammograms every 2 years and annually

Question 19

Screening for Cervical cancer

Answer 19

Female age 21-29–> PAP every 3 yrs

30-65–> PAP and HPV test every 5 yrs

Question 20

Screening for Colon cancer

Answer 20

Males and females age 45 and older–> colonoscopy every 10 yrs

Question 21

screening for lung cancer

Answer 21

Males and females 55-74 CT scan of chest if all of the following: in good health, have at least a 30ppy smoking history, and still smoking or quit within the past 15 years

Question 22

Screening for prostate cancer

Answer 22

Males 50 and older if the patient opts to be tested it involves: Prostate specific antigen (PSA) test +/- a digital rectal exam (DRE)

Question 23

Management of myelosuppression

Answer 23

• Neutropenia: colony-stimulating factors (CSFs)
• Anemia: RBC-transfusions and ESAs (in palliation only)
• thrombocytopenia: platelet transfusions (when very low, especially when bleeding

Question 24

Management of N/V

Answer 24

• Neurokinin-1 receptor antagonist (NK1-RA)
• serotonin-3 receptor antagonist (5HT3-RA)
• dexamethasone
• IV/PO fluids hydration

Question 25

management of mucositis

Answer 25

symptomatic treatment (lidocaine viscous)

Question 26

Management of diarrhea

Answer 26

- IV/PO fluid hydration, antimotility agents (loperamide) | - irinotecan: atropine for early onset diarrhea

Question 27

Management of constipation

Answer 27

stimulant laxatives: (PEG 3350 and Miralax)

Question 28

Management of Xerostomia

Answer 28

artificial saliva substitutes, pilocarpine

Question 29

management of cardio toxicity

Answer 29

Do not exceed recommended lifetime cumulative dose of 450-550 for doxorubicin. give dexrazoxane prophylactically in certain patients getting doxorubicin

Question 30

management of pulmonary toxicities

Answer 30

symptomatic management, stop therapy, or corticosteroids

Question 31

management of hepatotoxicity

Answer 31

symptomatic management, stop therapy, or corticosteroids if an auto immune mechanisms for PD-1 immunotherapy agents

Question 32

management of nephrotoxicity

Answer 32

Amifostine (ethyol) can be given prophylactically with Cisplatin, ensure adequate hydration do not exeeed max Cisplatin dose of 100mg/m2/cycle

Question 33

management of hemorrhagic cystitis

Answer 33

Mesna is always given prophylactically with ifosfamide and sometimes with cyclophosphamide to reduce the risk of hemorrhagic cystitits; always ensure adequate hydration

Question 34

management of neuropathy

Answer 34

systematic treatment with drugs for neuropathic pain. Vincristine: recommended to limit dose to 2mg per week Oxaliplatin: causes an acute cold-mediated sensory neuropathy--> avoid cold temps and beverages Bortezomib: SC is associated with less neuropathy than IV

Question 35

management of thromboembolic risk

Answer 35

Consider thromboembolic prophylaxis based on pt risk factors