ONCOLOGY I Flashcards
(118 cards)
1
Q
What is recommended for prevention of colorectal cancer and CVD in patients who are 50-59y, >10% ASCVD, >10 year life expectancy, low risk bleeding
A
aspirin low dose
2
Q
Screening for breast cancer
age 45-54
A
begin yearly mammograms
3
Q
Screening for breast cancer
age >55
A
mammograms every 2 years or continue yearly
4
Q
Cerivical cancer
age 21-29y
A
Pap smear every 3 years
5
Q
cervical cancer
age 30-65
A
Pap smear + HPV every 5 years
6
Q
Colon cancer
>45y
A
stool based tests, fecal occult blood test every year
colonoscopy every 10 years
FSIG every 5 years
7
Q
prostate
>50
A
if a patient opts to be tested-
PSA +/- DRE
8
Q
Lifetime cumulative dose of Bleomycin
A
400 units
9
Q
reason for lifetime cumulative dose of bleomycin
A
pulmonary toxicity
10
Q
lifetime dose of doxorubicin
A
450-550mg/m
11
Q
reason for doxorubicin cumulative dose limit
A
cardiotoxicity
12
Q
cisplatin dose per cycle max
A
100mg/m
13
Q
cisplatin dose limitation is due to
A
nephrotoxicity
14
Q
the single dose of vincristine is capped at
A
2mg
15
Q
why is vincristine capped at 2mg
A
neuropathy
16
Q
What is used to prevent cardiac damage from doxorubicin
A
dexrazoxane
17
Q
What drugs don’t cause myelosuppression
A
Asparaginase
bleomycin
vincristine
18
Q
How do you manage neutropenia
A
colony stimulating factors (CSFs)
19
Q
how do you manage anemia
A
ESAs (in palliation only)
20
Q
How do you manage thrombocytopenia
A
platelet transfusions when very low
21
Q
What are the common drugs that cause N/V
A
cisplatin
cyclophosphamide
ifosfamine
22
Q
management for NV
A
NK1-RA
5HT3-RA
dexamethasone
IV PO fluid rehydration
23
Q
what common drugs cause mucositis
A
fluorouracil
methotrexate
24
Q
Drugs that cause diarrhea
A
methotrexate
fluorouracail
capecitabine
irinotecan
25
What do you give to those that are taking irinotecan to help with early onset diarrhea
atropine
26
constipation drugs
vincristine
*stimulant laxatives, PEG
27
what can be used for xerostomia
artificial saliva substitutes and pilocarpine
28
What drugs are known for causing cardiomyopathy
anthracyclines
| dexrazoxane given with doxorubicin
29
what drugs cause QT
arsenic trioxide, many TKIs (-inib)
30
What drugs cause pulmonary fibrosis
bleomycin
busulfan
carmustine
lomustine
31
What drugs cause pneumonitis
methotrexate and immune therapy MAbs
32
common drugs that cause hepatoxocity
anti androgens (bicalutamide, flutamide, nilutamide)
33
How do you manage hepatotoxicity
steroids, immune therapy MAbs
34
What drugs cause nephrotoxicity
cisplatin
| methotrexate
35
What can help with cisplatin's nephrotoxity?
Amifostine (Ethyol)
36
What drugs can cause hemorrhagic cystitis
ifosfamide (all doses)
| cyclophosphamide (>1g)
37
What helps with hemorrhagic cysitis
mesa is always given with ifosfamide
38
What drugs cause peripheral neuropathy
vinca alkaloids (vincristine, vinblastine, vinorelbine)
platinums
taxanes
39
Which drug causes an acute cold mediated sensory neuropathy?
oxalipplatin - avoid cold temps and cold beverages
40
What drugs cause a risk for clotting
aromatase inhibitors (anastrozole, letrozole), SERMs (tamoxifen, raloxifene)
41
Bleomycin
Busulfan
Carmustine
Lomustine
pulmonary fibrosis
42
Platinum-based (cisplatin, carboplatin(
nephrotoxic/ototoxic
43
Doxorubicin and other anthracyclines
cardiotoxic
44
Methotrexate
mucositis
45
nitrosoureas (lomustine, carmustine)
neurotoxicity
46
Ifosfamide
| cyclophosphamide
hemorrhagic cysitisis
47
vinka alkaloids
| taxanes
peripheral neuropathy
48
immunotherapy targeting CTLA-4 or PD-L1 ipilimumab, atezolizumamb, durvalumab, nivolumab, pembrolizumab
autoimmune syndromes
49
Bone marrow suppression is a common toxicity of many agents including:
```
alkylators
anthracyclines
platinum based compounds (cisplatin)
taxanes
topoisomerase I and II inhibitors
antimetabolites
vinka alkaloids (blasten and vinorelbine)
```
50
cistplatin+
amifostine (Ethyol)
nephrotoxicity
51
Doxorubicin +
dexrazoxane (Zinecard)
Dexrazoxane (Totect)
prevent cardiomyopathy
treatment for extravasation
52
Fluoruracil +
leucovorin or levoleucovorin (Fusilev)
enhance efficacy
53
Fluoruracil or capecitabine +
| antidote
uridine triacetate (Vistogard)
use within 96 hours
54
Ifosfamide +
mesna (mesnex)
| hemorrhagic cystitis
55
Irinotecan +
atropine
loperamide
diarrhea
56
Methotrexate+
leucovorin or levoleucovorin (Fusilev)
glucarpidase (Voraxaze) (antidote_
dec myelosuppression and mucositis
57
What should you do when a drug damages the bladder or kidneys?
get it out!
| normal saline
58
What does myelosuppresion cause?
fewer RBCs, abcs platelets
59
the lowest point that WBCs and platelets reach is called
nadir
occurs 7-14 days after chemo; recovers in 3-4 weeks
60
ANC <1000 =
neutropenia
61
ANC <500
severe neutropenia
62
ANC<100
profound neutropenia
63
____ are given prophylactically after chemo to shorten the time that a patient is at risk for infection due to neutropenia and reduce mortality
CSFs
64
Brand: Neupogen
generic: filgrastim
| * daily
65
Brand: Neulasta
generic: pegfilrastin
| * longer acting/12 days
66
what are the common side effects of CSFs?
bone pain
67
when are empiric antibiotics started?
if a fever occurs with neutropenia
*must cover pseudomonas
68
Which bacteria have the highest risk for causing sepsis?
negative
69
Patient is at low risk of neutropenia (expected ANC<500 for <7 days)
what empiric antibiotics?
oral anti-pseudomonas antibiotics
cipro or levo
PLUS
augmenting or clindamycin
70
Patient is at high risk of neutropenia (expected ANC<100 for >7 days)
what empiric antibiotics?
```
IV anti-pseudomonas beta lactams
cefepime
ceftazidime
meropenem
imipenem/cilastin
pip/tazo
```
71
What levels need to be assessed when receiving ESAs?
serum ferritin
transferrin saturation
total iron binding capacity
72
What factors increase risk of NV
```
female
age <50
anxiety
depression
dehydration
history of motion sickness, N/V with prior regimens
```
73
When do you administer CINV?
30 mins prior to chemo and provide take home meds
74
Acute (within 24 hours after chemo) drug therapy?
5HT3 receptor antagonists (ondansetron, granisetron, dolasetron, palonosetron)
75
Delayed (>24h after chemo)
NK1RA (aripeptant PO, fosaprepitant IV), corticosteroids, palonosetron
olanzapine
76
Anticipaory (before chemo)
Benzes started evening prior
77
High emetic risk antiemetic regimen
3 or 4 drugs
Aripeptant PO + ondansetron + olanzapine + dexamethasone
olanzapine + palonosetron + dexamethasone
Arepitenant PO + ondansetron + dexamethasone
78
Moderate emetic risk
2 or 3 drugs
Arepitenant PO + ondansetron + dexamethasone
ondansetron + dexamethasone
79
low emetic risk
1 drug (NO arepeptant)
80
What medications may be beneficial for breakthrough CINV?
ondansetron
dopamine receptor antagonists (prochlorperazine, promethazine, metoclopramide)
cannabinoids
olanzapine
81
How do you treat acute dystonic reactions? (EPS)
anticholinergics (benztropine, Benadryl)
82
What are Substance P/Neurokinin-1 Receptor Antagonists?
Aprepitant (Emend)
| PO, IV
83
What is the IV version of aprepitant?
fosaprepitant (Emend)
84
When aprepitent is administered what do you do with the steroid dose?
decrease, (3a4 inhibitors)
85
Why can't you administer ondansetron with apomorphine?
severe hypotension
86
When do you apply the granisetron patch?
24-48 hours before chemo
87
Brand: Sancuso
generic: granisetron
88
Brand: aloxi
generic: palonosetron
89
What are side effects of 5HT3-RA
headache
| constipation
90
Brand: Decadron
generic: dexamethasone
91
Examples of dopamine receptor antagonists
prochlorperazine
promethazine
metoclopramide
olanzapine
92
Brand: Compazine
generic: prochlorperazine
93
Brand: Phenergan
generic: promethazine
| * NOT IV* IM is preferred due to extravasation
94
Brand: Reglan
generic: metoclopramide
95
Brand: Zyprexa
generic: olanzapine
96
Boxed warning for metoclopramide
tardive dyskinesia that can be irreversible
97
Dronabinol capsules vs solution
capsule CIII
| solution CII
98
Brand: Marinol
generic: dronabinol
99
Brand: Cesamet
generic: nabilone
100
What is the max of loperamide increased to with CID
24mg/day
101
What causes CID
fluorouracil, capecitabine, irinotecan
| several days later
102
oral mucositis increases the risk of what
candida infection
nystatin oral suspension or clotrimazole troches
103
Treatment for oral mucositis
lidocaine 2% topical solution
104
What syndrome happens commonly with capecitabine and fluorurcail
hand foot syndrome
105
how can you help the hand foot syndrome sypmtoms
cooling hands/feet with cold compress
emollients (aquaphor, Udder cream, Bag balm)
steroids and pain meds
106
In Tumor lysis syndrome, when the cell is lysed, the intracellular components that enter the bloodstream include:
potassium, phosphate, purines, and pyrimidines
*phosphate will bind to calcium = hypocalciema
hyperkalemia = arrhythmias
hyperurciema
107
What is used in TLS to stop the conversion of purines into uric acid
xanthine oxidate inhibitor
| allopurinol 400-800mg/day
108
What can be added to allopurinol if it fails?
rasburicase (C/I in G6Pd def)
109
How do you treat hypercalcemia of maligancy?
water & loops
110
Calcium >12... treatment
IV hydration with normal saline
calcitonin (48h)
IV bisphosphonates are generally considered first line
pamidronate, zoledronic acid
111
Brand: Miacalcin
generic: calcitonin
112
Brand: Zometa
generic: zoledronic acid
4mg IV may repeat in 7 days
(not yearly like in osteoporosis)
113
Brand: Xgeva
generic: denosumab
| monthly!!!! (not every 6 years like in osteoporosis)
114
how do you prevent immunologic reactions? (MAbs)
APAP
| benadryl
115
if extravasation occurs, apply cold compressed except with:
vinca alkaloids and etoposide (warm compress)
116
antidote for anthracyclines with extravasation
dexrazoxane (Totect) or dimethyl sulfoxide
117
antidote for vinca alkaloids and etoposide with extravasation
hyaluronidase
118
what drugs can be given intrathecally
```
cytarabine
methotrexate
hydrocortisone
thiotepa
***PRESERVATIVE FREE****
```
