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Flashcards in Oncology I Deck (109):
0

List the warning signs of cancer in adults

Change in bowel or bladder habits
A sore that doesn't heal
Unusual bleeding or discharge
Thickening or lump in breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in wart or mole
Nagging cough or hoarseness

CAUTION

1

Look at cancer screening guidelines in pg 750

Ok

2

List ways on which adults can control their health and reduce their cancer risk

Stay away from tobacco (smoking cessation if needed)

Stay at a health weight

Get moving with regular physical activity

Eat healthy with plenty of fruits and vegetables

Limit how much alcohol u drink (if u drink at all)

Protect your skin

Know you'll, ur FH and ur risks

Have regular check-ups and cancer screening tests

3

Most cancers will not relapse if a pt remains CA free for 5 yrs?

T

4

What's most often the primary tx of CA?

Surgery (if CA is resectable)

5

Role of radiation or chemo?

Neoadjuvant therapy.... May be used b4 surgery to shrink tumor initially

6

What's Neoadjuvant therapy?

Given B4 surgery

7

What's adjuvant therapy?

Radiation and/or chemo done AFTER surgery (to eradicate residual dx and decease recurrence)

8

Chemo regimens are usually designed for synergy?

T

Chemo regimens are designed to complement each other (with different MOA, toxicities, and cell cycle specificity)

9

What's the main cause of ADRs suffered by CA pts?

Damaging effects of chemo on rapidly dividing cells that are not cancerous

10

Where are the normal rapidly dividing cells? SEs from these?

GI, Hair follicles and bone marrow (blood cells)

T4, the most common SEs of chemo are

N/V; Alopecia; Myelosuppression

11

Why must the pts quality of Iife be accessed?

Bcuz of sever SEs of chemo

12

Is chemo advised during pregnacy (both males and females) and during breast feeding?

No

13

List the toxicities caused by chemo agents

Myelosuppression

Neuropathy

Cardiotoxicity

Pulmonary toxicity

Pulmonary toxicity

Nephrotoxicity/Bladder toxicity (cystitis)

Acneform rash

Mucositis

Hand-foot syndrome

Hepatoxicity

Clotting risk

Alopecia

Extravasation

14

What's Myelosuppression? Monitoring?

Bone marrow suppression => Decreased RBC, WBC, and platelets

CBC + differential (includes segs and bands, to calculate absolute neutrophil count (ANC))

15

Which drugs don't cause Myelosuppression?

ABV

Asparaginase

Bleomycin

Vincristine

16

Which chemo agents cause Neuropathy?

PP TV

Platinum agents

Proteosome inhibitors

Taxanes

Vinca alkaloids

17

Monitoring for Cardiotoxicity? What should be avoided?

ECG or ECHO or MUGA monitoring

Chest radiation is avoided...causes more damage

18

Cardiotoxicity is more severe with what agents?

CAB

CML drugs (Imatinib, nilotinib and dasatinib)

Anthracyclines

Breast cancer drugs (Trastuzumab and Lapatinib)

19

High risk agents for Pulmonary toxicity? Monitoring?

BAM

Belomycin

Alkylators (busulfan, Carmustine, Lomustine)

Methotrexate


If pt on any of these. Req pulmonary fxn test

20

Monitoring of Nephrotoxicity/Bladder toxicity (Cystitis)?

BUN

SCr

Urinalysis

Urine output

21

What's used to flush drug out and prevent bladder/renal toxicity?

Hydration

22

What may be used to reduce risk of Cisplatin-induced nal toxicity?

Amifostene (Ethyol)

23

What's always given with Ifosfamide? Why?

MESNA (Mesnex) (also recommended in HIGH doses of cyclophosphamide)

To prevent hemorrhagic cystitis

24

Which agents cuz Acneiform rash?

Cetuximab

Erlotinib

Panitumumab

Sorafenib

Sunitinib

And all agents with EGFR inh MOA

25

What's mucositis?

Painful inflammation of GI tract

Called oral mucositis if conc in mouth

26

High risk agents for Mucositis?

5- fluorouracil

Capecitabine

Irinotecan

Methotrexate

27

Which 2 agents are mist prone to causing Hand-foot syndrome?

Capecitabine

5-FU

28

Agents at mist risk of causing clotting risk?

SERMs (monitor for DVT/PE)

Some immunomodulators eg.
Thalidomide
Lenalidamide
Pomalidomide

29

Which agents cause the highest risk of alopecia?

Taxanes

Anthracyclines

These cause alopecia in nearly 100% of pts

30

What's Extravasation?

Leakage of drug from vein into extravascular space.

31

How to deal with Extravasation? Exception?

Stop infusion

Elevate limb

Use cold compress (except with Vinca alkaloids and Etoposide - use warm compress)

32

Agents that have a high risk of Extravasation?

Anthracyclines

Ixabepilone

Mitomycin

Teniposide

Vinca alkaloids

33

Antidotes for Extravasation caused by Anthracyclines?

Dimethyl Sulfoxide (DMSO)

or

Dexrazoxane (Totect) - Main one

Or

Mitoxantrone


34

Antidotes for Extravasation caused by Vinca alkaloids?

Hyaluronidase

35

Antidotes for Extravasation caused by Mechlorethamine?

Sodium thiosulfate

36

When does the Nadir (lowest point that WBC and platelets reach) occur?

About 7-14 days after chemotherapy

RBC - 120 days after chemo cuz of long lifespans

37

When do cell lines gen recover post-tx?

3-4 weeks pits tx

38

Effect of ESA on some CA?

ESAs can shorten and increase tumor progression in some CA

39

What must be fulfilled b4 ESA is used in CA?

ESA APPRISE (REMS program)

40

Normal hgb levels?

F - 12-16 g/dL

M - 13.5-18g/dL

41

What's ordered to access iron storage and transport?

Serum ferritin + Transferrin saturation + Total iron-binding capacity
(TIBC)

42

Why must iron storage and transport be measured b4 starting ESAs?

ESAs won't work well to correct anemia if iron levels are inadequate

43

BBWs for use of ESAs in CA?

Can shorten overall survival and/or increase the risk of tumor progression or recurrence

Prescribers and hospitals must enroll in and comply with ESA APPRISE

Pt must receive ESA MedGuide (when therapy begins and at least monthly, if continuing)

ESAs shouldn't be used if hgb level < 10g/dL

ESAs aren't indicated for pts when anticipated outcome is cure, since tumor may progress and there's thrombosis risk

44

At what level of hgb is ESA to recommended?

Hgb < 10g/dL

45

List ESA agents

Epoetin alfa (Epogen, Procrit)

Darbepoetin (Aranesp)

46

Brand name of Epoetin alfa (ESA)?

Epogen

Procrit

47

Brand name of Darbepoetin alfa (ESA)?

Aranesp

48

What may contribute to risk of ADRs with ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp)) use?

Rapid rise in hemoglobin (> 1 g/dL over 2 wks)

49

SEs of ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp))?

HTN

Thrombosis

50

Monitoring while on ESAs (Epoetin alfa (Epogen, Procrit) and Darbepoetin (Aranesp))?

Hgb

Hct

Transferrin saturation

Serum ferritin

BP

51

How do u categorize Neutropenia in CA?

< 1,000 mmol/L

52

How do u categorize Severe Neutropenia in CA?

< 500 mmol/L

53

How do u categorize Profound Neutropenia in CA?

< 100 mmol/L

54

Know how to calculate ANC?

Reviewed in calculations chapter

55

Role of CSFs (myeloid growth factors)?

When used prophylactically in pts with high risk of febrile neutropenia, that shorten risk of infection due to neutropenia and reduce mortality from inf

56

Agents under CSFs (myeloid growth factors)?

Sargramostim (Leukime) GM-SCG

Filgrastim (Neupogen) G-CSF

Pegfilgratim (Neulasta) Peglyated G-CSF

57

Brand name of Sargramostim - CSFs (myeloid growth factors)?

Leukine

58

Brand name of Filgrastim - CSFs (myeloid growth factors)?

Neupogen

59

Brand name of Pegfilgrastim - CSFs (myeloid growth factors)?

Neulasta

60

Ses of Filgrastim (Neupogen) & Pegfilgrastim (Neulasta)?

Bone pain

61

SEs of Sargramostim (Leukine)?

Fever

Bone pain

Arthralgias

Myalgias

Rash

62

When's platelet transfusion recommended in thrombocytopenia?

When counts fall below 10,000/mm^3

20,000/mm^3 if pt has an active bleed

63

List agents with high emetic risk (> 90% freq)

Cisplatin

AC combo (Doxorubicin or Epirubici + Cyclophosphamide)

Epirubicin > 90mg/m2

Ifofsamide >= 2 g/m2 per dose

Cyclophosphamide > 1,500mg/m2

Doxorubicin >= 60 mg/m2

64

List agents with minimal emetic risk (< 10% freq)

Majority of monoclonal antibodies
Bevacizumab
Cetuximab
Ipilimumab
Panitumumab
Pertuzumab
Rituximab
Trastuzumab

Bleomycin

Vinca alkaloids

65

List Anti-Emetic regimens for acute nausea and vomiting

Aprepitant (IV = Fosaprepitant) +

Dexamethasone + (1st two are for days 1-4)

Ondansetron (PO/IV) / Granisetron (PO/IV) / Dolasetron (PO only) / Palonosetron (IV preferred) (for day 1 only)

66

What's the alternative for n/v?

Olanzapine-Containing regimen

Olanzapine (PO) + Dexamethasone (IV) + Palonosetron (IV)

67

What's delayed emesis?

Vomiting occurring > 24 hrs after chemo

68

Prevention of delayed emesis?

Dexamethasone

Aprepitant

Palonosetron

( alone or in combo)

69

What may be added for anxiety/amnestic response?

Lorazepam (Ativan)

70

What could be used if upper GI sx similar to GERD are present?

H2RA or PPR

71

What's the gold standard to moderate emergencies chemo?

Steroid + 5-HT3 receptor antagonist

72

Agents used in Low emetic risk chemo?

Single agents eg

Dexamethsone

Or

Prochlorperazine

Or

Metoclopramide

73

Concern with Phenothiazines and Metoclopramide use?

Dopamine-blocking agents... Could cause or worsen movement disorder

Sedating and can cause cognitive dysfunctions

74

When do u reduce Metoclopramide dose?

Renal dysfunction

75

SEs of centrally-acting antihistamines eg diphenhydramine? Why?

Can cause central and periphetal anticholinergic SEs

These may be intolerable in elderly pts

76

Which can be used a 2nd line agents in low emetic risk?

Dronabinol (Marinol)

Nabilone (Cesamet)

(These are delta-9-tetrahydrocannabinol...from cannabis (marijuana))

77

MOA of 5-HT3 antagonist?

Block serotonin, both peripherally on vagal nerve terminals and central in the chemoreceptor trigger zone

78

Agents under 5-HT3 antagonist?

All these can be used in high emetic risk

Ondasetron (Zofran, Zuplenz film)

Granisetron (Granisol soln, Sancuso transdermal patch)

Dolasetron (Anzemet)

Palonosetron (Aloxil)

79

Brand name of Ondansetron (5-HT3 antagonist)?

Zofran

Zuplenz film

IV, PO, ODT, soln

80

Brand name of Granisetron (5-HT3 antagonist)?

Granisol soln

Sancuso transdermal patch

IV, PO, soln

81

Brand name of Dolasetron (5-HT3 antagonist)?

Anzemet

82

Brand name of Palonosetron (5-HT3 antagonist)?

Aloxil

83

What's the single max IV & PO dose of Ondansetron (Zofran, Zuplenz film)?

IV dose - 16mg

PO - 24mg

84

CIs to 5-HT3 antagonists use?

Don't use Dolasetron (Anzemet) IV for acute CINV (due to QT prolongation)

85

SEs to 5-HT3 antagonists use?

HA

Fatigue

Dizziness

Constipation

86

Role of Sancuso patch (Granisetron) in therapy?

Useful if sores in mouth (mucositis)

Apply day before chemo and leave on at least 24 hrs after last session - lasts up to 7 days

87

What's a risk associated with 5-HT3 antagonists use? What should be corrected b4 using 5-HT3 antagonist?

Risk of QT interval (torsades de Pointes)

Correct Mg and K and monitor ECG

88

MOA of Phenothiazines?

Block dopamine receptors in the CNS, including the chemoreceptor trigger zone (among other mechanisms)

89

Agents under Phenothiazines?

Prochlorperazine (Compro)

Chlorpromazine (Thorazine)

Promethazine (Phenergan, Phenadoz, Promethegan)

90

Brand name of Prochlorperazine - Phenothiazines?

Compro

91

Brand name of Promethazine - Phenothiazines?

Phenergan

Phenadoz

Promethegan

92

CI to Phenothiazines?

Don't use in children < 2 yrs

Don't admin Promethazine via SC route

93

SE to Phenothiazines?

Sedation

Lethargy

Acute EPS

94

List corticosteroid used in emetic?

Dexamethasone (Decadron) IV, PO

95

What's the brand name of Dexamethasone?

Decadron

96

Cannabinoids used as emetic?

Dronabinol (Marinol) - C III

Nabilone (Cesamet) - C II

97

How should Dronabinol (Marinol) - C III be stored?

Refrigerate capsules

98

SEs to Cannabinoids (Dronabinol, Nabilone)?

Drowsiness

Euphoria

Increased appetite

99

Uses of Substance P/Neurokinin-1 receptor antagonist?

Acute and delayed emesis

100

Agents under Substance P/Neurokinin-1 receptor antagonist?

Aprepitant (Emend)

Fosaprepitant (Emend for inj)

101

Brand name of Aprepitant and Fosaprepitant? (Substance P/Neurokinin-1 receptor antagonist)

Aprepitant (Emend)

Fosaprepitant (Emend for inj

102

SEs of Substance P/Neurokinin-1 receptor antagonist (Aprepitant (Emend) and Fosaprepitant (Emend for inj))?

Dizziness

Fatigue

Constipation

Hiccups

103

What's prophylaxis for mucositis that ALL pts can use? Which is FDA approved?

Saline rinse several times daily

(Palifermin (Kepivance) is FDA-approved only for high dose chemo prior to stem cell transplant)

104

What's best to prevent hand-foot syndrome?

Emollients such as petrolatum, Udderly smooth cream and Bag Balm


Note: lotions don't provide adequate protection

105

Whats used early in metastatic dx to PREVENT SKELETAL-RELATED EVENTS (bone pain, skeletal damage eg fracture)

Bisphosphonates

Or

Denosumab (Xgeva)

106

List tx of hypercalcemia of malignancy tx

Hydration with normal saline

Loos diuretics

Calcitonin

IV Bisphosphonates (Zoledronic acid (Zometa) or Pamidronate (Aredia))

107

How's loop diuretics used in CA?

Only with hydration

108

Vaccinations and chemo?

Avoid vaccinations during chemo

Vaccinations must be given at least 2 wks b4 chemo starts

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