Oncology II Flashcards
0
Q
Whats Dubois and Dubois Formular?
A
BSA (m^2) = 0.007184 x Height (cm)^0.725 x Weight (kg)^0.425
1
Q
What’s the most commonly used calculations for dosing, body surface area (BSA)?
A
DuBois and DuBois formula
2
Q
Whats Mosteller Formular? Also used for BSA calculation
A
BSA = | (Ht -cm x Wt -kg)/ 3600
3
Q
List phases of cell cycle
A
M - mitosis - cell divides into 2 daughters
Go - Resting phase post mitosis - no cell division occurs
G1 - Post-mitotic phase - where enzymes & proteins are synthesized
S - DNA synthesis and duplication occurs
G2 - Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepare for cell division
4
Q
What’s M-phase of the cell cycle? Drugs that work here?
A
Mitosis - cell divides into 2 daughter cell
Anti-mitotic drugs
Vinca alkaloids
Taxanes
5
Q
What’s Go-phase of the cell cycle? Drugs that work here?
A
Resting phase (post mitosis) - no cell division occurs
None! No drugs work here
6
Q
What’s G1-phase of the cell cycle? Drugs that work here?
A
Post-mitotic phase - where enzymes and proteins are synthesized (Cell growth and preparation for DNA replication)
None!
7
Q
What’s S-phase of the cell cycle? Drugs that work here?
A
DNA synthesis and duplication occurs
Topoisomerase I inhibitors + Anti-metabolites
- Irinotecan
- Topocetan
- MTX
- 5-FU
- Capecitabine
- Pemetrexed
- Cytarabine
8
Q
What’s G2-phase of the cell cycle?
A
Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepared for cell division
9
Q
Which drugs work on both G2 and S-phase?
A
Topoisomerase II inhibitors eg
Etoposide
10
Q
List non-cell cycle specific agents
A
Alkylating agents
Anthracyclines
Platinum agents
11
Q
MOA of Alkylators?
A
Non-cell cycle specific: Cross-links DNA, preventing cell replication
12
Q
List the main Alkylators?
A
Cyclophosphamide (Cytoxan)
Ifofsamide (Ifex)
13
Q
Brand name of Cyclophosphamide? Alkylator (non-cell cycle specific)
A
Cytoxan
14
Q
Brand name of Ifosfamide? Alkylator (non-cell cycle specific)
A
Ifex
15
Q
Whats concern with High-dose Cyclophosphamide (Cytoxan) and all doses of Ifosfamide (Ifex)? What’s done to mitigate concern?
A
Bladder toxicity
Give MESNA (Mesnex) + High-dose Cyclophosphamide (Cytoxan)
MESNA (Mesnex) + ALL doses of Ifosfamide (Ifex)
16
Q
Which Alkylators is a MAO-I?
A
Procarbazine (avoid interacting drugs/food)
17
Q
Which Alkylators is used with non-PVC bag and tubing due to leaching of DEHP?
A
Carmustine
18
Q
BBW of Alkylators?
A
Hemorrhagic cystitis (Ifosfamide, cyclophosphamide)
Secondary malignany
19
Q
Main SE of Busulfan, Carmustine, Lomustine (Alkyaltors)?
A
Pulmonary toxicity
20
Q
Which Alkylators is highly emetogenic and can cause flu-like sx?
A
Dacarbazine (DTIC)
21
Q
MOA of Anthracyclines?
A
Non-cell specific: works by various MOA, including intercalation into DNA
22
Q
List Anthracyclines agents
A
Doxorubicin (Adriamycin)
Idarubicin (Idamycin)
Daunorubicin (Cerubidine)
Mitoxantrone (Novantrone)
23
Q
Brand name of Doxorubicin? Anthracyclines
A
Adriamycin
24
Brand name of Doxorubicin Liposomal? Anthracyclines
Doxil
25
Brand name of Idarubicin? Anthracyclines
Idamycin
26
Brand name of Daunorubicin? Anthracyclines
Cerubidine
27
Brand name of Mitoxantrone? Anthracyclines
Novantrone
28
What limits use of Anthracyclines?
Very effective but use limited by cardiac toxicity and N/V
29
Anthracyclines are vesicants... What's used as an antidote for them?
Dexrazoxane (Totect)
Or
Dimethyl Sulfoxide
Don't use both!
30
How do u mitigate Cardiotoxicity caused by Anthracyclines?
There's max lifetime doses for most of the,
31
What's the max lifetime dose of Doxorubicin (Adriamycin)? With mediastinal radiation?
Doxorubicin = 450-550 mg/m^2
Mediastinal radiation = 450 mg/m^2
32
What's the cardioprotective agent used with Doxorubicin?
Dexrazoxane (Zinecard)
33
When should u consider adding Dexrazoxane (Zinecard) to Doxorubicin?
When doxorubicin doses are anticipated to continue beyond 300 mg/m^2
34
What color do anthracyclines turn body fluids into? Exception?
Red
Mitoxantrone (Novantrone) turns body fluid BLUE
35
BBW of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Irreversible myocardial toxicity
Potent vesicant
36
SEs of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Alopecia
Extravasation
Red urine and body secretions (blue with mitoxantrone)
37
MOA of platinum-based compounds?
Non-cell cycle specific: cross-links DNA, leading to apoptosis
38
Agents under Platinum-based compounds?
Cisplatin (Platinol)
Carboplatin (Paraplatin-AQ)
Oxaliplatin (Eloxatin)
39
Brand name of Cisplatin? Platinum-based compounds
Platinol
40
Brand name of Carboplatin? Platinum-based compounds
Paraplatin-AQ
41
Brand name of Oxaliplatin? Platinum-based compounds
Eloxatin
42
Unique concerns of Ciplatin (Platinol) - Platinum-based compounds?
Nephrotoxicity (vigorous hydration & sometimes, mannitol)
Electrolyte wasting (req Mg and K supplementation)
Ototoxicity (audio grams recommended b4 each prior)
Severe N/V (use 3 drug combo antiemetic regimen)
43
What may be used prophylactically for renal protection when using Cisplatin (Platinol)?
Amifostine (Ethyol)
44
Unique concerns wrt Oxaliplatin (Eloxatin)? Platinum-based Compds
Neuropathy exacerbation by exposure to cold
45
BBW associated with Platinum-based Compds?
Cumulative renal toxicity
46
SEs associated with Platinum-based Compds?
Neuropathy
47
Moa of Folate Antimetabolites?
Cell cycle specific, S-phase: prevent DNA synthesis
48
Agents under Folate Antimetabolites?
Methotrexate (Trexail, Rheumatrex)
Pemetrexed (Alimta)
Pralatrexate (Folotyn)
49
What's req with high-doses of MTX?
Leucovorin (or Levoleucovorin)
To reduce toxicity
50
What meds should be avoided with MTX? Why?
Aspirins, Beta-lactams, Probenecid and NSAIDs
Reduces active transport renal elimination => resulting in toxicity
51
What can be done to reduce toxicity of MTX?
Maintain hydration...drink fluids
Alkalinize urine (by giving bicarbonate IV)
52
What supplements should be used with Pemetrexed (Alimta)?
Folic acid supplements (1mg PO daily)
Vit. B12 (cyanocobalamin) + dexamethasone
53
BBWs of MTX?
Preserved formulation for intrathecal admin
54
SEs of MTX (Trexail, Rheumatrex)?
Myelosuppression
Mucositis
Hepatic and renal toxicity (renal is dose-related)
Pulmonary toxicity
Red-tender palms and feet (hand-foot syndrome)
55
MOA of Pyrimidine Analog Antimetabolites?
Cell cycle specific, S-phase: inihibits Pyrimidine synthesis
56
Agents under Pyrimidine Analog Antimetabolites?
Capecitabine (Xeloda)
Cytarabine (Ara-C, Cytosar)
Fluorouracil (5-FU, Adrucil)
Gemcitabine (Gemzar)
57
Brand name of Capecitabine? Pyrimidine Analog Antimetabolites
Xeloda
58
How should Capecitabine (Xeloda) be used?
PO --- take with meal
59
What testing should done with Capecitabine (Xeloda) use?
Pharmacogenomics testing for Dihydropyrimidine dehydrogenase (DPD)
Deficiency increases risk of sever toxicity
60
Capecitabine (Xeloda) and INR?
Increases INR up to 91% due to 2C9 inhibition
61
CI to Capecitabine (Xeloda) use?
Dihydropyrimidine dehydrogenase (DPD) deficiency
62
SEs of Capecitabine (Xeloda)?
Hand-foot syndrome (more than 5-FU)
Diarrhea
Mucositis
Gastritis
63
Unique concerns wrt Cytarabine (Ara-C, Cytosar)?
Ara-C syndrome eg fever, gen weakness, fatigue, skin rash, reddened eyes, bone, muscle, joint and/or chest pain
Responds to Coticosteroids
64
Brand name of Fluorouracil (Pyrimidine Analog Antimetabolites)?
5-FU
65
What's Fluorouracil given with? Why?
5-FU is given with Leucovorin
To increase efficacy of 5-FU
66
CI to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Dihydropyrimidine dehydrogenase (DPD) deficiency
67
SE to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Mucositis
Hand-foot syndrome (with continuos infusion)
68
Brand name of Gemcitabine? Pyrimidine Analog Antimetabolites
Gemzar
69
Unique concerns with Gemcitabine (Gemzar)? Pyrimidine Analog Antimetabolites
Prolonged infusion time may increased toxicities
70
MOA of Taxanes?
M-phase specific: Inhibit microtubule fxn
71
When used in combo, whys Taxanes given first?
Elimination of Taxanes is reduced when given immediately after admin of Cisplatin or Carboplatin
72
List Taxanes agents
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Carbazitaxel (Jevtana)
73
Brand name of Paciltaxel? (Taxanes)
Taxol
74
Brand name of Docetaxel? (Taxanes)
Taxotere
75
Unique concerns of Paciltaxel (Taxol) - Taxanes?
Anaphylaxis, hypersensitivity rxn
76
What's used to pre-.treat when using Paciltaxel (Taxol) - Taxanes?
Dexamethasone
Diphenhydramine
H2RA
(To reduce anaphylaxis, hypersensitivity rxns)
77
How should all Taxanes be given IV?
Use non-PVC IV bag and tubing, due to leaching of DEHP
78
SEs of Paciltaxel (Taxol); Docetaxel (Taxotere); Cabazitaxel - Taxanes?
Myelosuppression
Peripheral neuropathy
79
Unique concerns of Docetaxel (Taxotere)?
Hypersensitivity
| Cardio-Pulmonary: Fluid retention
Pre-treat with dexamethasone 8mg bid x 3 days
80
SE unique to Docetaxel (Taxotere)? (In addition to Myelosuppression, peripheral neuropathy)
Fluid retention
81
MOA of Vinca Alkaloids?
M-phase specific: Inhibit microtubule fxn
82
List agents under Vinca Alkaloids
Vincristine (Vincasar, Oncovin)
Vinblastine (Velban)
Vinorelbine (Navelbine)
83
Brand name of Vincristine (Vinca Alkaloids)?
Vincasar
Oncovin
84
Brand name of Vinblastine (Vinca Alkaloids)?
Velban
85
Brand name of Vinorelbine (Vinca Alkaloids)?
Navelbine
86
Vinca alkaloids are vesicants, whats the preferred way they should be delivered to the body?
Via central line
87
How should Extravasation be treated in Vinca Alkaloids?
Warm compress + Hyaluronidase
88
What's the only route of admin for vinca alkaloids?
IV only
Don't admin intrathecally - fatal
89
Which Vinca Alkaloids causes only mild suppression?
Vincristine (Vincasar, Oncovin)
90
What's the max single dose of Vincristine (Vincasar, Oncovin)?
2mg
91
BBWs of Vincristine (Vincasar, Oncovin)?
Intrathecal admin
92
Ses of Vincristine (Vincasar, Oncovin)?
Cumulative (dose-dependent) nerve damage/ peripheral neuropathy
93
BBWs of Vinblastine (Velban) and Vinorelbine (Navelbine)?
Myelosuppression
Peripheral neuropathy (less than vincristine)
Gastroparesis/constipation
94
MOA of Topoisomerase I inhibitors?
Blocks coiling uncoiling of DNA helix
95
Agents under Topoisomerase I inhibitors?
Irinotecan (Camptosar)
Topotecan (Hycamtin)
96
Brand name of Irinotecan? Topoisomerase I inhibitors
Camptosar
97
Types of diarrhea caused by Irinotecan (Camptosar) Topoisomerase I inhibitors? Tx?
Acute diarrhea (cholinergic sx) - treat with Atropine
Delayed diarrhea - treat with Loperamide (up to 24mg daily)
98
What's req B4 use of Irinotecan (Camptosar) Topoisomerase I inhibitors?
Pharmacogenomic testing
Those who are homozygous for the UGT1A1*28 allele are at increased risk for neutropenia and other tcoxicities
99
SEs of Irinotecan (Camptosar) Topoisomerase I inhibitors?
Diarrhea
Myelosuppression
Mucositis
100
MOA of Topoisomerase II inhibitors?
G2-phase specific
101
Agents under Topoisomerase II inhibitors?
Etoposide (VePesid)
Teniposide (Vumon)
102
Brand name of Etoposide? (Topoisomerase II inhibitors)
VePesid
103
Storage of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?
Refrigerate
104
Main SE of Etoposide (VePesid) capsules - Topoisomerase II inhibitors?
Hypotension
105
What should be used to deliver Teniposide (Vumon) - Topoisomerase II inhibitors?
Non-PVC IV bag and tubing due to leaching of DEHP
106
What's the agent under Epothilone?
Ixabepilone (Ixempra)
107
What should be used to deliver Ixabepilone (Ixempra)?
Use non-PVC IV bag and tubing due to leaching of DEHP
108
List miscellaneous agents
Tretinoin (all-Trans Retinoic acid)
Arsenic trioxide (Trisenox)
L-Asparaginase (Elspar)
Bleomycin
Mitomycin (Mutamycin)
109
Pregnancy category of Tretinion (All-Trans Retinoic Acid)?
D
110
BBW of Tretinion (All-Trans Retinoic Acid) & Arsenic trioxide (Trisenox)?
RA-APL differentiation syndrome
111
Monitoring of Arsenic trioxide (Trisenox)? Why?
Monitor ECG, keep Mg and K within normal range
Bcuz of QT prolongation
112
Role of Erwinaze in therapy?
FDA proved for pts who develop allergic rxns to the E.coli derived Asparaginase
113
SEs of L-Asparaginase (Elspar); Asparaginase (Erwinaze); Pegaspargase PEG (Oncaspar)?
Hypersensitivity rxns
Pancreatitis
114
SEs of Bleomycin?
Hypersensitivity rxn
Pulmonary rxns (10%) - such as pneumonitis
115
Advantage of Bleomycin?
Not myelosuppressive
116
Maximum lifetime dose of Bleomycin? Why is there a max dose?
400 units (400mg) of Bleomycin
Due to pulmonary toxicity risk
117
What's the source of U-mab? (MAB = monoclonal antibody)
U-mab = hUman
118
What's the source of O-mab? (MAB = monoclonal antibody)
O-mab = mOuse
119
What's the source of Xi-mab? (MAB = monoclonal antibody)
Xi = Chimeric (human + animal source)
120
What's the source of Zu-mab? (MAB = monoclonal antibody)
HumaniZed
121
Target of Bevacizumab (Avastin)?
Binds to VEGF-A
122
Target of Cetuximab (Erbitux)?
Binds to EGFR
123
Target of Trastuzumab (Herceptin)?
Binds to HER-2/neu
124
Target of Rituximab (Rituxan)?
Binds to CD-20
125
Target of Ipilimumab (Yervoy)?
Binds to Cytotoxic T-lymphocyte antigen-4 (CTL4) receptor
126
Brand name of Bevacizumab (Avastin)? Monoclonal antibodies
Avastin
127
Bevacizumab (Avastin) and wound healing?
Impairs wound healing: stop at least 28 days b4 elective surgery and may restart 28 days after surgery
128
SE of Bevacizumab (Avastin)?
Bleeding
HTN
HF
Thrombosis (including DVT, PE and stroke)
GI perforation
Wound dehiscence
129
Brand name of Trastuzumab?
Herceptin
130
What's required for Trastuzumab (Herceptin) use? And Ado-Trastuzumab Emtansine (Kadcyla)? And Petuzumab (Perjeta)
HER2/neu over-expression required for use (>= 2+ by immunohistochemical (IHC) testing to respond/use this drug)
Pharmacogenomics testing reveals this
131
Is Trastuzumab (Herceptin) interchangeable with Ado-Trastuzumab emtansine (Kadcyla)?
No!
132
Ses of Trastuzumab (Herceptin)?
Cardiomyopathy
133
SE of Ado-Trastuzumab emtansine (Kadcyla)?
Cardiac dysfunction
134
What's req for Cetuximab (Erbitux) & Panitumumab (Vectibix) use?
EGFR positive expressions (Correlates to better response rates)
K-Ras mutation (indicates poor response)
(T4 req EGFR +ve and K-Ras negative)
135
What must be done before Cetuximab (Erbitux) & Panitumumab (Vectibix) use?
Pharmacogenomics testing
136
SEs of Cetuximab (Erbitux) & Panitumumab (Vectibix)?
Acne-rash
Mg and Ca wasting
137
Cell surface marker targeted therapies?
Rituximab (Rituxan)
138
Brand name of Rituximab? (Cell surface marker targeted therapies)
Rituxan
139
Moa of Rituximab (Rituxan)? (Cell surface marker targeted therapies)
Targets CD-20 antigen on B lymphocytes
140
Where should the infusion of Rituximab (Rituxan) - (Cell surface marker targeted therapies) be done? Why?
In hospital or clinic
Since they can be fatal
141
What can be done prior to Rituximab (Rituxan) - (Cell surface marker targeted therapies) infusions?
Use Diphenhydramine and Acetaminophen (30-120 mins b4 infusion)
142
SE of Rituximab (Rituxan) - (Cell surface marker targeted therapies)?
Infusion rxn (chills, rigors, fever)
Tumor lysis syndrome
Reactivation of hepatitis B
143
Agents under Immunotherapy: stimulates the patients immune system?
Ipilimumab (Yervoy)
144
Unique SE of Ipilimumab (Yervoy)?
Primarily autoimmune system unchecked
145
SE of Ipilimumab (Yervoy)?
Dermatologic (rash, pruritus)
146
BBW of Ipilimumab (Yervoy)?
Fatal immune-mediated rxns
147
What's used in "castration sensitive" patient that has prostate CA?
Luteinizing Hormone-Releasing Hormone (LHRH) agonists
For chronic suppression of testosterone
148
What's usually started in "castration sensitive" pts that have prostate CA prior to LHRH? Why?
Antiandrogens are started 1-4 wks prior to LHRH agonists.
To help mitigate tumor flare
149
MOA of Antiandrogens?
Block androgens at the receptor site
150
List agents under Antiandrogens? Role in therapy?
Bicalutamide (Casodex)
Flutamide (Eulexin)
Nilutamide (Nilandron)
Use 1-4 wks prior to starting LHRH agonists to mitigate tumor flare
151
What's the brand name of Bicalutamide (Antiandrogens)?
Casodex
152
What's the brand name of Flutamide (Antiandrogens)?
Eulexin
153
List LHRH agonists (used in prostate CA in males)
| Endometriosis, fibroids and breast CA in Females
Goserelin (Zoladex)
Leuprolide (Lupron)
Histrelin (Vantas)
Triptorelin (Trelstar)
154
Brand name of Goserelin (LHRH agonists)?
Zoladex
155
Brand name of Leuprolide (LHRH agonists)?
Lupron
156
Why's supplementation req with LHRH agonist? What else is recommended?
Bcuz of low bone density and increased risk of Osteoporosis
Consider Ca + Vit. D
Weight-beating exercise + DEXA screening
157
What should be started at least 1 wk prior to use of LHRH agonists (Goserelin (Zoladex); Leuprolide (Lupron))?
Antiandrogens eg
Bicalutamide (Casodex)
Flutamide (Eulexin)
Nilutamide
158
SEs of LHRH agonists? (Goserelin (Zoladex); Leuprolide (Lupron))?
Hot flashes
Bone pain
Impotence
Injection site pain/swelling
Dyslipidemia
QT prolongation
Gynecomastia (men)
Peripheral edema
159
List Gonadotropin-Releasing Hormone (GRA) antagonist used in prostate CA
Degarelix (Firmagon)
160
Agent under Antiandrogen: inhibits the production of Androgen (Testosterone)?
Abiraterone acetate (Zytiga)
161
SEs of Abiraterone acetate (Zytiga)?
Mineralcorticoid elevation with fluid retention
162
Agent under Antiandrogen: Receptor-signaling pathway inhibitor?
Enzalutamide (Xtandi)
163
Ses of Enzalutamide (Xtandi)?
Seizures (~ 1%)
164
Vaccine: Re-programs the immune system against advanced prostate CA?
Sipuleucel-T (Provenge)
165
What's the role of hormonal therapy in breast CA?
To prevent recurrence
166
In what Grp of pts is hormonal therapy recommended, to prevent recurrence?
1) ER/PR+ (pre-menopausal) = SERM for 5-10yr (tamoxifen is 1st line)
2) ER/PR+ (post-menopausal) = Aromatase Inhibitor (AI) for 5-10 yrs
(Anastrozole is 1st line)
3) ER/PR (negative) = no benefit with hormonal agents
4) Malr breast CA pts with ER/PR+ will receive oral hormonal therapy (SERM agent for 5-10 yrs; Tamoxifen is typically 1st agent)
167
Whats 1st line in HER2/neu tve pts?
Pertzumab + Trastuzumab + Docetaxel
168
Role of Antiandrogen-Antiestrogen: Aromatase Inhibitors (AIs) -ALL ORAL?
Used in POST-menopausal women (not FDA-approved for men with breast cancer)
169
Aromatase Inhibitors (AIs) agents?
Anastrozole (Arimidex)
Letrozole (Femara)
Exemestane (Aromasin)
Mitotane (Lysodren ) non-selective
170
Brand name of Anastrozole? (Aromatase inhibitor -AI)?
Arimidex
171
Brand name of Letrozole? (Aromatase inhibitor -AI)?
Femara
172
Brand name of Exemestane? (Aromatase inhibitor -AI)?
Aromasin
173
Supplement to be used with AIs? Why?
Ca + Vit. D
Other things to consider include: wt beating exercise & DEXA screen
Cuz of low bone density + high risk for osteoporosis
174
Cardiovascular dx risk of AIs compared to SERMs?
AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin))
Have a HIGHER cardiovascular dx risk compared to SERMs
175
What supplementation is req with Mitotane use only?
Glucocorticoid + Mineralocorticoid supplementation
176
SEs to AIs (Anastrozole (Arimidex); Letrozole (Femara); Exemestane (Aromasin)) use?
Arthralgia
Edema
Lethargy/fatigue
Rash
Menopausal sx/hot flashes
Hepatoxicity
N/V
Weakness
Joint pain
Bone pain
HTN
Depression
177
Role of Antiestrogens/SERMs in therapy?
Used in PRE-menopausal women
Except Tamoxifen, which is indicated for Pre- & Post- menopausal women and men
178
Brand name of Tamoxifen? (SERMs)
Soltamox
179
Brand name of Fulvestrant? (SERMs)
Faslodex
180
Brand name of Raloxifene? (SERMs)
Evista
181
Uses of Raloxifene (Evista)?
For osteoporosis in women at risk of breast CA
182
Concern with Tamoxifen (Soltamox) use?
Increases risk of Endometrial CA (others decrease risk)
183
What's recommended for pts experiencing hot flashes due to Tamoxifen use?
Venlafaxine (over Fluoxeyine and Paroxetine)
184
SEs of SERMs (Tamoxifen; Fulvestrant; Raloxifene)?
DVT/PE
Menopausal sx
Hot flashes
Flushing
N/V
Edema
Weight gain
Increased blood pressure
Mood changes
Vaginal bleeding/discharge
Skin changes
Cataracts (Tamoxifen)
185
What's the concern with Lapatinib (Tykerb) use?
Tyrosine kinase inh (TKIs) targeting HER-2 neu
All TKIs are substrates of CYP3A4 & have many drug-drug interactions, some of which req dose modification
186
Main SE of Lapatinib (Tykerb)?
Decreased LVEF
187
What's renal cell cancer (RCC)?
Mist common type of kidney CA in adults
Primary therapy is surgery (radical or partial nephrectomy) and is for
CURATIVE intent
188
Agents under Tyrosine kinase inh (TKIs): targeting multiple kinases
Sunitinib (Sutent)
Pazopanib (Votreint)
Sorafenib (Nexavar)
189
Brand name of Sunitinib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Sutent
190
Brand name of Pazopanib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Votrient
191
Brand name of Sorafenib? (Tyrosine kinase inh (TKIs): targeting multiple kinases)
Nexavar
192
Which Tyrosine kinase inh (TKIs): targeting multiple kinases is used without regard to food?
Sunitinib (Sutent)
193
SEs of Sunitinib (Sutent) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Rash
Hand-for syndrome
HF
Reduced LVEF
QT prolongation
194
SEs of Pazopanib (Votrient) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Htn
Prolongs QT interval
195
SEs of Sorafenib (Nexavar) - (Tyrosine kinase inh (TKIs): targeting multiple kinases)?
Fatigue
HTN
Hand-foot syndrome
Diarrhea
196
SEs of Axitinib (Inlyta)? (Tyrosine Kinase inh (TKIs) targeting VEGF)?
HTN
Hand-foot syndrome
Dysphonia
197
Role of Everolimus (Afinitor) in therapy?
CA and transplantation
198
SEs of Everolimus (Afinitor)?
Dyslipidemia
Rash
Stomatitis
Interstitial lung dx
199
How should Temsirolimus (Torisel) be delivered to pts?
Use non-PVC bag & tubing due to leaching of DEHP
200
SEs of Temsirolimus (Torisel)?
Dyslipidemia
Hyperglycemia
Myelosuppression
Interstitial lung dx
201
List TKIs agents? What must be done prior to use of these agents?
Imatinib (Gleevec)
Nilotinib (Tasigna)
Dasatinib (Sprycel)
Bosutinib (Bosulif)
Use of these agents req pharmacogenomic testing for presence of bcr-able fusion gene
202
Brand name of Imatinib?
Gleevec
203
SEs of Imatinib (Gleevec)?
Fluid retention
Skin rash
Diarrhea
204
SEs of Nilotinib (Tasigna)?
Prolongs QT interval
205
SEs of Dasatinib (Sprycel)?
Pleural effusions
Fluid retention
Edema
206
SEs of Bosutinib (Bosulif)?
Diarrhea
207
Agents under Tyrosine kinase inh (TKIs): Targeting EGFR? For non-small cell lung CA
Erlotinib (Tarceva)
Afatinib (Gilotrif)
208
Brand name of Erlotinib? Used in non-small cell lung CA
Tarceva
209
Dose of Erlotinib (Tarceva)?
150mg daily PO
Take 1 hr b4 or 2 hr after meal
210
In what type of pts do Erlotinib (Tarceva) work best?
EGFR mutation positive
211
Ses of Erlotinib (Tarceva)?
Acneiform rash
Diarrhea
Hepatoxicity
GI perforation
212
In what type of pt is Afatinib (Gilotrif) approved for?
Pts with metastatic NSCLC + known EGFR exon 19 deletions or exon. 21 substitution
213
Ses of Afatinib (Gilotrif)?
Acneiform rash
Diarrhea
Stomatitis
Dry skin
Paronychia
Reduced appetite
Prurities
214
What condition must be met b4 using Crizotinib (Xalkori)?
Pt must be ALK tve to use this drug (Pharmacogenomics test req)
215
Ses of Crizotinib (Xalkori)?
Swelling (edema)
N/V/D
Constipation
Vision disturbances
216
List drugs used in melanoma
TKIs targeting BRAF: BRAF protein kinase mutation
Vemurafenib (Zelboraf)
Dabrafenib (Tafinlar)
Inh of Mitogen-Activated Extracellular Signal Kinase 1 and 2 (MEK1 and MEK 2)
Trametinib (Mekinist)
217
Role of Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar) in therapy?
Metastatic melanoma pts with BRAF V600E mutations
218
Which has less skin toxicities? Vemurafenib (Zelboraf) and Dabrafenib (Tafinlar)?
Dabrafenib (Tafinlar)
219
Se of Dabrafenib (Tafinlar)?
Pyrexia
220
SE of Vemurafenib (Zelboraf)?
Dermatologic disorders (rashes, photosensitivity, alopecia, pruritus, SJS/TEN)
Prolonged QT syndrome
221
Role of Trametinib (Mekinist) in therapy?
For metastatic melanoma pts with BRAF V600E or V600K mutations
222
SEs of Trametinib (Mekinist)?
Hand foot syndrome
Increased LFTs
Diarrhea
Anemia
Lymphedema
223
What must not happen when a pt is on Immunomodulators?
Pt must not get pregnant using these drugs
224
List agents under immunomodulators
Lenalidomide (Revlimid)
Pomalidomide (Pomalyst)
Thalidomide (Thalomid)
225
Brand name of Lenalidomide (immunomodulator)?
Revlimid
226
Brand name of Pomalidomide (immunomodulator)?
Pomalyst
227
Brand name of Thalidomide (immunomodulator)?
Thalomid
228
Pregnancy cat of immunomodulators?
X
229
When should u seek medical help? On which med?
If u develop SOB, chest pain, or arm or leg swelling
Lenalidomide (Revlimid)
230
MOA of Proteasome inh?
26S Proteasome inh
231
SEs of Bortezomib (Velcade) & Carfilzomib (Kyprolis)?
Peripheral neuropathy (worse with Bortezomib)
232
What's used with Bortezomib (Velcade) to prevent zoster reactivation?
Acyclovir
233
What's the prevalent toxicities of Bleomycin, Busulfan, Carmustine, Lomustine?
Pulmonary Fibrosis
234
What's the prevalent toxicities of Cisplatin, Carboplatin?
Nephrotoxicity
Ototoxicity
235
What's the prevalent toxicities of Doxorubicin & other Anthracyclines?
Cardiotoxic
236
What's the prevalent toxicities of Methotrexate?
Mucositis
237
What's the prevalent toxicities of Nitrosoureas (Lomustine, Carmustine)
Neurotoxicity (cross BBB)
238
What's the prevalent toxicities of Ifosfamide & Cyclophosphamide?
Hemorrhagic Cystitis
239
What's the prevalent toxicities of Vinca Alkaloids (Vincristine, Vinblastine & Vinorelbine) and Taxanes (Paclitaxel, Docetaxel)?
Peripheral Neuropathy
240
Bone marrow suppression (BMS) Is a common toxicity of many chemo agents, including
Alkylators
Anthracyclines
Folate antagonist
Platinum based Compds (Cisplatin)
Purine Antimetabolites
Pyrimidine Antimetabolites
Taxanes
Topoisomerase I and II inhi
Antimetabolites
Vinca alkaloids (Vinblastine & Vinorelbine)
241
Main concern with using SERMs (tamoxifen)
Endometrial CA
Strokes
Blood clot
Increases risk of cataract
242
When should Evista be d/c?
At least 72 hrs prior to and during immobilization
243
Role of Aromatase inh?
Best for post-menopausal women
244
Common SEs of AIs?
Joint pain
Osteoporosis
