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NAPLEX review 2024 RXPrep Book > Oncology: Oncology I: Overview & Side Effect Management > Flashcards

Oncology: Oncology I: Overview & Side Effect Management Flashcards

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1
Q

Neoadjuvant therapy is given…

A

before primary treatment to shrink size

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2
Q

Adjuvant therapy is given…

A

after primary therapy or with other therapy to get rid of remaining disease and decrease recurrence

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3
Q

Warning signs of cancer

A

C = change in bowel/bladder habits
A = sore that doesnt heal
U = unusual bleeding or discharge
T = thickening or lump in breast or elsewhere
I = indigestion or difficulty swallowing
O = obvious change in wart or mole
N = nagging cough or hoarseness

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4
Q

Breast cancer screening

A

40-44 = annual mammogram optional
45-54 = yearly mammogram
55 + = mammograms Q 2 yrs or yearly

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5
Q

Cervical cancer screening

A

25-65 yrs old

Pap smear every 3 yrs
HPA DNA test every 5 years
Pap smear + HPV test every 5 yrs

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6
Q

Colorectal stool based screening

A

> 45 yrs old
if positive, get a colonoscopy

FIT test yearly
gFOBT yearly
stool DNA test every 3 years

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7
Q

Colorectal visual based screening

A

> 45 yrs old

Colonoscopy every 10 yrs
CT colonography every 5 years
Flexible sigmoidoscopy every 5 yrs

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8
Q

Lung cancer screening

A

> 50 yrs old

annual CT of chest if….

  1. 20 pack/yr smoking history
  2. still smoking or quit last 15 yrs
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9
Q

Prostate cancer screening

A

if choose to get tested…

PSA
Digital rectal exam

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10
Q

Lifetime cumulative dose of Bleomycin

A

400 units
Pulmonary toxicity

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11
Q

Lifetime cumulative dose of Doxorubicin

A

450-550mg/m2
cardio toxicity

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12
Q

Lifetime cumulative dose of Cisplatin

A

no more than 100mg/m2 per cycle
Nephrotoxicity

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13
Q

Lifetime cumulative dose of Vincristine

A

single dose capped at 2mg
Neuropathy

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14
Q

Common drugs that cause Myelosuppression

A

Most chemo agents besides…..

  1. asparaginase
  2. bleomycin
  3. vincristine
  4. most monoclonal antibodies
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15
Q

Common drugs that cause nausea and vomiting

A

Cisplatin
cyclophosphamide
ifosfamide
doxorubicin
epirubicin

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16
Q

Common drugs that cause mucositis

A

fluorouracil
methotrexate
capecitabine
irinotecan
many TKIs

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17
Q

Common drugs that cause diarrhea

A

Irinotecan
capecitabine
fluorouracil
methotrexate
many TKIs

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18
Q

Common drugs that cause Constipation

A

Vincristine
pomalidomide
thalidomide

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19
Q

Common drugs that cause Xerostomia (dry mouth)

A

radiation to head or neck regions

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20
Q

Common medications that cause Cardiomyopathy

A

Anthracyclines
HER2 inhibitors
fluorouracil

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21
Q

Common medications that cause QT prolongation

A

Arsenic trioxide
many TKIs
Leuprolide

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22
Q

Common medications that cause Pulmonary fibrosis

A

Bleomycin
busulfan
carmustine
lomustine

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23
Q

Common medications that cause Pneumonitis

A

Methotrexate
MAbs targeting CTLA-4 or PD-1/PD-L1

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24
Q

Common medications that cause hepatotoxicity

A

Antiandrogens (bicalutamide, flutamide, nilutamide)
methotrexate
cytrabien
Many TKIs
some MAbs

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25
Common medications that cause Nephrotoxicity
Cisplatin High dose Methotrexate
26
Common medications that cause Hemorrhagic Cystitis
Ifosfamide = all doses cyclophosphamide = high dose > 1g/m2
27
Common medications that cause Peripheral Neuropathy
Vinca alkaloids Platinums Taxanes Proteasome inhibitors
28
Common medications that cause Autonomic Neuropathy
Vinca Alkaloids
29
Common medications that cause Thromboembolic risk
Aromatase inhibitors (anastrozole, letrozole) SERMs immunomodulators (thalidomide, lenalidomide, pomalidomide)
30
What should be avoided with Oxaliplatin
avoid cold temperatures and avoid drinking cold beverages
31
What is myelosuppression
dec in bone marrow activity results in fever RBCs, WBCs, and platelets complication of most chemo therapy
32
Lowest point that WBCs and platelets can reach is called...
nadir usually within 7-14 days after chemo for RBC, nadir is ~ 120 days
33
Drugs used to inc RBC count
ESA = Erythropoiesis-stimulating agent Epoetin alfa (Epogen, Procrit) Darbepoetin alfa (Aranesp)
34
Drugs used to inc WBC count
Colony-stimulating factor (CSF) Filgrastim (Neupogen) Pegfilgrastim (Neulasta)
35
Categories of Neutropenia and ANC
Neutropenia = < 1,000 Severe Neutropenia = < 500 Profound Neutropenia = < 100
36
Who should receive CSF when getting chemo?
all patients with > 20% chance of developing chemotherapy induced febrile neutropenia
37
CSF side effects
bone pain, fever, general rash, injection site reaction
38
CSF notes
store in fridge give 1st dose no sooner than 24hrs after chemo, can be up to 96hrs after report signs of enlarged spleen Pegfilgrastim: given atleast 14 days before next chemo cycle
39
Febrile neutropenia diagnosis requirements
Temp > 38.3C (101F) X 1 or > 38C (100.4F) for 1hr & ANC < 500 or ANC < 1000 expected to be < 500 next 48hrs
40
Empiric febrile neutropenia abx for low risk patients
Low risk = ANC < 100 for < 7 days Cipro/Levo + Amox/clav or clinda
41
Empiric febrile neutropenia abx for high risk patients
High risk = ANC < 100 for > 7 days, comorbidities, CrCl < 30 Cefepime or Ceftazdime or Meropenem or Impinge/cilastatin or pip/tazo
42
Why are ESA not recommended in patients receiving chemo with curative intent?
can shorten survival and inc tumor progression only used for palliative care in chemo
43
What would be assessed before doing ESA?
Serum ferritin TSAT TIBC
44
Threshold for platelet transfusion
<10K < 30k if active bleeding
45
3 types of Chemotherapy induced nausea and vomiting
Acute = within 24hrs of chemo Delayed = > 24 hrs after chemo Anticipatory = before chemo
46
Antiemetic regimen for minimal emetic risk drugs
no routine prophylaxis
47
Antiemetic regimen for low emetic risk drugs
1 of the following 5HT3-RA ( -setrons), Dexamethasone, prochloprperazine, metoclopramide
48
Antiemetic regimen for moderate emetic risk drugs
2 - 3 drugs 5HT3-RA + NK1-RA + dexamthasone 5HT3-RA + dexamethasone Palonosetron + Olanzapine + dexamethasone
49
NK1-RA drugs
Aprepitant Aprepitant IV Fosaprepitant IV Rolapitant
50
Antiemetic regimen for high emetic risk drugs
3 or 4 drugs NK1-RA + 5HT3-RA + olanzapine + dexamethasone = preferred Palonosetron + olanzapine + dexamethasone NK1-RA + 5HT3-RA + dexamethasone
51
NK1-RA drug notes
can dec dexamethasone dose when used with these drugs dont dec dexamethasone dose when used with Rolapitant
52
Granisetron patch notes
start 24-48hrs before chemo leave in place for up to 7 days
53
5HT3-RA medication contraindications
Dont use with apomorphine (Awoken) due to severe hypotension and loss of consiousness
54
5HT3-RA medication warnings
inc QT interval, Torsades limit IV to 16mg SErotonin syndrome when used in combo with serotonergic agents
55
5HT3-RA medication side effects
headache constipation fatigue dizziness inj site reactions
56
Dexamethasone (Decadron) used for CINV
Off label Side effects: inc appetite, weight gain, fluid retention, insomnia higher doses can inc BP and BG in diabetes patients
57
Dopamin receptor antagonists for CINV
Prochlorperazine (Compazine) Promethazine (Phenergan) Metoclopramide (Reglan) Olanzapine (Zyprexa) Haloperidol (Haldol)
58
Prochlorperazine boxed warnings
inc mortality in elderly with dementia related psychosis
59
Promethazine Boxed warnings
dont use children < 2 yrs old Dont give via SC, Deep IM preferred due to extravasation with IV
60
Metocloramide Boxed warnings
Tardive dyskinesia that can be irreversible, D/c if symptoms occur dont treat more than 12 wks dec dose with renal impairment
61
Haldol/Droperidol Boxed warnings
QT prolongation and serious arrhythmia
62
Dopamine receptor antagonists warnings
symptoms of Parkinson's maybe exacerbated, avoid in patients with disease
63
Dopamine receptor antagonist side effects
Sedation lethargy acute EPS dec seizure threshold QT prolongation NMS hypotension
64
Olanzapine side effects for CINV
mild sedation and orthostasis when used for CINV
65
Dronabinol (Marinol) info
SE: somnolence, euphoria, inc appetite Keep in fridge**
66
Meds used for anticipatory N/V
Lorazepam, start evening before
67
Chemo agents that commonly cause diarrhea
Fluorouracil Capecitabine Irinotecan occurs several days after chemo
68
Early onset diarrhea
Irinotecan cause cause it, occurs during infusion also causes symptoms of cholinergic excess
69
Cholinergic excess symptoms
cramping rhinitis lacrimation salivation
70
Hand-foot syndrome commonly occurs with
capecitabine fluorouracil cytarabine liposomal doxorubicin TKIs = sorafenib and sunitinib
71
symptoms of Hand-foot syndrome
tenderness pain inflammation maybe peeling of palms and soles
72
Hand-foot syndrome management
avoid pressure on sole and palms of hands avoid prolonged exposure to hot water avoid activities that cause friction or heat exposure to hands/feet
73
Tumor lysis syndrome occurs most commonly with which cancers
Leukemia and non-Hodgkin Lymphoma but can occur with most cancer types
74
Meds used to treat TLS
Allopurinol at 400-800mg/day until normalization
75
Tumor Lysis syndrome can cause
acute hyperkalemia = arrythmias hyperphosphatemia/hypercalcemia = anorexia, nausea, seizures) hyperuricemia
76
Hypercalcemia of malignancy
some cancers cause calcium to leach from bone to blood, leading to hypercalcemia
77
Txm of moderate to severe hypercalcemia
Corrected calcium form 12-13.9 to > 14 Iv bisphosphonates = 1st line calcitonin can be added, but short txm duration due to tachyphylaxsis w/ calcitonin Can also use Denosumab (Xgeva)
78
IV Bisphosphonates + Denosumab Dose
Bisphosphonates = 4mg IV once, can repeat in 7 days if needed Denosumab = 120mg SC days 1,8,15 of 1st month, then every month
79
Premedication to prevent immunologic reactions from MAbs
Tylenol Benadryl or another antihistamine
80
Major chemo vesicants
Anthracyclines vinca alkaloids
81
Antidote for Anthracycline extravasation
dexrazoxane or dimethyl sulfoxide
82
Antidote for vinyl alkaloid/etoposide extravasation
hyaluronidase
83
When should vaccines be given if receiving chemo therapy?
> 2 weeks prior

NAPLEX review 2024 RXPrep Book (78 decks)

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