Oncology (Pt 1) Flashcards
(80 cards)
1
Q
Warning signs of cancer?
A
CAUTION C - change in bowel or bladder habits A - a sore that won't 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
2
Q
Bleomycin has capped dosing due to _____ toxicity
A
pulmonary
3
Q
Doxorubicin has capped dosing due to _____ toxicity
A
cardiotoxicity
4
Q
Cisplatin has capped dosing due to _____ toxicity
A
nephrotoxicity
5
Q
Vincristine has capped dosing due to _____ toxicity
A
neuropathy
6
Q
Dose cap for bleomycin?
A
LIFETIME dose of 400 units
7
Q
Dose cap for doxorubicin?
A
LIFETIME cumulative dose: 450 - 550 mg/m^2
8
Q
Dose cap for cisplatin?
A
PER CYCLE do not exceed 100 mg/m^2
9
Q
Dose cap for vincristine?
A
2 mg per single dose
10
Q
Toxicities of Chemotherapy: MYLEOSUPPRESSION
— how to monitor?
A
CBC - complete blood count w/ differential
Temperature, bleeding, fatigue, shortness of breath
11
Q
Most agents cause myleosuppression: except which ones?
A
- bleomycin
- vincristine
- TKIs
- monoclonal antibodies
12
Q
what is the most emetogenic chemo agent?
A
cisplatin
13
Q
what chemo agents very commonly cause mucositis?
A
- fluorouracil
- capecitabine (prodrug of 5-FU)
- irinotecan
- methotrexate
14
Q
what cancer drugs cause cardiomyopathy?
A
- anthracyclines (doxorubicin)
- HER2 inhibitors (trastuzumab, pertuzumab)
15
Q
what chemo agents very commonly cause diarrhea?
A
- fluorouracil
- capecitabine (prodrug of 5-FU)
- irinotecan
- many TKIs
16
Q
what chemo agents very commonly cause constipation?
A
- vincristine
- pomalidomide
- thalidomide
17
Q
what drug can be given to prophylactically prevent doxorubicin cardiomyopathy
A
dexrazoxane
18
Q
what drugs cause QT prolongation?
A
mainly TKIs
19
Q
what drugs commonly cause pulmonary fibrosis?
A
- bleomycin
- busulfan
- carmustine/lomustine
20
Q
what drugs commonly cause nephrotoxicity?
A
- cisplatin
- methotrexate
21
Q
what drugs cause hemorrhagic cystitis?
A
- ifosfamide (all doses)
- cyclophosphamide (high doses)
22
Q
how to combat/prevent hemorrhagic cysitis?
A
give mesna and ensure adequate hydration
23
Q
what drugs cause peripheral neuropathy?
A
- vinca alkaloids (vincristine, vinblastine)
- platinums (cisplatin, oxaliplatin)
- taxanes (paclitaxel, docetaxel)
24
Q
what adjunctive medication should be given with cisplatin?
is is given to prevent ________
A
amifostine
prevent: nephrotoxicity
25
what adjunctive medication should be given with doxorubicin?
| is is given to prevent ________
dexrazonxane
prevent: cardiomyopathy; treat extravasation
26
what adjunctive medication should be given with fluorouracil?
is is given to prevent ________
leucovorin
to enhance efficacy
27
what is the antidote for fluorouracil or capecitabine?
uridine triacetate
28
what adjunctive medication should be given with ifosfamide?
| is is given to prevent ________
mesna
prevent hemorrhagic cystitis
29
what adjunctive medication should be given with irinotecan?
| is is given to prevent ________
atropine or loperamide
prevent diarrhea
30
what adjunctive medication should be given with methotrexate?
is is given to prevent ________
leucovorin
to decrease myleosuppression, mucositis
31
what is the nadir?
lowest point of WBCs and platelets
usually about 7 - 14 days after chemo
32
examples of CSF? (colony stimulating factors)
filgrastim
pegfilgrastim (long acting)
sargramostim
33
when to give a CSF (in relation to chemo?)
wait at least 24 hours after chemo -- then can administer
34
main side effect of CSF?
bone pain
35
ESAs _______ survival and _____ tumor progression
ESAs SHORTEN survival
and increase tumor progression
(do not use if treatment is for CURATIVE)
36
when should antiemetics be given in relation to chemotherapy?
30 minutes prior
37
what drugs are neurokinin receptor antagonists/substance P antagonists
the -pitants
| aprepitant, fosaprepitant, netupitant
38
examples of 5-HT3 antagonists
-setrons
| ondansetrons, granisetron, dolasetron
39
which 5-HT3 antagonists should not be given IV for CINV due to QT prolongation risk
dolasetron
40
common ADEs of ondansetron
fatigue, HA, constipation, dizziness
41
what drug can be used for xerostomia (other than artificial saliva substitutes)
pilocarpine
42
what dose adjustment is needed for pilocarpine
hepatic impairment
43
what is palmar-plantar erythrodysesthesia
hand foot syndrome (seen with fluorouracil and capecitabine most often)
44
how to deal with hand foot syndrome?
cooling/ice compresses (avoid hot water exposure for a long time)
avoid pressure on hand/and feets (jogging, tennis like sports, using knives/screwdrivers)
use emollients
45
what electrolyte is commonly elevated in malignancy conditions?
calcium
46
what are some possible treatment options for hypercalcemia?
oral/IV hydration + loop diuretics
or calcitonin
or IV bisphosphonates or denosumab
47
Expect calcium levels to drop within _______ when IV bisphosphonates or denosumab
1 - 3 days
48
Xgeva or Prolia is used for hypercalcemia in malignancy
Xgeva
| Prolia is indicated for osteoporosis and dosing is different
49
which chemo agents are vesicants?
anthracyclines and vinca alkaloids causes tissues necrosis
50
Vincristine should not de dispensed as _________; why?
do not dispense as a SYRINGE ---- if given intrathecally it is FATAL!
dispense in IVPB
51
vaccines and chemotherapy:
give vaccine at least ______ before starting chemo
give vaccine at least ______ after end of chemo
2 weeks before
at least 3 months after
52
what drugs are SERMs
tamoxifen
fulvestrant
raloxifene
toremifene
53
what drug is recommended to take with tamoxifen to help with hot flashes
venlafaxine
54
what are ADEs of SERMs
```
DVT/PE
menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)
```
55
Examples of aromatase inhibitors?
anastrazole
letrozole
exemestane
56
Aromatase Inhibitors:
| higher risk of ________ and ______ compared to SERMs
osteoporosis; CVD
| ^thus Ca2+/Vit D supplement
57
ADEs of AI's?
```
DVT/PE, bone pain/osteoporosis
menopausal symptoms (hot flashes, flushing, edema, weight gain, HTN, mood changes, amenorrhea, vaginal bleeding/discharge)
```
hepatoxicity, dyslipidemia
58
Ibrance (palbociclib) is used with _______ or _______ for better outcomes
letrozole;
| fulvestrant
59
boxed warning of tamoxifen?
risk of uterine/endometrial cancers
risk of thromboembolic events
60
need to discontinue _______ about 72 hours prior to/during prolonged immobilization
72 hours
61
drug classes used in prostate cancer?
GnRH/LHRH agonists
Antiandrogens
Androgen biosynthesis inhibitor
62
examples of GnRH/LHRH agonists?
Leuprolide (Lupron Depot or Eligard)
Goserelin (Zoladex)
63
GnRH/LHRH agonists have _______ risk
| and they may cause tumor _______
```
have osteoporosis
tumor flare (cause INITIAL raise in testosterone, then gradual reduction)
```
64
How to prevent tumor flare with GnRH/LHRH in prostate cancer patients?
antiandrogens
65
Examples of antiandrogens?
biclutamide
enzulatmide (Xtandi)
flutamide
66
Antiandrogens in prostate cancer: mono or dual therapy?
NEVER mono therapy (will just increase testosterone receptors)
always dual with GnRH agonists
67
what drug is a androgen biosynthesis inhibitor/inhibits CYP17 enzyme and is used in prostate cancer
abiraterone (Zytiga)
68
Side effects of LHRH agonists?
```
hot flashes
impotence
gynecomastia
peripheral edema
bone pain
injection site pain
QT prolongation
dyslipidemia/hyperglycemia
```
69
which drug given for prostate cancer needs prednisone?
abiraterone (because of aldosterone feedback system -- want to suppress hyperaldosteronism)
70
what cancer drugs work during the M phase?
vinca alkaloids
taxanes
(work on microtubules in different ways)
71
what cancer drugs are non-cell cycle specific?
alkylating agents
anthracyclines
platinum agents
72
what drugs are platinum based drugs?
cisplatin
oxaliplatin
carboplatin
73
what is the calvert formula?
just a formula used to dose carboplatin (uses AUC and GFR)
74
ADEs of platinum based compounds?
neuropathy
| nephrotoxicity and ototoxicity
75
vinca alkaloids:
| commonly cause diarrhea or constipation?
constipation (neuropathy issues related)
76
Vinca alkaloids:
_______ is related to CNS toxicity more (neuropathy)
______ and______ are more related to bone marrow suppression
vinCristine = CNS
vinBlastine and vinorelBine = bone marrow
77
Taxanes -- what drugs are examples?
paclitaxel and docetaxel
78
Taxanes:
| ________ before infusions
premedicate (diphenhydramine, corticosteroid, H2RAs)
they commonly have infusion related reactions/anaphylaxis
79
Drug interaction with taxanes and platinum drugs?
taxane elimination is reduced if platinums are given first -- thus give platinums first then taxanes
80
does Abaxane need premedication?
no the albumin form of paclitaxel does not premedication of steroids and diphenhydramine
