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Pharmacology > Oncology Treatment > Flashcards

Oncology Treatment Flashcards

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1
Q

Primary vs. Adjuvant vs. Neoadjuvant chemo

A
  1. Primary - used w/o surgery
  2. adjuvant - used after surgery
  3. neoadjuvant - used before surgery
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2
Q

Constitutional S/E of Chemotherapy

A
  1. weight loss
  2. fever
  3. chills
  4. anaphylactic reactions
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3
Q

Hematologic S/E of Chemotherapy

A
  1. pancytopenia

2. associated infections

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4
Q

HEENT S/E of Chemotherapy

A
  1. headaches
  2. mucositis
  3. thrush
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5
Q

Skin S/E of Chemotherapy

A
  1. rash
  2. hyperpigmentation
  3. desquamation
  4. edema
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6
Q

Cardiac S/E of Chemotherapy

A
  1. CHF

2. arrhythmias

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7
Q

Pulmonary S/E of Chemotherapy

A
  1. pneumonitis

2. pleural effusion

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8
Q

GI S/E of Chemotherapy

A
  1. N/V
  2. diarrhea
  3. constipation
  4. bowel obstruction
  5. mucositis
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9
Q

renal S/E of Chemotherapy

A
  1. acute kidney injury

2. chronic kidney disease

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10
Q

Urinary S/E of Chemotherapy

A
  1. hemorrhagic cystitis
  2. urine discoloration
  3. painful urination
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11
Q

reproductive S/E of Chemotherapy

A
  1. infertility

2. premature ovarian failure

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12
Q

Musculoskeletal S/E of Chemotherapy

A
  1. weakness
  2. motor neuropathy
  3. fractures
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13
Q

Neurological S/E of Chemotherapy

A
  1. neuropathy
  2. confusion
  3. seizures
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14
Q

Psychiatric S/E of Chemotherapy

A
  1. depression
  2. anxiety
  3. anticipatory nausea
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15
Q

Alkalating Agents examples

A
  1. cyclophosphamide

2. bendamustine

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16
Q

Alkalating Agents MOA

A

interfere with DNA replication to prevent cells from reproducing

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17
Q

Alkalating Agents are derived from what

A

nitrogen mustards

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18
Q

Alkalating Agents indications

A
  1. solid (lung, breast, ovary)

2. hematologic (leukemia, lymphoma, multiple myeloma)

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19
Q

Alkalating Agents S/E

A
  1. hemorrhagic cystitis
  2. pancytopenia
  3. secondary malignancy (leukemia MC)
  4. alopecia
  5. N/V
  6. kidney injury
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20
Q

Alkalating Agents metabolism

A

liver

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21
Q

Do Alkalating Agents cross the blood brain barrier

A

only bendamustine

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22
Q

Alkalating Agents long term effects

A
  1. secondary malignancy
  2. leukemia
  3. ovarian failure
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23
Q

Antimetabolites examples

A
  1. methotrexate
  2. fluorouracil
  3. mercaptopurine
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24
Q

Antimetabolites MOA

A

interferes w/ RNA/DNA replication by limiting metabolites necessary for cell division (ie. folic acid)

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25
Antimetabolites indications
1. solid (sarcoma, breast, ovary, GI) | 2. hematologic (CNS leukemia/lymphoma IT)
26
Antimetabolites SE
1. alopecia 2. GI stomatitis 3. liver dysfunction 4. renal failure
27
Antimetabolites metabolism
kidney and liver
28
do Antimetabolites cross the blood brain barrier?
yes, high dose methotrexate (used as monotherapy for CNS lymphoma)
29
Antimetabolites long term effects
1. infertility 2. cirrhosis 3. kidney disease
30
Other uses for methotrexate
1. psoriasis 2. lupus 3. RA
31
methotrexate in pregnancy?
teratogenic, causes demise of fetus
32
methotrexate route of chemo administration
intrathecal (given in CSF fluid to prevent cells from spreading across blood brain barrier)
33
Anthracycline example
doxorubicin
34
doxorubicin MOA
interfere w/ DNA by stopping cell division by interfering with coiling of double helix structure kills cancer and healthy cells
35
doxorubicin indications
1. leukemia 2. lymphoma 3. solid tumors (breast, lung, stomach, thyroid, sarcoma) - -> very common in breast cancer
36
doxorubicin SE
1. cardiotoxicity (acute rhythm abnormalities, CHF and delayed CHF) --> constrictive cardiomyopathy!! 2. myelosuppression 3. nausea 4. alopecia 5. mucositis 6. tissue necrosis if infiltrated
37
doxorubicin metabolism
GI and renal
38
does doxorubicin cross the blood brain barrier?
no
39
long term monitoring for doxorubicin
echo
40
special consideration for doxorubicin
need echo prior to every other dose of chemo
41
Bleomycin MOA
damages DNA (G2 phase cell cycle)
42
Bleomycin indications
1. Hodgkin's lymphoma | 2. solid tumors (head/neck, cervis, testis, bladder)
43
what kind of cell is pathonomonic for Hodgkin's lymphoma?
Reed-Sternberg cell
44
Bleomycin SE
1. pneumonitis 2. cutaneous peeling, erythema, hyperpigmentation usually on pales/soles 3. N/V 4. hypersensitivity (give test dose)
45
Bleomycin metabolism
through tissues
46
does Bleomycin cross the BBB?
no
47
Bleomycin special consideration
PFTs prior to initiation and throughout treatment, pulmonary fibrosis may be fatal
48
Vinca Alkaloids indications
1. leukemia 2. lymphoma 3. testicular cancer
49
Vinca Alkaloids examples
1. vincristine | 2. vinblastine
50
Vinca Alkaloids MOA
interferes with formation of microtubules necessary for mitosis "M phase"
51
caution for Vinca Alkaloids
fatal if given intrathecally
52
Vinca Alkaloids SE
1. severe neuropathy (most significant, usually stocking-glove, usually reversible but can be permanent) 2. constipation 3. myelosuppression 4. alopecia 5. N/V
53
Taxanes examples
1. paclitaxel | 2. docetaxel
54
Taxanes MOA
stop microtubules from breaking down, cell becomes overcrowded and cannot divide (M phase)
55
Taxanes indications
1. breast 2. lung 3. prostate 4. ovarian 5. Kaposi's sarcoma (AIDs)
56
Taxanes SE
1. neurotoxicity - confusion, headache, seizure 2. peripheral neuropathy 3. fluid retention 4. hypersensitivity reaction
57
Taxanes metabolism
liver
58
do Taxanes cross the BBB?
no
59
long term effects of Taxanes
neuropathy
60
Examples of platinum compounds
1. carboplatin 2. cisplatin 3. oxaliplatin
61
platinum compounds MOA
damage DNA
62
platinum compounds SE
1. oxaliplatin - spasm with cold exposure 2. nephrotoxicity 3. neurotoxicity 4. ototoxicity 5. peripheral neuropathy 6. myelosuppression
63
platinum compounds metabolism
renal - carboplatin dose adjusted every time based on renal function of the patient that day
64
platinum compounds long term effects
1. neuropathy 2. hearing difficulties 3. infertility
65
Red flag for what drug if you see lung toxicity in primary care
bleomycin
66
Red flag for what drug if you see cardiomyopathy in primary care
doxorubicin
67
Red flag for what drug if you see secondary malignancy in primary care
cyclophosphamide
68
Red flag for what drug if you see hemorrhagic cystitis
Ifosfamide/cyclophosphamide
69
Red flag for what drug if you see neurotoxicity in primary care
1. cisplatin 2. taxanes 3. vinca alkaloids
70
Red flag for what drug if you see kidney failure in primary care
1. cisplatin | 2. high dose methotrexate
71
what are molecular targeted therapies?
drugs that block the growth and spread of cancer by interfering with specific receptors that are on the cancer cells that are involved with growth or spread of cancer
72
types of targeted molecular therapy and routes of delivery
1. monoclonal antibodies - injection or infusion | 2. small molecules (can pass through cell wall) - pill
73
what are monoclonal antibodies? how are they made?
delivery system for transmitting a drug, antigen injected into animal --> animal makes antibodies --> antibodies are taken off the cells and developed into drug
74
BRAF-MEK inhibitors indication
melanoma
75
BRAF-MEK inhibitors SE
1. secondary malignancy 2. hemorrhage 3. HTN 4. visual changes 5. GI 6. fetal toxicity
76
Trastuzumab (Herceptin) indications
HER2 positive breast cancer
77
Trastuzumab (Herceptin) SE
CHF
78
BCR-ABL kinase inhibitors indication
CML / ALL (CML is a translocation)
79
what drug class is tamoxifen
selective estrogen receptor modulator
80
who is tamoxifen used in?
1. pre-menopausal women | 2. if aromatase inhibitors are contraindicated
81
tamoxifen MOA
inhibits growth of breast cancer cells by acting as competitive antagonist of estrogen receptor
82
tamoxifen SE
1. VTE 2. NASH 3. sexual dysfunction 4. hot flashes 5. vaginal discharge 6. menstrual irregularities 7. endometrial hyperplasia
83
is tamoxifen used alone or in combo?
either - alone or in combo with chemo or targeted therapy
84
length of tamoxifen treatmetn
minimum of 5 years, may be 10 years if high risk
85
tamoxifen indication
estrogen receptor and/or progesterone receptor positive breast cancer
86
who should aromatase inhibitors be used in ?
1, postmenopausal women | 2. premenopausal high risk
87
aromatase inhibitors example
anastrazole
88
aromatase inhibitors MOA
suppressed plasma estrogen levels by inactivating aromatase (which converts androgens to estrogens)
89
aromatase inhibitors SE
1. MSK (carpal tunnel) 2. joint pain/stiffness 3. osteoporosis 4. CV disease long term 5. sexual dysfunction
90
aromatase inhibitor length of treatment
minimum of 5 year
91
length of effect of aromatase inhibitors
improves outcomes up to 10 years
92
indications for gonadotropin-releasing hormone agonists
advanced prostate cancer
93
gonadotropin-releasing hormone agonist examples
1. Leuprolide (Lupron) | 2. Gosrelin (Zoladex)
94
gonadotropin-releasing hormone agonist MOA
potent inhibitor of gonadotropin release
95
gonadotropin-releasing hormone agonists SE
1. sexual dysfunction 2. osteoporosis/fractures 3. hot flashes 4. loss of lean body mass 5. fatigue, anemia 6. gynecomastia 7. emotional/cognitive changes / confidence issues 8. altered personality
96
gonadotropin-releasing hormone agonist treatment schedule
do intermittent to decrease SE | every other month or every 3 months
97
benefit of gonadotropin-releasing hormone agonists
help with bone pain and other symptoms associated with cancer
98
how does immunotherapy work?
Block PDL-1 or similar receptors that mask cancer cell from being recognized by T cell so patient's own immune system can identify and destroy the cancer
99
Opdivo (Nivolumab) MOA
PDL1 inhibitor
100
Opdivo (Nivolumab) indications
1. metastatic lung cancer 2. metastatic melanoma 3. head and neck cancer 4. Hodgkin lymphoma 5. colorectal cancer 6. hepatocellular cancer 7. renal cell cancer 8. urothelial cell cancers
101
Opdivo (Nivolumab) SE
most tolerate very well but if they do have SE, they are severe - immune system starts attacking healthy cells 1. rash 2. colitis 3. hepatotoxicity 4. pneumonitis 5. endocrinopathies: hypothyroid, "hypophysitis" (starts attacking pituitary gland)
102
How do you treat Opdivo (Nivolumab) SE?
high dose steroids
103
what is Car-T Cell
way of modifying patient's T cells to make them more aggressive take WBC out of patient's body, attach lab-made antibody bead to T cells and infuse back into patient
104
Car-T Cell SEs
1. anaphylactic reaction | 2. immune response to WBC
105
examples of integrative oncology treatments
1. music, arts, expressive therapy 2. meditation 3. yoga, physical exercise 4. acupuncture 5. massage 6. aromatherapy 7. lifestyle nutrition 8. pet therapy
106
causes of cancer related pain
1. neuropathy 2. radiation 3. metastases: bone, liver 4. secondary to radiation 5. post surgical pain 6. nerve impingement 7. phantom pain 8. wounds 9. pleural irritation
107
non-narcotic options for cancer-related pain
1. gabapentin - neuropathic pain 2. effexor - neuropathic pain 3. topical lidocaine
108
why do you avoid tylenol and NSAIDs
1. tylenol - can mask a fever and fever may be only sign of infection in immunocompromised patient 2. NSAIDs - increase risk of kidney damage
109
6 As of opioid therapy
1. appropriate? 2. adjuvants? 3. analgesia? (acceptable pain level) 4. activities of daily living? (what are the goals?) 5. adverse drug reactions? (already have constipation, somnolence?) 6. aberrant drug behavior?
110
MC opioid used
oxycodone | oxycontin is long-acting version
111
benefit of fentanyl patches
don't have to worry about swallowing w/ nausea, mouth sores
112
special consideration for fentanyl patches
need enough body fat or else drug may not be transmitted to blood well (needs subcutaneous fat)
113
other opioid routes of administration
liquid, rectal suppositories, concentrate
114
which laxatives do you need to be cautious about giving and why
saline laxatives - need to make sure good renal function before giving magnesium
115
categories of chemotherapy induced N/V
1. highly emetic: >90% risk of emesis 2. moderately emetic: 30-90% risk of emesis 3. low emetogenicity: 10-30% risk of emesis 4. minimally emetic: <10% risk of emesis
116
types of chemotherapy induced N/V
1. acute N/V: w/in 24 hours 2. delayed N/V: 24 hours to 7 days 3. anticipatory emesis: related to anxiety
117
anti-emetic agents
1. NK1R: Neurokinin-1 receptor antagonists 2. 5-HT3 antagonists 3. glucocorticoids 4. ativan - for anticipatory emesis 5. zyprexa (olanzapine)
118
examples of Neurokinin-1 receptor antagonists
1. aprepitant | 2. fosaprepitant
119
Neurokinin-1 receptor antagonists indications
highly emetogenic chemo; acute and delayed
120
Neurokinin-1 receptor antagonists MOA
inhibits substance P / neurokinin 1 and augments 5HT3 receptor
121
how are Neurokinin-1 receptor antagonists used?
added to 5-HT3 and dexamethasone for highly emetogenic chemo
122
Neurokinin-1 receptor antagonists SE
1. hiccups 2. fatigue 3. interacts with inhibitors of CYP3A4
123
5-HT3 antagonists examples
1. ondansetron (zofran) | 2. palonosetron (longer acting)
124
5-HT3 antagonists indications
acute and delayed nausea
125
5-HT3 antagonists MOA
block 5-HT3-receptors which in turn block serotonin, works centrally and peripherally
126
what anti-emetic is most effective?
5-HT3 antagonists
127
5-HT3 antagonists SE
1. QT prolongation 2. headache 3. malaise 4. constipation
128
zyprexa use
treat anticipatory emesis (anxiety type reaction) and delayed nausea take the night before chemo or a scan
129
example of highly emetic chemo
doxorubicin + cyclophosphamide
130
example of moderately emetogenic chemo
carboplatin
131
treatment regimen for highly emetic chemo
Day 1: NK1R antagonist + 5-HT3 receptor, dexamethasone, zyprexa Day 2-4: zyprexa nightly
132
treatment regimen for moderately emetic chemo
Day 1: NK1R + 5HT3 + dexamethosone
133
treatment regimen for low emetogenic chemo
dexamethasone

Pharmacology (27 decks)

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