2011 - Chemo

Front 1

Main SE associated with Chemotherapy (3)

Back 1

N/V
Bone Marrow Suppression
Tumor Lysis Syndrome

Front 2

Drug groups for treating N/V associated with Chemo?

Back 2

5-HT3 Serotonin Receptor Blockers
Steroids
Cannabinoids
Neurokinin (NK) 1 - Receptor Antagonists
Benzamides, Reglan, Antihistamines, Benzodiazepines

Front 3

List the 5-HT3 Serotonin Receptor Antagonists used for N/V

Back 3

***P-DOG

Palonosetron (Aloxi) - IV/PO; LONGEST HALF LIFE; dose: 0.5mg 1H before chemo

Dolasetron (Anzemet) - IV/PO

Ondansetron (Zofran) - IV/IM/PO/ODT

Granisetron (Kytril/Sancuso) - IV/PO/transdermal; dose: 1 patch 24-48H before chemo worn up to 7 days == avoid sunlight

Front 4

List the steroids used for N/V with their dosing.

Back 4

***Commonly used alone or with 5-HT3 antagonists or Reglan

Decadron (Dexamethasone)
- Prophylaxis: 8mg IV or 12mg PO prior to chemo
- Prophylaxis: 8mg PO QD for 2-4 days
- Treatment: 10-20mg IV/PO Q4-6H

Medrol (Methylprednisolone)

Front 5

What are the cannabinoids used for N/V?

Back 5

***Both are second line for N/V

Cesamet (Nabilone)
- CII

Marinol (Dronabinol)
- also approved to stimulate appetite in AIDS patients
- REFRIGERATED

Front 6

What is Emend?

Back 6

Neurokinin-1-Receptor Antagonist

Fosaprepitant (IV)
- Dose: 115mg on Day 1 of chemo with 5-HT3 blocker and steroid

Aprepitant (PO)
- Day 1: 125mg
- Day 2 & 3: 80mg
- INDUCER!!!! (watch with COC & monitor INR)

Front 7

What forms does Reglan come in?

Back 7

Metoclopramide (Reglan)
- IV/IM/PO
- MoA: blocks dopamine in the brain that contains the vomiting center
- SE: blocks dopamine THEREFORE results to EPS (benadryl helps with the SE)

Front 8

What are the meds used for Chemo induced anemia?

Back 8

*** Contraindicated: Uncontrolled HTN

*** Risk of CV, thromboembolic events and tumor progression

Erythropoietin (Epogen, Procrit)
- 150 - 300 U/kg SC 3x/week

Darbepoetin (Aranesp)
- 2.25mg/kg SC/week

Front 9

How do store Aranesp?

Back 9

Aranesp (Darbepoietin)
- Do not shake
- Protect from light
- Refrigerate
- Clear and colorless, don't use if cloudy

Front 10

What is used for Chemo induced thrombocytopenia?

Back 10

Oprelvekin (Neumega)
- SC QD until platelet levels are normal
- monitor: fluid & electrolytes

Front 11

Hgb levels should be between what when using Epogen/Araneps

Back 11

Hgb 10-12 g/dL

Front 12

What are the medications used for Granulocytopenia/Leukopenia

Back 12

Filgrastim (G-CSF, Neupogen)
- REFRIGERATE, use within 24H when @ RT
- 5mcg/kg QDay

Pegfilgrastim (Neulesta)
- REFRIGERATE, use within 48H @ RT; protect from light
- Bone pain

Front 13

Effects of Tumor Lysis Syndrome

Back 13

Hyperkalemia - leads to life threatening arrythmias
Hyperphosphatemia
Hyperuricemia

Hypocalcemia - leads to QT interval lengthening, which predisposes patients to ventricular arrhythmias

***These metabolic abnormalities can lead to acute renal failure (ARF) and multiple organ failure & death

Front 14

How do you treat arrythmias after tumor lysis

Back 14

Administer IV Calcium chloride: for hyperK & hypoCa. This protects the myocardium from hyperkalemia (arrythmias)

Insulin & dextrose: induces movement of K from the blood into the cells

Sodium polystyrene sulfonate (Kayexalate)
- exchanges sodium for potassium

Front 15

List the Alkylating agents

Back 15

Alkylating agents - works on G1 phase

Cisplatin (Platinol), Carboplatin (Paraplatin), Oxaliplatin
Busulfan (Myeleran)
Cyclophosphamide (Cytoxan), Ifosphamide (Ifex), Temozolamide
Carmustine (BiCNU), Lomustine (CeeNu)
Streptozosin (Zanucar)
Melphalan (Alkeran), Mechlorethamine (Mustargen), Altretamine (Hexalan)
Dacarbazine, Procarbazine (Matulane)
Bendamustine (Treanda)

Front 16

List the Anti-Metabolites

Back 16

Methotrexate
Fluorouracil (5-FU)
Mercaptopurine (6-MP) (Purinethol)
Cytarabine (Cytostar), Fludarabine (Fludara), Capecitabine (Xeloda), Cladribine
Pentostatin
Thioguanine
Hydroxyurea

Front 17

List the Antibiotics used in Chemotherapy

Back 17

Bleomycin
Dactinomycin, Daunorubicin, Valrubicin
Doxorubicin
Epirubicin, Idarubicin
Mitomycin, Plicamycin
Mitoxanthrone

Front 18

List the Plant Alkaloids

Back 18

Docetaxel, Paclitaxel
Etoposide, Teniposide
Irinotecan, Topotecan

Front 19

List the Vinca Plant Alkaloids. Major SE? Special labeling?

Back 19

***All cause PERIPHERAL NEUROPATHY

VinCristine - CNS effects
VinBlastine - Bone marrow suppression
VinOrelbine - Alopecia

***Label: "For Intravenous Use Only - Fatal if given intrathecally"

Front 20

How do you prevent Nephrotoxicity when using Platinol?

Back 20

Cisplatin (Platinol)

- Aggressive IV fluid to maintain renal blood flow, watch for urine output of 100-200mL/H

- AMIFOSTINE (Ethyol) is given prophylactically but can cause SEVERE HYPOTENSION. SE: flushing, chills, N/V

- Mannitol given before to promote excretion

Front 21

List the major SE when using Platinol

Back 21

Cisplatin (Platinol)
***ONE

Ototoxicity
Nephrotoxocity
Electrolyte abnormalities: decreases PO4, K, Ca, Mg

Front 22

What are the major SE of Busulfan?

Back 22

Busulfan (Myelera)

- Increase in Uric Acid (use allopurinol)
- Pulmonary Fibrosis

Front 23

List the SE of Cytoxan

Back 23

***Monitor: CBC, BUN, UA, electrolytes, SCr

Sterility
Alopecia
Renal
Hepatotoxicity
Cyclophosphamide (Cytoxan)
Hemorrhagic cystitis - due to acrolein; prevented by Hydration & MESNA

Front 24

Major SE of BiCNU/CeeNU?

Back 24

***Both are lipid soluble and used to treat CNS malignancies

Carmustine (BiCNU)
Lomustine (CeeNU)

- Pulmonary fibrosis (CXR)
- Hepatotoxicity (LFT)
- Nephrotoxicity (CMP)
- BMS: CBC

Front 25

What do you use to treat extravasation due to Mustargen?

Back 25

Mechlorethamine (Mustargen)
- treat with Na+ thiosulfate

Front 26

What group of antidepressants does Matulane have a similar action? Monitor?

Back 26

Procarbazine (Matulane), has MAOi activity

Monitor: CBC, Renal, Hepatic

Front 27

What do you use to treat extravasation due to Mustargen?

Back 27

Mechlorethamine (Mustargen)
- treat with Na+ thiosulfate

Front 28

Which Alkylating Chemo drugs have Hepatic and Renal effects?

Back 28

Cyclophosphamide (Cytoxan)
Carmustine (BiCNU), Lomustine (CeeNU)
Procarbazine (Matulane)

Front 29

Dosing for Treanda? What do you give with it? Storage?

Back 29

Bendamustine (Treanda) - IV

Dose: 100mg/m2 IV on days 1 & 2 of a 28 day cycle (up to 6 cycles)

Allopurinol - prevention for patients at risk of tumor lysis syndrome

Storage: 24H when REFRIGERATED or 3H @ RT; protect from light

Front 30

SE for Treanda?

Back 30

Myelosuppression
Infusion reactions (IV)
Anaphylaxis
Tumor Lysis Syndrome (like all the chemo agents)

Front 31

What do you monitor with Methotrexate?

Back 31

LFT's
Renal function: Avoid use with NSAID's (contraindicated)
CXR
CBC

Front 32

SE of Methotrexate?

Back 32

Mucocytosis
Pulmonary fibrosis
Hepatotoxicity
Renal failure
Photosensitivity
Pregnancy should be avoided (male: 3 months, female: 1 ovulatory cycle)

Front 33

What is 5-FU? Drug interactions?

Back 33

Fluorouracil (5-FU)

- Increases INR
- Leucovorin added to 5-FU increases its action

Front 34

What is Xeloda?

Back 34

Capecitabine (Xeloda), is a prodrug of 5-FU

Dose: cyclical - 2 weeks on, 1 week off, take with water 30 minutes after AM & PM meals

Front 35

Drug interactions with Mercaptopurine

Back 35

Mercaptopurine (6-MP) (Purinethol)

- Allopurinol will increase levels of 6MP

- Bactrim also increases levels of 6MP

Front 36

What are the cummulative doses of Doxorubicin, Daunorobicin & Idarubicin? Antidote?

Back 36

***Cold compress - for extravasation

Doxorubicin: 550mg/m2

Daunorubicin: 900mg/m2

Idarubicin: 150mg/m2

Antidote: Zinecard (Dexrazoxane)

Front 37

SE for Plicamycin?

Back 37

Electrolyte imbalance

- hypo K
- hypo Ca
- hypo PO4

Front 38

Points to remember with Paclitaxel?

Back 38

Hypersensitivity - PREMEDICATE (Dexamethasone)

Non-PVC tubing

Ethanol in the diluent

Disulfiram reactions with Flagyl

Contains castor oil

Front 39

Major SE for Etoposide/Tenoposide

Back 39

Hypotension - due to rapid infusion

Etoposide (VP-16) - capsules in the fridge

Front 40

Major SE for Irinotecan/Topotecan

Back 40

Diarrhea & dehydration (life-threatening)

Front 41

List the Tyrosine Kynase Inhibitors. Forms?

Back 41

***NILE - all PO

Nilotinib (Tasigna)

Imatinib (GLEEVEC) - substrate & inhibitor

Lapatinib (Tykerb)

Erlotinib (Tarceva)

Front 42

What is Zolinza? Dose:

Back 42

Vorinostat (Zolinza)

Dose: 400mg QD with food

Front 43

What is the effect of estrogen on breast cancer? What is Her2-positive cancer?

Back 43

Some breast cancers are sensitive to estrogen which causes the breast cancer tumor to grow.

HER2 refers to a gene that helps cell grow, divide, and repair themselves. Her2-positive cancer have a more aggressive disease and higher risk of recurrence.

Front 44

List the group of medications for hormonal therapy

Back 44

SERM's (selective estrogen receptor modulators)
- Tamoxifen (Nolvadex)
- Raloxifene (Evista)

Aromatase Inhibitors
- Anastrozole (Arimidex)
- Letrozole (Femara)
- Exemestane (Aromasin)

Front 45

What is Nolvadex? Dose? ADR? Drug interactions?

Back 45

Tamoxifen (Nolvadex)
- Dose: 20mg BID (premenopausal); 20mg QD (post)

ADR: thromboembolism, hyperCa, endometrial cancer

Drug interactions:
- Tamoxifen needs to be converted to its active metabolite; therefore inhibitors DECREASE its levels
- 2D6 Inh: Paxil, Luvox, Cymbalta, Amiodarone

Front 46

What is Evista? FDA approved for?

Back 46

Raloxifene (Evista)

Approved for postmenopausal women with OSTEOPOROSIS or at high risk for BREAST CANCER.

Front 47

Compare Evista and Nolvadex

Back 47

Both increase risk of blood clots; however, Evista less likely (blackbox).

Raloxifene is less likely to lead to uterine cancer, hysterectomy or cataracts.

Front 48

List the SE for Aromatase Inh. Advantage over SERM's?

Back 48

Hot flashes, tumor flare, GI upset, weight gain, vaginal bleed

Advantage: NO hyperCa, thromboembolism, or endometrial cancer.

Front 49

What is Trastuzumab? Dosing? Form? Black box warning?

Back 49

Trastuzumab (Herceptin) - IV

Dose: 4mg/kg IV infusion over 90 minutes then 2mg/kg over 30 minutes WEEKLY for 51 weeks (total 52)

Black Box Warning: Heart problems, infusion reactions, lung problems

Front 50

What is Faslodex? Form? Indication and dose?

Back 50

Faslodex (fulvestrant) - IM

Indication: HER2-positive breast cancer

Dose: slow IM injection in each buttok on days 1, 15, and 30 then once per month thereafter

Front 51

What is Megace indicated for? Dosage? SE?

Back 51

Megestrol (Megace) is for palliative treatment of advanced breast or endometrial cancer. Also used to stimulate appetite.

Dosage: 20 & 40mg scored

SE: thromboembolism

Front 52

What is Ixempra? Indication? Form?

Back 52

Ixabepilone (Ixempra) contains ALCOHOL & CASTOR OIL

Indication: breast cancer

SUBSTRATE!!!!

Dosage: 40mg/m2 by IV infusion over 3H, once every 3 weeks

Front 53

Dosing for Tykerb?

Back 53

Lapatinib (Tykerb) is used for breast cancer

Dose: 5 tabs (250mg) QD x 21 days with Xeloda (Capecitabine)

Front 54

What is PSA blood test? Normal range?

Back 54

Prostate-Specific Antigen (PSA) blood test: 0 - 4ng/mL

***If the PSA is above normal range then a biopsy is performed to confirm the diagnosis.

Front 55

List the LH-RH or RnRH analog medications. MoA? SE?

Back 55

LH-RH or GnRH analogs ***GTL

Goserelin (Zoladex) - SC
Triptorelin (Trelstar) - IM
Leuprolide (Lupron) - IM

MoA: stop release of pituitary derived LH & FSH (chemical castration). It works by negative feedback, first gets worse then gets better.

SE: tumor flare (prevented by anti-androgen therapy: Flutamide, Biclutamide, Nilutamide)

Front 56

What is Abarelix? MoA? Dose?

Back 56

Abarelix (Plenaxis depot)

MoA: GnRH antagonist = suppresses luteinizing hormone (LH) & follicle stimulation hormone secretion thus reducing the secretion of testosterone from the testes

Dose: 100mg IM Q2weeks (days 1, 15 & 29 and Q4weeks after)

Front 57

List the anti-androgens. MoA? SE?

Back 57

Nilutamide (Nilandron) - disulfiram rxn
Bicludatime (Casodex) - diarrhea
Flutamide (Eulixin) - LIVER dysfunction

Front 58

What medication is used for salvage hormone therapy?

Back 58

Ketoconazole (Nizoral)
- reduces levels of testosterone & cortisol => thus it can be used for Cushing's

Front 59

What are the two meds used to reduce Prostate Cancer Risk

Back 59

Finasteride (Proscar) (Propecia)
Dutasteride (Avodart)

MoA: inhibits 5-alpha-reductase, the enzyme that converts testosterone to the more potent androgen dihydrotestosterone

Front 60

Wat is Denosumab?

Back 60

Denosumab

Xgeva (prevention of skeletal-related events in cancer patients with bone mestastases)

Prolia (osteoporosis)