Naplex - Chapter 54 - Oncology I

Front 1

Warning signs?

Back 1

CAUTION

C: change in bowel or bladder habits

A: a sore that does not heal

U: unusual bleeding or discharge

T: thicken or lump in breast or elsewhere

I: indigestion or difficulty swallowing

O: obvious change in wart or mode

N: nagging cough or hoarseness

Front 2

ABCDE warning signs of melanoma skin cancer?

Back 2

A: asymmetry

B: border

C: color

D: diameter

E: evolving

Front 3

common drugs of Myelosuppression?

Back 3

Almost all EXCEPT:

- bleomycin

- vincristine

Front 4

common drugs of nausea/vomiting?

Back 4

- cisplastin***

- doxorubicin

- epirubicin

- cyclophosphamide

- ifosfamide

Front 5

common drugs of mucositis?

Back 5

- fluorouracil

- capecitabine

- irrinotecan

- methotrexate

Front 6

common drugs of diarrhea?

Back 6

- irrinotecan

- fluorouracil

- capecitabine

Front 7

common drugs of constipation?

Back 7

- vincristine***

- pomalidomide

- thalidomide

Front 8

common drugs of xerostomia?

Back 8

- radiation (to head and neck areas)

Front 9

common drugs of cardiotoxicity?

Back 9

- CHF: Anthracycline, HER2(trastuzumab, pertuzumab)

- QT prolong: Asenic trioxide, TKIs (everything end with -nib-)

Front 10

common drugs of hepatotoxicity?

Back 10

- anti androgens (bicalutamide, flutamide, nilutamide)

- folate antimetabolites (methotrexate, pemetrexate, pralatrexate)

- antimetabolites (cytarabine, gemcitabine)

- ipilimumab

Front 11

common drugs of nephrotoxicity?

Back 11

- Cisplatin

- Methotrexate (high dose)

Front 12

common drugs of hemorrhagic cystitis?

Back 12

- Ifosfamide, cyclophosphamide

-----> Mesna (Mesnex) is always given prophylactically to reduce the risk of hemorrhagic cystitis. Ensure adequate hydration

Front 13

common drugs of neuropathy?

Back 13

- Vinca alkaloids (Vincristine, Vinblastine, Vinorelbine)

- Texans (Paclitaxel, Docetaxel, Cabazitaxel)

- Proteasome inhibitors (Bortezomib, Cafrfilzomib)

Front 14

common drugs of clotting risk?

Back 14

- Aromataste inhibitors (Anastrazole, Letrozole)

- SERM (Tamoxifen)

- immunomodulators (Thalidomide, Lenalidomide, Pomalidomide)

Front 15

what is max dose for doxorubicin?

Back 15

NTE life time dose of 450-550 mg/m2 for doxorubicin

- dexrazoxan can be admin prophylactically in selected patients receiving doxorubicin

Front 16

what drug to give prophylactically with cisplatin to reduce the risk of nephrotoxicity?

Back 16

- Amifostine (Ethyol)

- Do NOT exceed max dose of 100 mg/m2/cycle for cisplatin

Front 17

what is max dose of Vincristine?

Back 17

2mg/week (regardless of BSA calculated dose)

Front 18

Neutropenia definition?

Back 18

- neutropenia: <1,000

- severe neutropenia: <500

- profound neutropenia: <100

Front 19

brand for filgrastim?

Back 19

Neupogen, Zarxio

Front 20

brand for pegfilgrastim?

Back 20

Neulasta

Front 21

brand for Sargramostim?

Back 21

Leukine

Front 22

SE, monitor and notes for filgrastim, pegfilgrastim, sargramostim?

Back 22

- SE: bone pain, fever, rash, site run

- mon: CBC, pulmononary function, weight, vital signs

- notes: store in fridge, protect from light, admin 1st dose 24-72hrs after chemo.

-----Pegfilgrastim: should NOT be given until 24hrs after the end of chemo infusion or within 14 days prior to the next cycle of chemo

-----Filgrastim/Sargramostim: should NOT be given within 24hrs before or after chemo

Front 23

what is definition of fever?

Back 23

- 38.3C or

- 38C for >1hr

Front 24

what is definition of neutropenia?

Back 24

- ANC < 500

Front 25

initial empiric ABX for low risk febrile neutropenia?

Back 25

- low risk: expect ANC <500 for <=7days with no comorbidities

- Txmt:

1. ciproflox + augmentin (amox+clavu)

2. ciproflox +- clinda

3. levoflox

Front 26

what is high risk febrile neutropenia?

Back 26

- expect ANC <100 for >7days

- some comorbidities

- evidence of renal or hepatic impairment (CrCl<30)

Front 27

empiric treatment for high risk neutropenia

Back 27

- cefepime or

- ceftazidime or

- meropenem or

- imipenem-cilastin or

- pip-tazo

Front 28

when is platelets transfusion indicated?

Back 28

when platelet count < 10,000 cels/ul

Front 29

5HT3 RA (receptor antagonist) drugs?

Back 29

- Ondansetron (Zofran, Zuplenz film)

- Granisetron (Kytril, Sancuso patch)

- Dolasetron (Anzemet) (iv is not indicated for CINV d/t risk of QT prolong)

- Palonosetron (Aloxil)

- palonosetron+netupitant (Akynzeo)

Front 30

Dopamine receptor antagonists drugs?

Back 30

- prochlorperazine (Compazine, Compro)

- promethazine (Phenergan, Phenadoz, Promethegan)

- metoclopramide (Reglan, Metozlv ODT)

SE: sedation, lethargy, acute EPS, can lower seizure threshold

Front 31

brand and CI, SE of dexamethasone?

Back 31

- band is Decadrone

- CI: systemic fungal infection, cerebral malaria

- SE: increase appetite, wt gain, fluid retention, insomnia

Front 32

two cannabinoids drugs?

Back 32

- Dronabinol (Marinol) - fridge

- Nabilone (Cesamet) - no fridge

SE: somnolence, euphoria, increase appetite

Front 33

brand for Aprepitant?

Back 33

Emend (give PO)

Front 34

brand for Fosaprepitant?

Back 34

brand is Emend (but IV not PO)

Front 35

generic for Akynzeo?

Back 35

netupitant + palonosetron

Front 36

generic for Varubi

Back 36

Rolapitant

Front 37

drug treat xerostomia?

Back 37

- Pilocarpine (Salagen)

(hepatic impairment)

(avoid admin with high fat meal)

Front 38

drugs that cause hand-foot syndrome?

Back 38

- mostly drugs that cause diarrhea (ic fudge)

- one week after iv: fluorouracil

- during duration expose: capecitabine ***

Front 39

treatment for Hypercalcemia of malignancy treatment?

Back 39

- hydration with NS and Loop Diuretics

- Calcitonin (Miacalcin)

- Zoledronic acid (Zometa 4mg iv once) ---(NOT Reclast 5mg iv yearly is for osteo)

- Denosumab (Xgeva 120mg SC day 1, 8, 15 of 1st month) ---(NOT Prolia 60mg sc q6mo for osteo)

Front 40

timing vaccination in malignancy treatment?

Back 40

- given >= 2 weeks prior to chemo start

- patients on chemo may receive inactivated flu vaccine in between cycle of chemo

- no live vaccines

Front 41

mod - high emetic risk for Oral antineoplastic agents?

Back 41

- Lomustine*** (single day)

- etoposide

- cyclophosphamide >= 100mg/m2/day

- temozolomide >75mg/m2/day

- procarbazine

- crizotinib

Front 42

chemo agent and adjunctive medication pair for Cisplatin?

Back 42

Cisplatin ----- Amifostine (Ethyol)

--> prevent nephrotoxicity

Front 43

chemo agent and adjunctive medication pair for Doxorubicin?

Back 43

1. Doxorubicin ----- Dexrazoxane (Zinecard)

--> prevent cardiomyopathy

2. Doxorubicin ----- Dexrazoxane (Totect)--> treatment for extravasation

Front 44

chemo agent and adjunctive medication pair for Fluorouracil?

Back 44

Fluorouracil ----- Leucovorin/ or levoleucovorin (Fusilev)

--> give with fluorouracil to enhance efficacy

Front 45

chemo agent and adjunctive medication pair for Ifosfamide?

Back 45

Ifosfamide ----- Mesna (Mesnex)

--> to prevent hemorrhagic cystitis

Front 46

chemo agent and adjunctive medication pair for Irinnotecan?

Back 46

Irinnotecan ----- Atropine

--> to prevent acute diarrhea

Front 47

chemo agent and adjunctive medication pair for Methotrexate?

Back 47

1. Methotrexate ----- Leucovorin/ or levoleucovorin (Fusilev)--> give after MTX to reduce myelo suppression and mucositis

2. Methotrexate ----- Glucarpidase (Voraxaze) --> give in acute renal failure (high conc of MTX)

Front 48

What conditions need to be met for the addition of epoetin alfa to be appropriate to stimulate red blood cell production in a patient with cancer?

Back 48

- If used in patients with cancer, the provider must be enrolled in the ESA APPRISE program and

- the hemoglobin should be < 10 g/dL.

- In addition, the patient should be symptomatic and iron stores adequate.

Front 49

In cancer patients, anemia is not being treated with erythropoiesis-stimulating agents due to what reasons?

Back 49

- Shortened survival and

- increased tumor progression have limited the use of ESAs in cancer patients.

Front 50

Which classes of medications is recommended for prevention of anticipatory Chemotherapy-Induced Nausea and Vomiting (CINV)?

Back 50

Benzodiazepine

Front 51

Which classes of medications is recommended for treating an Acute Chemotherapy-Induced Nausea and Vomiting (CINV)?

Back 51

5HT-3 receptor antagonists

(Ondansetron, ...)

Front 52

Which classes of medications is recommended for treating a delayed Chemotherapy-Induced Nausea and Vomiting (CINV)?

Back 52

- NK1-RA (aprepitant, fosaprepitant)

- corticosteroids (dexamethasone)

- Palonosetron

Front 53

generic for Aloxi?

Back 53

Palonosetron

Front 54

Which drug is most likely to cause symptoms of heart failure?

Back 54

Doxorubicin

Front 55

Which of the chemotherapeutic agent is associated with a > 90% frequency of emesis?

Back 55

- Cisplatin

Front 56

Which of chemotherapeutic medications is associated with the highest incidence of hand-foot syndrome?

Back 56

Doxil (doxorubicin) and DaunoXome (daunorubicin) are liposomal formulations. These liposomal formulations are associated with more hand-foot syndrome than the non-liposomal formulations.

Front 57

Can dolasetron be given by IV?

Back 57

Dolasetron (Anzemet) is NOT indicated for intravenous use for CINV due to increased risk of QT prolongation.

Front 58

anti-emetic regimens are recommended for highly emetogenic chemotherapy?

Back 58

1) Olanzapine + dexamethasone + palonosetron

2) NK-1 inhibitor + dexamethasone + a 5HT3 receptor antagonist

- either one can be used to prevent CINV from highly emetic regimens.

Front 59

which agents could be used to increase the hemoglobin level?

Back 59

Epoetin alfa (Procrit) and darbepoetin (Aranesp) may be used to treat anemia in cancer patients.

Front 60

brand names for Prochlorperazine ?

Back 60

Compro & Compazine

(DA receptor antagonist)

Front 61

what med to treat extravasation of doxorubicin?

Back 61

Totect (dexrazoxane) should be given for doxorubicin extravasation.