Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
72 Cards in this Set
- Front
- Back
|
Name the 3 alkylating agents |
Cyclophosphamide
Chlorambucil Carmustine |
|
|
What side effect is a particular concern with cyclophosphamide?
|
Hemorrhagic cystitis (active metabolite acrolein)
|
|
|
What can you do to prevent this?
|
Give mesna
Maintain adequate hydration |
|
|
Which drugs are of high emetic potential?
|
Cisplatin
Mechlorethamine Streptozotocin Cyclophosphamide Carmustine Dacarbazine Dactinomycin |
|
|
What percentage of patients will experience emesis on these medications?
|
More than 90%
|
|
|
Which agents can cause hepatotoxicity?
|
Chlorambucil
Etoposide Vincristine Paclitaxel Methotrexate |
|
|
Name the 3 platinum based agents
What is their mechanism? |
Cisplatin
Carboplatin Oxaliplatin Crosslink DNA, cause it to break |
|
|
Name the two topoisomerase inhibitors
How does inhibiting topoisomerase provide therapeutic effect? |
Irinotecan
Etoposide Inhibit DNA replication and repair |
|
|
Name the 4 anti-mitotic agents
How do they work? |
Vincristine
Vinblastine Paclitaxel Docetaxel |
|
|
Name the two anti-metabolite nucleoside agents
How do they work? |
Cytarabine
5-Fluorouracil They are pyrimidine analogs that are incorporated into DNA and cause cell cycle arrest and apoptosis |
|
|
Name the antimetabolite folic acid antagonist
How does this drug work? |
Methotrexate
Inhibits dihydrofolate reductase, synthesis of nucleosides and DNA synthesis |
|
|
Name the hormonal agents used in cancer therapy
|
Leuprolide
Tamoxifen Anastrozole |
|
|
How does Leuprolide work?
|
Acts as a GnRH agonist, acting on the pituitary gland - this causes decreased secretion of LH and FSH and therefore decreased estrodial and testosterone
|
|
|
How does anastrozole work?
|
Inhibits aromatase and the conversion of androgens to estrogens
|
|
|
How does Tamoxifen work?
|
Estrogen antagonist in the breast
Estrogen agonist in the endometrium |
|
|
Raloxifene is another serm used to prevent the risk of osteoporosis and breast cancer in post menopausal women. What is its MOA?
|
Antagonist in the breast and uterine
Agonist in the bone |
|
|
Name the 2 anthracycline agents
How do these agents work? |
Doxorubicin
Daunorubicin Intercalate DNA - cause reactive oxygen species |
|
|
Back to alkylating agents
What side effect is a particular concern with carmustine? |
Pulmonary Fibrosis
|
|
|
What side effect is of particular concern with Chlorambucil?
|
Stevens- Johnsons Syndrome
|
|
|
What is a major contraindication of all platinum agents?
|
Renal insufficiency
|
|
|
Which chemotherapy agents can cause peripheral neuropathy?
|
Platinum agents (Cisplatin, Carboplatin, Oxaliplatin)
Vincristine Vinblastine Paclitaxel |
|
|
What side effect is of particular concern with cisplatin?
|
Ototoxicity
|
|
|
Which class of chemotherapy agents is associated with anaphylaxis?
|
Platinum agents
|
|
|
What side effect is particularly concerning with irinotecan?
|
Severe, life threatening diarrhea
|
|
|
What side effect is particularly concerning with Vincristine?
|
Paralytic ileus (secondary to neurologic toxicity) - all patients should be on a prophylactic bowel regimen
|
|
|
What side effects are particularly concerning with Paclitaxel?
|
Cardiac rhythm abnormalities
Mucositis, stomatitis (Severe) |
|
|
What side effect is particularly concerning with docetaxel?
|
Significant fluid retention
|
|
|
What side effect is particularly concerning with cytarabine IV and IT?
|
IV: Cytarabine syndrome (myalgia, bone pain, rash, conjunctivitis, fever)
IT: Chemical arachnoiditis (N/V, Headache, Fever), Neurotoxicity |
|
|
Which chemotherapy agents can cause neurotoxicity?
|
IT Cytarabine
Methotrexate |
|
|
What are the primary side effects of 5-Fluorouracil?
|
Hand and foot syndrome (chemotherapy induced acral erythema)
N/V, Diarrhea, Mucositis, Stomatitis Bone marrow suppression |
|
|
5-FU (Adrucil) Med Pearl
|
Leucovorin increases effectiveness and decreases toxcitiy
|
|
|
Which chemotherapy agents are significant for renal toxicity?
|
Cisplatin
Methotrexate |
|
|
Which chemotherapy agents can cause stevens-johnson syndrome?
|
Chlorambucil
Methotrexate |
|
|
Methotrexate has man primary side effects. Name them (6).
|
Renal damage
Heptatotoxicity Neurotoxicity Bone marrow suppression Severe diarrhea and ulcerative stomatitis Stevens-Johnson Syndrome |
|
|
When do you want to give leucovorin rescure in regards to methotrexate?
|
24 hours after dosing to limit toxicity - Not concurrently
|
|
|
What are the primary side effects of leuprolide?
|
Abnormal menses
Exacerbation of endometriosis Hot flashes/sweats Decrease bone mineral density Spinal cord compression Urinary tract obstruction Tumor flare Depression, mood disturbances ***Monitor LH, FSH, testosterone, estrogen levels |
|
|
What are the primary side effects of anastrazole?
|
Decreased bone mineral density
Mood disturbances Hyperlipidemia (monitor lipid panel) |
|
|
What are the primary side effects of Tamoxifen?
|
Altered menses
Mood disturbances Hot flashes Thromboembolic events Increased risk of endometrial cancer (annual gynecologic exams) |
|
|
What is a contraindication to anthracycline therapy?
|
Pre-existing myocardial insufficiency or arrhythmia
|
|
|
What are the primary side effects of anthracyclines (doxorubicin, daunorubicin)?
|
Cardiotoxicity
Severe bone marrow suppression Red coloration of body fluids |
|
|
What additional side effect is caused by Doxorubicin?
|
Secondary leukemias
|
|
|
Which chemotherapy agents can cause secondary leukemias?
|
Chlorambucil
Carmustine Doxorubicin |
|
|
***Targeted and Biologic Agents***
|
Monoclonal Antibodies
EGFR Inhibitors VEGF Inhibitors Tyrosine Kinase Inhibitors |
|
|
Name the 4 Monoclonal antibodies
|
Alemtuzumab (Campath)
Ibritumomab (Zevalin) Rituximab (Rituxan) Tositumumab (Bexxar) |
|
|
What is the common toxicity between all the monoclonal antibodies?
|
Infusion-related reactions
|
|
|
What is the solution to this?
|
Pre-medicate with diphenhydramine and acetaminophen
|
|
|
What toxicity is common to 3 of these medications (and which 3)?
|
Alemtuzumab
Ibritumomab Tositumumab Myelosuppresion |
|
|
Describe the mechanisms of each of these monoclonal antibodies
|
Alemtuzumab - targets CD52 on cancer cells promoting cell mediated lysis
Ibritumomab - Attaches to malignant B cell (with radioactive isotope) causing cell death through radiation |
|
|
Continued
|
Rituximab - Binds to CD20 and induces apoptosis
Tositumumab - CD20 antibody linked to radioactive isotope |
|
|
What is each monoclonal antibody used for?
|
Alemtuzumab (B-cell CLL)
Irbritumomab (CD-20 positive B-cell NHL - Used in combination with rituximab Rituxumab (CD 20 positive, B-cell NHL, RA) Tositumumab (CD 20 positive, follicular, NHL refractory to rituximab |
|
|
EGFR Inhibitors (Cetuximab, Erlotinib, Lapatinib, Trastuzumab)
Which two have infusion related reactions that need pretreatment? |
Cetuximab
Trastuzumab |
|
|
Which can cause a severe rash?
|
Cetuximab
Erlotinib Lapatinib |
|
|
Which agent causes heptatotoxicity and QT prolongation?
|
Lapatinib
|
|
|
Which agent causes cardiotoxicity and myelosuppression?
|
Trastuzumab
- Do not use with anthracyclines |
|
|
What is each EGFR inhibitor used for?
|
Cetuximab - EGFR positive head, neck or colorectal cancer
Erlotinib - NSCLC, advanced unresectable pancreatic cancer Lapatinib - Metatstatic breast cancer with HER-2 expression Trastuzumab - Metastatic breast cancer with HER-2 expression |
|
|
VEGF Inhibitors (Bevacizumab, Sunitinib, Sorafenib)
What side effect is common between these agents? |
Hypertension
|
|
|
Which agent can cause thromboembolic events and bleeding?
|
Bevacizumab
|
|
|
Which agent can cause heart failure?
|
Sunitinib
|
|
|
Which agent can cause hand-foot syndrome?
|
Sorafenib
|
|
|
What is each agent used for?
|
Bevacizumab (Avastin) - metastatic colorectal cancer, NSCLC, HER-2 negative breast cancer, glioblastoma, metastatic renal cell carcinoma
Sunitinib - Gastrointestinal stromal tumor, Renal cell carcinoma Sorafenib - Advanced renal cell carcinoma, unresectable hepatocellular carcinoma |
|
|
Tyrosine Kinase Inhibitors (Dasatinib, Imatinib)
What side effect is common among tyrosine kinase inhibitors? |
Fluid retention
|
|
|
What side effect is particular to Dasatinib?
|
Myelosuppression
|
|
|
What side effect is particular to Imatinib?
|
Stevens-Johnson Syndrome
|
|
|
Supportive care: What is the use of benodiazepines, aprepitant?
|
Benzo - anticipatory N/V
Aprepitant - Severe N/V (cisplatin, cyclophosphamide, doxorubicin) |
|
|
What is given for less severe cases of nausea?
|
Prochlorperazine
Metoclpramide |
|
|
When does the lowest concentration of WBC typically occur?
|
1-2 weeks after chemotherapy administration
|
|
|
What are the values for neutrophils (Normal, Mild, Moderate, Severe)?
|
3,000-7,000
500-1000 100-500 <100 |
|
|
MOA of ondansetron, aprepitant, metoclopramide, corticosteroids
|
ondansetron - 5HT3 antagonist
aprepitant - NK1 antagonist metoclopramide - dopamine antagonist corticosteroids - potentiate anti-emetic properties of 5HT3 antagonists - can use as single agents in mild cases |
|
|
Side effects of metoclopramide
|
Dystonic reactions (EPS)
Sedation |
|
|
Filgastrim brand name
PEG-Filgastrim brand name Sargramostim brand name |
Neupogen
Neulasta Leukine |
|
|
What are some common side effects among the colony stimulating factors?
|
Bone pain
Hypertension Hypersensitivity reactions |
|
|
Difference between Neupogen/Neulasta and Leukine
|
Neupogen/Neulasta are neutrophil specific
Leukine stimulates all WBCs except lymphocytes |
