Oncology

Front 1

Major toxicity associated with bleomycin, busulfan

Back 1

pulmonary fibrosis

Front 2

Major toxicity associated with platinum agents like cisplatin, carboplatin

Back 2

Nephro- and oto-toxicity

Front 3

Major toxicity associated with doxorubicin (and other anthracyclines)

Back 3

Cardiotoxicity

Front 4

Major toxicity associated with methotrexate and 5-fluorouracil

Back 4

Myelosuppression

Front 5

Major toxicity associated with nitrosureas

Back 5

Neurotoxicity

Front 6

Major toxicity associated with cyclophosphamide

Back 6

hemorrhagic cystitis

Front 7

Major toxicity associated with vinca alkaloids

Back 7

Peripheral neuropathy

Front 8

BBW for all SERMs

Back 8

Increased risk of thromboembolic events

Front 9

Which SERM has increased risk of endometrial cancer?

Back 9

Tamoxifen

Front 10

Aromatase inhibitors are given?

Back 10

PO

Front 11

Name 3 main aromatase inhibitors

Back 11

Anastrazole
Exemestane
Letrozole

Front 12

What is the therapeutic indication for the aromatase inhibitors?

Back 12

Breast cancer

Front 13

Name 3 SERMs

Back 13

Fulvestrant
Raloxifene
Tamoxifen

Front 14

Which SERM is used for osteoporosis treatment in women at risk of breast cancer?

Back 14

Raloxifene (Evista)

Front 15

Common adverse effects seen with aromatase inhibitors and SERMs?

Back 15

Lethargy/fatigue, rash, hot flashes, menopause symptoms, weight gain

Front 16

Drug class of choice for breast cancer with 2D6 polymorphism *4/*5?

Back 16

Aromatase inhibitor

Front 17

Aminoglutethimide and mitotane are non-selective aromatase inhibitors that require ______ supplementation during therapy

Back 17

glucocorticoid and mineralcorticoid

Front 18

_______ is cardioprotective and should be considered when doxorubicin doses are expected to be continued beyond 300mg/m2

Back 18

Zinecard (dexrazoxane)

Front 19

Liposomal products are associated with increased incidence of ______ and ________

Back 19

Hand-foot syndrome and Allergic reactions

Front 20

All anthracyclines can have what effect on body fluids (exception?

Back 20

Turn them red (mitoxantrone turns them blue)

Front 21

______ is an anthracycline instilled in the bladder for the treatment of refractory bladder cancer

Back 21

Valrubicin

Front 22

4 major side effects of MTX?

Back 22

-myelosuppression
-mucositis
-hand/foot syndrome
-liver/kidney toxicity

Front 23

High dose MTC requires ______ to help reduce toxicity

Back 23

Leucovorin Rescue

Front 24

Avoid concurrent use of MTX and what 4 (there are more, but 4 important) drugs

Back 24

-ASA
-PCN
-Probenecid
-NSAIDs

Front 25

Essential counseling point for MTX?

Back 25

Hydrate!

Front 26

________ is the active form of folic acid- it bypasses enzyme block of dihydrofolate reductase by MTX

Back 26

Leucovorin

Front 27

Name the 2 immunomodulators

Back 27

-Lenalidomide
-Thalidomide

Front 28

Primary warning/contraindication with the immunomodulators?

Back 28

Pregnancy Category X

Front 29

Avonex is a ______ interferon

Back 29

Beta-1-A

Front 30

Betaseron is a _______ interferon

Back 30

Beta-1-B

Front 31

_______ is pegylated alpha-2-A interferon

Back 31

Pegasys

Front 32

Interleukins work by?

Back 32

Stimulating immune system to target cancer cells

Front 33

______ is an interleukin with use restricted to those with normal pulmonary and cardiac function only

Back 33

Aldesleukin (Proleukin)

Front 34

_____ is a monoclonal antibody-angiogenesis inhibitor used in numerous cancer types

Back 34

Bevacizumab (Avastin)

Front 35

Avastin binds to?

Back 35

VEGF-A

Front 36

_________ - CD-20 target on lymphocytes kills cancer but also releases cytokines

Back 36

Rituximab (Rituxan)

Front 37

Infusions of Rituxan must be given?

Back 37

In-patient

Front 38

Which drug does EGFR(+) expression correlate with increased response rates?

Back 38

Cetuximab (Erbitux)

Front 39

Colorectal cancer does NOT respond to cetuximab or panitumumab if patients have?

Back 39

K-ras mutation

Front 40

______ is a platinum agent with nephrotoxicity, requiring vigorous hydration

Back 40

Cisplatin

Front 41

_________ can be used as prophylaxis for cisplatin-induced nephrotoxicity

Back 41

Amifostine

Front 42

Which platinum agent is dosed based on AUC

Back 42

Carboplatin

Front 43

________ is a platinum agent associated with neuropathy, typically exacerbated by exposure to cold weather

Back 43

Oxaliplatin

Front 44

How should mercaptopurine (PO) be given?

Back 44

1 hour before or 2 hours after meals

Front 45

_________ is a pro-drug of mercaptopurine

Back 45

Azathioprine (Imuran)

Front 46

6-MP undergoes extensive 1st pass metabolism in liver by?

Back 46

Xanthine Oxidase

Front 47

_______ is a pro-drug of 5-FU

Back 47

capecitabine (Xeloda)

Front 48

How should Xeloda be taken?

Back 48

With meals

Front 49

What pre-screening test should be done before initiating therapy with capecitabine

Back 49

Testing for DPD deficiency

Front 50

5 drugs that are pyrimidine analog antimetabolites

Back 50

-Capecitabine
-Cytarabine
-Fluorouracil
-Floxuridine
-Gemcitabine

Front 51

Name the 3 taxane agents

Back 51

-Carbazitaxel
-Docetaxel
-Paclitaxel

Front 52

Primary side effect of docetaxel?

Back 52

Cardio-pulmonay effects (fluid retention)

Front 53

Pretreat Paclitaxel with?

Back 53

Dexamethasone + Benadryl + H2RA

Front 54

______ is TK1 targeting BCR-ABL given PO, with water and a full meal

Back 54

Imatinib (Gleevac)

Front 55

Indication for Gleevac?

Back 55

Ph(+) CML

Front 56

How should imatinib be given?

Back 56

With water and a full meal

Front 57

TK1 targeting EGFR

Back 57

Tarceva (erlotinib)

Front 58

How is Tarceva given?

Back 58

Orally, 1 hour before or 2 hours after meal

Front 59

TK1 targeting HER-2

Back 59

Lapatinib (Tykerb)

Front 60

Indication for Tykerb?

Back 60

Metastatic breast cancer in patients who have failed trastuzumab and chemotherapy

Front 61

_______= TK1 targeting multiple proteins; taken PO without regard to meals

Back 61

Sutent (sunitinib)

Front 62

______ is a vaccine for treatment of advanced prostate cancer (over $90,000 per dose)

Back 62

Siputeucel-T (Provenge)

Front 63

How is Sutent given?

Back 63

Orally; without respect to meals

Front 64

Name 3 vinca alkaloids

Back 64

-Vinblastine
-Vincristine
-Vinorelbine

Front 65

What is the dose-dependent toxicity associated with vinca alkaloids?

Back 65

Nerve damage

Front 66

ONLY route of administration allowed for vinca alkaloids?

Back 66

IV

Front 67

How to treat vesication as a result of vinca alkaloid administration?

Back 67

Hyaluronidase and WARM compresses

Front 68

________ is a debulking agent for leukemias and sickle cell disease

Back 68

Hydroxyurea (Hydrea)

Front 69

Anemia and chemotherapy- name 2 agents used for treatment and their doses

Back 69

-Epoetin Alfa (SQ weekly)
-Darbopoetin (SQ every 2-3 weeks)

Front 70

Name 3 colony-stimulating factors for neutropenia

Back 70

-Sargramostim
-Filgrastim
-Pegfilgrastim

Front 71

Primary side effect of colony-stimulating factors?

Back 71

Bone pain

Front 72

When are platelet transfusions indicated in thrombocytopenia?

Back 72

<10,000/mm3

Front 73

Name the one drug available for thrombocytopenia prevention

Back 73

Opreluekin (Neumega)

Front 74

Which agent carries the highest risk of nausea/vomiting with chemotherapy

Back 74

Cisplatin

Front 75

Which 3 agents/classes are a moderate risk for causing chemotherapy induced N/V?

Back 75

-Anthracyclines
-Carboplatin
-Oxaliplatin

Front 76

To prevent acute N/V, pre-treatment of patients should include?

Back 76

-Dexamethasone
-Zoftan
-Aprepitant

Front 77

______ is a neurokinin-1 receptor blocker used for chemotherapy-induced N/V

Back 77

Aprepitant

Front 78

Which 5-HT3 blocker comes as a transdermal patch?

Back 78

Granisetron (Sancuso)

Front 79

Do not use _______ for CINV due to increased risk of QT prolongation

Back 79

Dolasetron (Anzemet)

Front 80

5-HT3 blockers are contraindicated with which Parkinson's drug?

Back 80

Apomorphine (Apokyn)

Front 81

3 phenothiazines for nausea/vomiting

Back 81

-Prochlorperazine
-Chlorpromazine
-Promethazine

Front 82

Phenothiazines are only approved for patients age?

Back 82

>2 years old

Front 83

_____ is a substance-P/NK1 receptor antagonist

Back 83

Aprepitant (Emend)

Front 84

Best therapy for mucositis from chemotherapy?

Back 84

"Magic Mouthwash"

Front 85

Only FDA approved agent for chemotherapy-induced mucositis (restricted to chemotherapy before stem cell transplant)

Back 85

Palifermin (Keplvance)

Front 86

2 IV agents for hypercalcemia of malignancy?

Back 86

-Zoledronic Acid (Zometa)
-Pamidronate (Aredia)

Front 87

Reclast is ______ only for use in?

Back 87

Zoledronic acid; for osteoporosis only

Front 88

Which SERM should be stopped 72 hours before prolonged immobilization?

Back 88

Evista

Front 89

_______ are drugs approved for breast cancer only in patients who have FINISHED menopause

Back 89

Aromatase inhibitors

Front 90

Promethazine should be infused over?

Back 90

20-30 minutes

Front 91

Yearly mammograms should begin at age?

Back 91

40

Front 92

Clinical breast exams should be done every 3 years if age _____, and annually after age?

Back 92

20-39; 40

Front 93

Colonoscopies should be done after age?

Back 93

>50

Front 94

Cervical/PAP smears should be done at age?

Back 94

21

Front 95

ESAs should ONLY be used if Hgb is less than?

Back 95

10

Front 96

Most common disease associations with ESA therapy?

Back 96

CHF, Chest Pain, Thrombosis, Arrhythmias, CV death

Front 97

Define neutropenia?

Back 97

ANC < 500/mm3

Front 98

#1 side effect of bleomycin

Back 98

Pulmonary reactions (pneumonitis)

Front 99

_______ is a decrease in bone marrow activity resulting in decreased RBC, WBC, and platelets

Back 99

Myelosuppression

Front 100

________ and _______ are 2nd line agents for CINV. They are synthetic delta-9-tetrahydrocannibinol

Back 100

Dronabinol (Marinol)
Nabilone (Cesamet)

Front 101

Cesamet is C___

Back 101

C2

Front 102

Marinol is C___

Back 102

C3

Front 103

When to dose Emend

Back 103

Pre-chemotherapy

Front 104

Chemotherapy during pregnancy?

Back 104

Avoid whenever possible

Front 105

Storage for Leukeran?

Back 105

Refrigerator

Front 106

Chlorambucil trade name? Class?

Back 106

Leukeran; Alkylator

Front 107

2 main types of cancers treated with alkylating agents?

Back 107

Leukemias and lymphomas

Front 108

Name the 3 alkylating agents?

Back 108

-Cyclophosphamide
-Ifosfamide
-Temozolomide

Front 109

All patients receiving cyclophosphamide or ifosphamide should be treated with?

Back 109

MESNA (protection against hemorrhagic cystitis)

Front 110

Most common toxicity associated with busulfan, carmustine, lomustine?

Back 110

Pulmonary toxicities

Front 111

Which 2 alkylators can cause skin pigmentation changes?

Back 111

Busulfan
Carmustine

Front 112

Which alkylator can cause flu-like symptoms?

Back 112

Dacarbazine

Front 113

Which alkylator is an MAOI?

Back 113

Procarbazine

Front 114

Which alkylating agent uses weight-based dosing (all others based on BSA)?

Back 114

Busulfan

Front 115

Antiandrogens are given _______, usually with LHRH agonists for what cancer?

Back 115

Orally; Prostate Cancer

Front 116

Name some of the most common side effects of antiandrogens

Back 116

N/V/D, gynecomastia, hepatotoxicity, decreased libido, impotence

Front 117

Which antiandrogen hsa a warning for possible night-blindness

Back 117

Nilutamide (Nilandron)

Front 118

______ is a GNRH antagonist used in prostate cancer

Back 118

Degorelix (Firmagon)

Front 119

What are 4 indications for LHRH agonists?

Back 119

-Prostate Cancer
-Endometriosis
-Fibroids
-Breast Cancer

Front 120

Name 4 LHRH agonists

Back 120

-Goserelin
-Histrelin
-Leuprolide
-Triptorelin

Front 121

How are the LHRH agonists given?

Back 121

Monthly to every 6-months; in a medical office

Front 122

Most common side effects of LHRH agonists?

Back 122

Hot flashes, bone pain, dyslipidemia, injection site pain, QT prolongation, gynecomastia, decreased BMD

Front 123

Patients on LHRH agonists should also receive _____ supplementation

Back 123

Calcium + D

Front 124

Compared to SERMs, ______ have a higher CVD risk

Back 124

Aromatase inhibitors

Front 125

Of the SERMs, most are given PO. Which one is IM?

Back 125

Fluvestrant (Faslodex)

Front 126

_____ work by intercalating DNA, inhibiting TOPO-II, and creating oxygen free-radicals that damage cells

Back 126

Anthracyclines

Front 127

Anthracyclines biggest toxicity?

Back 127

Cardiotoxicity

Front 128

_____ and _____ are anthracyclines available as a standard and liposomal form

Back 128

Daunorubicin
Doxorubicin

Front 129

Anthracyclines are associated with _______ reactions

Back 129

Radiation Recall

Front 130

______ is an epthilone with a similar mechanism to taxanes; however, it is still effective in taxane-resistant breast cancer

Back 130

Ixabepilone (Ixempra)

Front 131

______ is the #1 folate antimetabolite used in cancer and rheumatoid arthritis

Back 131

MTX

Front 132

Lower/Higher doses of methotrexate should be used in RA and psoriasis?

Back 132

Lower

Front 133

Besides MTX, what are the other 2 commonly used folate antimetabolites?

Back 133

-Pemetrexed
-Pralatrexate

Front 134

Both pemetrexed/pralatrexate require supplementation with?

Back 134

Folic acid and B12

Front 135

______ is a microtubule destabilizer that inhibits polymerization of tubules; halting cell division during metaphase

Back 135

Eribulin Mesylate (Halaven)

Front 136

Immunomodulator agents are pregnancy category?

Back 136

X

Front 137

2 common side-effects to be aware of in counseling a patient on interferon therapy?

Back 137

-Depression/suicidal ideation
-Flulike symptoms

Front 138

Which class of medications can cause capillary-leak syndrome?

Back 138

Interleukins

Front 139

Which interleukin should have pre-treatment antibiotics with gram+ coverage due to increased risk of infective endocarditis

Back 139

Proleukin (aldesleukin)

Front 140

Which monoclonal antibody is very light sensitive- it should be prepared in the dark

Back 140

Gemtuzumab (Mylotarg)

Front 141

Which monoclonal antibody requires 2 positive IHC tests to make a patient eligible to receive?

Back 141

Herceptin (trastuzumab)

Front 142

#1 adverse effect of Herceptin?

Back 142

Cardiomyopathy

Front 143

To avoid allergic infusion-related reactions with Herceptin, patients should be pre-medicated with?

Back 143

APAP + H2RA

Front 144

_______ inhibits downstream regulation of VEGF, reducing cell growth, metabolism, proliferation and angiogenesis

Back 144

mTOR inhibitor

Front 145

Retinoids, such as tretinoin, are pregnancy category?

Back 145

X

Front 146

If receiving multiple drugs for chemotherapy, when should the taxane be given?

Back 146

First

Front 147

Name 2 Topoisomerase I inhibitors

Back 147

-Irinotecan
-Topotecan

Front 148

Which TOPO-I inhibitor can cause acute diarrhea?

Back 148

Irinotecan

Front 149

How to manage acute diarrhea from irinotecan?

Back 149

Atropine

Front 150

How to manage delayed diarrhea from irinotecan?

Back 150

Loperamide