Oncology Exam 1

Front 1

stage 2 Durie Salmon

Back 1

Hbg=8.5-10
serum Ca = 12
medium myeloma protein
IgG 5-7
IgA 3-5
Bence Jones protein = 4g-12g/24h
1-2 bone lesions
measured myeloma cells 0.6-1.2 x 10^12

Front 2

major MM criteria

Back 2

M-protein >/= 3.5 IgG or >/= 2 IgA
plasmacytoma
BM plasma cells >30%

Front 3

minor MM criteria

Back 3

monoclonal spike w/ levels < major criteria
IgM <50
IgA<100
IgG<600
BM plasma cells 10-30%
lytic bone lesions

Front 4

international staging system stage 1

Back 4

B2 microglobulin <3.5
albumin >/= 3.5

Front 5

international staging system stage 3

Back 5

B2 microglubulin >/= 5.5

Front 6

subclass staging (A and B)

Back 6

A = Scr <2
B = Scr >/= 2

Front 7

tx of solitary plasmacytoma

Back 7

radiation

Front 8

tx of smoldering MM

Back 8

observation q3-6 months

Front 9

tx of non-transplant MM pts

Back 9

lenalidomide + low-dose dexa

MPT (melphalan, prednisone, thalidomide/lenalidomide)

VMP (bortezomib, melphalan, prednisone)

Front 10

duration of tx for non-transplant MM pts

Back 10

until plateau (stable M-protein and no evidence of progressive MM)

Front 11

maintenance tx for non-transplant MM

Back 11

lenalidomide, interferon, steroids, thalidomide +/- prednisone (NO alkylating agents)
(same as maintenance tx for transplant MM!)

Front 12

transplant MM pt induction tx (and when)

Back 12

3-4 months prior to transplant

bortezomib + dexa

bortezomib, doxorubicin, dexa

bortezomib, thalidomide, dexa

lenalidomide + dexa

(NO alkylating agents -- can damage stem cell reserve!)

Front 13

high dose chemo for transplant tx MM

Back 13

IV melphalan

Front 14

maintenance tx for MM transplant pts

Back 14

interferon, lenalidomide, steroids, thalidomide +/- prednisone

Front 15

relapsing MM tx options

Back 15

repeat initial tx if >6 mo

1. bortezomib + liposomal doxirubicin
2. lenalidomide + dexa
3. cyclophosphamide
4. bendamustine (if CrCl>40)

Front 16

tx for vertebral compression fractions

Back 16

kyphoplasty

Front 17

uses for plasmaphoresis

Back 17

remove light chains from plasma, hyperviscosity

Front 18

tx for cord compression

Back 18

radiation, steroids

Front 19

infection prophylaxis (general and for bortezomib)

Back 19

general = PCP, herpes, fungal
bortezomib = herpes zoster

Front 20

melphalan (MOA, admin, disease state issues, a/e)

Back 20

cross links DNA
oral empty stomach; refrigerated
adjust for renal
myelosuppression, mucositis

Front 21

thalidomide (MOA, admin, disease state issues, a/e)

Back 21

immunomodulator, anti-angiogenic
200 mg qd oral empty stomach bedtime
DM
teratogenic, neuropathy, constipation, rash, DVT, fatigue/dizziness/confusion, hypocalcemia, secondary malignancies

Front 22

lenalidomide (MOA, admin, d/s issues, a/e)

Back 22

immunomodulator, anti-angiogenic, inhib growth of myeloma cells
25 mg qd x 21d (off for 7d) swallow whole
DM, adjust for renal
teratogen, edema, fatigue/dizziness/HA, DVT, rash/pruritis, myelosuppression, secondary malignancies

Front 23

bortezomib (MOA, admin, d/s issues, a/e, interaction)

Back 23

inhibit proteasomes
IV 1.3mg/m^2 (BIW or QW)
hepatic, DM, herpes prophylaxis
fever, hypotension, insomnia/dizziness, rash/pruritis, neuropathy, myelosuppression, diarrhea/constipation, dyspnea, cough
interaction w/ green tea

Front 24

vincristine (MOA, admin, d/s issues, a/e)

Back 24

inhib microtubule formation
IVPB, vesicant, NOT intrathecal
hepatic, neurologic
alopecia, peripheral neuropathy, constipation, abd cramping, confusion, HA

Front 25

doxorubicin (MOA, admin, formulation, d/s issues, a/e)

Back 25

topoisomerase II inhib
IVPB, vesicant, red
liposomal - 40mg/m^2 over 60 mins
hepatic
cardiac (EF!), myelosuppression, alopecia, n/v
liposomal = infusion-related, hand-foot

Front 26

high/low dose dexa

Back 26

high = 40 mg QD (days 1-4, 9-12, 17-20)
low = 40 mg QW

Front 27

bisphosphonates (MOA, specific drugs/doses, d/s issues, a/e)

Back 27

inhibit osteoclasts, decrease IL-6 production
zoledronic acid - 4mg IV over 15-30min q3-4 wks
pamidronate - 90mg IV over 120 min q month
adjust for renal, Ca/Vit D supplementation
flu-like, increase Scr, hypoK+, hypoCa2+, constipation, ONJ

Front 28

examples of nitrogen mustards

Back 28

bendamustine, ifosomide, cyclophosphamide

Front 29

mechanism of nitrogen mustards

Back 29

aziridinium ion (cation)

Front 30

mechanism of nitrosoureas

Back 30

cations that alkylate

Front 31

indication of bendamustine

Back 31

CLL

Front 32

description of ifosomide/cyclophosphamide

Back 32

bladder toxicity; ring w/ 3 C converted to acrolein

Front 33

mesna

Back 33

treats bladder toxicity of nitrogen mustards

Front 34

bexxar

Back 34

murine Ab conjugated to I-131

Front 35

antimetabolite examples

Back 35

cytarabine (inhib DNA polymerase)
fludarabine phosphate (analogy to Ara-A and Ara-C --> inhibits DNA polymerase)

Front 36

anthracycline Abx example

Back 36

doxorubicin (inhib topo-II)

Front 37

rasburicase

Back 37

tetrameric protein
converts uric acid to allantoin

Front 38

anthracyclines for MM
(details and examples)

Back 38

4 fused rings w/ sugar
daunorubicin, idarubicin, doxorubicin (and liposomal), epirubicin, valrubicin

Front 39

doxorubicin - MOA and s/e

Back 39

complexes w/ iron and forms free radicals that destroy DNA
red, cardiotoxic

Front 40

doxorubicin liposomal - description, indication, s/e

Back 40

pegylated
combo with bortezomib for MM
s/e=PPE, (less cardiotoxic)

Front 41

dexrazoxane

Back 41

cardioprotection from iron free radicals

Front 42

bortezomib - MOA

Back 42

reversible 26S proteasome inhibitor
dec proteasome --> more ubiquinated protein to inhibit NF-kB --> less NF-kB --> less growth of immune cells

Front 43

bisphosphonate specific MOA

Back 43

replace pyrophosphate

Front 44

thalidomide/lenalidomide - MOA

Back 44

angiogenesis inhibitor (dec blood supply to tumors)
immunomodulators (inhib TNF-a, IL-1B; increase NF-kB inhibitor) --> inhibit cancer growth

Front 45

microtubule formation inhibitors (examples)

Back 45

vincristine, vinblastine, vindesine, vinorelbine

Front 46

microtubule depolymerization inhibitors

Back 46

paclitaxel, doxetaxel, ixebepilone

Front 47

topoisomerase-I inhibs (MOA, examples)

Back 47

cut one DNA strand at a time
topotecan, irinotecan

Front 48

topoisomerase-II inhibitors (contain?, examples)

Back 48

contain sugars
etoposide, teniposide

Front 49

platinum compounds (activation?, examples)

Back 49

prodrugs -- nonenzymatic hydrolysis or displacement of ligands to form active mono/dihydroxy (aquated) compounds
cisplatin, carboplatin, oxaliplatin

Front 50

oxaliplatin vs cisplatin

Back 50

oxaliplatin binds DNA less than cisplatin, but is more toxic bc retains cyclohexane ring
(nitrogen groups stay, but Cl and O do Not)

Front 51

amifostine

Back 51

hydrolyzed to active thiol
complexes with platinum in kidney