P3-Tp 3 Final

Front 1

whats median age at diagnosis of breast cancer

Back 1

60
its most common cause of Cancer in chix

Front 2

Gail Model dose what

Back 2

determines chemoprevention eligibity with tamoifen

not validated for all ethnic groups

Front 3

2 types of non-invasive breast cancer

Back 3

LCIS- lobular carcinoma- not premalignant
observer, tx only in high risk

DCIS-ductal carincoma-premalignant
surgery, radiation

Front 4

whats recommended age for mammography

who should get a breast MRI

Back 4

40 y.o.

BRCA mutation carriers
1st degree relative of one

Front 5

use staging of cancer for

Back 5

prognosis and kind of tx to use

Front 6

sentintel LN vs axillary LN

Back 6

sentinel- if cancer is not in 1st LN, then its not in 2nd, or 3rd

axillary-removal of axillary LN-causes lymphedema

Front 7

IF hormone receptor and progesterone receptor are negative..

Back 7

tends to be more aggressive

Front 8

If breast cancer is HER2 (+)

Back 8

this is an oncogene-so promotes cell growth

ups tumor aggressivness

use trastuzumab theraphy

Front 9

anthrocylclines S.E.

Back 9

cardiotox thats irreversible

Front 10

treatment for EBC

Back 10

surgery->adjuvant chemo-> radiation-> hormonal therapy

Front 11

treatment for LABC

Back 11

neoadjuvant therapy**-> surgery-> adjuvant chemo-> radiation-> hormonaltheraphy

Front 12

masectomy vs breast conservation surgery

Back 12

masectomy-older way, skin and nipple sparing

BCS- lumpectomy, LN evaluation, and radiation= results like masectomy
ALLOWS FOLLOWED BY SURGERY**

Front 13

candidates for BCS

C/I for BCS

Back 13

stage 0-2 and ppl with T3N0M0

C/I- >=2 primary tumors in diff areas

radiation hx, pregnancy

Front 14

radiation in breast cancer
reduces risk of reoccurance by

started when?

Back 14

20%

start 4 wks AFTER CHEMO..chemo increases cardiotox or radiation recall

but hormone tx can be used same time as radiation

Front 15

what is radiation recall

drugs that cause this

Back 15

inflam of skin from radiation and then chemo -like bad sunburn

capecitabine, cyclophosphamide, docetaxel, doxorubicin, 5FU, methotrexate, paclitaxel

Front 16

oncotype DX
what does it do

Back 16

screens for expression of 21 genes

if low score- avoid chemo and do hormon tx

if high-do adjuvant chemo

Front 17

adjuvant theraphy
tumors <.5cm and LN -

Back 17

wont benefit from adjuvant theraphy (chemo, hormonal tx)

Front 18

adjuvant theraphy
tumors .6-1 cm and LN -

Back 18

low recurrence
may give chemo

Front 19

adjuvant theraphy
tumors with LN+

Back 19

give chemo (adjuvant therapy)

Front 20

adjuvant theraphy
tumors >1cm

Back 20

may require adjuvant tx
if HER2-benefit from Trastuzumab

Front 21

adjuvant horomonal therapy
premenopausal pt's

Back 21

-tamoxifen
-ovarian ablation (removal or irradiation)
-LH-RH agonist -ovarian suppresion

Front 22

adjuvant horomonal therapy
postmenopausal pts

Back 22

tamoxifen
armatase inhibitors

Front 23

tamoxifen
what kinda drug is it
which HR is it in?
how long to tx with generally

Back 23

SERM- antag-agonist
its in pre and postmenopausal HR

generally tx with 5 yrs

Front 24

S.E. of tamoxifen

Back 24

hotflashes, thromboembolism (cause its estrogen agonist)

prevents bone loss

Front 25

Aromatase inhibitors
MOA
drugs

Back 25

blocks conversion of androgens to estrogen
anastrazole
letrozole
exemastane

Front 26

AI (Aromatase inhib)
used in...why
S.E.

Back 26

for adjuvant in postmenopausal
increase chances of BCS surgery

bone loss- so get baseline

Front 27

which 2 AIs have cross sensitivity

if fail one of those, which one cause u use

Back 27

anastrazole + lerozole
if fail one, can't use other

use exemestane if fail 1 of others

Front 28

premenopausal tx
use

after 5 yrs you get postmenopause- use what

Back 28

tamoxifen x 5 yrs

after 5 yrs get menopause- stop tamox, do AI x 5 yrs

Front 29

premenopause tx
but get postmenopause before 5 yrs-tx how?

Back 29

complete tamoxifen x5 yrs, then switch to AI x 2-3 yrs to complete 5 yrs?

Front 30

postmenopause tx
regimens

Back 30

-AI x 5 yrs
-Tamoxifen x 5 yrs
-Tamox 2-3 yrs, then AI to complete 5 yrs
-Tamox 5-6 yrs, then AI x 5yrs

Front 31

whats tx for
low risk, LN -

Back 31

CMF
cyclophosphamide/MTX/5-FU

Front 32

whats tx for
HIGH RISK, LN - (HER2+, HR-)

if LN+

Back 32

anthracycline based regimen

if LN+ give taxane also

Front 33

whats tx for
HER2+ AND TUMOR >1

Back 33

trastuzumab regimen

Front 34

chemo toxicities
for anthracyclines

Back 34

BMS, mucositis
alopecia
hepatic dose, vesicant
IRREVS. CARDIOTOX!

Front 35

chemo toxicities
for Taxanes

Back 35

TOTAL BODY ALOPECIA
premedicate

Front 36

chemo toxicities
trastuzumab

Back 36

REVERSB. cardiotox

Front 37

what do you premedicate with for trastuzumab

S.E.

Back 37

APAP 650MG + BENADRYL 50mg

S.E.-CHF, fever,

Front 38

metastatic therapy
goal
who has better prognosis

Back 38

palliation NOT cure, inc QOL

bone and soft tissue metastatis

Front 39

for metastatis
use hormonal therapy for who?

Back 39

HR+
bone metastatis

Front 40

for metastatis
use chemo for who?

Back 40

HR-, symptomatic visceral metastatis(lung/liver)

Front 41

which meds are targeted therapy for metastatic cancers

Back 41

trastuzumab
lapatinib

Front 42

horomonal therpy options in metatic breast cancer

Back 42

premenopause-tamoxifen, ovarian ablation

postmeno-tamox, AI, fULVESTRANT

Front 43

whats preferred tx for HR+ postmenopausal metastatic dx

Back 43

AIs- anastrazole, letrezole

if dx progresses- use exemastene

Front 44

whats alternative tx for HR+ postmenopausal metastatic dx

Back 44

tamoxifen or toremifene
has cross resistance

Front 45

whats second line tx for HR+ postmenopausal metastatic dx

Back 45

fulvestrant-its pure estrogen receptor blocker- unlike tamox who has agonist action also

Front 46

chemo drugs for metastatic breast cancer

Back 46

single tx is preferred
doxorub
paclitaxel, docetaxel
capecitabine
vinorelbine
gemcitabine
eribulin

Front 47

lapatinib MOA

requires?

SE

Back 47

Inhib tyrosine kinase of HER2 and Epithel growth factor (EPGF)

use if failed anthracyline, taxane, trastuzumab

requires hepatic dose adjust
SE-hand + foot syndrome

Front 48

Lung Cancer
R.F

Back 48

tobacco promotes carcinogens
tks 5 yrs of quiting to impact risk

if smoke 15cigs/day,cut to half, risk decrease by 25%

Front 49

Lung Cancer
more R.F.

Back 49

environment-asbestos, benzene, radon

genetic-1st degree relative

hx of TB, pulm fibrosis, bronchitis, COPD, empys. asthma

Front 50

genetic mutations
EGFR mutations-confirm sensitivty to what
K-Ras oncogene mutation-

ALK fusion oncogene

Back 50

sensitivty to egfr kinase inhib( eriotonib + Gefitinib)

ALK-crizotonib

Front 51

lung cancer normally advances to

Back 51

bone pain, neurlogical pain, spinal cord compression

Front 52

2 types of lung cancer

Back 52

NSCLC-non small cell lung Cancer

SCLC-small cell lung cancer

Front 53

NSCLC- subdivdes into

Back 53

adenocarcinoma-common in nonsmokers (pheripheral llung)

squamous cell CA- central lung-due to smoking

Large cell CA- pheripheral lung

Front 54

SCLC

Back 54

rapidally growing
agressive

Front 55

in NSCLC tx
when would you do surgery

Back 55

stages 1-2, only curative stage 3

stages for palliation therapy

Front 56

in NSCLC tx
when to do radiation

Back 56

unresectable tumor
chemoradiation

Front 57

in NSCLC TX
when to do chemo

what drug is notmally in this regimen

Back 57

stages 2-4, ADJUVANT(surgery)

cisplantin based

Front 58

in NSCLC TX
what stage would you use bevacizumab

Back 58

stage IV

Front 59

what is preferred tx for chemo in NSCLC

a stage IIIb is considered

Back 59

DOUBLETS

IIIB- unresectable tumor= give chemoradiation

Front 60

common tx in chemoradiation
(stage IIIB)

Back 60

cisplatin +etoposide or vinblastine

always give taxenes first, then cisplatin=less BMS

Front 61

NSCLC stage IV( nonsquamous) tx
ALK mutation

EGFR mutation

EGFR mutation - or unknown

Back 61

ALK- criztonib (PO)

EGFR + erlotonib

EGFR unknown- cisplatin + pemetrexed + bevacuzimab

Front 62

NSCLC Stage IV (squamous) tx

Back 62

cisplatin based doublet
cisplatin + vinorebline + cetuximab

Front 63

NSCLC Stage IV
PS 3-4

Back 63

PS 3-4: give supportive care, no benefit from chemo

Front 64

NSCLC tx for stage 4
Second line agent

Third line?

Back 64

Use single agent
Docetaxel, pemetrexed or erlonib

3rd- erlotonib

Front 65

Crizotinib
Used for?
MOA
SE

Back 65

NSCLC locally advanced or metastatic ALK+ mutation

Inhibs ALK tyrosine kinase

Requires renal dose adjustment

QT prolong**

Front 66

Erlotinib
MOA
SE

Back 66

Inhibs EGFR tyrosine
Use in EGFR+ mutation

Need hepatic adjustment

SE- dermatological toxicity- acne rash, mild use top clinda or cortisone
Severe- oral minocycline

Front 67

Bevacizumab
MOA
Use in? But not?

Back 67

Angiogenesis inhib

Use in Stage 4 non squamous

NOT for squamous type- cause pulmonary hemorrhage

SE- wound healing complication, proteinuria**, thromboembolism

Front 68

Pemetrexed

Back 68

Inhibs folate metab(like 5-fu + methotrexate)

Need hepatic and renal adjust
SE-myleosuppression

Front 69

What do you premed pt with if on pemetrexed

Back 69

Give folic acid and b12 start wk before tx

Front 70

Cisplatin dosing is based on?
What adjust needs to be done

Back 70

BSA mg/m2

Renal impairment adjust

Front 71

Carboplatin dosing is based on?

What's general auc wanted

Back 71

Calvert formula
Dose= auc x ( CrCL + 25)

Untxed 6-8 usually 6

Front 72

If using Cockcroft formula use which weight

If Salazar use
What's formula

Back 72

Actual body weight

Sal- adjusted
Adjus(kg)= (actual- ideal) x .4 + ideal

Front 73

Whats the minimum scr used in carboplatin dosing

What's max crcl used

Back 73

0.6 mg/dl

Max 125 ml/min

Front 74

SCLC
Limited stage
Extended stage

Back 74

Dx confined to 1 hemithorax and regional LN

Ex-beyond 1 thorax

Front 75

SCLC
Limited stage tx

Back 75

Goal is cure
Tudors < 3cm do surgery + adju chemo

Chemoradiation= cisplatin + etoposide + concurrent radiation

Front 76

SCLC
Extended stage tx

Back 76

Goal is PALIATIVE
Chemo cisplatin + etoposide
Or ironotecan + etop

Front 77

SCLC 2nd line tx
When to do it and what drug

Back 77

If relapsedrugs elapse > 6 months after 1st tx rechallenge w/ topotecan

Front 78

When to do prophylactic cranial radiation

Back 78

Once receive CR with chemo this is recommended for limited and extended stages of SCLC

Front 79

Nociceptive pain has 2 types

Back 79

Somatic pain- from bone, joints
sharp, well localized, throbbing

Visceral pain- from internal organs
Aches, cramps

Front 80

Transduction of pain

Back 80

Injury releases bradykinin, serotonin K, histamine
Triggers PG's and subst P release

Front 81

Transmission of pain

Back 81

Type A- somAtic- myelinated

Type C- visCeral - unmyelinated(dull pains)

Front 82

Endogenous opiate system

Back 82

Release endorphins bind opiate receptors
Kappa, mu, and delta

Front 83

Assesing pain

Back 83

Use Pqrstu
Precip- what worsens it
Quality- how feel, visceral?
Region-where?
Severity-
Time- constant?
U- You how's it affecting you

Front 84

WHO analgesic ladder

Back 84

Mild pain- Tylenol (non opiate)
Mild-mod pain- hydrocodone
Mod-severe- IV opioids

Front 85

Class of opioids

Back 85

Phenanthrenes
Phenylheptylamines
Phenylpiperdines
Morphinans
Benzomorphans

Front 86

NSAIDS indicated for?

Back 86

Mild pain (1-3) and/or bone

Use NSAID that worked for pt in past

Front 87

Which NSAIDs don't inhibit plt aggregation

Back 87

Selective cox2 inhibit
Salsalate
Choline+ Mg salicylate

Front 88

NSAID toxicities

Back 88

Renal- RF if pt >60, really excreted chemo...D/C if scr/BUN doubles

GI- RF >60, hex of PUD
Tx w/ H2 blocker, PPI, misoprostol
Switch to COX2 selective

Front 89

Cox2 selective meds

Back 89

Meloxicam> Celebrex> etodolac> ibuprofen> naproxen

Front 90

Pts with CV RF should not get Celebrex in what doses

Back 90

Not more than >400 mg/D or Naproxen > 440mg/D

These Show dose related inc in MI

Front 91

Ketorlac IV vs. PO dose
Max days? Why?

Back 91

30mg IV but 10 mg PO max 120mg/d

Max 5 days cause GI effects

Front 92

Ketorlax max for pts >65 yo and <50 kg

Back 92

Max 60 mg/D

Front 93

NSAIDS adv vs disadvantage

Back 93

Adv- additive analgesia
Bone pain, no constipation, no tolerance

Disadvantage- ceiling doses(max)
Renal insuff bleeds, antipyretic(may mask fever)

Front 94

Tylenol
Moa

Back 94

Inhibs prostaglandin synthesis blocks pain impulse
NO anti-inflam action

Front 95

Tylenol toxicity
How much?
Mech
Antidote

Back 95

>4g for 1-2 days
Depletes glutathione, destroys hepatocytes

Give mucomyst- nasty dilute in juice
Use Rumack/Mathews nomogram to see if use or not

Front 96

Whats are phases/presentations of Tylenol toxicity

Back 96

Phase 1- (1-24H) N/V, anorexia, diaphoresis

Phase2- (24-72H) RUQ pain, inc in LFTs

Phase3- (72-96h) jaundice

Front 97

Opioids formulation for mod pain
For severe pain

Back 97

Mod(4-6) PO
Severe(7-10) IV

Front 98

Mu receptor produces-

Kappa produces-

Delta-

Back 98

Mu- analgesia, resp depress, euphoria, dependence, miosis

Kappa- analgesia, sedation (NO euphoria)

Delta- analgesia

Front 99

Opioid allergy vs SE
Important card!!

Back 99

True allergy- anaphylaxis, bronchospasm

SE- N/V, constipation, drowsiness, confusion

Front 100

Phenanthrenes meds

Back 100

Morphine, codeine, nalbuphine
Oxycodone

Front 101

Phenylpiperidines meds

Back 101

If allergic to opioids(rare) use this class

Meperidine, fentanyl, diphenoxylate

Front 102

Phenylheptylamines meds

Back 102

Methadone- not 1st line, use in tolerant pts

Front 103

Morphinans

Back 103

Levorphanol, butorphanol
Antag/ agonists

Front 104

Comparison chart
Morphine

Back 104

Iv- 10mg
PO -30mg
Standard everything is compared to

Front 105

Comparison chart
Buprenorphine

Back 105

Iv- 0.3
PO- 0.4 mg

Front 106

Comparison chart
Codeine

Back 106

IV- 100
PO- 200mg

Front 107

Comparison chart
Fentanyl

Back 107

IV- 0.1 mg
Takes 12 h to work, so use another med till kicks in

Front 108

Comparison chart
Hydrocodone

Back 108

PO 30mg

Front 109

Comparison chart
Hydromorphone

Back 109

IV- 1.5
PO- 7.5mg
Potent, preferred in renal insuff

Front 110

Comparison chart
Meperidine

Back 110

IV- 75 to 100mg
PO- 300mg
Toxic metab

Front 111

Comparison chart
Oxycodone

Back 111

PO 20mg

Front 112

Comparison chart
Oxymorphone

Back 112

IV- 1mg
PO- 10mg

Front 113

Comparison chart
Tramadol

Back 113

PO- 120mg

Front 114

Pts with difficulty swallowing can use

Back 114

Kadian or avinza- can open and put in applesauce,
Kadian-(long acting)can sprinkle in 10mls of water for GT

Don't crush, chew or let dissolve

Front 115

Morphine dosing in renal insuff

Back 115

Crcl 10-50 dec dose by25%

<10 dec dose by 50%

Front 116

Hydro morphine/ hydrocodone in renal insuff

Back 116

Crcl 10-50 dec dose by 50%

<10 dec dose by 75%

Front 117

Oxycodone in renal insuff

Back 117

10-50 dec by 50%
<10 don't use

Front 118

If pt is renal insuff what's preferred opioids

Back 118

Fentanyl or methadone for tolerant pts

Front 119

Usual morphine ratio is 10:30 but what is ratio in renal insuff

Back 119

10: 20 cause metab formed m6G is more active then morphine

Front 120

Hepatic dosing for
Morphine
Hydrocodone
Oxycodone

Back 120

Morp- incr dosing interval by doubling it (q2h-> q 4 h now)

Hydrocodone- dec dose by 50%

Oxycodone- dec dose by 25-50%

Basically use fentanyl

Front 121

Uncommon opioid se

Common

Back 121

Hallucinations
Dysphoria
Seizures

Common- no tolerant constipation
sedation! Pruritis

Front 122

How to tx opioid constipation?

Tx opioid reps depress

Opioid pruritis

Back 122

ATC constip= ATC laxative (softener+stim)
If fail 2 lax +on opi x2wks use methylnaltrexone sc once

Reps dep- naloxone in 9ml of NS

Pruritis- 1st Benadryl, if persists use nalbuphine

Front 123

Opioid dosing steps

Back 123

Calc dosage incr by total use in 24H (ATC +breakthrough)
Then calc dose for new drug

If pain is controlled then dec dose by 25-50% for cross tolerance

If pain NOT controlled- switch keep 100% or inc to 125%

Calc breakthrough dose-10or20% total 24H dose and give over 1H

Front 124

Neuropathic pain describe

Back 124

Tingling, stabbing, shooting
If nerve compression use glucocorticoids

Front 125

Tx of neuropathic pain

Back 125

TCA- nortriptyline, desipramine
Anticonv- gabapentin, pregabalin***

SSRIs- venlafax, duloxetine
Topic- lidocaine(12h on/ off or arrithymias) capsaicin

Front 126

Meds for bone pain

Back 126

NSAIDs and inc till analgesic effex

Local bone pain- local radiation or nerve block

Diffuse bone pain- bisphosph, hormonal/ chemotherapy

Consider physical therapy