Pt Onco Test 2

Front 1

Antimetabolites most effective Phase

Back 1

S phase

Front 2

Antimetabolites subclasses

Back 2

Fluorinated pyrimidines

cytidine analogs

purines

antifolates

Front 3

Antmetabolites major tox

Back 3

bone marrow suppression

GI: stomatitis, n/v

Front 4

Antimetabolites MOA

Back 4

Inhibits replication by falsely incorporating into DNA, causes death

Front 5

Fluorinated Pyrimidines Drugs

Back 5

5-Fu

Capecitabine

Floxuridine

Front 6

5-FU MOA

Back 6

Prevents synthesis of thymidine needed for DNA synth, Acts as a "false" base

Front 7

5-FU drug interactions

Back 7

It is a strong CYP2C9 inhibitor, increases concentration of warfarin

Front 8

5-FU Continuous infusion AE

Back 8

hand-foot syndrome

diarrhea

Front 9

5-FU bolus AE

Back 9

neutropenia

thrombocytopenia

anemia

Front 10

Capecitabine Route

Back 10

Oral Prodrug of 5-FU

Front 11

Fluorinated Pyrimidines Tox

Back 11

Diarrhea

Hand-Foot syndrome

n/v

mucositis

Photosensitivity, Ocular tox

Front 12

Cytidine analogs drugs

Back 12

cytarabine

gemcitabine

azacitidine

decitabine

Front 13

Cytarabine Route

Back 13

intrathecal, injection, liposomal

Front 14

cytidine analogs hypomethylating agents

Back 14

azacitidine

decitabine

Front 15

Cytarabine MOA

Back 15

ara-CTP competitively inhibits DNA polyermerase which decreases DNA synth and repair

Also inhibits replication

Front 16

Cytarabine liposomal formulation

Back 16

only for intrathecal administration

Front 17

cytarabine resistances

Back 17

decreased membrane transport

decreased formation of phosphorylated derivatives

increased breakdown of drug

Front 18

cytarabine tox

Back 18

dose dependent:

n/v cerebellar tox, conjunctivitis, ataxia, seizure

risk over 50yo and renal/hepatic dysfunction

Front 19

cytarabine intrathecal tox

Back 19

n/v

arachnoiditis, dizzy, HA, dehydration

Tumor Lysis syndrome

Front 20

gemcitabine MOA

Back 20

incorporated into DNA, inhibits DNA polymerase

also inhibits ribonucleotide reductase

Front 21

gemcitibine intracellular concentrations

Back 21

20x higher than cytarabine

Front 22

gemcitibine tox

Back 22

myelosuppression: thrombocytopenia

flu-like

rash

elevation of liver enz

SEVERE: respiratory distress, pulmonary edema, hemolytic uremic syndrome

Front 23

Antifolates drugs

Back 23

methotrexate

pemetrexed

pralatrexate

Front 24

methotrexate routes

Back 24

oral, injection, INTREATHECAL

Front 25

methotrexate MOA

Back 25

binds reversibly to dihydrofolate reductase, inhibiting cell's ability to activate folate

impairs cells ability to synth DNA

Looks just like folic acid and leucovorin

Front 26

Doses of MTX when leucovorin rescue required

Back 26

over 500-1000mg/m2

Front 27

MTX clearance

Back 27

depends on renal fx

avoid cocominant NSAID, penicillins, PPIs, bactrim

Front 28

MTX tox

Back 28

HYDRATION IS CRUCIAL

tox mitigated by lecovorin

bone marrow supp, cucositis, n/v, CNS TOX

renal/hep tox, tumor lysis syndrome, oppo infect

Front 29

pemetrexed MOA

Back 29

multi-targeted that inhibits ihymidine and purine synth

Front 30

pemetrexed supplements

Back 30

REQUIRES FOLIC ACID AND VB12

lower risk of tox and mortality

Front 31

pemetrexed pre-medication

Back 31

dexamethasone

prevent rash

Front 32

pemetrexed CrCl required

Back 32

at least 45mL/min

Front 33

pemetrexed tox

Back 33

fatigue, myelosupp, stomatitis, pharyngitis, rash

Front 34

pemetrexed avoid concomitant

Back 34

NSAIDS 2-5 days prior to pemetrexed and 2 days following

Front 35

purine and purine analogs drugs

Back 35

6-mercaptopurine

fludarabine

cladribine

clofarabine

nelarabine

pentostatin

Front 36

6-mercaptopurine MOA

Back 36

rabid metab to ribonucleotides that inhibit purine synth

Front 37

6-mercaptopurine tox

Back 37

myelosupp, dry skin, photosensitivity, hep tox, n/v

Front 38

6-mercaptopurine DDI

Back 38

allopurinol, AZA, febuxostat

Front 39

fludarabine MOA

Back 39

interferes with DNA polymerase causing chain termination, also inhibits transcription

Front 40

fludarabine tox

Back 40

myelosuppression, pulm tox, tumor lysis syndrome

immunosuppression

neurotox with high doses

Front 41

microtubule targeting agents classes

Back 41

vinca alkaloids

taxanes

epothilones

halichondrins

Front 42

Vinca alkaloids drugs

Back 42

vincristine

vinblastine

vinorelbine

Front 43

vincristing routes

Back 43

injection, liposomal

Front 44

vinca alkaloids only route

Back 44

ONLY IV, FATAL IF GIVEN BY OTHER ROUTES

Vesicants

Front 45

Vinca alkaloids MOA

Back 45

inhibits mitosis

binds to tubulin and inhibits assembly of microtubules

cells undergo apoptosis

Front 46

vinca alkaloids metab

Back 46

liver

monitor LFTs

Front 47

vincristine tox

Back 47

neuropathy: can be irreversible

LOW RISK MYELOSUPP

constipation

Front 48

vincristine DDI

Back 48

major 3a4 substrate, p-gp

Front 49

Taxanes drugs

Back 49

paclitaxel

docetaxel

cabazitaxel

Front 50

taxanes MOA

Back 50

promote microtubule assembly, interfere with disassembly

makes nonfx microtubules

inhibit angiogenesis

Front 51

taxanes resistances

Back 51

alterations in tubulin or tubulin binding sites

p-gp multidrug resistance

Front 52

paclitaxel tox

Back 52

myelosupp, infection, hypersensitivity rxn, periph neuropathy, myalgias,

TOTAL BODY HAIR LOSS

Front 53

paclitaxel pre-medication

Back 53

dexamethasone, benydryl, h2 antag

prevents hypersensitivity

Front 54

paclitaxel CI

Back 54

treatment of solid tumors in pT with neutrophil lower than 1500

Front 55

docetaxel pre-medication

Back 55

dexamethasone

Front 56

docetaxel CI

Back 56

neutrophil count less than 1500

Front 57

docetaxel tox

Back 57

myelosuppression, fluid retention, hypersensitivity, n/v/d, rash stomatitis,

caution with hepatic impairment

Front 58

topoisomerase inhibitors classes

Back 58

anthrancene derivatives

camptothecins

semisynthetic podophyllotoxin derivatives

Front 59

anthracene derivatives drugs

Back 59

DOXORUBICIN

idarubicin

daunorubicin

epirubicin

mitoxantrone

valrubicin

Front 60

all IV anthracene derivatives are...

Back 60

VESICANTS

Front 61

doxorubicin CI

Back 61

recent MI, severe arrhythmia, severe myelosupp, severe myocardial insuff

Front 62

doxorubicin tox

Back 62

myelosupp

cardiotox

2ndary malignancy

n/v, alopecia, mucositis, arrhythmias

Front 63

doxorubicin DDI

Back 63

major substrate of CYP2D6, 3A4

Front 64

doxorubicin resistance

Back 64

P-gp

altered topoisomerase 2 activity

Front 65

doxorubicin clinical pearls

Back 65

prior to initiation, must determine baseline heart fx with either:

MUGA (multigated acquistion)

ECHO (echocardiogram)

LVEF more than 50 percent

Front 66

dexrazoxane clinical pearl

Back 66

chemoprotectant that reduces cardiotox and treats anthracycline extravasation

Front 67

campothecins

Back 67

ininotecan

topotecan

Front 68

irinotecan tox

Back 68

myelosupp

diarrhea

n/v, alopecia, mucositis, weakness

Front 69

irinotecan DDI

Back 69

substrate of BCRP, 3A4, PGP, UGT1A1

Front 70

irinotecan caution

Back 70

PT HOMOZYGOUS FOR UGT1A1*28

hepatic impairment

Front 71

semisynthetic podophyllotoxin derivatives drugs

Back 71

etoposide

teniposide

Front 72

etoposide tox

Back 72

myelosupp, n/v, alopecia, hypotension,

hypersensitivity to polysorbate 80

Front 73

etoposide caution in

Back 73

renal impair: dose adj CrCl50

Front 74

etoposide DDI

Back 74

substrate of pgp, 3a4,

INHIBITS 2C9

Front 75

etoposide capsules counseling

Back 75

must keep capsules refrigerated

Front 76

Alkylating agents classes

Back 76

Nitrogen mustards

nitronoureas

platnims

triazenes

"other"

Front 77

alkylating agents class effects

Back 77

cytotoxic

mutagenic

teratogenic

carcinogenic

myelosuppressive

Front 78

alkylating agents resistance

Back 78

increased activation inside cells

DNA repair up

decreased entry into cells

lack of cell death after DNA damage

Front 79

nitrogen mustards drugs

Back 79

cyclophosphamide

chlorambucil

mechlorethamine

melphalan

ifosfamide

dendamustine

Front 80

cyclophosphamide CI

Back 80

urinary outflow obstruction

Front 81

cyclophosphamide tox

Back 81

hemorrhagic cystitis (active metab)

n/v, SIADH, alopecia

cardiotox

Front 82

cyclophosphamide DDI

Back 82

2c9 inducer

2b6 substrate

Front 83

cyclophosphamide caution in

Back 83

hepatic impairment

Front 84

cyclophosphamide prevention of hemorrhagic cystitis

Back 84

2L of oral or IV fluid/day and/or mesna.

Front 85

ifosfamide CI

Back 85

urinary outflow obstruction

Front 86

ifosfamide tox

Back 86

HEMORRHAGIC CYSTIS

CNS TOX

NEPHROTOX

n/v, SIADH, infertility, sterility, alopecia

Front 87

ifosfamide DDI

Back 87

2c9 inducer

2b6 substrate

Front 88

ifosfamide caution in

Back 88

renal impairment

consider aurinalysis to assess for hematuria

Front 89

Nitrosoureas drugs

Back 89

carmustine

lomustine

streptozocin

Front 90

carmustine (BCNU) tox

Back 90

n/v, TOTAL BODY HAIR LOSS,

MYELOSUPP

PULM TOX

Front 91

platinums drugs

Back 91

cisplatin

carboplatin

oxaliplatin

Front 92

cisplatin tox

Back 92

NEPHROTOX

OTOTOX

HYPERSENSITIVITY

n/v, k/mg waste, less myelosupp

Front 93

cisplatin prevent tox

Back 93

HYDRATION, aggressive antiemetics

Front 94

carboplatin total dose(mg) equation

Back 94

target area under the curve (AUC) x (GFR+25)

Front 95

carboplatin tox

Back 95

MYELOSUPP

N/V

HYPERSENSITIVITY

Front 96

triazenes drugs

Back 96

dacarbazine

temozolomide

Front 97

temozolomide CI

Back 97

hypersensitivity to dacarbazine

Front 98

temozolomide tox

Back 98

myelosupp, n/v, fatigue, constipation

Front 99

temozolomide DDI

Back 99

VPA

Front 100

temozolomide clinical pearl

Back 100

readily crosses BBB

Front 101

temozolomide phrophylaxis

Back 101

must admin PCP prophy in pT on temozolomide and radiation

Front 102

Misc agents drugs

Back 102

arsenic trioxide

ASPARAGINASE

bexarotene

BLEOMYCIN

dactinomycin

HYDROXYUREA

Front 103

asparaginase MOA

Back 103

hydrolyzes L0asparagine to ammonia

inhibits protien synth

apoptosis

Front 104

asparaginase CI

Back 104

pancreatitis, thrombosis, other hemorrhagic event with prior asparaginase tx

Front 105

asparaginase tox

Back 105

pancreastitis

thrombosis and bleed

hyperammonemia

hypertriglyceridemia

Front 106

bleomycin MOA

Back 106

inhibits synth of DNA, binds DNA, breaks strands

inhibits RNA and protien synth

Front 107

bleomycin tox

Back 107

PULMONARY FIBROSIS

flu sx, hepatotox

Front 108

bleomycin clinical pearls

Back 108

obtain PFTs before use and if signs develop during tx

Front 109

hydroxyurea MOA

Back 109

potents inhibitor of ribonucleotide reductase

halts cell cycle at G1/S phase

rapid decrease WBC in acute leukemia

Front 110

hydroxyurea tox

Back 110

skin/nail pigmentation

tumor lysis sundrome

Front 111

hydroxyurea caution in

Back 111

renal dysfx

Front 112

-tu- meaning

Back 112

tumor

Front 113

-ci- meaning

Back 113

cardiovascular

Front 114

-li- meaning

Back 114

inflammation

Front 115

monoclonal Abx classes

Back 115

target cell surface glycoprotiens

target growth factor recpt and ligands

target VEGF signal pathways

immunotx

Front 116

Agents that target cell surface glycoprotiens

Back 116

rituximab

brentuximab

Front 117

rituximab MOA

Back 117

targets CD20 on b-lymph

mediats cell lysis

Front 118

rituximab tox

Back 118

HEP B reactivate

PML

infusion rxn

Front 119

rituximab pT should avoid

Back 119

live vax

Front 120

brentuximab vedotin MOA

Back 120

targets CD30, is internalized, releases MMAE

messes with microtubules

causes apoptosis

Front 121

brentuximab vedotin tox

Back 121

n/v/d, neuropathy, rash, infustion rxn, neutropenia

Front 122

Agents that target VGEF pathways

Back 122

Bevacizumab

Front 123

bevacizumab tox

Back 123

GI PERFORATION

HEMMORRHAGE

IMPAIRED WOUND HEALING

HTN, proteinuria, thrombolic events

Front 124

bevacizumab monitoring peram

Back 124

BP with tx, proteinuria

Front 125

Agents that target growth factor receptors and ligands

Back 125

cetuximab (EGFR1/HER1)

trastuzumab (EGFR2/HER2)

Front 126

cetuximab tox

Back 126

INFUSION RXN

CARDIOPULMONARY ARREST

hypoMg, weakness, fatigue

Front 127

trastuzumab tox

Back 127

CARDIOMYOPATHY

INFUSION RXN,

PULM TOX

PREGNANCY

pain, HA, nausea, cough

Front 128

trastuzumab verify what before tx

Back 128

HER2 status, ejection fraction

Front 129

Immunotherapy agents

Back 129

ipilimumab

nivolumab

Front 130

ipilumumab tox

Back 130

fatigue, immune-mediated tox, HA, nausea

Front 131

immune related tox

Back 131

pneumonitis, hep, pancreatitis, arthritis, dermatitis, thyroiditis

Front 132

nivolumab MOA

Back 132

prevents programmed cell death by binding PD1 receptor

Front 133

nivolumab tox

Back 133

rash, pruritus, fatigue, n/d, immune mediated SE

Front 134

biologic cytokines

Back 134

interferon alfa

interleukin

Front 135

interleukin 2 tox

Back 135

CNS

CAPILLARY LEAK SYNDROME

INFECTIONS

Front 136

BCR-ABL MOA

Back 136

halts proliferation via BCR-ABL

causes apoptosis

Front 137

sunitinib clinical pearl

Back 137

causes hepatotox

Front 138

nilotinib clinical pearl

Back 138

causes QTc prolongation

Front 139

lapatinib clinical pearl

Back 139

causes hepatotoxicity

Front 140

cabozantinib clinical pearls

Back 140

GI perforation

hemorrhage

Front 141

b b

Back 141

b