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