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150 Cards in this Set
- Front
- Back
Major toxicity associated with bleomycin, busulfan
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pulmonary fibrosis
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Major toxicity associated with platinum agents like cisplatin, carboplatin
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Nephro- and oto-toxicity
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Major toxicity associated with doxorubicin (and other anthracyclines)
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Cardiotoxicity
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Major toxicity associated with methotrexate and 5-fluorouracil
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Myelosuppression
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Major toxicity associated with nitrosureas
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Neurotoxicity
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Major toxicity associated with cyclophosphamide
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hemorrhagic cystitis
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Major toxicity associated with vinca alkaloids
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Peripheral neuropathy
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BBW for all SERMs
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Increased risk of thromboembolic events
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Which SERM has increased risk of endometrial cancer?
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Tamoxifen
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Aromatase inhibitors are given?
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PO
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Name 3 main aromatase inhibitors
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Anastrazole
Exemestane Letrozole |
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What is the therapeutic indication for the aromatase inhibitors?
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Breast cancer
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Name 3 SERMs
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Fulvestrant
Raloxifene Tamoxifen |
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Which SERM is used for osteoporosis treatment in women at risk of breast cancer?
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Raloxifene (Evista)
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Common adverse effects seen with aromatase inhibitors and SERMs?
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Lethargy/fatigue, rash, hot flashes, menopause symptoms, weight gain
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Drug class of choice for breast cancer with 2D6 polymorphism *4/*5?
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Aromatase inhibitor
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Aminoglutethimide and mitotane are non-selective aromatase inhibitors that require ______ supplementation during therapy
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glucocorticoid and mineralcorticoid
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_______ is cardioprotective and should be considered when doxorubicin doses are expected to be continued beyond 300mg/m2
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Zinecard (dexrazoxane)
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Liposomal products are associated with increased incidence of ______ and ________
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Hand-foot syndrome and Allergic reactions
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All anthracyclines can have what effect on body fluids (exception?
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Turn them red (mitoxantrone turns them blue)
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______ is an anthracycline instilled in the bladder for the treatment of refractory bladder cancer
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Valrubicin
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4 major side effects of MTX?
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-myelosuppression
-mucositis -hand/foot syndrome -liver/kidney toxicity |
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High dose MTC requires ______ to help reduce toxicity
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Leucovorin Rescue
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Avoid concurrent use of MTX and what 4 (there are more, but 4 important) drugs
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-ASA
-PCN -Probenecid -NSAIDs |
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Essential counseling point for MTX?
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Hydrate!
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________ is the active form of folic acid- it bypasses enzyme block of dihydrofolate reductase by MTX
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Leucovorin
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Name the 2 immunomodulators
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-Lenalidomide
-Thalidomide |
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Primary warning/contraindication with the immunomodulators?
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Pregnancy Category X
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Avonex is a ______ interferon
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Beta-1-A
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Betaseron is a _______ interferon
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Beta-1-B
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_______ is pegylated alpha-2-A interferon
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Pegasys
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Interleukins work by?
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Stimulating immune system to target cancer cells
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______ is an interleukin with use restricted to those with normal pulmonary and cardiac function only
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Aldesleukin (Proleukin)
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_____ is a monoclonal antibody-angiogenesis inhibitor used in numerous cancer types
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Bevacizumab (Avastin)
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Avastin binds to?
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VEGF-A
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_________ - CD-20 target on lymphocytes kills cancer but also releases cytokines
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Rituximab (Rituxan)
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Infusions of Rituxan must be given?
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In-patient
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Which drug does EGFR(+) expression correlate with increased response rates?
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Cetuximab (Erbitux)
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Colorectal cancer does NOT respond to cetuximab or panitumumab if patients have?
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K-ras mutation
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______ is a platinum agent with nephrotoxicity, requiring vigorous hydration
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Cisplatin
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_________ can be used as prophylaxis for cisplatin-induced nephrotoxicity
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Amifostine
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Which platinum agent is dosed based on AUC
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Carboplatin
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________ is a platinum agent associated with neuropathy, typically exacerbated by exposure to cold weather
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Oxaliplatin
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How should mercaptopurine (PO) be given?
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1 hour before or 2 hours after meals
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_________ is a pro-drug of mercaptopurine
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Azathioprine (Imuran)
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6-MP undergoes extensive 1st pass metabolism in liver by?
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Xanthine Oxidase
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_______ is a pro-drug of 5-FU
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capecitabine (Xeloda)
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How should Xeloda be taken?
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With meals
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What pre-screening test should be done before initiating therapy with capecitabine
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Testing for DPD deficiency
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5 drugs that are pyrimidine analog antimetabolites
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-Capecitabine
-Cytarabine -Fluorouracil -Floxuridine -Gemcitabine |
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Name the 3 taxane agents
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-Carbazitaxel
-Docetaxel -Paclitaxel |
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Primary side effect of docetaxel?
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Cardio-pulmonay effects (fluid retention)
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Pretreat Paclitaxel with?
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Dexamethasone + Benadryl + H2RA
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______ is TK1 targeting BCR-ABL given PO, with water and a full meal
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Imatinib (Gleevac)
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Indication for Gleevac?
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Ph(+) CML
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How should imatinib be given?
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With water and a full meal
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TK1 targeting EGFR
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Tarceva (erlotinib)
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How is Tarceva given?
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Orally, 1 hour before or 2 hours after meal
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TK1 targeting HER-2
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Lapatinib (Tykerb)
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Indication for Tykerb?
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Metastatic breast cancer in patients who have failed trastuzumab and chemotherapy
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_______= TK1 targeting multiple proteins; taken PO without regard to meals
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Sutent (sunitinib)
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______ is a vaccine for treatment of advanced prostate cancer (over $90,000 per dose)
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Siputeucel-T (Provenge)
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How is Sutent given?
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Orally; without respect to meals
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Name 3 vinca alkaloids
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-Vinblastine
-Vincristine -Vinorelbine |
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What is the dose-dependent toxicity associated with vinca alkaloids?
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Nerve damage
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ONLY route of administration allowed for vinca alkaloids?
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IV
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How to treat vesication as a result of vinca alkaloid administration?
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Hyaluronidase and WARM compresses
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________ is a debulking agent for leukemias and sickle cell disease
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Hydroxyurea (Hydrea)
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Anemia and chemotherapy- name 2 agents used for treatment and their doses
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-Epoetin Alfa (SQ weekly)
-Darbopoetin (SQ every 2-3 weeks) |
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Name 3 colony-stimulating factors for neutropenia
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-Sargramostim
-Filgrastim -Pegfilgrastim |
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Primary side effect of colony-stimulating factors?
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Bone pain
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When are platelet transfusions indicated in thrombocytopenia?
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<10,000/mm3
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Name the one drug available for thrombocytopenia prevention
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Opreluekin (Neumega)
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Which agent carries the highest risk of nausea/vomiting with chemotherapy
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Cisplatin
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Which 3 agents/classes are a moderate risk for causing chemotherapy induced N/V?
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-Anthracyclines
-Carboplatin -Oxaliplatin |
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To prevent acute N/V, pre-treatment of patients should include?
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-Dexamethasone
-Zoftan -Aprepitant |
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______ is a neurokinin-1 receptor blocker used for chemotherapy-induced N/V
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Aprepitant
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Which 5-HT3 blocker comes as a transdermal patch?
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Granisetron (Sancuso)
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Do not use _______ for CINV due to increased risk of QT prolongation
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Dolasetron (Anzemet)
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5-HT3 blockers are contraindicated with which Parkinson's drug?
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Apomorphine (Apokyn)
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3 phenothiazines for nausea/vomiting
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-Prochlorperazine
-Chlorpromazine -Promethazine |
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Phenothiazines are only approved for patients age?
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>2 years old
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_____ is a substance-P/NK1 receptor antagonist
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Aprepitant (Emend)
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Best therapy for mucositis from chemotherapy?
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"Magic Mouthwash"
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Only FDA approved agent for chemotherapy-induced mucositis (restricted to chemotherapy before stem cell transplant)
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Palifermin (Keplvance)
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2 IV agents for hypercalcemia of malignancy?
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-Zoledronic Acid (Zometa)
-Pamidronate (Aredia) |
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Reclast is ______ only for use in?
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Zoledronic acid; for osteoporosis only
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Which SERM should be stopped 72 hours before prolonged immobilization?
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Evista
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_______ are drugs approved for breast cancer only in patients who have FINISHED menopause
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Aromatase inhibitors
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Promethazine should be infused over?
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20-30 minutes
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Yearly mammograms should begin at age?
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40
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Clinical breast exams should be done every 3 years if age _____, and annually after age?
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20-39; 40
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Colonoscopies should be done after age?
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>50
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Cervical/PAP smears should be done at age?
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21
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ESAs should ONLY be used if Hgb is less than?
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10
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Most common disease associations with ESA therapy?
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CHF, Chest Pain, Thrombosis, Arrhythmias, CV death
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Define neutropenia?
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ANC < 500/mm3
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#1 side effect of bleomycin
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Pulmonary reactions (pneumonitis)
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_______ is a decrease in bone marrow activity resulting in decreased RBC, WBC, and platelets
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Myelosuppression
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________ and _______ are 2nd line agents for CINV. They are synthetic delta-9-tetrahydrocannibinol
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Dronabinol (Marinol)
Nabilone (Cesamet) |
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Cesamet is C___
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C2
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Marinol is C___
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C3
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When to dose Emend
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Pre-chemotherapy
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Chemotherapy during pregnancy?
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Avoid whenever possible
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Storage for Leukeran?
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Refrigerator
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Chlorambucil trade name? Class?
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Leukeran; Alkylator
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2 main types of cancers treated with alkylating agents?
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Leukemias and lymphomas
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Name the 3 alkylating agents?
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-Cyclophosphamide
-Ifosfamide -Temozolomide |
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All patients receiving cyclophosphamide or ifosphamide should be treated with?
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MESNA (protection against hemorrhagic cystitis)
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Most common toxicity associated with busulfan, carmustine, lomustine?
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Pulmonary toxicities
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Which 2 alkylators can cause skin pigmentation changes?
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Busulfan
Carmustine |
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Which alkylator can cause flu-like symptoms?
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Dacarbazine
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Which alkylator is an MAOI?
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Procarbazine
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Which alkylating agent uses weight-based dosing (all others based on BSA)?
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Busulfan
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Antiandrogens are given _______, usually with LHRH agonists for what cancer?
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Orally; Prostate Cancer
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Name some of the most common side effects of antiandrogens
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N/V/D, gynecomastia, hepatotoxicity, decreased libido, impotence
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Which antiandrogen hsa a warning for possible night-blindness
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Nilutamide (Nilandron)
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______ is a GNRH antagonist used in prostate cancer
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Degorelix (Firmagon)
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What are 4 indications for LHRH agonists?
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-Prostate Cancer
-Endometriosis -Fibroids -Breast Cancer |
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Name 4 LHRH agonists
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-Goserelin
-Histrelin -Leuprolide -Triptorelin |
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How are the LHRH agonists given?
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Monthly to every 6-months; in a medical office
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Most common side effects of LHRH agonists?
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Hot flashes, bone pain, dyslipidemia, injection site pain, QT prolongation, gynecomastia, decreased BMD
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Patients on LHRH agonists should also receive _____ supplementation
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Calcium + D
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Compared to SERMs, ______ have a higher CVD risk
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Aromatase inhibitors
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Of the SERMs, most are given PO. Which one is IM?
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Fluvestrant (Faslodex)
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_____ work by intercalating DNA, inhibiting TOPO-II, and creating oxygen free-radicals that damage cells
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Anthracyclines
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Anthracyclines biggest toxicity?
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Cardiotoxicity
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_____ and _____ are anthracyclines available as a standard and liposomal form
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Daunorubicin
Doxorubicin |
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Anthracyclines are associated with _______ reactions
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Radiation Recall
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______ is an epthilone with a similar mechanism to taxanes; however, it is still effective in taxane-resistant breast cancer
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Ixabepilone (Ixempra)
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______ is the #1 folate antimetabolite used in cancer and rheumatoid arthritis
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MTX
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Lower/Higher doses of methotrexate should be used in RA and psoriasis?
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Lower
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Besides MTX, what are the other 2 commonly used folate antimetabolites?
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-Pemetrexed
-Pralatrexate |
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Both pemetrexed/pralatrexate require supplementation with?
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Folic acid and B12
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______ is a microtubule destabilizer that inhibits polymerization of tubules; halting cell division during metaphase
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Eribulin Mesylate (Halaven)
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Immunomodulator agents are pregnancy category?
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X
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2 common side-effects to be aware of in counseling a patient on interferon therapy?
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-Depression/suicidal ideation
-Flulike symptoms |
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Which class of medications can cause capillary-leak syndrome?
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Interleukins
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Which interleukin should have pre-treatment antibiotics with gram+ coverage due to increased risk of infective endocarditis
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Proleukin (aldesleukin)
|
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Which monoclonal antibody is very light sensitive- it should be prepared in the dark
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Gemtuzumab (Mylotarg)
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Which monoclonal antibody requires 2 positive IHC tests to make a patient eligible to receive?
|
Herceptin (trastuzumab)
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#1 adverse effect of Herceptin?
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Cardiomyopathy
|
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To avoid allergic infusion-related reactions with Herceptin, patients should be pre-medicated with?
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APAP + H2RA
|
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_______ inhibits downstream regulation of VEGF, reducing cell growth, metabolism, proliferation and angiogenesis
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mTOR inhibitor
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Retinoids, such as tretinoin, are pregnancy category?
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X
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If receiving multiple drugs for chemotherapy, when should the taxane be given?
|
First
|
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Name 2 Topoisomerase I inhibitors
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-Irinotecan
-Topotecan |
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Which TOPO-I inhibitor can cause acute diarrhea?
|
Irinotecan
|
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How to manage acute diarrhea from irinotecan?
|
Atropine
|
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How to manage delayed diarrhea from irinotecan?
|
Loperamide
|