Oncology II - Rxprep

What are factors that contribute to the type of chemo treatment ?

the cancer type and characteristics

the stage of the cancer - size and how far it has metastasized

patient characteristics

Chemo is most likely to have what damaging effects ?

chemo damages non-cancerous rapidly dividing cells in the GI tract, hair follicles and bone marrow

Common side effects of chemo include ?

diarrhea, hair loss and myelosuppression

How are the patient's physical functioning assessed ?

with rating systems - Karnofsky and ECOG (Eastern Cooperative Oncology Group)

What are risk factors for skin cancer ?

UV light exposure, light skin that burns easily. light hair color, immunosuppressant drugs or disease and a past history of skin cancer

What are the ABCDE - warning signs of melanoma skin cancer ?

Asymmetry - one half of the mole does not match the other half

Border - edges are irregular notched

Color - color is not the same all over

Diameter - larger than 6 mm, or the size of the top of a pencil eraser

Evolving - mole is changing in size, shape, color or symptoms

What are modifiable risk factors for breast cancer ?

overweight

physical activity

poor nutrition

tobacco use

What genes normally suppress tumor growth ?

BRAC1 and BRAC2

Mutations in BRAC1 and BRAC2 gene will lead to ?

preventing cell repair and cause dramatic increase in breast cancer incidence

What is Klinefelter syndrome ?

a condition in which males have one Y chromosome and two or more X chromosomes

Men with Klinefelter syndrome have a higher risk of what type of cancer ?

breast cancer

The choice of hormone treatment depends on what ?

the menopause status of the patient

What is the first line treatment for premenopausal women with hormone sensitive cancer ?

tamoxifen - a selective estrogen receptor modulator (SERM)

What is the MOA for aromatase inhibitors ?

reduce the estrogen production by blocking the aromatase enzyme that catalyzes the conversion of androgens

Raloxifene is used for ?

breast cancer prophylaxis not treatment - it increases bone density and is indicated for osteoporosis prevention and treatment in postmenopausal women

What are common side effects of Raloxifene ?

hot flashes and clotting risk

What is the most potent estrogen ?

estradiol

Raloxifene is mostly used in ?

postmenopausal women

A premenopausal women can be put into menopause by ?

taking gonadotropin-releasing hormone (GnRH) agonist (goserelin or leuprolide)

What is the MOA of GnRH agonist ?

decrease LH and FSH which suppresses estradiol production

What is an oncogene ?

a protein that can turn a normal cell into a cancer cell

What oncogene promotes breast tumor growth ?

HER2

What is the MOA of HER2 inhibitors ?

they bind to HER2 receptors and prevent dimerization

What is the premedication used for monoclonal antibodies ?

steroid, antihistamine, acetaminophen

What are SERMs ?

Selective Estrogen Receptor Modulators

- estrogen antagonist in breast tissue

What are types of SERMs ?

tamoxifen (Soltamox)

fulvestrant (Faslodex)

raloxifene (Evista)

Can paroxetine and fluoxetine be used with tamoxifen ?

No

What is the preferred treatment for hot flashes and night sweats causes by Tamoxifen ?

venlafaxine

What is the dosage form of fluvestrant ?

IM

What are boxed warnings for tamoxifen ?

increase risk of uterine or endometrial cancer

increased risk of thromboembolic events

What are boxed warning for raloxifene ?

increased risk of thromboembolic events

What are common side effects of SERMs ?

hot flashes/night sweats, vaginal bleeding/spotting, vaginal discharge/dryness / pruritus / decrease in libido / decreased bone density (tamoxifen)

What are supplements that can be taken to help with decreased bone density from tamoxifen use ?

supplement with calcium/vitamin D

What is the MOA for aromatase inhibitors ?

blocks the conversion of androgens to estrogens

anastrozole

Arimidex

What are the aromatase inhibitors ?

anastrozole (Arimidex)

letrozole (Femara)

Patients who take anastrozole are at higher risk of what ?

osteoporosis and CVD

What are side effects associated with aromatase inhibitors ?

hot flashes/night sweats, arthralgia/myalgia , lethargy/fatigue

What are the CDK4/6 inhibitors ?

palbociclib (Ibrance)

What drug is contraindicated in breast cancer patients ?

estrogen

What is recommend for a patient taking anastrozole ?

calcium and vitamin D supplementation

weight bearing exercise

DEXA screening

Which SERM increases the risk of getting cataracts ?

tamoxifen

What are common side effects of raloxifene ?

hot flashes, might sweats and joints and muscle aches

What are the prostate screening exams?

digital rectal exam (DRE)

prostate specific antigen (PSA)

What level of PSA is indicative of prostate cancer ?

level above 4ng/ml

What is the primary hormone that is blocked in prostate cancer ?

testosterone

What is the hormonal treatment for prostate cancer ?

androgen deprivation therapy (ADT)

What is another name for ADT ?

chemical castration

What are common ADE associated with ADT ?

impotence, weakness, hot flashed and loss of bone density

Which SERM is teratogenic ?

tamoxifen

What feeds prostate cancer ?

testosterone

What is a second line alternative in postmenopausal women who can not tolerate AIs ?

tamoxifen

Why is an antiandrogen given initially with GnRH agonist in treatment of prostate cancer ?

Initially GnRH agonist will increase testosterone levels causing a tumor flare, anti androgen will block the initial testosterone surge effect on the cancer cells

What is the benefit of GnRH antagonists?

they do not cause the initial tumor flare and do not need to be given with anti androgen

What is the MOA of GnRH agonists ?

they reduce testosterone through a negative feedback mechanism, they cause an initial surge (tumor flare) in testosterone, followed by a gradual reduction.

What is given with GnRH agonist to prevent the tumor flare ?

antiandrogen for several weeks

What are the GnRH agonists ?

leuprolide (Lupron Depot)

goserelin (Zoladex)

What are effects of GnRH agonists ?

decreases bone density

tumor flare - causing bone pain and difficulty urinating

What are gonadotropin releasing hormone antagonist ?

degarelix (Firmagon)

What are the risk associated with Firmagon ?

osteoporosis

What is an advantage of Firmagon ?

no tumor flare

What are side effects of GnRH ?

hot flashes, impotence, gynecomastia, bone pain

What are antiandrogens (first generation) ?

bicalutamide (Casodex)

flutamide

nilutamide

What is the MOA for antiandrogens?

inhibits testosterone from binding to prostate cancer cells

only used in combination with GnRH agonist

What are second generation antiandrogens ?

enzalutamide (Xtandi)

What is the androgen biosynthesis inhibitor ?

abiraterone (Zytiga)

Which drugs work in the M-phase ?

paclitaxel. docetaxel

Vinca alkaloids

Vincristine, Vinblastine

Which drugs work in the G1-phase ?

asparaginase

interferons

steroids

Which drugs work in the S-phase ?

antimetabolites

- methotrexate, pemetrexed (folate antimetabolites)

- fluorouracil (5-FU)

- capecitabine

Topoisomerase I inhibitors

- irinotecan

- topotecan

- etoposide

* AT the S-Phase the DNA replicATes

What drugs work at the G2-phase ?

topoisomerase II inhibitors

- etoposide

- bleomycin

What happens in the M-phase of the cell cycle ?

Mitosis - cell division into 2 daughter cells

What happens in the G0-Phase of the cell cycle ?

G0- has zero growth, it is the resting phase after mitosis has occurred

What happens in the G1-Phase of the cell cycle ?

G1 and G2 are growth phases to make DNA/RNA/proteins to get prepared for cell division

What happens in the S phase of the cell cycle ?

DNA replication

What happens in the G2-phase of the cell cycle ?

growth phases to make DNA/RNA/proteins to get prepared for cell division

What drugs are cell cycle independent ?

Alkylating agents

- cyclophosphamide

- Ifosfamide

Anthracycline

- doxorubicin

- mitoxantrone

Platinum Compounds

- Cisplatin

- Carboplatin

All Awesome Pharmacists

What weight should be used for BSA in chemo calculations?

actual body weight

What are the cell cycle independent drug classes ?

alkylating cells

platinum-based components

anthracyclines

What is the MOA for alkylating agents ?

cross link DNA strands and inhibit protein synthesis and DNA synthesis

What metabolite is produced from ifosfamide and cyclophosphamide ?

acrolein

The accumulation of acrolein in the bladder causes what ?

hemorrhagic cystitis

What is the chemo protectant given with ifosfamide and high doses of cyclophosphamide ?

mesna (Mesnex) - given with adequate hydration

What are toxicities of cyclophosphamide and ifosfamide?

hemorrhagic cystitis

What are the alkylating agents ?

cyclophosphamide

ifosfamide

carmustine

busulfan

Which alkylating agent must be administered in non-PVC bags and tubing ?

carmustine

What is the MOA of platinum based compounds ?

they cross link DNA and interfere with DNA synthase and cell replication

Which chemo agent is associated with the highest incidence of nephrotoxicity and CINV ?

cisplatin

What are common toxicity caused by platinum based compounds ?

neuropathy, ototoxicity, nephrotoxicity

What are the platinum based compounds ?

cisplatin

carboplatin

oxaliplatin

The risk of anaphylatic-like reactions increases with repeated exposure to which chemo agent ?

carboplatin

What are the MOA of anthracyclines ?

1) intercalation into DNA

2) inhibiting topoisomerase II

3) creating oxygen-free radicals

Which drug causes red urine and discoloration ?

doxorubicin

What are boxed warnings for doxorubicin ?

myocardial toxicity

vesicant

myelosuppression

Cardiotoxicity is associated with what chemo agents ?

anthracyclines

What are the vinca alkaloids ?

vincristine

vinblastine

vinorelbine

Peripheral sensory and autonomic neuropathies (constipation) are common with which chemo agents ?

vinca alkaloids

Which vinca alkaloid is associated with the more CNS toxicities ?

vinCristine

Accidental intrathecal administration of what agent causes progressive paralysis and death ?

vincristine

Which vinca alkaloid is associated with more bone marrow suppression ?

vinBlastine, vinorelBine

What are boxed warnings for vinca alkaloids ?

vesicants

For IV administration only