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Oncology Intro Meds
Gundrum Day 1
| Question | Answer |
|---|---|
| Trastuzumab dosing | Weight based |
| Carboplatin dosing | Calvert Formula |
| Methotrexate | Antifolate, Antimetabolite |
| Pemetrexed | Antifolate, Antimetabolite |
| 5-Fluoruracil | Antipyrimidine, Antimetabolite |
| Capecitabine | Antipyrimidine, Antimetabolite |
| Cytaraine | Antipyrimidine, Antimetabolite |
| Gemcitabine | Antipyrimidine, Antimetabolite |
| 6-MP | Antipurine, Antimetabolite |
| Fludarabine | Antipurine, Antimetabolite |
| Cladribine | Antipurine, Antimetabolite |
| Clofarabine | Antipurine, Antimetabolite |
| Hydroxyurea | Antimetabolite |
| Vincristine | Vinca Alkaloid, Antimicrotubule |
| Vinblastine | Vinca Alkaloid, Antimicrotubule |
| Vinorelbine | Vinca Alkaloid, Antimicrotubule |
| Paclitaxel | Taxane, Anitmicrotubule |
| Docetaxel | Taxane, Antimicrotubule |
| Irinotecan | Camptothecan, Topoisomerase I inhibitor |
| Topotecan | Camptothecan, Topoisomerase I inhibitor |
| Etoposide | Epipodophyllotoxin, Topoisomerase II Inhibitor |
| Cell Cycle Specific Classes | Antimetabolites, Antimicrotubules, Topoisomerase I Inhibitors, Topoisomerase II Inhibitors, Hormonal Agents, mTORs |
| Antimetabolite subclasses | Antifolates, Antipyrimidines, Antipurines, |
| Antimicrotubule subclasses | Vinca Alkaloids, Taxanes |
| Topoisomerase I Inhibitor Subclasses | Camptothecans |
| Topoisomerase II Inhibitor Subclasses | Epipodophyllotoxin |
| Hormonal Agents subclasses | SERMS, Aromatase Inhibitors, LHRH agonists, Antiandrogens |
| Tamoxifen | SERM, Hormonal Agent |
| Raloxifene | SERM, Hormonal Agent |
| Letrozole | Aromatase Inhibitor, Hormonal Agent |
| Anastrazole | Aromatase Inhibitor, Hormonal Agent |
| Exemestane | Aromatase Inhibitor, Hormonal Agent |
| Everolimus | mTOR inhibitor |
| Temsirolimus | mTOR inhibitor |
| Blemoycin | Cell cycle specific |
| L-asparaginase | Cell cycle specific |
| Peg-asparagase | Cell cycle specific |
| Erwinia asparaginase | Cell cycle specific |
| Cell Cycle non-specific Classes | Alkylating agents, anthracyclines, tyrosine kinase inhibitors, monoclonal antibodies, hormonal agents, immunomodulators, proteasome inhibitors |
| Alkylating Agent Subclasses | Nitrogen Mustard, Platinums |
| Chlorambucil | Nitrogen Mustard, Alkylating agent |
| Cyclophosphamide | Nitrogen Mustard, Alkylating agent |
| Ifosfamide | Nitrogen Mustard, Alkylating agent |
| Cisplatain | Platinum, Alkylating agent |
| Carboplatin | Platinum, Alkylating agent |
| Oxaliplatin | Platinum, Alkylating agent |
| Daunorubicin | Anthracycline |
| Doxorubicin | Anthracycline |
| Idarubicin | Anthracycline |
| Epirubicin | Anthracycline |
| Imatinib | Tyrosine Kinase Inhbitor |
| Dasatinib | Tyrosine Kinase Inhbitor |
| Nilotinib | Tyrosine Kinase Inhbitor |
| Bosutinib | Tyrosine Kinase Inhbitor |
| Erlotinib | Tyrosine Kinase Inhbitor |
| Rituximab | Monoclonal Antibody |
| Bevacizumab | Monoclonal Antibody |
| Cetuximab | Monoclonal Antibody |
| Trastuzumab | Monoclonal Antibody |
| Leuprolide | LHRH agonist, hormonal agent |
| Goserelin | LHRH agonist, hormonal agent |
| Bicalutamide | Antiandrogen, hormonal agent |
| Flutamide | Antiandrogen, hormonal agent |
| Nilutamide | Antiandrogen, hormonal agent |
| Thalidomide | Immunomodulator |
| Lenalidomide | Immunomodulator |
| Bortezomib | Proteasome Inhibitor |
| Carfilzomib | Proteasome Inhibitor |
| -trex- | Antifolates |
| -bine | antipyrimidine, antipuriness (excet 5-FU, 6-MP) |
| Vin- | Vinca Alkaolid |
| -taxel | taxanes |
| -otecan | Topoisomerase I inhibitors |
| -oposide | topoisomerase II Inhibitors |
| -fen- | SERMS |
| -ozole | Aromatase Inhibitors (except Exemastane) |
| -olimus | mTOR Inhibitors |
| -platain | platinums |
| -rubicin | anthracyclines |
| -tinib | Tyronse kinase inhbitors |
| -mab | monoclonal antibodies |
| -amide | antiandrogens |
| -lidomide | immunomodulators |
| -zomib | proteaseome inhibitors |
| antimetabolites MOA | similar in structure to nucleotides, disrupts the replication of DNA, RNA and nucleic acids; S phase |
| Antifolates MOA | inhibits DHFR, S phase |
| Methotrexate DIs | NSAIDS, PPIs, Penicillins |
| Methotrexate Clinical pearls | -high dose MTX requires leucovorin resucue + NaHCO3 to maintain urine pH > 7 |
| Pemetrexed Clinical pearls | -supplement with folic acid 400 mcg PO daily and vitamin B 12 1000 mcg IM every 9 weeks to prevent myelosuppression -premedicate with dexamethasone 4 mg PO BID the day before, day of and day after treatment fo avoid rash |
| Leucovorin Indications | -folate rescue with high dose methotrexate -stabilizes FdUMP binding when used with 5-Fluorouracil |
| 5-Fluorouracil MOA: continuous infusion | FdUMP binds to/inactivates thymidylate synthase |
| 5-Fluorouracil MOA: Bolus | Incorporates into DNA /RNA as a flase nucleotides and interferes with function |
| 5-Fluorouracil Drug interactions | Strong CYP2C9 inhibitor- increased warfarin effect |
| Cytarabine MOA | inhibits DNA polymerase (inhibits DNA elongation) |
| Cytarabine Adverse Effects | High-dose = cellbeullar toxicity, conjunctivitis |
| Cytarabine Clinical pearls | -corticosteroids may help with flu-like symptoms -steroids eye drops should be administered during high-dose administration to avoid conjunctivitis |
| Gemcitabine MOA | inhibits DNA polymerase (inhibits DNA elongation), Inhibits DNA synthesis/repair |
| Gemcitabine Clinical pearls | -rash may respond to topical steroids, fevers may respond to acetaminophen |
| Purines MOA | incorporates into DNA as a false purine and stops DNA synthesis |
| 6-MP drug interactions | allopurinol increases toxicity, 6-MP reduces anticoagulant effects of warfarin |
| Fludarabine Adverse effects | tumor lysis syndrome, pulmonary toxicity, peripheral neuropathis, altered mental status |
| Fludarabine Clinical pearls | Prophylaxis required for PCP and HSV infections |
| Cladribine Clinical pearls | requires prophylaxis against PCP |
| Clofarabine adverse effects | elevated LFTs, nausea/vomiting, tumor lysis syndrome |
| Hydroxyurea Clinical pearls | Can be used to decreased WBC counts rapidly to prevent adverse effects of leukocyotosis |
| Vinca Alkaloids MOA | Destabilize microtubule assembly, M phase |
| Taxanes MOA | Stabilize microtubule assembly, M phase |
| Vincristine DLT | Peripheral neuropathies, constipation |
| Vinca Alkaloids Clinical Pearls | lethal if administered intrathecally |
| Paclitaxel Clinical Pearls | Contains CREMOPHOR which leads to hypersensitivity reactions. Pre-medicate with dexamethasone, diphenhydramine and ranitidine to decrease hypersensitivity reactions |
| Docetaxel clinical Pearls | Contains POLYSORBATE 80 (less hypersensitivity); Give Dexamethasone day before, day of and day after administration to decrease fluid retention |
| Topoisomerase I inhibitors MOA | active during the S phase, single strand breaks |
| Topoisomerase II Inhibitors MOA | active during the G2 phase, double strand breaks |
| Irinotecan DLT | diarrhea |
| Acute diarrhea | <12 hours after administration, treated with atropine |
| Delayed diarrhea | >12 hours after administration, treated with loperamide |
| Active metabolize of irinoteccan | SN-38 |
| Etoposide Adverse Effects | secondary malignancies |
| Bleomycin DLT | pulmonary toxicity, requires pulmonary function test |
| L-asparaginase, Peg-asparagase and Erwinia asparaginase ADRs | Pancreatitis |
| Peg-asparagase is derived from | E Coli |
| Erwinia asparaginase is derived from | Erwinia Chrysanthemi |
| Chlorambucil ADRs | secondary malignancies |
| Cyclophosphamide ADRs | hemorrhagic cystitis |
| Cyclophosphamide Clinical Pearls | -Hydration needed to prevent hemorrhagic cystitis -Mesna may be requried with high-dose regimens |
| Ifosfamide ADR | hemorrhagic cystitis |
| Ifosfamide Clinial Pearls | -Hydration needed to prevent hemorrhagic cystitis -Mesna always given to prevent hemorrhagic cystitis -methylene blue may be given for CNS toxicities |
| Cisplatin Clinical Pears | Highly emetogenic |
| Calavert Formula | Dose (mg) = Target AUC x (CrCl + 25) |
| Oxaliplatin DLT | peripheral neuropathies exacerbated by cold |
| Anthracyclines ADRs | cardiac toxicity, LVEF monitoring, maximum lifetime doses |
| mAb soure: -o- | Murine, 100% mouse |
| mAb soure: -xi- | chimeric 67% human |
| mAb soure: -zu- | humanized 90% human |
| mAb soure: -u- | human 100% human |
| monoclonal antibodies DLT | infusion-related reactions |
| Rituximab Clinical Pears | -reactivation of hep B can occur -Premedicate with APAP and diphenhydramine |
| Trastuzumab ADRS | Cardiac toxicity, dosed as mg/kg |
| Cetuximab MOA | binds to epidermal growth factor receptor-1, premedicate with diphenhydramate |
| Cetiximab ADR | Rash |
| Bevacizumab MOA | Binds to VGEF ligand |
| Tyrosine Kinase Inhibitors MOA | inhibits BCR-ABL tyrosine kinase |
| Imatinib ADRs | -CHF |
| Nilotinib counseling points | -take twice daily, hyperglycemia |
| mTOR MOA | targets mTOR, which is a molecule that is required for multiple interacellular signaling pathways, G1 phase |
| Temsirolimus Clinical Pearls | requires diphenhydramine pemedication |
| Bortezomib MOA | Reversible inhibition of 26S proteasome, leading to accumulation of cellular debris |
| Carfilzomib MOA | Irreversible inhibition of 20s proteasome, leading to accumulation of cellular debris |
| DLT: Diarrhea, hand-foot syndrome, mucositis | Continuous infusion 5-FU, Capectabine |
| DLT: peripheral neuropathies, constipation | Vincristine |
| DLT: diarrhea | Irinotecan |
| DLT: pulmonary toxicitiy | Bleomycin |
| DLT: hypersensitivity reations | Asparaginase |
| DLT: N/V | Cisplatin |
| DLT: Peripheral neuropathies exacerbated by cold | Oxaliplatin |
| DLT: Infusion-related reactions | Monocolonal antibodies |
| DLT: peripheral neuropathies, myelosuppression | Bortezomib, Cafilzomib |
| Rifampin | CYP3A4 inducer |
| CBZ | CYPEA4 inducer |
| phenytoin | CYP3A4 inducer |
| phenobarbital | CYP3A4 inducer |
| St. John's Wort | CYP3A4 inducer |
| Azole Antifungals | CYP3A4 inhbitor |
| Calcium Channel Blockers | CYP3A4 inhbitor |
| Amiodarone | CYP3A4 inhbitor |
| SSRIs | CYP3A4 inhbitor |
| Cyclosporine | CYP3A4 inhbitor |
| Tacrolimus | CYP3A4 inhbitor |
| Aprepitant | CYP3A4 inhbitor |
| Grapefruit | CYP3A4 inhbitor |
| Asparaginase Cell Cycle | G1 |
| Bleomycin Cell Cycle | G2 |
Created by:
Bmiller01
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