Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Naplex
Oncology
| Question | Answer |
|---|---|
| ABCDE - Warning Signs of Melanoma | - Asymmetry - Border (irregular) - Color (irregular) - Diameter > 6mm - Evolving |
| Screening - Breast Cancer (Age ≥ 45 years) (PNN: 40 yrs old) | - Annual mammogram (every 2 years: ≥ 55 years) |
| Screening - Cervical Cancer (Age 25-65 years) | Cervical cell analysis: - Pap smear every 3 years - HPV DNA test every 5 years - Pap smear + HPV DNA test every 5 years |
| Screening - Colorectal Cancer (Age ≥ 45 Years) | Stool: •Fecal immunochemical test or guaiac-based fecal occult blood test ANnually •Multi-targeted stool DNA test every 3 yrs Visual: • Colonoscopy every 10 yrs • CT colonography or flexible sigmoidoscopy every 5 yrs |
| Screening -Lung Cancer (Age ≥ 50 Years) | ANnual CT of the chest if: • ≥ 20 pack-year smoking history • Still smoking or quit smoking within the past 15 years |
| Screening - Prostate Cancer | If patient chooses to be tested: • Prostate-specific antigen blood test • +/- digital rectal exam |
| Warning Signs of Cancer | C A U T I O N |
| Diagnosis | • Biopsy • Imaging • Laboratory tests - Comprehensive metabolic panel - Tumor markers - Genetic testing |
| Breast, colon, prostate cancer | Adenocarcinoma |
| Cancer staging | T = Tumor size N = Node status M = Metastasis The higher the number, the more advance the cancer is |
| Treatment Response | • Complete response • Partial response • Progressive disease • Stable disease |
| Chemo: Cytotoxic = kills cells | Interferes with DNA replication and cell division |
| Cell cycle nonspecific: A - A - P (DNA cross-linking → inhibition of DNA & protein synthesis) | • Alkylating agents (eg, cyclophosphamide) • Anthracyclines (eg, doxorubicin) • Platinum compounds (eg, cisplatin) |
| Cycle cell: list of all phase | - S phase: Antimetabolites, Topoisomerase I inhibitors (eg, irinotecan) - G2: Topoisomerase Il Inhibitors - M phase: Taxanes, Vinca Alkaloids |
| What chemo class acts on G zero | - NON |
| G1 phase | - Cell growth and duplication of organelles occurs. - Prepare DNA and RNA for cell division - MoA for Pegaspargase (breaking down asparagine) |
| The S phase | - DNA replication or synthesis occurs • Antimetabolites (eg, methotrexate) • Topoisomerase I inhibitors (eg, irinotecan) |
| G2 phase | - Correction of replication errors occurs - Cell growth (prepares itself for mitosis) • Etoposide • Bleomycin |
| M phase " TiVi" | - Mitosis • Taxanes (eg, paclitaxel) • Vinca alkaloids (eg, vincristine) |
| Common Alkylating Agents | - Cyclophosphamide & ifosfamide - Busulfan - Carmustine |
| Common AEs of Cyclophosphamide & ifosfamide | - Hemorrhagic Cystitis PREVENTION - Hydration - Mesna (started before chemotherapy): Any ifosfamide doses, cyclophosphamide doses > 1g/m2 - Treatment: Bladder irrigation w NS |
| Busulfan & Carmustine Safety Concerns | - Pulmonary toxicity - Neurotoxicity (Carmustine wafer implant). Prevention/Treatment: Antiseizure meds |
| Platinum-Based Compounds | - Cisplatin - Carboplatin - Oxaliplatin |
| There is no risk of Hypersensitivity reactions in patients who have previously received Platinum | - FALSE - Hypersensitivity reaction can RE-happen again |
| Cisplatin and carboplatin can cause electrolyte disorder | Decrease all 4: K, Na, Ma, Ca (=loop) |
| Platinum : Nephrotoxicity | - Monitor: Renal function (eg, BUN, SCr), Electrolytes PREVENTION • Hydration • Amifostine (Ethyol) w cisplatin • Cisplatin dose/cycle: ≤ 100 mg/m2 |
| Max cisplatin dose / cycle | 100 mg/m2 to prevent nephrotoxicity |
| What test should be taken prior initiating cisplatin | Audiogram, esp pediatric population |
| Avoid Capecitabine & Fluorouracil in pt | - Dihydropyrimidine Dehydrogenase (DPD) Deficiency - (DPD in charge for metabolizing 5FU) |
| Antidote: Capecitabine & FluoroURacil | - URidine triacetate (Vistogard) |
| Leucovorin is given 1 day prior MTX (as premed) | - FALSE - Given AFTER methotrexate - Tetrahydrofolate - competes with MTX and replenishes depleted folate metabolites |
| What is MTX antidote: Glucarpidase or Leucovorin | - Leucovorin = standard antidote/rescue - Glucarpidase (Voraxaze) = antidote for severe MTX toxicity, especially with renal failure |
| Voraxaze | - Glucarpidase, MTX antidote |
| What chemo to AVOID COLD exposure (eg, cold temperatures, consumption of cold food/beverages) | Oxaliplatin (Platinum): acute cold-mediated sensory neuropathy |
| List of Anthracyclines | - Doxorubicin (Adriamycin) - RED - Daunorubicin (Cerubidine) - Epirubicin (Ellence) - Idarubicin (Idamycin) - Mitoxantrone - Anthracycline-like - BLUE |
| Doxorubicin lifetime cumulative dose | - 450-550 mg/m2 |
| Doxorubicin toxicity | Cardiotoxicity |
| Why IV sodium bicarbonate is given with HIGH-dose MTX | - Alkalinize the urine - Increase methotrexate solubility - Prevent crystal precipitation in renal tubules - Reduce nephrotoxicity. |
| Folic acid (folate) 1-5 ma daily is recommended with HIGH-dose MTX to prevent nephrotoxicity | - Leucovorin or levoleucovorin "rescue" is required for doses ≥ 500 mg/m2 - Folic acid (folate) 1-5 ma daily is recommended prophylactically w low dose MTX in In autoimmune diseases |
| Capecitabine decreases INR, increase clotting risk | - FALSE - Capecitabine is prodrug of 5FU - Both INCREASE INR, increase bleeding risk |
| Platinum base: Safety Concern | - Hypersensitivity reactions - Nephrotoxicity - Ototoxicity - Peripheral neuropathy - Oxaliplatin: acute cold-mediated sensory neuropathy |
| Platinum base MoA | - Non cycle cell - DNA cross-linking → inhibition of DNA & protein synthesis |
| Alkylating Agents MoA | - Non cycle cell - DNA cross-linking → inhibition of DNA & protein synthesis |
| What chemo agent dosing based on target AUC and GFR | - Total carboplatin dose (mg) = (Target AUC) × (GFR + 25) - Cap for GFR is 125 mL/min/1.73m2 - If GFR isn't available, creatinine clearance may be used |
| Irinotecan safety concerns | - Topoisomerase I group, S phase - Irinotecan-Induced Diarrhea - Acute: Atropine - Chronic: Loperamide |
| Etoposide Safety Concern | - Topoisomerase II group, G2 phase - Infusion rate-related hypotension |
| List of Vinca alkaloids | - M phase - Vincristine - Vinblastine - Vinorelbine |
| Vinca alkaloids safety concerns | - Peripheral neuropathies: treated by gabapentin, duloxetine - Constipation (autonomic neuropathies) |
| Vinca alkaloids route of Intrathecally | - Paralysis & Death If Given Intrathecally - IV ONLY |
| List of Taxanes | - M phase - Paclitaxel - Cabazitaxel - Docetaxel |
| Taxanes - Safety Concerns | - Peripheral neuropathy - Hypersensitivity reactions - Docetaxel: severe fluid retention - Use non-PVC bag and tubing - paclitaxel, cabazitaxel: Use 0.22 micron filter |
| Hand-Foot Syndrome | - Pyrimidine Analog |
| Folate Antimetabolites | MTX |
| Pyrimidine Analog Antimetabolites | - Capecitabine (prodrug) - Fluorouracil |
| Other safety concerns of Pyrimidine Analog Antimetabolites | - Diarrhea - Mucositis - Warfarin Drug Interaction |
| Other safety concerns of MTX | - Gastrointestinal toxicity (eg, diarrhea, mucositis) - Leucovorin or levoleucovorin "rescue" |
| Prevent MTX Mucositis | - Good oral hygiene (eg, brushing with a soft toothbrush) - Hold ice chips in the mouth (prior chemo and several hrs after): Decreases drug delivery to oral mucosal tissues |
| Bleomycin | - G2 phase - Pulmonary toxicity (eg, pulmonary fibrosis): BW - Lifetime cumulative dose: 400 units - Hypersensitivity reactions Test dose and/or premedicate |
| Arsenic trioxide safety concern | QT prolongation - arrhythmias |
| Tretinoin safety concern | - Differentiation syndrome (fever, dyspnea, pleural effusion) - Systemic steroids (eg, dexamethasone) - Interrupt therapy |
| Chemo agents: Severe birth defects (need 2 negative pregnancy tests) | - Lenalidomide - Pomalidomide - Thalidomide - Thrombosis (DVT/PE) |
| Pegaspargase | - Hypersensitivity reactions - Premed with acetaminophen, diphenhydramine & an H2RA |
| Chemo agents NOT cause BMS | - Bleomycin - Pegaspargase - Vincristine |
| Seg presented in different ways | segs, neutrophils, polys or polymorphonuclear leukocytes. |
| Neutropenia Definitions based on ANC value (cells/mm3) | - Neutropenia: < 1,000 - Severe neutropenia: < 500 - Profound neutropenia: < 100 |
| Granulocyte Colony-Stimulating Factors (G-CSFs): stimulate production of platelet | - FALSE - WBC - Shorten duration of neutropenia and reduce mortality from infections - Given PPx after chemotherapy in high-risk patients |
| Neulasta OnPro | - On-body injector applied to the abdomen, back of the arm - Automatically release of pegfilgrastim about 27 hours after application |
| Neupogen | - Filgrastim - 5 mcg/kg IV/SC daily - Until neutrophil recovery |
| Pegfilgrastim | - 6 mg SC once per chemotherapy cycle - Neulasta, Neulasta OnPro |
| Granulocyte Colony-Stimulating Factors (G-CSFs): Side effects | - Bone pain - Splenic rupture - Rash - Hypersensitivity/allergic reaction |
| Granulocyte Colony-Stimulating Factors (G-CSFs): Storage | Refrigerate, protect vials & syringes from light |
| Febrile Neutropenia: start empiric IV anti-pseudomonal beta-lactams IF | - High risk (eg, ANC ≤ 100 for ≥ 7 days, comorbidities) • Cefepime or ceftazidime • Imipenem/cilastatin or meropenem • Piperacillin/tazobactam |
| Febrile Neutropenia: start empiric PO anti-pseudomonal beta-lactams IF | - Low risk (eg, ANC ≤ 100 for < 7 days, no comorbidities) • Ciprofloxacin or levofloxacin + amoxicillin/clavulanate or clindamycin (if penicillin allergy) |
| G-CSFs for anemia | - FALSE - Neutropenia - Erythropoiesis-stimulating agent (ESA) is for anemia |
| Erythropoiesis-Stimulating Agents (ESAs) for pt w CURATIVE intent | - FALSE, it causes tumor progression - For PALLIATIVE intent only |
| Refractory N/V | Occurs when antiemetic PPX and/or RESCUE treatment is INeffective |
| Breakthrough N/V | Occurs any time after chemotherapy DESPITE antiemetic PPX |
| Anticipatory N/V | Occurs before chemotherapy (experienced in previous cycle) |
| Acute N/V | Occurs within 24 hours after chemotherapy |
| Delayed N/V | Occurs > 24 hours after chemotherapy |
| Neurokinin-1 receptor antagonists (NK1 RAs) | - Aprepitant - Fosaprepitant - Rolapitant |
| Serotonin receptor antagonists (5-HT3 RAs) | - Ondansetron - Granisetron - Palonosetron - Dolasetron |
| Dopamine receptor antagonists | - Olanzapine - Prochlorperazine - Promethazine - Metoclopramide - Haloperidol |
| Other for N/V | - Dexamethasone - Dronabinol - Lorazepam |
| Vaccinations for pt who is on chemo agents | • Avoid during chemotherapy • Do not administer live vaccines • If planned chemotherapy, precede by ≥ 2 weeks |
| Chemo agents cause Extravasation | - Anthracyclines (DNA binding) >>> Vinca alkaloids (non-DNA binding) - Anthracyclines: Cold compress, antidote w Dexrazoxane - Vinca alkaloids: Warm compress, Hyaluronidase |
| Extravasation: Signs & symptoms | - Redness & edema around IV site - Discomfort/pain - Blister formation - Necrosis in severe cases |
| vs chemo agent, what test should be done prior initiate targeted therapy? | - Specific biomarkers and proteins that control cancer growth |
| Monoclonal Antibodies safety concern | - Infusion-related reactions - 30 min to few hrs after drug infusion |
| Monoclonal Antibodies: Prevent infusion related reaction - premed | - Tylenol - Antihistamine (eg, diphenhydramine) |
| Rituximab (Rituxan): MoA, safety concerns | - Binds to CD20 antigen • Hepatitis B reactivation: Check hepatitis B panel before starting, some pt to take antiviral agents |
| Cetuximab: MoA, safety concerns | - Binds to epidermal growth factor receptor (EGFR) • Dermatologic toxicity (eg, acneiform rash) • Use general skin care (eg, sunscreen) & prophylactic measures (eg, antibiotics) |
| Trastuzumab (Herceptin): MoA, safety concerns | - Binds to human epidermal growth factor receptor 2 (HER2) • Cardiotoxicity (eg, cardiomyopathy) • Monitor LVEF before & after treatment |
| Bevacizumab (Avastin): MoA, safety concerns | - Binds to vascular endothelial growth factor (VEGF) • Impaired wound healing • Avoid for 28 days before or after surgery • Thromboembolic events • Hemorrhage/fatal bleeding • GI perforation |
| PD-1 - Pembrolizumab - Nivolumab MoA, safety concerns | - Bind to programmed death receptor-1 (PD-1) • Immune-mediated toxicities (eg endocrinopathies, colitis, hepatotoxicity) • Systematic steroid |
| Ipilimumab: MoA, safety concerns | - Binds to cytotoxic T-lymphocyte antigen-4 (CTLA-4) • Immune-mediated toxicities (eg endocrinopathies, colitis, hepatotoxicity) • Systematic steroid |
| TKI route of administration | PO |
| Which as the highest risk for QT prolongation: - Imatinib (Gleevec) - Dasatinib - Nilotinib | - Nilotinib - MoA for all: Bind to BCR-ABL fusion gene • Assess QT interval with an ECG • Correct electrolyte abnormalities • Avoid concurrent QT-prolonging drugs & strong CYP3A4 inhibitors |
| Gl upset (eg, abdominal pain) | - Imatinib (Gleevec) • Take imatinib with food |
| What pharmacogenomic testing require for - Dabrafenib - Vemurafenib | - BRAF inhibitors - BRAF V600E, or V600K mutations. |
| Safety concerns w: - Dabrafenib - Vemurafenib | • New malignancies • QT prolongation |
| MoA of: - Cobimetinib - Trametinib | - Bind to mitogen-activated extracellular kinase (MEK) - BRAE mutation status must be assessed prior to use |
| MoA of: - Afatinib - Erlotinib | - Bind to epidermal growth factor receptor (EGFR) - Dermatologic toxicity (eg, acneiform rash) - Use general skin care (eg, sunscreen) & prophylactic measures (eg, antibiotics) |
| BC • Genetics risk | • BRCA1 and BRCA2 gene mutations • Klinefelter syndrome |
| BC dx | Imaging studies - Mammogram - Ultrasound - Breast MRI Biopsy |
| BC treatment options | - Surgery - Radiation - Chemotherapy - Hormone Receptor-Positive Treatment (Endocrine Therapy) - HER2-positive treatment |
| Aromatase inhibitor (anastrozole) MOA | - Block to conversion of Androgen to Estrogen in the peripheral tissues - Postmenopausal |
| SERM (tamoxifen) MOA | - Binds to estrogen receptors and blocks the effects of estrogen, regardless of where it is produced. - Pre & post menopausal |
| The preferred for hot flashes caused by tamoxifen | - Tamoxifen: Prodrug converted via CYP2D6 to endoxifen - Venlafaxine preferred for hot flashes |
| Tamoxifen BW | - Increase risk of thromboembolic events - Increase risk of uterine or endometrial cancer |
| Tamoxifen other SEs | - Vaginal bleeding/discharge - Bone density: counselling pt to take Can, Vit D |
| Selective estrogen receptor degrader: fulvestrant | - Fulvestrant is an estrogen receptor antagonist, causes down-regulation of estrogen receptors, which inhibits tumor growth. - IM for more advanced BC |
| Fulvestrant safety concerns | - LFTs • Injection site pain (IM) • Hot flashes • Increase LFTS |
| Aromatase Inhibitors safety concerns (anastrozole, letrozole, exemestane) | • Osteoporosis: Calcium and vit D supplementation - Weight bearing exercise - DEXA screening • Increase risk of cardiovascular disease • Hot flashes/night sweats • Arthralgia/myalgia |
| Aromatase Inhibitors list | - Anastrozole - Letrozole - Exemestane |
| Trastuzumab (Herceptin) is 1st line treatment for metastatic breast cancer with HER-2 negative | - FALSE - Herceptin is ONLY for BC HER-2 positive |
| Next step If: - Digital Rectal Exam (DRE) abnormal - PSA > 10 ng/mL | - Further evaluation such as biopsy |
| Role of Hormone Therapy (Androgen Deprivation Therapy) in prostate cancer | - Reduce the amount of testosterone - Block its effects |
| What are Androgen Deprivation Therapy | - GnRH (or LHRH) agonist - GnRH antagonist - Antiandrogen |
| MoA of GnRH (or LHRH) agonist in prostate cancer (also called: luteinizing hormone-releasing hormone agonists) | - Initiation: surge in LH & FSH, which increases testosterone - Then via negative feedback loop: suppresses gonadotropins and shuts off testosterone production. |
| List of Gonadotropin-releasing hormone (GnRH) agonists | - Leuprolide (Lupron Depot) - Goserelin (Zoladex) |
| Why taking Calcium & vitamin D supplement if on GnRH agonists | GnRH causes: - Decrease bone density - Risk of osteoporosis |
| Why antiandrogen is initially given concurrent with GnRH agonists | - Tumor flare and worsening of symptoms like urinary retention. caused by GnRH initially (increase testosterone production) |
| Other safety concerns for GnRH agonist | - Hot flashes - Impotence, gynecomastia - Bone pain - QT prolongation |
| List of GnRH antagonists | - Degarelix - Relugolix |
| Is tumor flare common w GnRH antagonist | - NO tumor flare - GnRH antagonist blocks GnRH receptor directly - Common AEs is hot flashes |
| List of anti-androgens for prostate cancer | - Bicalutamide - Flutamide - Nilutamide |
| Anti-androgens AEs | • Hot flashes • Gynecomastia • Hepatotoxicity |
| What released into the blood upon TLS | Cellular components • Potassium (hyperkalemia) • Phosphate (hyperphosphatemia and secondary hypocalcemia) • Nucleic acids (Hyperuricemia) |
| Consequency of TLS | - Acute renal failure - Cardiac arrest |
| Drugs make TLS worsen | - Thiazide - NSAIDs - D/C |
| Management TLS | • Aggressive IV hydration • Electrolyte correction • Urate lowering therapies |
| TLS - Urate lowering therapies: Alternative option if pt experiences server skin reaction with Allopurinol | - Allopurinol inhibits Xanthine Oxidase, prevent Purine nucleic acids converting to uric acid - It does not eleminate preexisting uric acid - Alternative is Febuxostat |
| TLS - Urate lowering therapies: Patients with preexisting hyperuricemia, what is the option? | - Rasburicase converts uric acid to the water soluble - Rasburicase is contraindicated in G6PD deficiency. |
| TLS or risk of TLS, what to be monitored | • Electrolytes (eg, potassium, phosphate, calcium) • Uric acid • Renal function (eg, SCr, urine output) • ECG changes (hyPERkalemia, hyPOcalcemia: N/V, muscle cramps) |
| 3 reasons for Hypercalcemia of Malignancy | - Tumor secretion of Parathyroid hormone-related protein secretion: stimulates calcium reabsorption in the kidneys. - Bone metastases: osteoclast production can be stimulated. - Calcitriol overproduction |
| Classify of Hypercalcemia | - Mild: 10.6-11.9 mg/dL - Moderate: 12-13.9 mg/dL - Severe > 14 mg/dL: requires aggressive treatment |
| Clinical Manifestations of Hypercalcemia | "Stones, bones, groans, and moans" |
| Zometa vs Reclast | - Zometa: hypercalcemia of malignancy - Reclast: osteoporosis - Different dose and frequency |
| XGEVA vs Prolia | - XGEVA: Bisphosphonate alternative or for refractory use: Manifestations of Hypercalcemia - Prolia: osteoporosis |
| MOA of Denosumab (Xgeva) | RANKL inhibitor that prevents osteoclast formation |
| Gleevec | - Imatinib, TKI - With FOOD |
| Tarceva | Erlotinib, PO EMPTY stomach |
| Tykerb | Lapatinib, PO EMPTY stomach, Breast cancer |
| Tasigna | Nilotinib, PO EMPTY stomach |
| Vectibix | - Panitumumab, IV, EGFR |
| Erbitux | - Cetuximab, IV, EGFR |
| Avastin | - Bevacizumab, VEGF, IV - Bleeding (Hemoptysis, Epitaxis) |
| Zanosar | - Streptozocin - Alkylating agent - Pancreatic cancer - Watch for T1D |
| TKI | - PO - 3A4 substrate - Diarrhea |
| Platinol | - Cisplatin, Alkylating agent - Max cycle dose: 100mg/m2 - Ototoxicity - Nepthrotoxicity (hydrated, Mannitol_clear like water_5 micron filter, Amipostine): all given before chemo - - Most N/V |
| What do you tell the nurse to take mannitol | - Filter: 5 micron filter |
| Mannitol if having crystalize, tell the tech | - Warm up - Shake |
| Eloxatin | - Oxaliplatin - Colorectal cencer - Aggravated by COLD, give warm blanket |
| FOL F OX | - FOL = Folinic Acid (Leukovorin): makes 5FU works better - F = Fluorouracil (5FU) - OX = Oxaliplatin |
| BuSulfan safety concerns | - Pulmonary fibrosis (CXR) - Seizure: premed (PheNyltoin...) - Increase Acid uric, BMS |
| Cytoxan | - Cyclophosphamide, IV/PO - Hemorrhagic cystitis (Shedding of bladder): pink urine, blood urine: hydrated, Mesna |
| Why Mesna given with Cytoxan | - Bind to Acrolein (cause Hemorrhagic cystisis) |
| BiCNU | - Carmustine, - Alkylating agent - Lipid soluble - CNS malignancies |
| CeeNu | - Losustine, - Alkylating agent - Lipid soluble - CNS malignancies |
| Melphalan | - PO - IV: limited stabilit use 60 min of reconstitution |
| Mechlorethamine (Valchlor) | - Topical gel - Fridge - Use glove |
| Hexalen | - Altreramine - Ovarian cancer - Oral - Fertility impairement |
| Procarbazine (Matulane) | - PO - MAOi - Watch for Disfulfram reaction (avoid alcohol) |
| Bendamustine (Treanda) | - IV (infusion reaction) - PO - To prevent increasing uric acid: Allopurinol |
| MTX (autoimmune) indication | - RA, Psoriasis - Max 20mg QW |
| MTX off label indication | - Ectopic pregnancy (Thai ngoài tử cung) - Crohn's disease |
| MTX formulation | - PO, IM, IV, SQ - Intrathecal (presevative FREE) - Onco: 12,000 mg/m2 IV Q2-3 Weeks, give Leucovorine to stop from working |
| MTX rescue | - Leucovorine (Folinic acid): 24-48 hrs post |
| MTX - role of Voraxaze | - Glucarpidase: for renal impairment pt - enzyme breaks down MTX prior it goes into the kidney |
| MTX safety concerns | - Mucositosis - Hepatoxicity - Renal: Sodium bicarbonate to create alkalize, Voraxaze - X: NOT given to pregnancy, check XR for Pulmonary fibrosis |
| Adrucil | - 5FU (Fluorouracil) - Topical 5%: Efudex - Leucovorine: works better - - Increase INR - IV - Hand foot syndrome |
| Xeloda | - Capecitabine - Prodrug of 5FU - With FOOD - Ciclicia: 2 wks on 1 wk off - Increase INR |
| 6MP (Purinethol, Purixan) | - Mercaptopurine - DDI: NEEDs xathine oxidase to be metabolised - If block XO: increase 6MP - If add allopurinol / Febuxostate: decrease dose 6MP |
| Cytarabine, Fludarabine toxicity | - Blindness irreversable |
| Bleomycin | - IV, IM, SQ - Pulmonary fibrosis (C-XR) - Max life time dose: 400 UNITs |
| DoxoRUBicin, DaunoRUBicin | - CHF: Give Dextrazoxane IV (Zinecard) - Extravasation: Dextrazoxane (Totect). Apply COLD "ice" - Life time max dose Doxorubicin: 550 mg/m2 |
| DoxoRUBicin dose 60mg/m2 for pt w BSA 2m2. How many max total cycles can be given? | 550 /60 = 9 cycles (ignore BSA for calculating total cycles) |
| Novantrone | - Mitoxantrone - FDA: Multiple sclerosis (MS) dose of 140mg/m2 |
| Docetaxel | - Hypersensitive reaction- premed steroid - Fluid retention - give laxis - Peripheral neuropathy - Ocular effects: eye exam |
| Taxol | - Paclitaxel - NON PVC bag (leach chemicals to the PVC) - 0.22 mircon filter - Castro oil allergy - IV ONLY - Peripheral neuropathy - Premed by Steroid, H2 blocker, diphelnhydramine - Ethanol content |
| Toposar | - Etoposide - IV |
| Irinotrecan | - Diarrhea - Acute: Atropine - Chronic: Loperamide (Opioid receptor) |
| VP-16 | - Etoposide - PO, in Fridge |
| Breast cancer dx | - Estrogen receptor: ??? (+) - HER-2 receptor: ??? (+) |
| Breast cancer Tx | - Chemotherapy - Hormone therapy: Tamoxifen, Raloxifen (Elista); AI; Fulvestrant (IM) - Target therapy - CDK4-6 inhibitors: Palbociclib (Ibrance), ribociclib (Kisqali), Everolimus (Afinitor ): add to AI |
| Herceptin | - Trastuzumab, IV - HER-2 + - Cardiotoxicity, Pulmonary toxicity (rare) |
| Prejeta | - Pertuzumab, adding to Herceptin - HER-2 + |
| Tykerb | - Lapatinib, PO, EMPTY stomach - HER-2 + |
| Nerlynx | - Neratinib - HER-2 + |
| GnRH /LHRH agonist list (premenopause) | - Leuprolide (Pupron) - Goserelin - Triptorelin |
| Tamoxifen | - SERM - CLOTssss - Prodrug via 2D6 to be active - Inhibitors (Paroxetine, Setraline, Fluoxetine, Duloxetine, Bupropion): NOT. Okie for venlafacxine - Given for premenopause |
| Aromatase inhibitors (AIs) | - Postmenopause - Anastrezole (Arimidex) 1mg PO QD - Letrozole (Femara) 2.5. mg Po QD - Exemestane (Aromasin) 25 mf PO QD |
| Faslodex | - Fulvestrant - IM - Bleeding |
| Prevention: Pre-menopause | - Tamoxifen - Clots - 5-10 yrs |
| Prevention: Post-menopause | - Raloxifen (Evista) 60 mg PO QD - SERM - Clots - 5-10 yrs |
| Prostate cancer dx | PSA - 0-4 ng/mL: NL - > 10 ng/mL: suspecious (take biopsy) |
| Prostate cancer tx | - LHRH /GrRH agonist (analog): Goserelin (Zoladex) SQ, Leuprolide (Lupron) IM , histrelin (Vantas), triptorelin (Trelstar) - Antiandrogen: Flutamide, Bicalutamide, Nilutamide: start 2-4 wks prior LHRH agonist and ctn ONE week after |
| LHRH /GrRH agonist indications | - Prostate - Pre-menopause BC - Endocetrial cancer |
| Firmagon | - degarelix - LHRH |
| Cervical cancer screening | - Papsmear: 21-29 every 3 yrs |
| Breast cancer screening | - 40 yrs |
| Colon cancer screening | - Colonoscopy - 45 yrs |
| Lung cancer LDCT | - Low - dose - computer - tomography - 50 - 80 yrs - 20 pack years smoking or quit within last 15 yrs - |
Created by:
dao.vo11017