Naplex 2025 😭 > Oncology > Flashcards

Oncology Flashcards

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1
Q

What is Cancer?

A
  • Group of abnormal cell profileration where they divide uncontrollably
  • Cancer can be Benign or Malignant
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2
Q

What is the difference between Benign and Malignant tumors?

A
  • Benign: harmless and stay in one spot
  • Malignant: travels through Lymph & Blood making Secondary tumor
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3
Q

What is the way that Cancer is caused by?

A
  • Genetic Mutations
  • Mutated proto-oncogenes = Oncogenes [EGFR, HER2]
  • Mutations in DNA repair
  • Mutations in Tumor Suppression [BRCA]
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4
Q

What are some of the ways that we can prevent cancers?

A
  • Avoid tobacco [lung cancers]
  • Limit alcohol [liver cancers]
  • Healthy Lifestyle
  • Get vaccinated
  • Low-dose aspirin [Prevents colorectal]
  • Skin protection [skin cancer]
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5
Q

What are the warning signs of Melanoma?

ABCDE

A
  • Asymmetry: one half not match the other
  • Border: edges are irregular
  • Color: NOT the same allover
  • Diameter: Larger than 6mm
  • Evolving: changing overtime
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6
Q

What are the Cancer Screening Guidelines for Breast Cancers?

A
  • 40 - 44 years = Annual Mammograms
  • 45 - 55 years = Yearly Mammograms
  • > 55 years = Yearly or 2 years

FEMALES

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7
Q

What are the Cancer Screening Guidelines for Cervical Cancer?

A
  • 21 - 65 years
  • PAP Smear x 3y; HPV test x 5y; PAP + HPV x 5y

FEMALES

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8
Q

What are the Cancer Screening Guidelines for Colorectal Cancer?

A
  • > 45 years
  • Stool Test [Fecal Occult Blood Tests Yearly & Stool DNA Test x 3y]
  • Visual Exams [Colonscopy x 10y]
  • sigmouidscopy x 5 years

MALE/FEMALES

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9
Q

What are the Cancer Screening Guidelines for Lung Cancer?

A
  • > 50 years
  • CT scan of chest

MALES/FEMALES

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10
Q

What are the Cancer Screening Guidelines for Prostate Cancers?

A
  • Individualized Decision
  • PSA test +/- Digital Rectal Exam
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11
Q

What are some of the warning signs of cancer?

Remember CAUTION

A
  • Changes in bowel or bladder habits
  • A sore that does not heal
  • Unusual bleeding or discharge
  • Thickening in breast or eslewhere
  • Indigestion or hard swallowing
  • Obvious changes in wart/mole
  • Nagging cough
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12
Q

What is the way that we Diagnosis cancers?

A
  • Staging 1 - 4
  • TMN staging
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13
Q

What is the way that cancer treatment is decided?

A
  • Type and characterisitcs of cancer
  • Stage [1 - 4]
  • Physical functioning [age, comorbidities, past treatments]
  • Efficacy vs Tolerability of treatments
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14
Q

What is the treatment goals based around the treatment of cancers?

A
  • Curative: eradicate cancer cells
  • Palliative: controls symptoms and provide comfort [not really “curing”}
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15
Q

What are the different types of cancer treatments?

A
  • Primary: remove or eliminate the cancer [surgery is the best]
  • Neoadjuvant: BEFORE surgery to shrink cancer
  • Adjuvant: after Primary to help remove anything left over
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16
Q

What are some of the Calculations to help with finding the chemotherapy doses?

A
  • Mosteller or Du Bios Equations [Body Surface Area]
  • Calverts [ONLY carboplatin]
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17
Q

What are some of the non-specific cell cycle agents used in cancer chemotherapy?

A
  • Alkylating Agnets
  • Platinums
  • Anthracyclines
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18
Q

What is the MOA for the Alkylating Agents used in Chemotherapy?

A
  • Cross links DNA strands to inhibit DNA/Protein synthesis = cell death
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19
Q

What are some of the Alkylating Agents what are used in Chemotherapy?

A
  • Cyclophosphamide
  • Ifosfamide
  • Busulfan
  • Carmustine
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20
Q

What are some of the Safety concerns for Cyclophosphamide & Ifosfamide?

A
  • Hemorrhagic Cystitis [caused by acrolein in the bladder]
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21
Q

What are some of the Monitoring for Cyclophosphamide & Ifosfamide?

A
  • Hematuria, Urinalysis [RBS?], Dysuria
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22
Q

What are some of the management things for Cyclophosphamide & Ifosfamide?

A
  • Prevent: Hydration
  • Treat: MESNA [for all Ifos and High Cyclo doses]
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23
Q

What are some of the Safety concerns for Busulfan?

A
  • Pulmonary Toxicity [Fiborsis]
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24
Q

What are some of the Monitoring things for Busulfan?

A
  • Signs/Symptoms of Pulmonary issues
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25
What are some of the **management things** for **Busulfan**?
- Oxygen or supportive care
26
What are some of the **Safety Concern** for **Carmustine**?
- **Neruotoxicity** [seizures] - **Pulmonary Toxicity**
27
What are some of the **Monitoring things** for **Carmustine**?
- **Seizures** [Neruotox] - Signs/Symptoms of Pulmonary issues
28
What are some of the **Management things** for **Carmustine**?
- Antiseizure meds - Supportive Care or Oxygen
29
What is the **MOA** for the **Platinum Based Compounds**?
- Cross link DNA, that interfere with **DNA Synthesis** & cell replication = cell death
30
What are the **Platinum Based Compounds** that are used in Chemotherapy?
- **Cisplatin** - Carboplatin - Oxaliplatin
31
What are some of the **Safety Concers** for **Platinum Based Compounds**?
- Hypersensitivty Recations - **Nephrotoxicity** - **Ototoxcity** - Peripheral Neruopathy - Oxali: cold exacrbation
32
What are some of the **monitoring things** for **Platinum Based Compounds**?
- Signs/Symptoms of **Anaphylaxis** [Hypersensitivity Rx] - Renal Function [**Nephrotoxcity**] - Hearing Loss or Tinnitus [**Ototoxicity**] - Numbness, Pain [Neruopathy]
33
What are some of the **mangament things** for **Platinum Based Compounds**?
- Symptomatic Care [Hypersensitivity Rx] - **Hydration, Amifostine [for toxcity], LIMIT CISPLATIN TO < 100 mg/m^2** [Nephrotoxicity] - Avoid other ototoxic meds [Ototoxicity]
34
What is the **MOA** for the **Anthracyclines**?
- Intercalate DNA [insert into DNA], **Inhibition of topoisomerase II**, makes oxygen free rads
35
What are the **Anthracyclines** that are used in Chemotherapy?
- **DoxoRUBIcin** - Danorubicin ## Footnote All have **-RUBI-**
36
What are some of the **safety concerns** for **Doxorubicin**?
- **Cardiotoxicity** - **Red Discoloration** of body fluids ## Footnote Remember **-RUBI- red body fluids**
37
What are some of the **monitoring things** for **Doxorubicin**?
- Left Ventricular Ejection Fraction - Red Urine?
38
What are some of the **Managemnt** for **Doxrubicin**? ## Footnote Doses? Antidote?
- Limit **total lifetime dose to 450 - 550 mg/m^2** - **Dexrazoxane** is a protectant
39
What are some of the **cell cycle specific** drug classes in **oncology**?
- Topo I - Topo II - Vincas - Taxenes - Pyrimidine Antimetabolites - Folate Antimetabolites
40
What is the **MOA** for the **Topoisomerare I Inhibitors**?
- Topo I **Block** coiling/uncoiling of **double stranded DNA** during the **S PHASE** = preventing DNA from sealing up
41
What are the **Topo I Inhibitors** that are used?
- Irinotencan
42
What are some of the **safety concerns** for the **topo I inhibitors**?
- **Acute DIARRHEA** plus **chonlinergic symptoms** (Salivation, lamcrimation...) - **Delayed DIARRHEA**
43
What are some things to **monitor** with the **topo I Inhibitors**?
- Bowel Movements (how many) - Eletrolytes (K, Mg...) - Dehydration (from all the diarrhea)
44
What are some **managment** options for the **topo I Inhibitors**?
- Prevent: **Atropine** - Treat: Acute - **Atropine**; Delayed - **Loperamide** - Also like hydration or electrolyte replacement
45
What is the **MOA** for the **Topoisomerase II Inhibitors**?
- Topo II **Blocks** the coiling/uncoiling of **double stranded DNA** during the **G2 PHASE** = preventing DNA from sealing up
46
What are some of the **Topo II Inhibitors** that are used?
- Etoposide
47
What are some **safety concerns** for the **Topo II Inhibitors**?
- Infusion related **Hypotension**
48
What are some things to **monitor** with the **topo II Inhibitors**?
- Vitals (BP, HR...)
49
What are some **managment** options for **topo II Inhibitors**?
- Prevent: **infuse over 30 - 60 mins** - Treat: **IV Hydration, decrease infusion rate**
50
What is the **MOA** for the **Vinca Alkaloids**?
- **Inhibit** microtubule formation during **M PHASE** ## Footnote why it leads to **neurotoxicities**
51
What are some of the **vincas** that are used?
- **Vincristine** - Vinblastine - Vinorelbine
52
What are some of the **safety concerns** for the **vincas**?
- Peripheral Neuropathy - Constipation - Paralysis/Death if given **intrathecally** ## Footnote **only for IV**
53
What are some things to **monitor** for with the **vinca**?
- Signs/Symptoms of **neuropathy** (numbness, pain) - Sign/Symptoms of **Constipation** - Make sure to give it **IV**
54
What are some of the **managment** options for **vincas**?
- Neuro: Prevent - **limit single dose to 2 mg**; Treat - Neuropathic meds (gabapentin...) - Constipation: Prevent/Treat - diet changes or laxatives - **IV ONLY** - make a **small IV Bag**
55
What is the **MOA** for the **taxanes**?
- **Inhibits** the **depolymerization of tubulin** during the **M PHASE** ## Footnote destabilizes the microtubules
56
What are some of the **taxanes** that are used?
- **Paclitaxel** - Cabazitacel (Jevtana) - Docetaxel ## Footnote use **NON-PVC** bags & **0.22 micron filters**
57
What are some **safety concerns** for the **taxenes**?
- Peripheral Neuropathy - Hypersensitivity Reactions - Severe Fluids Reatention (Doectaxel)
58
What are some things to **monitor** with the **taxanes**?
- Signs/Symptoms of **neuropathy** - Signs/Symptoms of **anaphylaxis** - Signs/Symptoms of **edema**
59
What are some **management** options for the **taxenes**?
- Neuro: Treat - Neuropathic Meds (gabapentin...) - Anaphylaxis: Prevent - **Steroids, Benadryl, or H2RA**; Treat - STOP therapy - Fluid Retention: Prevent - **Steroids**; Treat - **Diuretics**
60
What is the **MOA** for the **Pyrimidine Antimetabolites**?
- Inhibit Pyrimidine synthesis during **S PHASE** ## Footnote Leucovorin is given with 5-FU to **increase** efficacy
61
What are the **Pyrimidine Antimetabolites** that are used?
- Flurouracil (**5-FU**) - Capecitabine (Prodrug for 5-FU)
62
What are some **safety concerns** for the **Pyrimidine Antimetabolites**?
- **Hand-and-Foot syndrome** - **Diarrhea** - **Mucositis** - DPD Deficiency: increase risk of toxicities - Drug interactions
63
What are some things that should be **monitored** with the **Pyrimidine antimetabolites**?
- Signs/symptoms of **HFS** (peeling of skin, redness, pain) - Bowel Movement (how many) - Signs/Symptoms of **Mucositis** (painful mouth ulcers) - Toxicities - INR, Bleeding (drug interactions with Warfarin)
64
What are some **management** options for the **pyrimidine antimetabolites**?
- HFS: Prevent/Treat - **avoid heat, do cold compresses, emollients (urea, aquaphor)** - Diarrhea: Treat - **Loperamide**, hydration, electrolyte replacement - Toxicities: Treat - **Uridine Triacetate** ("Antidote used within 96h")
65
What is the **MOA** for the **folate antimetabolites**?
- **interferes** with **folic acid cycle**, blocking synthesis during **S PHASE**
66
What are the **Folate Antimetabolites** that are used?
- Methotrexate
67
What are some **safety concerns** for the **folate antimetabolites**?
- Nephrotoxicity (with high doses > 500 mg/m2) - GI Issues (Diarrhea, Mucositis)
68
What are some things to **monitor** with the **folate antimetabolites**?
- Renal Function (BUN, SCr, Urine Output) - Bowel Movements (how many)
69
what are some of the **management** options for the **folate antimetabolites**?
- Nephrotoxicity: Prevent - **Leucovorin** (increases efficacy), Hydration, Avoid Drug interactions; Treat - **Glucarpidase** ("antidote" that lowers MTX levels) - Mucositis: Prevent/Treat - Good oral hygiene, mouth washes...
70
What is **myleosuppression**?
- Reduce WBCs (**neutropenia**), RBCs (**Anemia**), & Platelets (**Thrombocytopenia**)
71
What are some of the **agents** that can help with **Neutropenia** and what is there **MOA**?
- Granulocyte Colony-Stimulating Factors (**GCSFs**) - Stimulate WBC production and are given prophylactically after chemo
72
What are some of the **GCSFs** that are used for **Neutropenia**?
- Filgrastim (Neupogen) - Pegfilgrastim (Neulasta, Neulasta Onpro)
73
What are some **Side effects** of the **GCSFs** for **Neutropenia**?
- **Bone Pain, Splenic Rupture** - Rash, Respiratory Distress Syndrome
74
What are some things to **Monitor** with the **GCSFs** for **Neutropenia**?
- CBC, Upper Abdominal Pain
75
What are soem **additional notes** over the **GCSFs** for **neutropenia**?
- store in fridge - Administer no sooner than **24 hours** after chemo - Onpro: On body injector
76
What is the **diagnostic Criteria** for **Febrile Neutropenia**?
- Fever > 38.3 C - ANC < 500 ## Footnote **MUST** start empric antibiotics
77
What are the **different** types of Chemotherapy Induce Nausea and Vomting (**CINV**)?
- **Acute**: < 24h after chemo - **Delayed**: > 24h after chemo - **Anticipatory**: Before chemo (because they know what will happen) - **Breakthrough**: happens anytime
78
What are some of the **treatment** options for **CINV**?
- Neurokinin-1 Receptor Antagonists (NK1 RAs) - Serotonin Receptor Antagonist (5-HT3 RAs) - Dopamine Receoptor Antagonist - Other (Dexamethasone, Dronabinol, Lorazepam)
79
What is the **Antiemetic Regimen** for someone with **High Emetic Risk**? ## Footnote Taking cisplatin
- NK1 + 5-HT3 + Olzanapine + Dexamethasone ## Footnote **Lorazepam** is added during anticipatory
80
What is the **antiemetic regiemn** for someone with **moderate emetic risk**?
- NK1 + 5-HT3 + Dexamethasone ## Footnote **Lorazepam** if anticipatory
81
What is the **antiemetic regimen** for someone with **low emetic risk**?
- 5-HT3 OR - Dexamethasone OR
82
What are the **neurokinin 1 receptor antagonists** that are used for **CINV**?
- **Aprepitant (Emend**, Tri-Pack, Cinvanti) - **Fosaprepitant (Emend)**
83
What are some of the **Serotonin Receptor Antagonist** that are used for **CINV**?
- Ondanstron (Zofran) - Granisetron (sancuso) - Palonosetron
84
What are some of the **contraindictions** for the **5-HT3** for **CINV**?
- DO NOT use with apomorphine = severe hypotension
85
What are some of the **warnings** with the **5-HT3** used for **CINV**?
- QT Prolongation - more common with IV (limit to 16 mg) - Serotonin Syndrome
86
What are some of the **side effects** of the **5-HT3** used for **CINV**?
- Headache, Constipation
87
What **steroids** are used for **CINV**
- Dexamethasone
88
What is **Lorazepam** used for?
- Anticipatory CINV
89
What are the **dopamine Receptor antagonist** that are used for **CINV**?
- Olanzapine (Zyprexa) - Prochlorperazine - Promethazine (phenergan) - Metoclopramide (reglan) - Haloperidol
90
What are some of the **boxed warnings** for the **Dopamine Receptor Antagonists** for **CINV**?
- Promethazine: **DO NOT** use in kids < 2yo - Reglan: Tardive that is irreversible
91
What are some of the **warnings** for the **Dopamine Receptor Antagonist** for **CINV**?
- Parkinsons (exacerbates it)
92
What are some of the **Side effects** of the **Dopamine recepotor antagonists** for **CINV**?
- Sedation, Lethargy, EPS (Tardive), QTc Prolongation
93
How are **targeted therapies** used for **cancer**?
- Most therapies are **monoclonal antibodies** - **Pharmacogenomic** are used to find the right receptors **except** for **VEGF**
94
What is the **most common side effects** for the **monoclonal antibodies** that are used for **targeted therapies** in **oncology**?
- Injection site reactions - Typically give **aceteminophen 650 mg PO & Benadryl IV or PO** to help ## Footnote could also use **H2RAs, Steroids, and/or Meperidine** (for rigors)
95
What are the **monoclonal Antibodies** that are used in **oncology**?
- **Rituximab** (Targets CD20) - **Ceuximab** (Targets EGFR or KRAS) - **Trastuzumab** (Targets HER2) - **Bevacizumab** (Targets nothing?) - Pembrolizumab - Nivolumab - Ipilimumab
96
What is the target for **Rituximab**? What is the **MOA**?
- Target: **CD20** - MOA: Binds to specific antigens expressed ont he cell surface = cell death ## Footnote **Rituxan**
97
What are the **key saftey concerns** for **Rituximab**?
- **HEP B REACTIVATION** - check Hep B panel **BEFORE** treatment starts
98
What is the **target** for **Cetuximab**? What is the **MOA**?
- Target: **EGFR** or **KRAS wild type** or BRAF - MOA: Inhibit pathways involved in cell proliferation, differentiation & survival ## Footnote **Erbitux**
99
What are the **key saftey concerns** for **Cetuximab**?
- Dermatologic toxicities - **Ance rash** within 1st 2 weeks of use (this shows that the treatment is **WORKING**) - Use skin care measures (**Avoid sun, use sunscreen, apply moisturizers**) and consider **topical steroids or antibiotics** if need be
100
What is the **target** for **Trastuzumab**? What is the **MOA**? ## Footnote Brand Name?
- Targets: **HER2 overexpression** - MOA: Binds to HER2 protein to stop signaling pathways and cell growth ## Footnote **HERceptin**
101
What are the **key saftey concerns** for **trastuzumab**?
- **Cardiotoxicity** - monitor LVEF with **echo or MUGA scan** - The **different** types of Trastuzumabs are **NOT INTERCHAGABLE**
102
What is the **target** for **Bevacizumab**? What is the **MOA**? ## Footnote Brand name
- Target: **VEGF** - MOA: **Inhibits growth of blood vessels** for tumor growth ## Footnote Avastin
103
What are the **key saftey concerns** for **Bevacizumab**?
- **Impaired Wound Healing** - **DO NOT** give 28 days before surgery - **Thromboebolic Events** - DVT stuff - **Fatal Bleeding** - **GI Proforation**
104
What are the **Targets** for **Pembrolizumab & Nivolumab**? What is the **MOA**?
- Target: **PD-1 Receptors** - MOA: Binds to **PD-1** on T-cells blocking the binding of PD-1**increasing T-cell response** = antitumor response ## Footnote Pembro = **Keytruda** & NIvo = Opdivo
105
What are the **key saftey concerns** for **PD-1 Inhibitors & CLTA-4 Inhibitors**?
- Immune Mediated Toxicities
106
What is the **target** for **Ipillumamb**? What is the **MOA**?
- Target: **CLTA-4 Receptors** - MOA: Binds to CTLA-4 removing the "brakes" from T-cell activation = **increase T-cell activity**
107
What are the **Tyrosine Kinase Inhibitors** that are used in **oncology**?
- Imatinib, Dasatinib, Nilotinib (BCR-ABL Genes) - Dabrafenib, Vemurafenib (BRAF V600E or V600K) - Cobimetinib, Trametinib (BRAF) - Afatinib, Erlotinib (EGFR Genes)
108
What is the **targets** for **Imatinib, Dastinib, Nilotinib**? What is the **MOA**?
- Target: **BCR-ABL Fusion Gene** - blocking tyrosine kinase that is made from the BCR-ABL Protein = more controlled cell division
109
What are the **key saftey concerns** for **BCR-ABL Inhibitors**?
- Fluid Retention - QTc Prolongation - GI Upset (**imatinib** must be taken with food or 1 hr after meals)
110
What is the **target** for **Dabrafenib, Vemurafenib**? What is the **MOA**?
- Target: **BRAF V600E or V600K** - MOA: Inhibits certain forms of **BRAF** = tumor cell death
111
What are the **key saftey concerns** for **BRAF inhibitors**?
- New Malignancies (like basal cell carcinoma) - QTc Prolongation
112
What is the **target** for **Cobimetinib, Trametinib**? What is the **MOA**?
- Target: **BRAF** - normally combined with a BRAF Inhibitor - MOA: Inhibits **MEK** which is a protein downstream from RAF
113
What is the **Target** for **Afatinib, Erlotinib**? What is the **MOA**?
- Target: **EGFR Genen mutations** MOA: Inhibits the pathways that are helping with cell growth
114
What are the **key saftey concerns** for **EGFR inhibitors**?
- Dermatologic toxicities - **Ance rash** within 1st 2 weeks of use (this shows that the treatment is **WORKING**) - Use skin care measures (**Avoid sun, use sunscreen, apply moisturizers**) and consider **topical steroids or antibiotics** if need be
115
What is the **condition** in males that could **increase** their risk for **breast cancer**?
- Klinefelter Syndrome - Males having **one Y** and **two X chromosomes** = more estrogen
116
What is important to know about the **BRAC 1 & 2 Mutations** in **breast cancer**?
- Normally they **supress tumor growth** but with the mutations they **prevent cell repair**; increases the risk for breast cancer
117
What are some of the **medications** that can help with **breast cancer prevention**?
- Tamoxifen: SERM that is used in both **Pre or Post** menopause - Raloxifene: SERM that is used in **ONLY POST** menopause ## Footnote Tamoxifen and AI can be used ofr treatment and prevention Raloxifene is ONLY for prevention
118
What are the **different sensitivites** for **breast cancers**?
- HR+ = hormone sensitive - ER+ = Estrogen receptor positive - PR+ = Progesterone receptor positive
119
How long should **breast cancer treatment last**?
- ~ 5 - 10 years
120
What is the **treatment choice** if the patient is **premenopausal**?>
- 1st line: **Tamoxifen** (preventing estrogen from binding) - **Aromastase Inhibitors** (not really good as Monotherapy unless menopause in induced [that can be done with **GnRH Agonists** ])
121
what is the **treatment choice** for someone that is **postmenopausal**?
- Tamoxifen or AIs
121
What are the **unique concerns** about **tamoxifen**?
- Prodrug via **2D6** - efficacy can be decrease in thos that are taking 2D6 inhibitors (i.e., estrogen, Fluoxetine, Paroxetine) ## Footnote **Venlafaxine** is preferred for hot flashes
122
What are the **boxed warnings** for **tamoxifen**?
- Increased risk for **Uterine or endometrial cancers** and **thromboembolic events** -
123
What are some **side effects** for **tamoxifen**?
- Hot flashes/Night Sweats - Vaginal Bleeding/Discharge - Decrease bone mineral density
124
What are some**additional notes** for **tamoxifen**?
- Teratogenic
125
What are some **side effects** for **Fulvestrant**?
- Increase LFTs - **Injection Site Reactions** (IM Injection) - Hot Flashes
126
What are the **Aromatase Inhibitors** that are used?
- Anastrozole (Arimidex) - Letrozole - Exemestane
127
What are some **Unique concerns** about the **aromastase inhibitors**?
- **higher** risk for **osteoporsis** - give Ca or Vit D supp) - **Higher** risk of **CVDs**
128
What are some **side effects** for the **AIs**?
- Hot Flashes/Night Sweats, - Arthralgia/Myalgia
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