Chemo
The most serious manifestations of hyperkalemia are muscle weakness and cardiac arrhythmias. Which of the following are measures in treating a patient with a serum potassium level of 8.0 mEq/L? Select ALL that apply.
Answer: C, D, E Phosphate is generally not used to treat a hyperkalemic emergency. Calcium directly antagonizes the membrane actions of hyperkalemia, and it protects the heart from the arrhythmogenic effects of hyperkalemia until the K+ is removed from the serum. We can administer either calcium gluconate or calcium chloride (calcium chloride contains three times the concentration of elemental calcium compared to calcium gluconate). Calcium acetate (Phoslo) is for treatment of hyperphosphatemia. Insulin administration lowers the serum potassium concentration by driving potassium into the cells. Dextrose is administered to prevent hypoglycemia; however, it is not needed if serum glucose is ≥250 mg/dL. Insulin administration only transiently lowers the serum K+ concentration. Additional therapy is typically required to remove excess K+ from the body such as sodium polystyrene sulfonate (Kayexalate).
Which of the following agents is used to prevent Platinol-induced nephrotoxicity?
Amifostine (Ethyol) is given prophylactically to prevent nephrotoxicity.
Which of the following is fluorouracil used for? Select ALL that apply.
Answer A,B Fluorouracil topical is used for actinic keratoses: (Topical: Carac, Efudex, Fluoroplex). Fluorouracil IV is used for the treatment of breast, colon, pancreatic, and stomach (gastric) cancer.
What is the maximum number of days a patient can leave Sancuso patch on?
Answer E Granisetron transdermal patch (Sancuso) can be left on for a maximum of 7 days.
In addition to limiting the lifetime cumulative dose of doxorubicin, which of the following medications has been used to reduce the risk of cardiotoxicity?
Answer: A Dexrazoxane (Zinecard) is indicated for the prevention of doxorubicin cardiomyopathy. IV: A 10:1 ratio of dexrazoxane:doxorubicin (dexrazoxane 500 mg/m2:doxorubicin 50 mg/m2). Cardiac monitoring should continue during dexrazoxane therapy. Deferoxamine (Desferal) is the treatment for acute iron toxicity. Dextromethorphan is a cough suppressant. Amifostine is a chemoprotective agent for reduction of cisplatin-induced renal toxicity.
Which of the following agents is used prophylactically before starting Cytoxan (cyclophosphamide)?
Answer: A MESNA binds to acrolein and works as a prophylactic agent to help prevent hemorrhagic cystitis associated with cyclophosphamide.
What is the mechanism of action of tamoxifen?
Answer: A Tamoxifen is a SERM; it has potent anti-estrogenic properties which compete with estrogen for binding sites in breast and other tissues. It competitively binds to estrogen receptors on tumors and other tissue targets, producing a nuclear complex that decreases DNA synthesis and inhibits estrogen effects.
Which of the following agents is administered with Ifex (ifosfamide)?
Answer: A To prevent bladder toxicity, ifosfamide should be given with MESNA and hydration (at least 2 L of oral or IV fluid per day). MESNA binds to acrolein and works as prophylaxis to help prevent hemorrhagic cystitis.
D.G. is a 67-year-old male with prostate cancer. His physician has started him on triptorelin 11.25 mg IM once every 12 weeks. In addition to Trelstar, which of the following classes of medications do you recommend?
Answer: A Triptorelin is a GnRH analog that causes a transient rise in LH and can cause a surge in serum testosterone which causes a "flare": increase in bone pain, bladder obstruction, and other symptoms due to the rise in testosterone. The flare phenomenon can be effectively prevented with antiandrogen therapy, which blocks the effect of the increased serum testosterone.
The vinca alkaloids are plant-derived cytotoxic agents whose mechanism of action involves antimicrotubule activity. Which of the following vinca alkaloids is the MOST neurotoxic?
Answer: A Vincristine is the most neurotoxic. Virtually all patients receiving vincristine have some degree of neuropathy (paresthesias in the fingertips and feet, with or without pain, and muscle cramps/weakness).
Reducing the effect and/or amount of estrogen in the body is the cornerstone of hormonal therapy for breast cancer. All the following medications are associated with an increased risk of venous thromboembolism EXCEPT:
Answer: A (Arimidex) Anastrozole Tamoxifen, raloxifene, goserelin, and megestrol can all increase the risk of thromboembolic events.
In the United States, which of the following formulations is palonosetron available in?
Answer: A only Palonosetron (Aloxi) is IV only (the oral formulation is not marketed in the United States).
C.P., a 35-year-old female patient is currently on ondansetron, dexamethasone, and aprepitant to treat her chemotherapy-induced nausea and vomiting (CINV); however, she is still complaining of nausea. Which of the following may be useful as adjuncts to her conventional antiemetic treatment? Select ALL that apply.
Answer: A, B Lorazepam and diphenhydramine are useful as adjuncts to conventional antiemetic agents; however, they are not recommended as single agent antiemetic. Lorazepam is used for chemotherapy-associated nausea and vomiting (off-label use). Lorazepam is FDA approved for: - Premedication for anesthesia - Anxiety disorder - Insomnia due to anxiety or stress
Which of the following is/are TRUE about mannitol? Select ALL that apply.
Answer: A, B Mannitol produces an osmotic diuresis by increasing the osmotic pressure of glomerular filtrate, which inhibits tubular reabsorption of water and electrolytes and increases urinary output. Once the IV is made, it should be inspected for crystals prior to administration. If crystals are present, re-dissolve by warming solution and shaking to dissolve.
Which of the following formulations is/are dolasetron (Anzemet) available in? Select ALL that apply. IV Oral ODT Oral Soluble Film Patch
Answer: A, B Dolasetron can be administered PO or IV.
Which of the following is/are TRUE about dolasetron? Select ALL that apply.
Answer: A, B, C With dolasetron, think ECG, QT, K+, Mg++. Dolasetron is associated with an increase in ECG intervals (PR, QRS, and QT interval). QT interval prolongation may occur resulting in torsade de pointes when used in conjunction with other agents that prolong the QT interval (e.g., class I and III antiarrhythmics). Avoid use in patients at risk of QT prolongation and/or ventricular arrhythmia (e.g., patients with congenital long QT syndrome, medications known to prolong QT interval, electrolyte abnormalities [hypokalemia or hypomagnesemia], and cumulative high-dose anthracycline therapy). Correct potassium or magnesium abnormalities prior to initiating therapy. With apomorphine, 5HT3 antagonist antiemetics may enhance the hypotensive effect of apomorphine. Risk X: Avoid combination
Which of the following is/are TRUE about letrozole? Select ALL that apply.
Answer: A, B, C Letrozole (Femara) is an aromatase inhibitor. Tamoxifen may decrease the serum concentration of letrozole. Risk C: monitor therapy.
Which of the following can cause pulmonary toxicity/fibrosis? Select ALL that apply.
Answer: A, B, C, D Pulmonary fibrosis can occur with amiodarone, bleomycin, busulfan, and methotrexate. With bleomycin, pulmonary fibrosis is more common in patients receiving > 400 units total dose.
What formulation(s) is/are ondansetron available in? Select ALL that apply.
Answer: A, B, C, D There is no ondansetron (Zofran) patch. Ondansetron IV - 8 mg or 0.15 mg/kg IV once. Ondansetron oral - 8 mg by mouth twice daily. Ondansetron oral dissolving tablet (ODT) - 8 mg dissolved in the mouth every 12 hours as needed. Ondansetron oral soluble film - 8 mg dissolved in the mouth every 12 hours as needed. The only 5-HT3 receptor antagonist that comes in a patch is granisetron.
With regards to flutamide, which of the following are CORRECT? Select ALL that apply.
Answer: A, B, C, D, E All of the above are correct. Flutamide (Eulexin) is an anti-androgen. It is indicated for prostate cancer. It blocks testosterone; thus, can cause gynecomastia. Flutamide (Eulexin) black box warning is HEPATIC FAILURE (monitor LFT). Not Indicated for Females
Which of the following is used to reduce the incidence of chemo-induced neutropenic fever/infection? Select ALL that apply.
Answer: C, E Neulasta, Neupogen Granulocyte colony-stimulating factors (G-CSFs) have been widely used to minimize the extent and duration of neutropenia associated with myelosuppressive chemotherapy or radiation therapy (RT). Filgrastim (G-CSF, Granix, Neupogen) Biosimilar form of filgrastim (filgrastim-sndz, Zarxio) Pegfilgrastim (Neulasta)
Mr. R.J. is a 66-year-old male with recently diagnosed acute myelogenous leukemia. He recently started induction chemotherapy. He calls you worried about his urine color being red. Which of the following medications could be the culprit for his red urine?
Answer: D Doxorubicin may give a reddish color to the patients' urine, tears, and sweat.
What is Akynzeo?
Answer: D Akynzeo is the combination of netupitant 300 mg plus palonosetron 0.5 mg (NEPA).
What is the black box warning of Evista?
Answer: D Black box warnings of Evista (raloxifene) are related to clot formation. Increased risk of venous thromboembolism (VTE) and increased risk of death caused by thromboembolic stroke/MI.
If your patient has congenital long QT syndrome or is on medications known to prolong QT interval, which of the following 5-HT3 antagonists would you recommend?
Answer: D If your patient has congenital long QT syndrome or is on medications known to prolong QT interval, you should recommend palonosetron.
Which of the following antiemetics has the LONGEST half-life?
Answer: D The second-generation agent palonosetron has a significantly longer half-life (about 40 hours) compared with first-generation 5-HT3 receptor antagonists.
In adults without risk factors for cardiotoxicity, the lifetime cumulative dose of daunorubicin should be limited to which of the following?
Answer: E Manufacturer's labeling for daunorubicin: Cumulative doses above 550 mg/m2 in adults without risk factors for cardiotoxicity and above 400 mg/m2 in adults receiving chest irradiation are associated with an increased risk of cardiomyopathy.
Which of the following adverse effects is generally NOT associated with busulfan?
Answer: E Although hypocalcemia is occasionally encountered with busulfan use, hypercalcemia is generally not associated as a side effect of busulfan. The other given choices (hyperuricemia, pulmonary fibrosis, hyperpigmentation of the skin, and seizures) are possible side effects seen with administration of busulfan.
What is the mechanism of action of Emend?
Answer: E Neurokinin-1 antagonists: Aprepitant oral (Emend) Fosaprepitant IV (single dose) (Emend IV)
What pregnancy category is thalidomide?
Answer: E Thalidomide is pregnancy category X. Thalidomide is available only through a special restricted distribution program (Thalomid REMS).
Y.J. is a 33-year-old premenopausal female with HER2-negative breast cancer. Her oncologist has prescribed her Arimidex 1 mg once daily with or without food. As her pharmacist, which of the following is the most appropriate action?
Arimidex is indicated for postmenopausal females only! DO NOT FILL, NOT APPROPRIATE
Which of the following is/are side effects associated with cyclophosphamide? Select ALL that apply.
Answer: A, B, C, D, E All of the above. Cyclophosphamide is associated with the development of hemorrhagic cystitis, pyelitis, ureteritis, and hematuria. Hemorrhagic cystitis may rarely be severe or fatal. Bladder fibrosis may also occur, either with or without cystitis. Increased hydration and frequent voiding are recommended to help prevent cystitis; some protocols utilize MESNA to protect against hemorrhagic cystitis. Alopecia (reversible; onset: 3-6 weeks after the start of treatment). Hepatic sinusoidal obstruction syndrome (SOS), formerly called veno-occlusive liver disease (VOD), has been reported in patients receiving cyclophosphamide.
Which of the following is/are US boxed warnings for methotrexate? Select ALL that apply.
Answer: A, B, C, D, E All of the above. Renal: Methotrexate can cause renal impairment. Liver: Methotrexate can cause hepatotoxicity with cirrhosis, but generally only after prolonged use. Respiratory: Methotrexate-induced lung disease - acute or chronic interstitial pneumonitis (dry, nonproductive cough) may occur at any time during therapy and is not always fully reversible. Potentially fatal opportunistic infections, especially Pneumocystis jirovecii pneumonia, may occur with methotrexate.
Which of the following are TRUE about megestrol? Select ALL that apply.
Answer: A, B, D, E Megestrol is a synthetic progestin with ANTIESTROGENIC properties which disrupts the estrogen receptor cycle. It may stimulate appetite by antagonizing the effects of catabolic cytokines. Megestrol causes weight GAIN because increased progestin stimulates appetite. Monitoring parameters of Megace include observing for signs of THROMBOEMBOLISM, blood pressure, weight, and serum glucose (DIABETES). It is pregnancy category D (tablet) / X (suspension).
Which of the following side effects are associated with cisplatin (Platinol)? Select ALL that apply.
Answer: A, C Cumulative RENAL toxicity associated with cisplatin is severe. Other major dose-related toxicities are myelosuppression, nausea, and vomiting. OTOTOXICITY which may be more pronounced in children is manifested by tinnitus or loss of high-frequency hearing and occasionally, deafness. Cisplatin is associated with a HIGH EMETIC potential. Cyclophosphamide can cause hemorrhagic cystitis (NOT cisplatin). Cisplatin is used "off-label" to treat cervical cancer; it does not cause cervical cancer.
Which of the following IV medications can cause the highest level of nausea?
Cisplatin has the highest emetogenicity of parenteral chemotherapeutic drugs.
Which of the following is/are FDA approved indications of methotrexate? Select ALL that apply.
MTX is used for the treatment of breast cancer, psoriasis, and RA.
Which of the following is an indicated use of Zanosar?
Streptozocin (Zanosar) is indicated to treat pancreatic islet cell carcinoma.
Which of the following agents is/are used to pre-medicate patients before administering paclitaxel? Select ALL that apply.
Answer: A, C, D All paclitaxel patients are pretreated with corticosteroids, diphenhydramine, and histamine H2 antagonists. Dexamethasone (20 mg orally at 12 and 6 hours prior), diphenhydramine (50 mg IV 30 to 60 minutes prior to the dose), and cimetidine, famotidine, or ranitidine (IV 30 to 60 minutes prior to the dose) are recommended. Side Note: Meperidine is used for amphotericin B rigors and chills. Patients who experience infusion-related immediate reactions to Ampho B should be premedicated with the following drugs 30 to 60 minutes prior to drug administration: NSAID and/or diphenhydramine or acetaminophen with diphenhydramine or hydrocortisone. If the patient experiences rigors during the infusion, meperidine may be administered.
Which of the following treatment measures can minimize cyclophosphamide bladder toxicity? Select ALL that apply.
Answer: A, C, D Amifostine is given before cisplatin to protect the kidneys. Deferoxamine is an iron chelator. Cyclophosphamide bladder toxicity is not related to iron; it is due to the accumulation of acrolein. To minimize cyclophosphamide bladder toxicity, hydration and frequent voiding is recommended. Some protocols utilize MESNA to bind to acrolein to protect against hemorrhagic cystitis.
Which of the following is/are TRUE about Aranesp? Select ALL that apply.
Answer: A, C, D Aranesp (darbepoetin alfa) is similar to erythropoietin in use and side effects. Just like erythropoietin, it is administered by SubQ or IV injection, and the IV route is recommended in hemodialysis patients. Do NOT shake Aranesp; vigorous shaking denatures it. It is stored in the refrigerator. Discard any unused portion of the vial. Do not pool unused portions. Similar to erythropoietin, it is contraindicated in patients with uncontrolled hypertension.
M.S. is a 65-year-old female with recently diagnosed acute myelogenous leukemia. She recently started induction chemotherapy with idarubicin and cytarabine. This combination is expected to cause a drop in ANC and prolonged neutropenia in about 5-7 days after starting it. Unfortunately, due to a series of miscommunications among the medical team, the patient did not receive prophylaxis for emesis and tumor lysis syndrome. This morning, M.S. was taken to ED for vomiting, and inability to take any food or medication by mouth. Her labs are as shown: Na+ .............. 151 mEq/L (135-145 mEq/L) K+ ................ 8.0 mEq/L (3.5-5.2 mEq/L) HCO3- ........... 24 mEq/L (23-29 mEq/L) Ca+2 ............. 9.5 mg/dL (8.5-10.2 mg/dL) PO4- ............. 6.0 mg/dL (2.5-5.5 mg/dL) Uric Acid ...... 11.4 mg/dL (2.4-6.0 mg/dL) BUN ............ 30 mg/dL (10-20 mg/dL) SCr ............. 2.0 mg/dL (0.6-1.3 mg/dL) Glucose ...... 90 mg/dL (70-100 mg/dL) AST ............ 22 IU/L (< 35 IU/L) ALT ............ 16 IU/L (< 35 IU/L) Albumin ..... 4.7 g/dL (3.5-5.4 g/dL) WBC .......... 9.0 thou/mm3 (3.5-10.5 thou/mm3) Hgb ............ 13.2 g/dL (12.0-15.5 g/dL for females) Hct .............. 45% (35-50%) Plt .............. 101 thou/mm3 (150-450 thou/mm3) ECG ............ QT prolongation What are the indicators of acute Tumor Lysis Syndrome? Select ALL that apply
Answer: A, C, D Tumor Lysis Syndrome (TLS) is an oncologic emergency that is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acids into the systemic circulation. Catabolism of the nucleic acids to uric acid leads to hyperuricemia; the marked increase in uric acid excretion can result in the precipitation of uric acid in the renal tubules resulting in acute kidney injury. Hyperphosphatemia with calcium phosphate deposition in the renal tubules can also cause acute kidney injury.
Which of the following is TRUE about 5-FU? Select ALL that apply.
Answer: A, C, D 5-FU is an antimetabolite. Leucovorin is given at the same time as 5-FU to make it work better (not an antidote). Leucovorin is the antidote for MTX and FDA approved for methotrexate-rescue. 5-FU can cause hand-foot syndrome and diarrhea.
What is the recommended hemoglobin level range for patients taking Aranesp (darbepoetin alfa) or epoetin alfa (Epogen, Procrit)?
Answer: B In controlled trials, patients experienced greater risks of death, MI, DVT, and stroke when administered ESAs to target a hemoglobin level of greater than 11 g/dL; therefore, if indicated, we initiate ESAs when Hgb < 10 g/dL with the goal of not exceeding 11.0 g/dL.
Which of the following is used for the prevention of thrombocytopenia?
Answer: B Oprelvekin (Neumega) is approved for the prevention of chemo-induced thrombocytopenia. It is given SubQ: 50 mcg/kg once daily for ~10-21 days (until post-nadir platelet count ≥50,000/mm3). Administer the first dose 6-24 hours after the end of chemo & discontinue at least 48 hours before beginning the next cycle of chemotherapy.
Which of the following allergies is considered a contraindication to the use of paclitaxel?
Answer: B Paclitaxel is contraindicated with Cremophor EL (polyoxyethylated castor oil) allergy.
What is the generic name of Sancuso?
Answer: B Sancuso is granisetron transdermal patch.
What is PhosLo?
Answer: B (Calcium acetate) Examples of phosphate binders include calcium carbonate, calcium acetate (PhosLo, Eliphos, Phoslyra, Calphron), sevelamer (Renagel, Renvela), and lanthanum (Fosrenol). See chemotherapy, tumor lysis syndrome.
Which of the following is TRUE about capecitabine? Select ALL that apply.
Answer: B, C, D Capecitabine (Xeloda) is an antimetabolite and prodrug of 5-FU . It is a tablet to be taken with food. U.S. Boxed Warning: capecitabine may increase the anticoagulant effects of warfarin.
What are the indications of Evista? Select ALL that apply.
Answer: B, C, D Evista is used for prevention and treatment of osteoporosis in postmenopausal women, risk reduction for invasive breast cancer in postmenopausal women with osteoporosis and postmenopausal women with high risk for invasive breast cancer. NOT INDICATED FOR PREMENOPAUSAL WOMEN. Megace is used to increase patients' appetite, not Evista.
Metoclopramide is generally reserved for patients intolerant or refractory to first-line agents when treating chemotherapy-induced nausea and vomiting (CINV). Which of the following medical conditions is of concern with metoclopramide?
Answer: C Metoclopramide (Reglan) is NOT recommended in Parkinson's disease. As a dopamine antagonist, it may worsen symptoms.
Z.Z. is a 43-year-old premenopausal female with HER2-negative breast cancer. Which of the following are considered treatment options for her? Select ALL that apply.
Answer: C, D (Goserelin and Tamoxifen) Aromatase inhibitors: letrozole (2.5 mg daily), anastrozole (1 mg daily), and exemestane (25 mg daily) block the enzyme aromatase, which prevents peripheral conversion of androgens to estrogen. They are NOT used in premenopausal women and are NOT active against breast cancer in the presence of functional ovaries. Goserelin causes pharmacologic-induced ovarian suppression (i.e., use of gonadotropin-releasing hormone [GnRH] agonists) effective in premenopausal women. Tamoxifen (selective estrogen receptor modulator) is also commonly used in premenopausal women.
P.G. is a 58-year-old female patient with epidermal growth factor receptor 2 (HER2)-positive breast cancer. Which of the following is indicated for HER2+ breast cancer?
Trastuzumab (Herceptin) is indicated for HER2+ breast cancer.
The intra-thecal administration of which of the following medications can result in death?
Vincristine should NEVER be given intra-thecal (fatal). For IV use only.
What is the generic name of Cytoxan?
Answer: B Cyclophosphamide (Cytoxan)
Which of the following is a monitoring parameter of streptozocin?
Answer: B If you remember that streptozocin is used to treat pancreatic cancers, then it would be easy to remember that it affects the pancreatic cells and thus can affect glucose levels.
Alkylating chemotherapeutic agents work on the G1 phase of the cell cycle. Which of the following medications is an alkylating agent?
Answer: B Cytoxan (cyclophosphamide) is an alkylating agent.
Which of the following measures are generally used to reduce cisplatin-induced nephrotoxicity? 1. IV hydration 2. Amifostine 3. Mannitol 4. MESNA 5. Eulexin
Answer: C IV hydration, amifostine, and mannitol can be used to reduce cisplatin-induced nephrotoxicity.
M.S. is a 65-year-old female with recently diagnosed acute myelogenous leukemia. She recently started induction chemotherapy with idarubicin and cytarabine. This combination is expected to cause a drop in ANC and prolonged neutropenia in about 5-7 days after starting it. Unfortunately, due to a series of miscommunications among the medical team, the patient did not receive prophylaxis for emesis and tumor lysis syndrome. This morning, M.S. was taken to ED for vomiting, and inability to take any food or medication by mouth.Her labs are as follows: Na+ .............. 151 mEq/L (135-145 mEq/L) K+ ................ 8.0 mEq/L (3.5-5.2 mEq/L) HCO3- ........... 24 mEq/L (23-29 mEq/L) Ca+2 ............. 9.5 mg/dL (8.5-10.2 mg/dL) PO4- ............. 6.0 mg/dL (2.5-5.5 mg/dL) Uric Acid ...... 11.4 mg/dL (2.4-6.0 mg/dL) BUN ............ 30 mg/dL (10-20 mg/dL) SCr ............. 2.0 mg/dL (0.6-1.3 mg/dL) Glucose ...... 90 mg/dL (70-100 mg/dL) AST ............ 22 IU/L (< 35 IU/L) ALT ............ 16 IU/L (< 35 IU/L) Albumin ..... 4.7 g/dL (3.5-5.4 g/dL) WBC .......... 9.0 thou/mm3 (3.5-10.5 thou/mm3) Hgb ............ 13.2 g/dL (12.0-15.5 g/dL for females) Hct .............. 45% (35-50%) Plt .............. 101 thou/mm3 (150-450 thou/mm3) ECG ............ QT prolongation Based on her labs and her acute symptoms, which of the following agents are the MOST APPROPRIATE medications to treat her acute emergency? Select ALL that apply.
Answer: A, C, D Patient has been vomiting and is unable to hold any food or medication down. Therefore, recommending a PO medication would not be appropriate. This patient's high level of potassium is a medical emergency which can be treated with a combination of: - CaCl2 IV injection is the first step in stabilizing the heart. - Insulin + dextrose can drive K+ into the cells and help with the immediate danger of hyperkalemia. - Lasix IV increases excretion of K+ (kaluresis).
L.L. is a 66-year-old female with invasive breast cancer on raloxifene 60 mg once daily. Which of the following is/are correct counseling points? Select ALL that apply.
Answer: A, C, D Raloxifene (Evista) is associated with THROMBOEMBOLIC events. The risk for DVT and PE are higher during the first 4 months of treatment. Prolonged immobilization management: Discontinue raloxifene at least 72 hours prior to and during prolonged immobilization (postoperative recovery or prolonged bed rest); restart only once a patient is fully ambulatory. The NCCN breast cancer risk reduction guidelines recommend stopping raloxifene 2-4 weeks prior to elective surgery. Raloxifene (Evista) may be taken without regard to meals.
Paclitaxel is an antimicrotubule agent used to treat a variety of tumors. Which of the following effects is/are associated with its use? Select ALL that apply.
Answer: A, C, D, E Anaphylaxis and severe hypersensitivity reactions are common with paclitaxel. Therefore, patients are pretreated with corticosteroids, diphenhydramine, and histamine H2 antagonists. Do not rechallenge. Paclitaxel can cause peripheral neuropathy. All chemotherapy agents can cause BMS. Also can cause neutropenia and anemia Paclitaxel is a substrate of CYP3A4 (major). St John's wort is an inducer and DECREASES the serum concentration of CYP3A4 substrates.
Which of the following is TRUE about dronabinol? Select ALL that apply.
Answer: A, C, D, E Marinol, a cannabinoid, is a CIII PO capsule stored in the refrigerator of the pharmacy. Uses: As an appetite stimulant (AIDS-related): Oral: Initial: 2.5 mg twice daily (before lunch and dinner); titrate up to a maximum of 20 mg/day. Antiemetic: Oral: 5 mg/m2 1-3 hours before chemotherapy, then give 5 mg/m2/dose every 2-4 hours after chemotherapy for a total of 4-6 doses/day; dose may be increased up to a maximum of 15 mg/m2/dose if needed (dosage may be increased by 2.5 mg/m2 increments).
Which of the following three categories have the HIGHEST therapeutic index for the management of chemotherapy-induced nausea and vomiting (CINV)?
Answer: A, C, E The three categories with the highest effectiveness for the management of CINV include: - 5-hydroxytryptamine (5-HT3) receptor antagonists - Glucocorticoids - Neurokinin-1 (NK1) receptor antagonists
Which of the following formulations is granisetron available in? Select ALL that apply.
Answer: A, C, and E Granisetron IV - 1 mg or 0.01 mg/kg IV once. Granisetron oral - 2 mg by mouth once. Granisetron transdermal patch - Apply 24 - 48 hours prior to chemotherapy. FDA approved August 2016 - SQ granisetron: Sustol (granisetron extended-release injection). The recommended dosage in adults is 10 mg administered as a single subcutaneous injection at least 30 minutes before the start of emetogenic chemotherapy on Day 1. Do not administer Sustol more frequently than once every 7 days.
Which of the following medications are used to treat chemotherapy-induced anemia? Select ALL that apply. Aranesp Neumega Neulasta Procrit Granix
Answer: A, D The medications used to treat chemotherapy-induced anemia are: - Darbepoetin alfa (Aranesp) - Erythropoietin (Epogen, Procrit)
Which of the following is/are TRUE about fulvestrant? Select ALL that apply.
Answer: A, D, E Fulvestrant (Faslodex) is an estrogen receptor antagonist. It competitively binds to estrogen receptors on tumors and other tissue targets, producing a nuclear complex that causes a dose-related down-regulation of estrogen receptors and inhibits tumor growth. Fulvestrant (Faslodex) is indicated for post-menopausal breast cancer ONLY. It is administered IM ONLY (do not administer IV or SubQ). Use with caution in patients with a history of bleeding disorders or patients on anticoagulant therapy.
The nitrosourea drugs, a class of DNA alkylating agents related to nitrogen mustards, include carmustine (BCNU), and lomustine (CCNU). Nitrosourea drugs are used to treat lymphoma, brain tumors, melanoma, and other solid tumors including breast cancer. Which of the following side effects is/are associated with carmustine?Select ALL that apply.
Answer: A, D, E Carmustine can cause pulmonary toxicity and renal failure. All chemotherapy agents can cause BMS. Stomatitis (oral mucositis) is seen with MTX. Hand-foot syndrome is seen with 5-FU fluorouracil.
Which of the following medications are more likely to cause chemo-induced peripheral neuropathy (CIPN)? Select ALL that apply.
Answer: A, D, E Chemotherapy drugs that are more likely to cause CIPN: Platinum drugs: cisplatin, carboplatin, oxaliplatin Taxanes: paclitaxel (Taxol), docetaxel (Taxotere), and cabazitaxel (Jevtana) Epothilones, such as ixabepilone (Ixempra) Plant alkaloids: vinblastine, vincristine, vinorelbine, and etoposide (VP-16)
M.S. is a 65-year-old female with recently diagnosed acute myelogenous leukemia. She recently started induction chemotherapy with idarubicin and cytarabine. This combination is expected to cause a drop in ANC and prolonged neutropenia in about 5-7 days after starting it. Unfortunately, due to a series of miscommunications among the medical team, the patient did not receive prophylaxis for emesis and tumor lysis syndrome. This morning, M.S. was taken to ED for vomiting, and inability to take any food or medication by mouth. Her labs are as shown: Na+ .............. 151 mEq/L (135-145 mEq/L) K+ ................ 8.0 mEq/L (3.5-5.2 mEq/L) HCO3- ........... 24 mEq/L (23-29 mEq/L) Ca+2 ............. 9.5 mg/dL (8.5-10.2 mg/dL) PO4- ............. 6.0 mg/dL (2.5-5.5 mg/dL) Uric Acid ...... 11.4 mg/dL (2.4-6.0 mg/dL) BUN ............ 30 mg/dL (10-20 mg/dL) SCr ............. 2.0 mg/dL (0.6-1.3 mg/dL) Glucose ...... 90 mg/dL (70-100 mg/dL) AST ............ 22 IU/L (< 35 IU/L) ALT ............ 16 IU/L (< 35 IU/L) Albumin ..... 4.7 g/dL (3.5-5.4 g/dL) WBC .......... 9.0 thou/mm3 (3.5-10.5 thou/mm3) Hgb ............ 13.2 g/dL (12.0-15.5 g/dL for females) Hct .............. 45% (35-50%) Plt .............. 101 thou/mm3 (150-450 thou/mm3) ECG ............ QT prolongation During her stay in the hospital, she developed systemic aspergillosis. Considering her labs, which of the following medications can be used to treat her systemic aspergillosis? Select ALL that apply.
Answer: B, C, D Patient has renal impairment. Don't use conventional amphotericin B because it can easily cause nephrotoxicity (otherwise, it can be used in normal renal function). AmBisome can be a safer option for patients with renal impairment. Cancida and Vfend cover aspergillosis; fluconazole and Eraxis do not.
Which of the following is/are TRUE about busulfan? Select ALL that apply.
Answer: B, C, D, E Busulfan is an alkylating agent. It is a potent cytotoxic drug that causes severe and prolonged myelosuppression. Pulmonary fibrosis ("busulfan lung") is associated with chronic busulfan use; ONSET IS DELAYED with symptoms occurring at an average of 4 years (range: 4 months to 10 years) after treatment; may be fatal. Symptoms generally include a slow onset of a cough, dyspnea, and fever (low-grade), although acute symptomatic onset may also occur. Live vaccines: Immunosuppressants may enhance the adverse/toxic effect of live vaccines. Vaccinial infections may develop. Avoid use of live organism vaccines with immunosuppressants; live-attenuated vaccines should not be given for at least 3 months after immunosuppressants. Seizures have been reported with IV busulfan and with high-dose oral busulfan. Initiate prophylactic anticonvulsant therapy (e.g., phenytoin, levetiracetam, benzodiazepines, or valproic acid) prior to treatment. Use with caution in patients predisposed to seizures.
Which of the following is/are TRUE about leuprolide? Select ALL that apply.
Answer: B, C, D, E Leuprolide (Lupron) is a GnRH agonist (not antagonist). GnRH agonists bind to the GnRH receptors on pituitary gonadotropin-producing cells, causing an initial release of both luteinizing hormone (LH) and follicle stimulating hormone (FSH), which cause a subsequent increase in testosterone production. This transient rise in LH when GnRH therapy is initiated can cause a surge in serum testosterone, which may stimulate prostate cancer growth. This "flare" may cause an increase in bone pain, bladder obstruction, or other symptoms due to prostate cancer. After about one week of therapy, GnRH receptors are down-regulated on the gonadotropin-producing cells, with a decline in the pituitary production of LH and FSH.
Which of the following is/are indications of megestrol acetate? Select ALL that apply.
Answer: B, C, E Megace is a synthetic progestin with antiestrogenic properties which disrupts the estrogen receptor cycle; thus, it is only used for breast and endometrial cancer and NOT prostate cancer (with patients that have prostate cancer, our goal is to decrease testosterone, not estrogen). Megace also stimulates appetite and thus can be used for anorexia or cachexia associated with AIDS. Indications of Megace: Anorexia or cachexia associated with AIDS - oral suspension Breast cancer - oral tablet Endometrial cancer - oral tablet Megace causes hunger; therefore, it can worsen the symptoms of binge eating disorder. Binge eating disorder can be treated with Vyvanse (lisdexamfetamine).
Which of the following are concerns related to procarbazine? Select ALL that apply.
Answer: B, D, E Procarbazine may cause a disulfiram-like reaction; therefore, avoid ethanol consumption. Procarbazine possesses MAO inhibitor activity and thus has potential for severe drug and food interactions; Follow MAOI diet: Avoid tyramine-containing foods/beverages (aged or matured cheese, air-dried or cured meats including sausages and salamis, fava or broad bean pods, tap/draft beers, marmite concentrate, sauerkraut, soy sauce and other soybean condiments). Procarbazine may also enhance the toxic effects of serotonin reuptake inhibitors.
Which of the following waste bins is appropriate to discard used vinorelbine vials?
Answer: C Chemotherapy contaminated items such as gowns, gloves, masks, empty IV bags/bottles, empty syringes should be discarded in the YELLOW waste bin.
Which of the following is NOT an alkylating agent?
Answer: C Capecitabine is a pro-drug of fluorouracil. Fluorouracil is a fluorinated pyrimidine antimetabolite.
Which of the following is the generic name of Anzemet?
Answer: C Dolasetron (Anzemet)
For the general population, it has been generally recommended that lifetime cumulative doses of doxorubicin be limited to which of the following?
Answer: C Doxorubicin lifetime cumulative doses above 550 mg/m2 in adults have been associated with an increased risk of cardiomyopathy.
Which of the following chemotherapy agents arrest cell division in the early G2 phase of cell cycle?
Answer: C Etoposide has been shown to delay transit of cells through the S phase and arrest cell division in the early G2 phase of cell cycle.
R.I. is a 49-year-old male patient with recently diagnosed small cell lung cancer. His physician has recently started him on oral etoposide capsules. Where is etoposide stored in the pharmacy?
Answer: C Etoposide is refrigerated; however, it can be stored at room temperature for 3 months.
What is the brand name of exemestane?
Answer: C Exemestane (Aromasin) Leuprolide (Eligard, Lupron Depot)
Which of the following agents is MOST commonly associated with chemotherapy-induced diarrhea (CID)?
Irinotecan
Which of the following is the CORRECT generic name of Aloxi?
Palonosetron (Aloxi)
Which of the following is TRUE about Epoetin alfa?
It causes increased risk of MI stroke and DVT It causes HTN and administered SQ or IV NEVER GIVE IM OR PO
What is the generic name of Gleevec?
Gleevec is imatinib.
M.B. is a 54-year-old male with recently diagnosed acute nonlymphocytic leukemia (ANLL). He recently started chemotherapy. He calls you worried about his urine color being blue. Which of the following could be the culprit for the blue discoloration of his urine?
Mitoxantrone can turn the patients' urine & eyes blue-green.
What is the generic name of Zuplenz?
Ondansetron, the psoluble film name
Which of the following is a brand name of sevelamer?
Sevelamer hydrochloride is Renagel, and sevelamer carbonate is Renvela.
