Cancer Pharmacology and Chemotherapy Flashcards

A patient on capecitabine develops palmar-plantar erythrodysesthesia (hand-foot syndrome). Which management strategy is most appropriate?

Answer: Dose reduce capecitabine and initiate pyridoxine and urea-based cream

Grade 2-3 hand-foot syndrome requires capecitabine dose reduction, with supportive care including pyridoxine and emollient creams.

Which of the following best describes the mechanism of action of bortezomib in multiple myeloma?

Answer: Inhibits the 26S proteasome, preventing degradation of pro-apoptotic factors

Bortezomib is a proteasome inhibitor that prevents degradation of regulatory proteins, promoting apoptosis in myeloma cells.

A patient receiving high-dose methotrexate develops delayed clearance with rising creatinine. Which intervention is most critical?

Answer: Administer leucovorin rescue and aggressive IV hydration with urinary alkalinization

Leucovorin rescue combined with aggressive IV hydration and urinary alkalinization is essential to prevent life-threatening toxicity from delayed methotrexate clearance.

Which toxicity is most specifically associated with bleomycin and requires monitoring with pulmonary function tests?

Answer: Pulmonary fibrosis and pneumonitis

Bleomycin causes pulmonary toxicity ranging from pneumonitis to fibrosis, which can be life-threatening and requires baseline and serial PFTs.

An AOCNP is managing a patient on tamoxifen who is also prescribed paroxetine for depression. What is the primary concern?

Answer: Paroxetine inhibits CYP2D6, reducing conversion of tamoxifen to its active metabolite endoxifen

Paroxetine is a potent CYP2D6 inhibitor that significantly reduces conversion of tamoxifen to endoxifen, potentially reducing efficacy of hormonal therapy.

Which VEGF pathway inhibitor is associated with a unique toxicity profile including hand-foot skin reaction, hypertension, and hepatotoxicity, and requires liver function monitoring?

Answer: Sorafenib

Sorafenib, a multi-kinase inhibitor targeting VEGFR and RAF, is specifically associated with hand-foot skin reaction, hypertension, and hepatotoxicity requiring LFT monitoring.

A patient with colorectal cancer is found to have a RAS mutation. Which targeted therapy should be avoided?

Answer: Cetuximab

RAS mutations (KRAS or NRAS) confer resistance to EGFR inhibitors such as cetuximab and panitumumab, making these agents ineffective.