AOCNP Cancer Pharmacology and Chemotherapy 5

Question 1

Which statement best describes the mechanism of resistance to imatinib in chronic myeloid leukemia (CML)?

Accepted Answer

Point mutations in the BCR-ABL kinase domain, particularly T315I

Answer

The T315I gatekeeper mutation in BCR-ABL is the most common and problematic resistance mutation, conferring resistance to first- and second-generation TKIs.

Question 2

A patient receiving cisplatin-based chemotherapy develops severe nausea and vomiting despite standard antiemetics. Which agent targets substance P/NK-1 receptors and is most appropriate to add?

Accepted Answer

Aprepitant

Answer

Aprepitant is a neurokinin-1 (NK-1) receptor antagonist that blocks substance P binding, effective for delayed emesis associated with highly emetogenic chemotherapy.

Question 3

Which of the following describes the pharmacodynamic rationale for using leucovorin (folinic acid) in combination with 5-fluorouracil (5-FU)?

Accepted Answer

Leucovorin stabilizes the ternary complex of 5-FU with thymidylate synthase, enhancing inhibition

Answer

Leucovorin provides reduced folate that stabilizes the ternary complex between FdUMP (5-FU metabolite) and thymidylate synthase, enhancing its cytotoxic effect.

Question 4

An oncology nurse practitioner is reviewing a patient on enzalutamide for metastatic castration-resistant prostate cancer. Which CNS toxicity requires patient counseling?

Accepted Answer

Seizures, which occur in approximately 1% of patients

Answer

Enzalutamide has seizurogenic potential, occurring in ~1% of patients, and patients should be counseled to avoid driving and activities requiring alertness if seizures occur.

Question 5

A patient is receiving pemetrexed for mesothelioma. Which supplementation is required to reduce hematologic and GI toxicity?

Accepted Answer

Folic acid and vitamin B12 supplementation

Answer

Folic acid (daily, starting 7 days before) and vitamin B12 (IM, every 9 weeks) supplementation are required to reduce pemetrexed-related hematologic and GI toxicities.

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP - Advanced Oncology Certified Nurse Practitioner Practice Test

AOCNP Cancer Pharmacology and Chemotherapy 5