Cancer Chemotherapy Side Effects and Mechanism
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Questions and Answers

What is a contraindication for the use of Celecoxib?

  • Patients with a history of asthma
  • Patients with a history of kidney disease
  • Patients with a history of hypertension
  • Patients with a sulfonamide allergy (correct)

    • Which medication is known to have a high abuse potential?

  • Tizanidine
  • Cyclobenzaprine
  • Carisoprodol (correct)
  • Baclofen

    • What is the mechanism of action of Gabapentin?

  • Blocks the reuptake of serotonin
  • Blocks the release of dopamine
  • Blocks the reuptake of norepinephrine
  • Blocks the presynaptic release of calcium, reducing the release of excitatory amino acids (correct)

    • What is the maximum number of Lidocaine patches that can be applied at one time?

    <p>3</p> Signup and view all the answers

    What is the recommended time of day to take Duloxetine to prevent insomnia?

    <p>In the morning</p> Signup and view all the answers

    What is the primary use of Butalbital?

    <p>Relief of tension headaches</p> Signup and view all the answers

    What is the primary effect of opioids on pain perception?

    <p>They alter the perception and response to pain</p> Signup and view all the answers

    Which opioid receptor is primarily responsible for spinal analgesia?

    <p>Kappa (κ) receptor</p> Signup and view all the answers

    What is the primary mechanism by which tramadol exerts its analgesic effect?

    <p>Inhibition of serotonin and norepinephrine reuptake</p> Signup and view all the answers

    What is the primary reason for the boxed warning associated with codeine use in children?

    <p>Risk of ultra-rapid metabolism to morphine</p> Signup and view all the answers

    What is the primary effect of opioids on the respiratory system?

    <p>Sedation leading to respiratory depression</p> Signup and view all the answers

    What is the primary treatment for constipation associated with opioid use?

    <p>Stool softeners and stimulant laxatives</p> Signup and view all the answers

    Which of the following medications can cause neurotoxicity in patients with renal impairment due to its metabolites crossing the blood-brain barrier?

    <p>Morphine</p> Signup and view all the answers

    What is the primary concern when initiating a CYP3A4 inhibitor with which of the following medications?

    <p>Hydrocodone</p> Signup and view all the answers

    Which of the following medications comes in an abuse deterrent formulation?

    <p>Xtampza ER</p> Signup and view all the answers

    Which of the following medications is available in numerous dosage forms, except for an oral tablet?

    <p>Fentanyl</p> Signup and view all the answers

    What is the primary concern with the oral solution of which of the following medications?

    <p>Morphine</p> Signup and view all the answers

    Which of the following medications can cause pruritis, which can be treated with an antihistamine?

    <p>Morphine</p> Signup and view all the answers

    What is the mechanism of action of Anthracyclines?

    <p>Inhibits DNA and RNA synthesis</p> Signup and view all the answers

    What is the main purpose of giving prednisone to patients on Abiraterone?

    <p>To supplement low cortisol levels</p> Signup and view all the answers

    What is the mechanism of action of Antiandrogens?

    <p>Disrupt androgen production</p> Signup and view all the answers

    What is the potential cardiovascular side effect of Doxorubicin?

    <p>Cardiac toxicity</p> Signup and view all the answers

    What is the purpose of Mesna medication?

    <p>To protect the bladder from hemorrhagic cystitis</p> Signup and view all the answers

    What is the recommended dosing of Abiraterone?

    <p>1000 mg once daily with prednisone 5 mg twice daily</p> Signup and view all the answers

    What is the most likely cause of JC's dry mouth and constipation?

    <p>Atrovent (ipratropium)</p> Signup and view all the answers

    What is the recommended addition to SE's regimen for moderate to persistent asthma?

    <p>Montelukast (Singulair)</p> Signup and view all the answers

    Which of the following is NOT a common allergy associated with SABAs?

    <p>Food</p> Signup and view all the answers

    Which intranasal steroid is recommended for use during pregnancy?

    <p>Rhinocort Aqua (budesonide)</p> Signup and view all the answers

    What is the generic equivalent of Atarax?

    <p>Hydroxyzine</p> Signup and view all the answers

    What type of pain is characterized by damage to sensory nerves?

    <p>Neuropathic pain</p> Signup and view all the answers

    Study Notes

    Analgesics and Pain Management

    • Celecoxib: contraindicated in patients with sulfonamide allergy, most potent COX-2 inhibitor

    Skeletal Muscle Relaxants

    • Baclofen (Lioresal): high abuse potential
    • Carisoprodol (Soma): high abuse potential
    • Tizanidine (Zanaflex): interacts with benzodiazepines and opioids, barbiturates
    • Cyclobenzaprine (Flexiril): interacts with benzodiazepines and opioids, barbiturates

    Antidepressants

    • Duloxetine (Cymbalta): blocks reuptake of norepinephrine, used for neuropathic pain, takes 1-2 weeks for effect, recommended to be taken in the morning to prevent insomnia, serious adverse effects: SIADH

    Anticonvulsants

    • Gabapentin (Neurontin, Gralise, Horizant): blocks presynaptic release of calcium, reducing release of excitatory amino acids, used for postherpetic neuralgia, neuropathic, chronic, and postoperative pain, restless leg syndrome, common side effects: peripheral edema, weight gain

    Topical Agents

    • Lidocaine (Lidoderm): 4% strength OTC, 5% strength Rx, calms neuronal membrane, used for postherpetic neuralgia, relief of localized pain, adverse effects: application site reactions, no more than 3 patches can be applied at 1 time

    Chemotherapy Agents

    • Ifosfamide/cyclophosphamide: causes hemorrhagic cystitis, prevention: Mesna, hydration
    • Anthracyclines: incorporates with DNA base pairs, inhibits DNA and RNA synthesis, causes cardiac toxicity, severe side effects: cardiac toxicity
    • Antiandrogen: disrupts androgen production, affects androgen activity, testosterone is the main androgen hormone, CYP17 enzyme inhibitors: Abiraterone (Zytiga), dosing: 1000 mg once daily with prednisone 5 mg twice daily, common side effects: hot flashes, fatigue, hypertriglyceridemia, joint swelling, hyperglycemia, counseling points: take on an empty stomach, swallow tablet whole, do not crush or chew

    Antiestrogen

    • MOA: selective estrogen receptor modulators, competes with estrogen for binding sites, antagonist effect on breast tissue, patches may be cut into smaller sizes, apply patches only once for up to 12 hours in 24 hours

    Opioid Analgesics

    • Opioid MOA: targets Mu, Kappa, and Delta opioid receptors, alters perception and response to pain
    • Mu (μ) receptor: found primarily in the brainstem and thalamus, responsible for supraspinal analgesia
    • Kappa (κ) receptor: found in the limbic and other diencephalic areas, brainstem, and spinal cord, effects not well-studied
    • Delta (δ) receptor: responsible for spinal analgesia
    • Adverse effects of opioids: constipation, nausea, vomiting, respiratory depression, sedation, euphoria, pruritis, physical dependence
    • Tramadol: additional MOA: inhibits serotonin and norepinephrine reuptake, warnings: seizure risk, serotonin syndrome risk
    • Ultracet: tramadol in combination with acetaminophen
    • Codeine: gets metabolized to morphine by CYP2D6, additional boxed warnings: respiratory depression and death in children who are ultra-rapid metabolizers, contraindications: children < 12 years of age
    • Tylenol #3: 30 mg of codeine, Tylenol #4: 60 mg of codeine
    • Morphine: additional boxed warnings: medication errors with oral solution, may cause pruritis, gets further metabolized to M6G and M3G, be careful with patients with renal impairment
    • Hydrocodone: additional boxed warnings: initiation of CYP3A4 inhibitors can cause fatal overdose, dosing: Q12H, Zohydro ER capsule, Norco (short-acting), Tussionex (oral solution)
    • Oxycodone: additional boxed warnings: initiation of CYP3A4 inhibitors can cause fatal overdose, caution with oxycodone oral solution and oral concentrate, Xtampza ER (abuse deterrent formulation), Percocet (short-acting)
    • Fentanyl: additional boxed warnings: potential for medication errors when converting between different dosage forms, use with strong or moderate CYP3A4 inhibitors may result in increased effects and fatal respiratory depression, available in numerous dosage forms except for an oral tablet

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    Test your knowledge on the common and severe side effects of chemotherapy, as well as the mechanisms of action of specific drugs such as Ifosfamide and Cyclophosphamide. Learn how to prevent and manage these side effects.

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