oncology / chemotherapy

Oncology / Chemotherapy

Oncology / Chemotherapy

NAPLEX

PG 121

PG 121

What is Cancer?

• Group of over 100 different diseasesGroup of over 100 different diseases

•Characterized by uncontrolled cellular growth & Characterized by uncontrolled cellular growth & proliferationproliferation

• Local tissue invasionLocal tissue invasion

•Distant metastasesDistant metastases

•As a group, the second-leading cause of death in As a group, the second-leading cause of death in AmericansAmericans

PG 121

Cancer TreatmentsCancer Treatments Surgery---local disease

Radiation---local or “regional” disease Alpha & beta particles, neutrons penetrate cell wall

Chemotherapy- generally for metastatic disease or suspicion/high probability of micrometastatic dx can be used before surgery can cure some cancers (testicular & leukemias)

Hormonal therapy- use in prostate, breast, uterine cancers; i.e. Prostrate – delay the progression of androgen-dependent cancer i.e. Breast – estrogen/progesterone receptor positive tumors

Targeted therapy---most “mab”s (monoclonal antibodies) used alone or combination with chemo, targets a specific bioligic marker on the tumor or enzyme/compont

See table 2-24 and 2-25

Surgery---local disease

Radiation---local or “regional” disease Alpha & beta particles, neutrons penetrate cell wall

Chemotherapy- generally for metastatic disease or suspicion/high probability of micrometastatic dx can be used before surgery can cure some cancers (testicular & leukemias)

Hormonal therapy- use in prostate, breast, uterine cancers; i.e. Prostrate – delay the progression of androgen-dependent cancer i.e. Breast – estrogen/progesterone receptor positive tumors

Targeted therapy---most “mab”s (monoclonal antibodies) used alone or combination with chemo, targets a specific bioligic marker on the tumor or enzyme/compont

See table 2-24 and 2-25

Target “Arrow” USE Route Side EffectHER2 Trastuzumamb (Herbeptin) Breast IV Cardiotoxicity

CD33 Gemtuzumab (Mylotarg) AML IV Myleosuppression

EGFR Cetuximab Colorectal IV Diarrhea

CD52 Alemtuzumab CLL IV or SQ Myelosuppression

AngiogenesisAngiogenesis

Angiogensis – process of neovascularization – macrophages secrete angiogensis factor

Occurs from existing capillaries

Tumor cannot survive without adequate blood supply

Tumors secretes vascular endothelial growth factor (VEGF) which acts on the endothelial growth factor receptor (EGFR) to “recruit” a blood supply

MAB’s – target VEGF and EGFR Bevacizumab (VEGF) & Cetuximab (EGFR) target

Angiogensis – process of neovascularization – macrophages secrete angiogensis factor

Occurs from existing capillaries

Tumor cannot survive without adequate blood supply

Tumors secretes vascular endothelial growth factor (VEGF) which acts on the endothelial growth factor receptor (EGFR) to “recruit” a blood supply

MAB’s – target VEGF and EGFR Bevacizumab (VEGF) & Cetuximab (EGFR) target

PG 122

PG 122

Cell CycleSpecificityCell CycleSpecificity

M M (mitosis)(mitosis)

G1 phase G1 phase (Gap 1)(Gap 1)

S phase S phase (DNA synthesis)(DNA synthesis)

G2 G2 (Gap 2)(Gap 2)

SEE TABLE 2-26SEE TABLE 2-26

Phase-specific agentsPhase-specific agents

- Most active during a - Most active during a particular phaseparticular phase

-May be active during other May be active during other phasesphases

Nonphase-specific agentsNonphase-specific agents

- May favor a stage- May favor a stage

-Dose dependent agentsDose dependent agents

Cell CycleSpecificityCell CycleSpecificity

M M (mitosis)(mitosis)

Vinca alkaloidsVinca alkaloidstaxanestaxanes

G1 phase G1 phase (Gap 1)(Gap 1)

S phase S phase (DNA synthesis)(DNA synthesis)AntimetabolitesAntimetabolites

5-FU, cytarabine, methotrexate5-FU, cytarabine, methotrexate

G2 G2 (Gap 2)(Gap 2)

Alkylating Agents:Alkylating Agents:CisplatinCisplatinIfosfamideIfosfamidecyclophosphamidecyclophosphamide

Hormones:Hormones:GoserelinGoserelinTamoxifenTamoxifenAnastrozoleAnastrozole

Antibiotics:Antibiotics:BleomycinBleomycin““rubicins”rubicins”

SEE TABLE 2-26SEE TABLE 2-26

PG 122

Chemo Therapy ClassesChemo Therapy Classes Antimetabolites - Interferes with synthesis of pyrimidine bases thus DNA synthesis

Fluorouracil Folic Acid Analog – interferes with synthesis of pyrimidine bases thus DNA synthesis

Methotrexate Purine Analogs – interferes with synthesis of purine bases

Fludarabine Vinca Alkaloids – bind to tubulin to prevent formation of microtubules during mitosis

Vincristine Podophyllotoxins – bind to tubulin – inhibiting topoisomerase II to cause DNA strand breaks

Etoposide Taxanes – bind to tubulin – promotes synthesis of nonfunctional microtubules

Paclitaxel Camptothecins – inhibits topiosomerase I, stabilizing single strand breaks in DNA

Topotecan Antiandrogens – Inhibit uptake & binding of testosterone and didhydrotestosterone

Flutamide (Eulexin) Progestins – suppresses release of luteinizing hormone and increase estrogen metabolism

Megestrol (Megace) Antiestrogen – Bind to estrogen receptor in breast tissue – prevent binding of estrogen

Tamoxifen (Nolvadex) Gonadotropin-releasing hormone analog – turn off negative-feedback release of FSH & LH,

reduces testosterone and estrogen production Leuprolide (Lupron)

Antimetabolites - Interferes with synthesis of pyrimidine bases thus DNA synthesis Fluorouracil

Folic Acid Analog – interferes with synthesis of pyrimidine bases thus DNA synthesis Methotrexate

Purine Analogs – interferes with synthesis of purine bases Fludarabine

Vinca Alkaloids – bind to tubulin to prevent formation of microtubules during mitosis Vincristine

Podophyllotoxins – bind to tubulin – inhibiting topoisomerase II to cause DNA strand breaks Etoposide

Taxanes – bind to tubulin – promotes synthesis of nonfunctional microtubules Paclitaxel

Camptothecins – inhibits topiosomerase I, stabilizing single strand breaks in DNA Topotecan

Antiandrogens – Inhibit uptake & binding of testosterone and didhydrotestosterone Flutamide (Eulexin)

Progestins – suppresses release of luteinizing hormone and increase estrogen metabolism Megestrol (Megace)

Antiestrogen – Bind to estrogen receptor in breast tissue – prevent binding of estrogen Tamoxifen (Nolvadex)

Gonadotropin-releasing hormone analog – turn off negative-feedback release of FSH & LH, reduces testosterone and estrogen production

Leuprolide (Lupron)

PG 123

Common adverse events related Common adverse events related to chemotherapyto chemotherapy

Common adverse events related Common adverse events related to chemotherapyto chemotherapy

MyelosuppressionMyelosuppression• Neutropenia, anemia, Neutropenia, anemia,

thrombocytopeniathrombocytopenia

Nausea/vomitingNausea/vomiting• cisplatincisplatin

AlopeciaAlopecia• CyclophosphamideCyclophosphamide

MucositisMucositis Peripheral neuropathyPeripheral neuropathy

MyelosuppressionMyelosuppression• Neutropenia, anemia, Neutropenia, anemia,

thrombocytopeniathrombocytopenia

Nausea/vomitingNausea/vomiting• cisplatincisplatin

AlopeciaAlopecia• CyclophosphamideCyclophosphamide

MucositisMucositis Peripheral neuropathyPeripheral neuropathy

Renal dysfunctionRenal dysfunction RashRash Infusion reactionsInfusion reactions Flu-like syndromeFlu-like syndrome

• MAB’s, docetaxelMAB’s, docetaxel

Hemorrhagic CystitisHemorrhagic Cystitis• cylcophosphamidecylcophosphamide

Renal dysfunctionRenal dysfunction RashRash Infusion reactionsInfusion reactions Flu-like syndromeFlu-like syndrome

• MAB’s, docetaxelMAB’s, docetaxel

Hemorrhagic CystitisHemorrhagic Cystitis• cylcophosphamidecylcophosphamide

Common Adverse Effects Caused by Antineoplastic Drugs

** Information above is embedded in the tables p.125-130 **** Information above is embedded in the tables p.125-130 **

Which of the following medications for

cancer is associated with causing

cardiotoxicity?

a. tamoxifen (Nolvadex)

b. fluorouracil (5-FU)

c. paclitaxel (Taxol)

d. doxorubicin (Doxil)

e. methotrexate (Rheumatrex)

Which of the following medications for

cancer is associated with causing

cardiotoxicity?

a. tamoxifen (Nolvadex)

b. fluorouracil (5-FU)

c. paclitaxel (Taxol)

d. doxorubicin (Doxil)

e. methotrexate (Rheumatrex)

PG 135 – Drug Antagonist Chart

Drug for prevention of adverse Drug for prevention of adverse events related to chemotherapyevents related to chemotherapy

Drug ActionMesna (Mesnex) Inhibits hemorrhagic cystitis

caused by ifosfamide

Dexrazoxane (Zinecard) Reduces cardiotoxicity caused by doxorubicin

Leucovorin (Wellcovorin)Leucovorin (Wellcovorin) Reduced from of folic acid, dosed with MTX to preserve normal tissue, rescue dose based on MTX levels, also used with 5-FU

Amifostine (Ethyol) Reduces renal toxicity caused by cisplatin

Supportive Care – Nausea/VomitingSupportive Care – Nausea/Vomiting 5HT3 inhibitors – mod/high emetogenic regimens, give one dose prechemo and

sometimes oral dose for 3 days postchemo Not for PRN use----can cause HA Ondansetron (zofran) – inhibits 1A2, 2C9, 2D6 (weak) Granisetron (Kytril) - less drug interactions Dolesetron (Anzement)- QTc prolongation - 2D6 (weak) Palonosetron (Aloxi) - subtrate 1A2, 2D6, 3A4

NK1 (neurokinin) inhibitor - highly emetogenic regimens only- Aprepitant (Emend) Drug interactions – 3A4 inhibitor and inducer Combination with 5HTs inhibitors

Benzodiazepines – anticipatory N/V Lorazepem (Ativan)

Dexamethasone – moderately emetogenic regimens or in combo with 5HT3 for delayed N/V

5HT3 inhibitors – mod/high emetogenic regimens, give one dose prechemo and sometimes oral dose for 3 days postchemo

Not for PRN use----can cause HA Ondansetron (zofran) – inhibits 1A2, 2C9, 2D6 (weak) Granisetron (Kytril) - less drug interactions Dolesetron (Anzement)- QTc prolongation - 2D6 (weak) Palonosetron (Aloxi) - subtrate 1A2, 2D6, 3A4

NK1 (neurokinin) inhibitor - highly emetogenic regimens only- Aprepitant (Emend) Drug interactions – 3A4 inhibitor and inducer Combination with 5HTs inhibitors

Benzodiazepines – anticipatory N/V Lorazepem (Ativan)

Dexamethasone – moderately emetogenic regimens or in combo with 5HT3 for delayed N/V

PG 123-124

Supportive CareSupportive Care

Anemia

Hgb < 11 g/dL with symptoms; < 10 without symptoms

EPO (Procrit) 40,000 units sq qweek

Darbopoetin (Aranesp) 2.25 u/kg sq qweek

Don’t forget Iron supplements

Anemia

Hgb < 11 g/dL with symptoms; < 10 without symptoms

EPO (Procrit) 40,000 units sq qweek

Darbopoetin (Aranesp) 2.25 u/kg sq qweek

Don’t forget Iron supplements

Neutropenia

Nadir occurs 1-2 weeks after chemo

Absolute neutrophil count - ANC < 500

Filgrastim (Neupogen) 300 uq sq qd x 5-7 days

Pegfilgrastim (Neulasta) 6 mg sq once 24 h post chemo

Sargramostim (Leukine) 250 mcg SQ daily x 5-7 days

Neutropenia

Nadir occurs 1-2 weeks after chemo

Absolute neutrophil count - ANC < 500

Filgrastim (Neupogen) 300 uq sq qd x 5-7 days

Pegfilgrastim (Neulasta) 6 mg sq once 24 h post chemo

Sargramostim (Leukine) 250 mcg SQ daily x 5-7 days

PG 124

Which of the following is a therapeutic substitution for ondansetron? a. Adaptin

b. Kytrilc. Inderald. Seroquele. Neurontin

Which of the following is a therapeutic substitution for ondansetron? a. Adaptin

b. Kytrilc. Inderald. Seroquele. Neurontin

All of the following exhibit antiemetic properties EXCEPT:

a. granisetron

b. loratadine

c. ondansetron

d. prochlorperazine

e. trimethobenzamide

All of the following exhibit antiemetic properties EXCEPT:

a. granisetron

b. loratadine

c. ondansetron

d. prochlorperazine

e. trimethobenzamide

ContraceptionContraception

NAPLEX

PG 103

PG 103

ContraceptionContraception

Mechanism of action: inhibit ovulation via negative feedback Mechanism of action: inhibit ovulation via negative feedback on the hypothalmus affecting FSH/LH release. Also alter genital on the hypothalmus affecting FSH/LH release. Also alter genital tract, thicken cervical mucus. tract, thicken cervical mucus.

Hormonal AgentsHormonal Agents

EstrogenEstrogenethinyl estradiol, mestranolethinyl estradiol, mestranol

ProgestinProgestindesogestrel, norgestimate, desogestrel, norgestimate, levonorgestrel, levonorgestrel, norethindrone, norgesterelnorethindrone, norgesterel

Types of oral contraceptive products---various doses Types of oral contraceptive products---various doses but estrogen dose is held constant while progestin but estrogen dose is held constant while progestin variesvaries

MonophasicMonophasicDesogen, Yasmin, etc.Desogen, Yasmin, etc.

BiphasicBiphasicOrtho Novum 10/11, etc.Ortho Novum 10/11, etc.

TriphasicTriphasicTriphasil, tri-Norinyl, Cyclessa, etc.Triphasil, tri-Norinyl, Cyclessa, etc.

Progestin onlyProgestin onlyMicronor, Ovrette, Nor-qdMicronor, Ovrette, Nor-qd

Extended/continuous - SeasonaleExtended/continuous - Seasonale

Two Possible ComponentsTwo Possible Components

Estrogens – 2Estrogens – 2

• Ethinyl Estradiol (EE)

• Mestranol

Estrogens – 2Estrogens – 2

• Ethinyl Estradiol (EE)

• Mestranol

Progestins – 12Progestins – 12Progestins – 12Progestins – 12

Synthetic Estrogens Synthetic Progestins

PG 103

Contraception (cont’d)Contraception (cont’d)

- Treatment should be delayed one year post menarche to allow for normal cycle development

- Adverse effects of oral contraceptives- Adverse effects of oral contraceptives

Major:Major:

• • ThromboembolismThromboembolism

• • StrokeStroke

• • Myocardial infarctionMyocardial infarction

• • Endometrial carcinomaEndometrial carcinoma

• • Pregnancy category XPregnancy category X

• • Risk factorsRisk factors

- Smoking - Smoking

- Age > 35- Age > 35

PG 104


Minor:Minor:

• • Weight gain, edemaWeight gain, edema

• • Breakthrough bleeding Breakthrough bleeding

- Early BTB: Insufficient estrogen activity; associated with amenorrhea

- Late BTB: Insufficient progestin activity

• • Nausea and vomitingNausea and vomiting

• • Mild depressionMild depression

Drug Interactions:Drug Interactions:

• • Antimicrobials (griseofulvin, penicillins, tetracyclines)Antimicrobials (griseofulvin, penicillins, tetracyclines)

• • Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Enzyme inducer (barbiturates, rifampin, PIs, St.Johns Wart.)Wart.)

Anticonvulsants/Sedatives/Hypnotics: Induction of liver enzymes causes rapid metabolism of estrogen and increased binding of progestin and EE to SHBG - Sex hormone-binding globulin. Not a problem with valproic acid or some

newer anticonvulsants such as lamotrigine. Antibiotics cause enterohepatic circulation

disturbance. Rifampin increases the metabolism of progestins.

Anticonvulsants/Sedatives/Hypnotics: Induction of liver enzymes causes rapid metabolism of estrogen and increased binding of progestin and EE to SHBG - Sex hormone-binding globulin. Not a problem with valproic acid or some

newer anticonvulsants such as lamotrigine. Antibiotics cause enterohepatic circulation

disturbance. Rifampin increases the metabolism of progestins.

Drug Interactions with Oral Contraceptives

Drug Interactions with Oral Contraceptives

PG 104

Non-Oral Hormonal Contraceptives

- Medroxyprogesterone acetate injection (Depo-Provera) – - Medroxyprogesterone acetate injection (Depo-Provera) – q q 3 mths3 mths

- Estradiol cypionate and medroxyprogesterone acetate - Estradiol cypionate and medroxyprogesterone acetate (Lunelle) - DC(Lunelle) - DC

- Intrauterine progesterone contraceptive system - Intrauterine progesterone contraceptive system (Progestasert)(Progestasert)

- Levonorgestrel intrauterine system (Mirena) - Levonorgestrel intrauterine system (Mirena) – can last up to 5 years

- Ortho Evra patch – apply weekly for 3 weeks, 1 week off. Less effective if > 198 lbs.-------Think about general counseling points about patches

- Nuva Ring – intravaginal ring inserted for 3 weeks

PG 104


Non-Hormonal MethodsNon-Hormonal Methods

Copper interuterine devide (ParaGard) – replaced every 10 Copper interuterine devide (ParaGard) – replaced every 10 yearsyears

Spermicidal foams or suppositories – do not protect from Spermicidal foams or suppositories – do not protect from sexual transmitted diseases.sexual transmitted diseases.

Barrier methods - condomsBarrier methods - condomslatex, animal membrane, latex, animal membrane, male versus female); cervical cap; diaphragmsmale versus female); cervical cap; diaphragms

Natural family planning - basal body temperature method; Natural family planning - basal body temperature method; symptothermal method; calendar (rhythm) methodsymptothermal method; calendar (rhythm) method

PG 104


Abortion PillAbortion Pill

Mifepristone (Mifeprex-RU486)- generally used with Mifepristone (Mifeprex-RU486)- generally used with misoprostol (Cytotec); for termination of early pregnancy (<49 misoprostol (Cytotec); for termination of early pregnancy (<49 days)days)

- Increase for bacterial infections (sepsis), prolonged - Increase for bacterial infections (sepsis), prolonged vaginal vaginal bleedingbleeding

- Only be prescribe by physicians with a “Prescribers - Only be prescribe by physicians with a “Prescribers Agreement”Agreement”

- Not available in public pharmacies- Not available in public pharmacies

Emergency ContraceptiveEmergency Contraceptive

First dose within 72 hours of unprotected sex and a second First dose within 72 hours of unprotected sex and a second dose 12 hours laterdose 12 hours later

- Levonorgestrel (high dose) (Plan B) - 89% effective- Levonorgestrel (high dose) (Plan B) - 89% effective

-Yuzpe Regimen Reduces risk of pregnancy by 75%

-Lo/Ovral 30ug EE + 0.3mg norgestrel 4 now and 4 in 12 hrs

PG 105

Miscellaneous Hormonal Agents

Ovulation stimulantsOvulation stimulants

Estrogen antagonistEstrogen antagonist

Clomiphene citrate (Clomid, Serophene)Clomiphene citrate (Clomid, Serophene).

Induces the release of FSH & LH – 6 cycles only

Gonadotropins containing FSH (recombinant DNA technology)

Follitropin alfa (Gonal-F) – Follitropin alfa (Gonal-F) – FSH analogsFSH analogs

Follitropin beta (Follistim)Follitropin beta (Follistim)

Urofollitropin (Fertinex)

Human menopausal gonadotropinsHuman menopausal gonadotropins

Menotropins (Pergonal, Humegon) – Menotropins (Pergonal, Humegon) – mixture of mixture of FSH/LHFSH/LH

PG 105

Miscellaneous Hormonal Agents (cont’d)Miscellaneous Hormonal Agents (cont’d)

Posterior pituitary hormonesPosterior pituitary hormones

Vasopressin (Pitressin)Vasopressin (Pitressin)antidiuretic hormone for antidiuretic hormone for diabetes diabetes

insipidus (injection)insipidus (injection)

Lypressin (Diapid)Lypressin (Diapid)antidiuretic hormone for antidiuretic hormone for diabetes insipidus diabetes insipidus (intranasal)(intranasal)

Desmopressin (DDAVP)Desmopressin (DDAVP)antidiuretic hormone, antidiuretic hormone, used to treat used to treat primary nocturnal enuresis and diabetes primary nocturnal enuresis and diabetes insipidus (nasal spray insipidus (nasal spray

and tablets) – and tablets) – also useful for hemophilia A also useful for hemophilia A

Oxytocin (Pitocin)Oxytocin (Pitocin)uterine stimulant – (injection)uterine stimulant – (injection)

PG 106

Hormones (cont’d)Hormones (cont’d)

EstrogensEstrogens• • Conjugated estrogen (premarin, etc.)Conjugated estrogen (premarin, etc.)

- - synthetic forms : estradiol, estropipate synthetic forms : estradiol, estropipate

• • Estrogen dosage forms - tablet, cream, ring, Estrogen dosage forms - tablet, cream, ring, transdermal transdermal

patches, etc.patches, etc.

- HRT improves lipid levels, reduces fracture risk, - HRT improves lipid levels, reduces fracture risk, reduces reduces vasomotor symptoms,vasomotor symptoms, DOES NOT reduce CV DOES NOT reduce CV disease (WHI, disease (WHI, HERS)HERS)

- breast cancer risk - small, but there. Long-term - breast cancer risk - small, but there. Long-term use, family hxuse, family hx

- Black Cohosh herbal has been touted for - Black Cohosh herbal has been touted for treatment of hot treatment of hot flashes, SSRIs, Soy product and flashes, SSRIs, Soy product and clonidine are effective clonidine are effective

Selective estrogen receptor modulator (SERMs)Selective estrogen receptor modulator (SERMs)raloxifene raloxifene (Evista)(Evista)

- indicated for prevention and treatment of - indicated for prevention and treatment of osteoporosisosteoporosis

When counseling a patient about medroxyprogesterone what are the important factors to discuss?

I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III

When counseling a patient about medroxyprogesterone what are the important factors to discuss?

I. Weight gainII. OsteoporosisIII. Risk of pulmonary embolism

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III

Low bone mass associated with age, hormone levels and medications.

DEXA T-score >-1 is normal, -1 to -2.5 is osteopenia, and <2.5 is

osteoporosis

Oral calcium and vitamin D requirement

Medications Oral Bisphosphonates ---1 st line Raloxifene Calcitonin Teriparitide Zoledronic acid (Reclast)

Low bone mass associated with age, hormone levels and medications.

DEXA T-score >-1 is normal, -1 to -2.5 is osteopenia, and <2.5 is

osteoporosis

Oral calcium and vitamin D requirement

Medications Oral Bisphosphonates ---1 st line Raloxifene Calcitonin Teriparitide Zoledronic acid (Reclast)

OsteoporosisOsteoporosis

PG 105-106

The medication Fosamax (alendronate):I. must be taken with a meal

II. is used to treat hot flashes

III. is available as a once weekly dose

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III

The medication Fosamax (alendronate):I. must be taken with a meal

II. is used to treat hot flashes

III. is available as a once weekly dose

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, and III

Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:

a. Evista

b. Actonel

c. Calcimar

d. Prempro

e. Proscar

Drugs used in the prevention/treatment of osteoporosis include all of the following EXCEPT:

a. Evista

b. Actonel

c. Calcimar

d. Prempro

e. Proscar

Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?

I. Zoledronic Acid

II. Raloxifene

III. Calcium + Vitamin D

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, III

Which of the following is an alternative treatment for osteoporosis in patients unable to tolerate oral biphosphonates due to GI upset?

I. Zoledronic Acid

II. Raloxifene

III. Calcium + Vitamin D

a. I only

b. III only

c. I and II only

d. II and III only

e. I, II, III

Which of the following products is a topical HRT?

a. Evamist

b. Cenestin

c. Premphase

d. Provera

e. FemHRT

Which of the following products is a topical HRT?

a. Evamist

b. Cenestin

c. Premphase

d. Provera

e. FemHRT

Thyroid Case StudyThyroid Case Study

NAPLEX

PG 106

Page 106Page 106

A goiter is caused by:

a. hypothyroidism

b. hyperthyroidism

c. deficient TSH

d. a thyroid tumor

e. a parathyroid dysfunction

A goiter is caused by:

a. hypothyroidism

b. hyperthyroidism

c. deficient TSH

d. a thyroid tumor

e. a parathyroid dysfunction

L-thyroxine is the same as:

a. T4

b. T3

c. liothyronine

d. liotrix

e. cytomel

L-thyroxine is the same as:

a. T4

b. T3

c. liothyronine

d. liotrix

e. cytomel

Which of the following is used as an antithyroid drug:

a. methamine

b. fluorouracil

c. aspartame

d. propylthiouracil

e. protamine sulfate

Which of the following is used as an antithyroid drug:

a. methamine

b. fluorouracil

c. aspartame

d. propylthiouracil

e. protamine sulfate

Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?

a. 24

b. 32

c. 40

d. 56

e. 99

Iodine-131 is a radioisotope that has a half-life of 8 days. How many days after a dose is administered will less than 1% of the original dose remain?

a. 24

b. 32

c. 40

d. 56

e. 99

The parathyroid gland controls the body’s level of:

a. iron

b. calcium

c. iodine

d. potassium

e. glucose

The parathyroid gland controls the body’s level of:

a. iron

b. calcium

c. iodine

d. potassium

e. glucose

oncology / chemotherapy

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