Learning Assessment: Oral Anti-Cancer Agents: Bridging the Gap
The purpose of this assessment is for us to ensure that the educational material was effective in
meeting its goals. For answering some of these questions you may need to use the resources that
were provided in the “Resources Available For Your Support” section.
1. You receive a prescription from CCMB via fax. The prescription states “Capecitabine 1650
mg BID after meals for 14 days, then 7 days off”. The protocol regimen, which is also stated
on the prescription, indicates that the dose should be 1,250 mg/m². The patient’s BSA is also
indicated and is 1.8 m². What do you do next?
a. Fill the prescription and trust that the specialists at CCMB have checked all the
calculations.
b. Increase the dose to match the intended protocol regimen and fill the prescription.
c. Check what the patient’s dose was before and fill the prescription, given that the
dose did not change significantly.
d. Call the clinic/prescriber to inquire about the reason for the discrepancy in the dose.
2. A patient drops off a prescription for lomustine 210 mg PO x 1 dose. Along with other patient
information, the serum creatinine is provided and using the Cockroft-Gault formula you
estimate creatinine clearance to be around 50 ml/min. The guideline indicates that when
creatinine clearance is < 60 ml/min the dose should be omitted. What is the next best step?
a. Decline filling the prescription and let the patient go to another pharmacy.
b. Explain to the patient what has been prescribed and the potential consequences of
taking this dose and let the patient decide.
c. Call the clinic/prescriber and express your concerns regarding the appropriateness of
the dose.
d. Check the date of the bloodwork and fill the prescription if the bloodwork was done
more than 3 days ago.
3. A 50-year old male patient is prescribed Temodal® (temozolomide) for the first time, but you
notice that there is no accompanying supportive therapy. After asking the patient you
discover there were no other prescriptions given to the patient. You would expect to see the
following prophylactic agent(s) on the prescription:
a.
b.
c.
d.
Ondansetron and dexamethasone
Ranitidine and ondansetron
Metoclopramide and diphenhydramine
Aprepitant
4. You receive a faxed temozolomide prescription for a 30-year old female patient. This patient
has been filling her prescriptions at your pharmacy for as long as you remember. She also
has come in a few times asking for Gravol® before going on road trips, since she is prone to
getting motion sickness. The patient’s husband shows up to pick up the prescription. What do
you do in this situation?
a. Fill and dispense the temozolomide with extensive patient counseling.
b. Check the administration date and reassure the husband that in order to ensure that
his wife gets best care you need to contact CCMB to clarify the absence of
supportive treatments (antiemetics).
c. Since the patient is young and healthy otherwise, she is not likely to experience many
side effects from temozolomide, so you fill the prescription as is.
d. Fill and dispense the temozolomide and recommend that the husband buys a box of
Gravol® just in case if the patient experiences nausea.
5. One of your patients approaches you asking if you could help her find the prune juice in the
grocery department. Upon asking a few questions you discover that she is looking for a
constipation relief for her husband, who is treated with a chemotherapy agent called
vincristine. He has been constipated for two days and also feels nauseated. What would you
recommend?
a. Lactulose 15-30 ml daily
b. Senna Tab 8.6 mg 2-4 tablets HS prn dosed to achieve at least 1 bowel movement in
48 hours
c. Docusate calcium 240 mg BID.
d. Refer the patient to see the doctor
6. One of your patients is receiving irinotecan IV at CCMB. Due to his recent colon surgery he is
using colostomy bags. Today he comes in and tells you that the colostomy output has lately
become loose and watery. Following the instructions from CCMB the patient has been taking
loperamide 4mg at first sign of diarrhea, then 2mg q2h. He started taking loperamide
yesterday morning; however, there has been no improvement. What would you recommend
to this patient?
a.
b.
c.
d.
Keep taking loperamide for another day and then call the clinic.
Call the clinic immediately and inform the doctor of this problem.
Stop taking loperamide and instead try another product, like Kaopectate®.
Increase the dose of loperamide to 4mg q2h.
7. A patient who has started anti-cancer treatment with methotrexate is complaining of the
painful ulcers in her mouth. She is convinced that this is just something that had to happen
(as she heard from her friend) and that she should just wait it out. She is continuing to take
methotrexate. What would you recommend?
a. Fax the doctor to receive a prescription for chlorhexidine mouth rinse.
b. Recommend that she uses a benzocaine over-the-counter product for canker sores.
c. Recommend that she makes a sodium bicarbonate solution (½ teaspoon baking
soda or salt in 1 cup warm water) and rinses several times a day.
d. Call the doctor as soon as possible.
8. One of your patients who is on chemotherapy comes in with a prescription for Eprex®. He is
very concerned as his wife has done some research online and found out that this medication
can cause progression of his cancer. How would you respond?
a. Educate the patient on how to choose the resources online and suggest that the
website his wife found this information on is probably unreliable.
b. Discuss the risks, explaining that this concern is currently being investigated, and
explain the benefits of Eprex®.
c. Reassure the patient that Eprex® has no such concerns associated with it.
d. Tell the patient that it would be best if they would talk to their doctor.
9. A mother is asking if you could direct her to the Children’s Tylenol® section. Upon some
questioning you find out that her 10-year old daughter has a fever of 38.3ºC. It is the flu
season right now and you’ve had other parents today asking for Children’s Tylenol®. At the
cash register you notice that on her key chain it says “CancerCare Manitoba” and you ask if
she works for this organization. She reveals to you that unfortunately, her daughter is a
patient there and spends 5 mornings a week receiving chemotherapy. What do you do now?
a. Reassure the mother that the fever could be caused by the chemotherapy and
Tylenol will deal with it.
b. Ask mom when her daughter had the last blood test and what the doctor said after.
c. Suggest that she calls the clinic, or takes her daughter to an Emergency department
immediately.
d. Suggest that she checks the temperature one more time after giving Tylenol and if it
does not go down then go to Emergency.
10. Your pharmacy is signing up to provide FluMist® vaccinations. The patients’ sign-up sheet is
completed and you have ordered the exact amount of vaccines. On the morning of the clinic
you receive a call from one of the patients, asking if she can come earlier, since there is a
time conflict with her chemotherapy administration time. How do you respond?
a. Accommodate the patient by trying to see if another patient could come later in the
day.
b. Ask her to come in another day, so that she does not get the vaccine and
chemotherapy on the same day.
c. Suggest that she receives a regular influenza vaccine (i.e. inactivated vaccine).
d. Recommend that she talks to her family doctor and gets her vaccine there in 3
months after her chemotherapy will be completed.
11. One of your patients has recently started docetaxel chemotherapy and today he comes in
complaining about his muscle pain. He has never experienced muscle pain before and feels
really down because of his concerns that his body does not accept the chemotherapy. How
do you respond?
a. Refer the patient to see his doctor.
b. Fax the patient’s doctor suggesting that an agent for neuropathic pain be prescribed.
c. Myalgia / arthralgia is a common side effect of this agent, and he can try using
acetaminophen or NSAIDs for symptom relief.
d. Suggest to the patient to take it easy and get more bed rest to relieve his symptoms.
12. One of your elderly patients has been recently diagnosed with cancer and prescribed
cyclophosphamide. You know that this patient always had a weak appetite and did not like
drinking plenty of water throughout the day. You have had many discussions with her about
her appetite. Upon receiving this prescription what is your main concern and what do you
recommend?
a. Dehydration and recommend intensive hydration.
b. Worsening of the appetite due to the therapy and recommend Boost® that you know
has worked for other patients.
c. Hemorrhagic cystitis and recommend intensive hydration.
d. Urinary incontinence and recommend prophylaxis with oxybutynin.
13. One of your patients is being treated at CCMB with paclitaxel. Today he brings in a
prescription for amitriptyline. You always knew this patient as a happy individual and even
going through such difficult time you did not notice him being depressed. He admits to having
no sleeping problems. What is the most likely indication for using amitriptyline?
a.
b.
c.
d.
Coping with depression that he could be hiding well.
Prophylaxis for neuropathic toxicity that can be caused by paclitaxel.
Migraine prophylaxis that could be caused by his new medications.
Treating an eating disorder that he started developing after getting diagnosed.
14. Out of the four options below, choose one that is not a potential route of exposure to cytotoxic
chemicals:
a.
b.
c.
d.
Counting out uncoated tablets / capsules from a stock bottle.
Shaking hands with your patient who is on chemotherapy.
Crushing tablets to formulate liquid dosage forms.
Compounding cytotoxic powders.