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Derm Pharm 2020 > 2 - Topical and Intralesional Chemotherapeutic Agents > Flashcards

2 - Topical and Intralesional Chemotherapeutic Agents Flashcards

1
Q

5-FU is an antimetabolite and structural analog of uracil

A

True

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2
Q

5-FU and its metabolites are misincorporated into RNA and disrupt RNA synthesis

A

True

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3
Q

5-FU metabolites also block the function of thymidylate synthetase, interfering with DNA synthesis as well

A

True

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4
Q

Topical 5-FU is not significantly systemically absorbed

A

True

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5
Q

The selective effect allows the use of topical 5-FU over a broad area of skin without concern for damaging normal skin

A

True

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6
Q

5-FU is converted to 3 active metabolites:

(1) fluorodeoxyuridine monophosphate
(2) fluorodeoxyuridine triphosphate
(3) fluorouridine triphosphate

A

True

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7
Q

The key enzyme which converts 5-FU to dihydrofluorouracil is dihydropyrimidine dehydrogenase (DPD)

A

True

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8
Q

80% of 5-FU is catabolised in the liver

A

True

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9
Q

Topical 5-FU is used in the field treatment of AKs in that it is more selective for AK than for normal skin

A

True

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10
Q

Topical 5-FU is useful in the treatment of SCC in situ or superficial BCC

A

True

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11
Q

Topical 5-FU is not more effective than other treatments in the treatment of warts

A

True

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12
Q

Topical 5-FU may be useful in the treatment of multiple disseminated porokeratosis

A

True

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13
Q

Topical 5-FU is contraindicated in patients with known dihydropyrimidine dehydrogenase (DPD) deficiency, the key enzyme in metabolism of 5-FU

A

True (should not be used due to a case of life threatening toxicity from topical 5-FU in a patient who had deficiency of DPD)

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14
Q

Topical 5-FU is contraindicated in pregnancy

A

True (pregnancy category X)

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15
Q

Allergic contact dermatitis has been reported in topical 5-FU use

A

True

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16
Q

Systemic adverse effects are rare in topical 5-FU use

A

True

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17
Q

The most common adverse effects from topical 5-FU use are localised to areas of treatment I.e. Erythema, irritation, burning, pain, pruritus, hypopigmentation, hyperpigmentation

A

True

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18
Q

Topical corticosteroids used concurrently with topical 5-FU and for 1-2 weeks beyond cessation of topical 5-FU application to relieve the inflammatory reaction does not impact on topical 5-FU efficacy

A

True

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19
Q

Mechlorethamine (Nitrogen Mustard) is an alkylating agent highly reactive with DNA as donation of alkyl groups to DNA disrupts normal cell function

A

True

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20
Q

The ultimate cause of cell death from Mechlorethamine (Nitrogen Mustard) is unknown

A

True

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21
Q

Topical Mechlorethamine (Nitrogen Mustard) is not systemically absorbed

A

True (no known significant systemic absorption of topical Nitrogen Mustard and no systemic toxicities from cutaneous absorption have been observed in long term use in Mycosis Fungoides)

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22
Q

The mechanism of action of topical Mechlorethamine (Nitrogen Mustard) is unknown

A

True

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23
Q

The primary indication for topical Mechlorethamine (Nitrogen Mustard) is the treatment of Mycosis Fungoides

A

True

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24
Q

Topical Mechlorethamine (Nitrogen Mustard) is not contraindicated in a previous history of multiple cutaneous SCCs

A

True (but need to use with caution if patients have had other skin damaging therapies such as radiation)

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25
Q

Irritant or allergic (delayed type hypersensitivity) contact dermatitis is the most common effect of topical Mechlorethamine (Nitrogen Mustard)

A

True (irritant contact dermatitis more common than allergic contact dermatitis)

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26
Q

Urticaria and anaphylactic reactions are rare in topical Mechlorethamine (Nitrogen Mustard)

A

True

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27
Q

Irritant contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) is most common and particularly if used on the face or in skin folds

A

True

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28
Q

Allergic contact dermatitis is more common in topical Mechlorethamine (Nitrogen Mustard) aqueous formulation than ointment formulation

A

True

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29
Q

Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) can be managed by reducing the frequency of applications

30
Q

Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard) can be managed by reducing the strength of the application

31
Q

Topical corticosteroids can be helpful in the management of Irritant or contact dermatitis from topical Mechlorethamine (Nitrogen Mustard)

A

True (Topical Mechlorethamine/Nitrogen Mustard can be discontinued briefly and topical corticosteroids applied to reduce the inflammation, after which the topical Mechlorethamine/Nitrogen Mustard can be restarted at a lower concentration)

32
Q

Patients with allergic contact dermatitis to topical Mechlorethamine (Nitrogen Mustard) can undergo a formal desensitisation protocol

33
Q

Non-melanoma skin cancers have been reported in patients treated with topical Mechlorethamine (Nitrogen Mustard)

A

True (although most of these patients were also treated with multiple skin damaging therapy i.e. Phototherapy or radiation, or used topical Mechlorethamine/Nitrogen Mustard in the genital areas)

34
Q

There is no evidence of increased risk for secondary cutaneous malignancy in non-genital skin with long term use of topical Mechlorethamine (Nitrogen Mustard) as monotherapy

35
Q

Post inflammatory hyperpigmentation or hypopigmentation from topical Mechlorethamine (Nitrogen Mustard) gradually improves with time

36
Q

Patients should not apply topical Mechlorethamine (Nitrogen Mustard) to genital skin

A

True (risk of secondary cutaneous malignancy)

37
Q

There are no large randomised trials comparing the efficacy of total skin topical Mechlorethamine (Nitrogen Mustard) application versus treatment of affected areas only

38
Q

Topical carmustine is a nitrosurea compound used in the treatment of Mycosis Fungoides

39
Q

Nitrosureas (I.e. carmustine @ BCNU) are DNA alkylating agents leading to interstrand or intrastrand cross-linking of DNA

40
Q

Topical carmustine (BCNU) is available in solution or ointment form

A

True (although experience with the ointment is considerably less than the solution and there are no published series of patients treated with this modality)

41
Q

Class I topical corticosteroids had less adverse reactions than topical carmustine (BCNU) ointment

42
Q

Erythema simulating a sunburn mainly in body folds is a common side effect from topical carmustine (BCNU) especially in the solution form

A

True (severe reactions are often followed by benign telengiectasias)

43
Q

Telengiectasias from topical carmustine (BCNU) solution are benign but may rarely persist for years

A

True (usually resolves within months)

44
Q

Irritant or allergic contact dermatitis may occur with topical carmustine (BCNU)

A

True (treatment must be stopped if moderate-severe erythema, pruritus develop during treatment)

45
Q

There is higher risk of systemic absorption from topical carmustine (BCNU) when used in children

A

True (higher body surface area in children -use with caution)

46
Q

Systemic absorption of topical carmustine (BCNU) may cause Bone marrow suppression including mild leukopenia and mild anaemia

A

True (thrombocytopenia has not been noted)

47
Q

Thrombocytopenia has not been noted from bone marrow suppression of systemic absorption of topical carmustine (BCNU)

A

True (only leukopenia and anaemia have been noted)

48
Q

The face, genitals and intertriginous areas are not treated with topical carmustine (BCNU) unless involved

49
Q

Intralesional chemotherapeutic agents used in Dermatology include Vinblastine, Vincristine and Bleomycin

50
Q

Vinblastine and vincristine are vinca alkaloids that disrupt microtubular function leading to arrest of cell division in metaphase and cell death

51
Q

Vinblastine and vincristine are vinca alkaloids used intralesionally for treatment of Kaposi’s sarcoma lesions

52
Q

Intralesional Vinblastine injections are painful

A

True (Lignocaine is added in an attempt to reduce injection pain although this did not reduce the pain of the injection)

53
Q

Lignocaine added to intralesional Vinblastine (to reduce pain of injection) did not reduce the efficacy of Vinblastine

54
Q

The therapeutic effect of intralesional Vinblastine is enhanced by injection of hyaluronidase before Vinblastine

55
Q

Intralesional Vinblastine adverse effects include pain, inflammation, blistering and post inflammatory hyperpigmentation

56
Q

Severe pain and ulceration is rare in intralesional Vincristine

A

True (erythema, burning pruritus more common)

57
Q

The overall response rate of classic Kaposi’s sarcoma nodular lesions to intralesional Vincristine was 99%

58
Q

Bleomycin is a fermentation product of the bacterium Streptococcus verticillus

59
Q

Intralesional Bleomycin may be used off label in viral warts, vascular anomalies keloids and hypertrophic scars

60
Q

Intralesional Bleomycin’s cytotoxic effect results from its ability to cause oxidative damage to the deoxyribose backbone of the DNA chain which lead to single and double stranded breaks in DNA

61
Q

Intralesional Bleomycin is not the first line agent in treatment of viral warts

A

True (used for treatment of viral warts refractory to standard therapies)

62
Q

Intralesional Bleomycin has demonstrated a slightly higher cure rate for MOSAIC plantar warts than other conventional therapies

63
Q

Intralesional Bleomycin resulted in complete resolution of infantile maxillofacial haemangiomas with no serious adverse effects

64
Q

Intralesional Bleomycin is a safe and effective treatment for macrocystic lymphatic malformations, superficial oral mucosal lymphatic malformations, and localised depot macrocystic lesions

65
Q

Pain is the most frequent adverse effect of intralesional Bleomycin

A

True (erythema with swelling, and burning sensation also may occur)

66
Q

Intralesional Bleomycin can cause blistering and tissue necrosis at the site of injection

67
Q

Intralesional Bleomycin has led to nail dystrophy or nail loss when used for periungual warts

A

True (care should be taken to avoid injecting into the nail matrix)

68
Q

Persistent Raynaud’s phenomenon, anaphylaxis, and flagellate hyperpigmentation are uncommon in intralesional Bleomycin

A

True (more common in intravenous administration)

69
Q

Intralesional Bleomycin should be injected directly into a wart in such a way so as to try to blanch it

70
Q

Topical chemotherapeutic agents include:

1) 5-Fluorouracil
(2) Mechlorethamine (nitrogen mustard
(3) Carmustine (BCNU)

71
Q

Intralesional chemotherapeutic agents include:

(1) Vinblastine
(2) Vincristine
(3) Bleomycin

Derm Pharm 2020 (47 decks)

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