Alkylating Agents and Antimetabolites Flashcards

2
Q

What is tumor lysis syndrome? (TLS)

A

tumor cells killed and cellular materials dumped into circulation. Adverse effects in kidney. Can cause gout. Often prophylactically treat with hydration, acid/base correction, and sodium bicarbonates.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What do alkylating agents do?

A

leave a chemical moiety bound to DNA to prevent cell division.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do bis(chloroetyl)amine alkylating agents usually bind to on DNA?

A

N7 guanine. Messes Up DNA enough to trigger apoptosis and halt cell division.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the unique negative effects of bis(chloroethyl)amine alkylating agents?

A

IV administration causes vascular damage and irritation. Pulmonary fibrosis.Ifosfamide causes CNS toxicity.Acrolein production, which can cause renal failure and urotoxicity. Treat with MESNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is MESNA

A

prophylactic to treat the acrolein production from cyclophosphamide and alkylating agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is busulfan?

A

and alkyl sulfonate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What unique toxicities does busulfan have?

A

veno-occlusive disease of liver as well as pulmonary fibrosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are nitrosoureas? What is unique about them?

A

BCNU and CCNU - both alkylators. They can penetrate the CNS and brain (unique).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What anticancer drug becomes active in hypoxic locations (such as necrotic tumor centers)?

A

Mitomycin C.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is a unique toxicity of cisplatin?

A

ototoxicity from accumulation in ear. Also persistant peripheral neuropathy that can worsen even after cessation of treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is disulfiram-like effect?

A

disulfiram is a drug that makes alcoholic patients feel sick when they drink. Drugs like hprocarbazine can mimick this effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does methotrexate work?

A

dihydrofolate reductase inhibition. Deny availability of DHF to provide carbon groups for DNA and RNA synthesis. It is polyglutamated so it becomes trapped inside cell and increases duration of function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is a unique side effect of 5-fluorouacil?

A

foot and hand neuropathy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What drug can erase fingerprints over time?

A

capecitabine (very similar to 5-fluorouacil.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the mechanism of cyclophoshamide and is there anything unique about it?

A

nitrogen mustard, alkylate DNA, intra or inter crosslinks.Creates acrolein so protect by using MESNA with it.Lung fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the mechanism of ifosfmaide and is there anything unique about it?

A

nitrogen mustard, alkylate DNA, intra or inter crosslinks.Creates acrolein so prevent toxicity with MESNA

18
Q

What is the mechanism of mechlorethamine and is there anything unique about it?

A

nitrogen mustard, alkylate DNA, intra or inter crosslink

19
Q

What is the mechanism of melphalan and is there anything unique about it?

A

alkylate DNA, produce intra or inter crosslinks.Lung fibrosis

20
Q

What is the mechanism of chlorambucil and is there anything unique about it?

A

nitrogen mustard, alkylate DNA intra or inter crosslinks.Lung fibrosis

21
Q

What is the mechanism of busulfan and is there anything unique about it?

A

alkyl sulfonate, alkylate DNA intra or inter crosslinks.Hepatic veno-occlusive diseaseAddison-like syndrome

22
Q

What is the mechanism of carmustine (BCNU) and is there anything unique about it?

A

nitrosoureas, alkylate DNA, intra or inter crosslinkshepatic veno-occlusiveCNS issues

23
Q

What is the mechanism of lomustine (CCNU) and is there anything unique about it?

A

nitrosoureas, alkylate DNA, intra or inter crosslinks.CNS (seizures, dementia)

24
Q

What is the mechanism of thiotepa and is there anything unique about it?

A

aziridine, alkylate DNA, intra or inter crosslinksCNS

25
Q

What is the mechanism of mitomycin C and is there anything unique about it?

A

antibiotic, alkylate DNA, intra or inter crosslinks.

26
Q

What is the mechanism of cisplatin and is there anything unique about it?

A

platinu, alkylate DNA, inter or intra crosslinks.Renal and oto-toxicity.Severe peripheral neuropathy, reduce with Amifostine

27
Q

What is the mechanism of carboplatin and is there anything unique about it?

A

platinum, alkylate DNArenal toxicity, thrombocytopenia

28
Q

What is the mechanism of oxaliplatin and is there anything unique about it?

A

platinum, alkylate DNA

29
Q

What is the mechanism of dacarbazine and is there anything unique about it?

A

methylating, triazene, methylate on 06 guanine on DNA

30
Q

What is the mechanism of procarbazine and is there anything unique about it?

A

methylating, hydrazine, DNA methylator via CYP activation on 06 guanine.Disulfiram-effect (makes you feel bad with alcohol)

31
Q

What is the mechanism of methotrexate, pemetrexed, trimetrexate and is there anything unique about it?

A

antimetabolite, folic acid analog, DHFR.GI toxicity.Give Leucovorin AFTER for metabolic rescue to save non cancer cells.

32
Q

What is the mechanism of 5-fluorouracil and is there anything unique about it?

A

antimetabolite, pyrimidine analog, inhibits Thymidylate synthase and DNA synthesis by thymine absence. Inhibits mRNA translation.Hand-foot syndrome.Give Leucovorin WITH it to ‘enhance’ uptake and effect.

33
Q

What is the mechanism of capecitabine and is there anything unique about it?

A

antimetabolite, pyrimidine analog. It is converted to 5-FU. inhibits Thymidylate synthase and DNA synthesis by thymine absence. Inhibits mRNA translation.Hand-foot syndrome.

34
Q

What is the mechanism of cytarabine (ARA-C) and is there anything unique about it?

A

antimetabolite, pyrimidine analog, inhibits DNA polymerase and prevents DNA cain elongation.Foot-hand syndrome

35
Q

What is the mechanism of gemcitabine and is there anything unique about it?

A

antimetabolite, pyrimidine analog, inhibits DNA polymerase and prevents DNA cain elongation.Foot-hand syndrome

36
Q

What is the mechanism of 6-MP (mercaptopurine), thiogaunine and is there anything unique about it?

A

antimetabolite, purine analog, RNA and DNA inhibitors by incorporating into them.6-MP dose must be reduced if allopurinol present or if TPMT enzyme absent.

37
Q

What is the mechanism of pentostatin, caldribine, fludarabine and is there anything unique about it?

A

antimetabolites, purine analogs, inhibit DNA synthesis and ribonucleotide reductase.