Anti-neoplastic focus Flashcards
Alkylating Agents
MOA: prevents cell division by cross linking DNA strands and decreasing DNA synthesis
Cell cycle non specific
Myelosuppresion is the dose limiting toxicity
Other common toxicity
- N/V
- Alopecia
- Secondary malignancies
- inferititly
Ifosfamide / Cyclophosphamide
Alkylating Agents
Hemorrhagic cystitis due to acrolein metabolite
Give mesna
Cisplatin
Alkylating Agent
Nephrotoxicity
N/V
Ototoxicity
Oxaliplatin
Neuropathy exacerbated by cold temperatures
Antimetabolites
MOA:
structural analogs of naturally occurring substances necessary for specific biochemical reactions
Compete with normal metabolites or falsely insert themselves for a metabolite normally incorporated into DNA and RNA
Most commonly active in the S phase
Common toxicity
- Myelosuppression, mucositis, mild N/V, diarrhea
Capecitabine - hand - foot syndrome
Cytarabine - high dose therapy ; NS toxicity, ocular irritation
Methotrexate
Antimetabolites
Renal toxicity
Folic acid suppressor
chemo protection - leukovorin - timing is important, leukovorin increases efficacy / toxicity of fluorouracil
Anthracyclines
Antitumor antibiotic
MOA: block RNA and DNA transcription
ADR: cardiotoxicity - congestive heart failure
lifetime max dose (doxorubicin 450)
Free radicals from Fe – fibrosis of myocardium
esp w/ doxorubicin - risk of CHF
chemo-protection: dexrazoxane binds/removes Fe
Bleomycin
antitumor antibiotic
MOA: cell cycle specific DNA inhibition (testicular cancer)
ADR: pulmonary toxicity - fibrosis and pneumonia
life time max 400 units
Biggest Antitumor Antibiotics ADR
Myocardiotoxicity (dose dependent)
- production of free radicals, membrane lipid per oxidation leading to irreversible damage and replacement by fibrous tissue
Dexrazoxane: MOA chelating agent, binds intracellular iron released following lipid per oxidation
Microtubule agents main ADR
Natural products
Significant neuropathy / loss of fine motor control
Texans
Microtubule agents -Natural products
MOA: prevent microtubule dissemble
ADRs: neuropathies, peripheral edema, hypersensitivity reactions
Paclitaxel - premeditate with H1 + H2 blocker + steroid
Vinca alkaloids
MOA: prevent microtubule assembly
ADR: neuropathy, constipation
Vincristine - DO NOT GIVE INTRATHECALLY
Topoisomerase I inhibitors
Irinotecan
Diarrhea in 2 phases
immediate - anti cholinergic ; treat w/ atropine
delayed - treat with ioperamide
Topoisomerase II inhibitors
Etoposide
Secondary cancers (AML)
Enzyme
Asparaginase
Pegasparigase
Hypersensitivity reactions
hyperglycemia
Pancreatitis
Coagulopathies
Eribulin
Marine based - natural
microtubule like
Fatigue, peripheral neuropathy, CINV
Trabectedin
Marine based - natural
alkylating like
toxicity - hand food syndrome, CINV, hepatic damage
SERM - Tamoxafen
MOA: inhibits estrogen-R in breast tissue
used in pre-menopause (or post)
ADRs: VTE (blood clots > stroke), endometrial cancer, cataracts, hot flashes
Aromatase inhibitors
MOA: inhibits aromatase enzyme that converts androgen to estrogen
used in post - menopause (preferred over SERM)
ADRs: osteoporosis, fractures, arthralgia, CV disease, hot flashes
LHRH Agonist
Prostate cancer
MOA: inhibit pituitary from releasing LH and FSH which stops stimulation of testes to produce testosterone
ADR: tumor flare initial growth
LHRH antagonist
MOA: directly inhibits pituitary from release LH and FSH
Antiandrogens
MOA: block androgen receptor
Monoclonal antibodies
Targeted Agent
Antibodies that match an antigen on the cancer cell surface
-mabs
ADRs: hypersensitivity reactions
Molecularly targeted therapies
Block signal inside cancer cell
ADRs: hypothyroidism, QT prolongation, fatigue, hair thinning, CYP3A4 interactions
