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Clinical Pharm Exam 3 > Anti-Neoplastic Therapy > Flashcards

Anti-Neoplastic Therapy Flashcards

1
Q

Cytotoxic Chemotherapy

A
  • Traditional
  • Toxic to all cells but more specific for rapidly dividing cells
  • Alkylating agents
  • Antimetabolites
  • Natural products
  • Miscellaneous agents
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2
Q

Alkylating Agents

A
  • Cyclophosphamide, Ifosfamide
  • Cisplatin, Carboplatin, Oxaliplatin
  • Carmustine, Lomustine, Procarbazine
  • Busulfan, Melphalan
  • Chlorambucil
  • Mechlorethamine
  • Temozolomide/dacarbazine
  • Mechlorethamine
  • Streptozocin
  • Thiotepa
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3
Q

Alkylating Agents: Toxicity

A

Common toxicities

  • Nausea/Vomiting (most acute/some delay; often moderately to high emetogenic)
  • Myelosuppression
  • Alopecia
  • Sterility/infertility
  • Secondary malignacies
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4
Q

Cyclophosphamide/ifosfamide

A
  • Hemorrhagic cystitis (primarily ifosfamide) due to acrolein metabolite
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5
Q

Cisplatin

A
  • Nephrotoxicity
  • Nausea/vomiting (acute and delayed)
  • Ototoxicity
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6
Q

Oxaliplatin

A
  • Neuropathies (exacerbated by cold temeratures)
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7
Q

Antimetabolites

A
  • Structural analongs of naturally occurring substances necessary for specific biochemical reactions
    Complete with normal metabolites OR
    Falsely insert themselves for a metabolite normally incorporated into DNA and RNA
  • Most commonly active in the S phase
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8
Q

Antimetabolites Agents

A 
Methotrexate
Pemetrexed
Pralatrexate
Fludarabine
Mercaptopurine
Cladribine
Pentostatin
Clofarabine
Capecitabine
Fluorouracil
Cytarabine
Azacitidine
Decitabine
Gemcitabine
Thioguanine
Nelarabine
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9
Q

Antimetabolites: Toxicities

A
  • Common toxicities: myelosuppression, mucositis, mild N/V, diarrhea
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10
Q

Methotrexate

A
  • Renally toxicity

- Leucovorin rescue for high dose (>1gm/m2)

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11
Q

Cytarabine

A
  • High dose therapy: Nervous system (cerebrllar) toxcitiy

- Ocular irritation - eye drops

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12
Q

Capecitabine

A

Hand-foot syndrome

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13
Q

Natural Products

A
  • Antitumor antibiotics
  • Plant alkaloids
    Vinca alkaloids, taxanes, topoisomerase I & II
  • Marine-based products
  • Enzymes
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14
Q

Antitumor Antibiotics

A
  • Anthracyclines
  • Mitomycin
  • Dactinomycin
  • Bleomycin
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15
Q

Anthracyclines

A

block DNA and RNA transcriptase

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16
Q

Mitomycin

A

Cross-links DNA

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17
Q

Dactinomycin

A

Blocks RNA synthesis

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18
Q

Bleomycin

A

Inhibits DNA synthesis (only cell-cycle specific agent)

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19
Q

Antitumor Antibiotics - Toxicities

A
  • Nausea/Vomiting, Alopecia, Stomatitis, myelosuppression
  • Bleomycin: lung toxicity - pulmonary fibrosis, Interstitial pneumonitis (lifetime max 400 units)
  • Anthracyclines: cardiotoxicity - congestive heart failure
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20
Q

Myocardiotoxicity

A

(dose-dependent)
- Production of toxic free radicals, membrane lipid peroxidation leading to irreversible damage and replacement by fibrous tissue
- Risk factors: Cumulative dose, patient age, concomitant chemotherapy with known cardiotoxicity, radiation therapy
- Early toxicity: HF can develop within 3 months following completion
- Late toxicity: Symptoms may appear one decade following
completion
- Dexrazoxane MOA: EDTA-like chelating agent, binds intracellular iron released following lipid peroxi

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21
Q

Microtubule agents

A
  • synthetic and semi-synthetic
  • different mechanisms of action
  • Taxanes (docetaxel, paclitaxel, cabazitaxel, nab-paclitaxel)
  • Vinca alkaloids (vinblastine, vincristine, vinorelbine)
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22
Q

Microtubule Toxicities

A
  • Taxanes
    Docetaxel – neuropathies, peripheral edema,
    hypersensitivity reactions
    Paclitaxel – neuropathies, hypersensitivity reactions
    Premedicate with H1 and H2 blocker + steroid
  • Vincristine
    neuropathies, constipation, DO NOT give intrathecally
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23
Q

Topoisomerase I inhibitor

A

irinotecan, topotecan

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24
Q

Topoisomerase II inhibitor

A

etoposide, teniposide

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25
Q

enzyme

A

asparaginase, pegaspargase

26
Q

Topoisomerase I inhibitor Toxicities

A

Diarrhea (2 phase)

  • immediate - cholinergic reaction
  • delayed - loperamide, diphenoxylate/atropine
27
Q

Topoisomerase II inhibitor Toxicities

A

secondary cancer

28
Q

Enzyme Toxicities

A

hypersensitivity reaction, hyperglycemia, pancreatitis, coagulopathies
- E. coli derived PEGylated erwinia-derived

29
Q

Marine-based products

A

Eribulin - sea sponge
- microtubule-like agent
- toxicities: fatigue, peripheral neuropathy, Chemo Induced N/V (CINV)
Trabectedin - sea squirt
- mechanism - somewhat like an alkylating agent
- toxicities: fatigue, hand-foot syndrome, CINV, hepatic damage

30
Q

Hormonal Treatment

A
  • Block production of hormones or hormone receptors in the body
  • Anti-estrogens
  • Anti-adrogens
  • Luteinizing hormone-releasing hormone (LHRH) analogs
  • Ex. Breast, prostate cancer
31
Q

Serm Hormone Therapy

A
  • Tamoxifen
  • Use in hormone receptor + dosease: premenopausal, postmenopausal
  • Benefits: decrease odds of recurrence, increase 15 year survival
  • ADE: cataracts, endometrial cancer, VTE CYP2D6 active metabolite
32
Q

Aromatase Inhibitor Horomone Therapy

A
  • Letrozole, anastrozole, exemestane
  • Use in hormone receptor + dosease: postmenapausal (preferred), premenopausal when in comboination with ovarian suppression
  • Postmenopausal: decrease in recurrence
  • Premenopausal:
  • ADE: osteoprosis, fractures, arthralgias
33
Q

LHRH Agonists

A
  • Inhibit the pituitary (through negative feedback) from releasig LH and FSH which stops stimulation of the testes to produce testosterone (can also be used in breast cancer with same MOA but stops stimulation of ovaries to produce estrogen
  • Tumor flare
  • Leuprolide, goserelin, triptorelin
34
Q

LHRH Antagonists

A
  • directly inhibits pituitary from releasing LH and FSH

- Degarelix

35
Q

Antiandrogens

A
  • Blocks androgen receptor
  • Bicalutamide, Flutamide, Nilutamide, Enzalutamide
  • Abiraterone
36
Q

Targeted Agents

A
  • Identifies certain features of a cancer cell that make it different from the normal cell
  • prevent tumor cells from entering cell cycle or target signals that trigger cancer growth, metastasis, and immortality
37
Q

Molecularly targeted therapies

A

Block signaling inside the cell

38
Q

Monoclonal Antibodies

A

Antibodies that match an antigen on the cancer cell surface

39
Q

VEGF signaling Pathway (VSP) Inhibitors

A
  • Vascular endothelial growth factor
  • Hypertension proteinuria, bleeding, impared wound healing
  • Hypertension may indicate effectiveness
  • Becacizumb, Sunitinib, Pazopanib, Regorafenib
40
Q

EGFR Inhibitors

A
  • epidermal growth factor receptor
  • Acneiform rash
  • Rash may indicate effectiveness
  • Erlotinib, gefitinib, alectinib, cetuximab, panitumumab
41
Q

EGFR - Acneiform Rash

A

acneiform-like rash with EGFR inhibitors

  • tetracyclines
  • topical antibiotics
  • surrogate marker for response?
42
Q

mTOR inhibitors

A

mammalian target of rapamycin

  • hyperglycemia, dyslipidemia, mucosal sensitivity, ulcers
  • DDI 3A4
  • Everolimus, Sirolimus, temsirolimus
43
Q

BCR-ABL Mutation inhibitor

A 
Imatinib: edema, n/v
Dasstinib: neutropenia, edema, n/v
Nilotinib: n/v, fatigue
Ponatinib: cardiac
Bosutinib: diarrhea, n/v
- CYP3A4 substrate (except ponatinib) DDI possible
- Imatinib 3A4 inhibitor
44
Q

mTOR inhibitor Toxicities

A

mucosal ulcer

45
Q

CD20

A

rituximab, ofatumumab, obinutuzumab

46
Q

HER2 inhibition

A

human epidermal growth factor receptor-2

- Trastuzumb, pertuzumab, Lapatinib

47
Q

Trastuzumb, pertuzumab Toxicities

A

cardiotoxicity

48
Q

Lapatinib

A

N/V, fatigue, diarrhea, hand-foot syndrome; drug interactions with strong 3A4 inducers/inhibitors

49
Q

CD20 Toxicities

A

infusion reactions, myelosuppression

50
Q

Monoclonal antibodies Toxicities

A

Potential hypersensitivity reactions based on mAb origin
• QT prolongation
Nilotinib, pazopanib, ponatinib

51
Q

Brentuximab

A

Neuropathy

52
Q

Vemurafenib

A

Colitis

53
Q

Bortezomib

A

Neuropathies

54
Q

Target Agents Toxicities General

A
  • Fatigue, Hair thinning
  • Low grade (if at all)
    n/v, myelosuppression
  • Hair depigmentation
  • Dysphonia
  • Hypothyroidism (sunitinib, pazopanib, regorafenib)
55
Q

Immunological Therapies

A 
Interferon
Interleukin
Lenalidomide
Thalidomide
CTLA-4 inhibitors
PD-1/PD-L1 inhibitors
Cancer vaccine
56
Q

PD1 and PD-L1 inhibitors

A

Pembrolizumab

Nivolumab

57
Q

Pembrolizumab

A
  • Melanoma, gastric, head & neck, Hodgkin lymphoma, lung cancer, urothelial, Merkel cell
  • Toxicities: fatigue, itching, rash
58
Q

Nivolumab

A
  • Melanoma, lung cancer, colorectal cancer, head & neck, hepatocellular, Hodgkin lymphoma, renal cell cancer, urothelial cancer
  • Toxicities: fatigue, malaise
59
Q

Anti-PD-L1

A

Atezolizumb
Avelumab
Durvalumab

60
Q

Bone Marrow Transplants

A

Autologous (self) - high dose with stem cell rescue
allogeneic (other)
Nonmyeloablative

61
Q

Stem Cell Sources

A

Bone marrow
Peripheral blood
Cord Blood

Clinical Pharm Exam 3 (5 decks)

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