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Pharm Exam 3 > Anti-neoplastic therapy > Flashcards

Anti-neoplastic therapy Flashcards

1
Q

TNM staging

A

used for solid tumors

Stage I, II, III, IV

Tumor, nodal status, metastasis

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2
Q

Adjuvant chemotherapy

A

given after surgery to reduce the risk of local and systemic recurrence

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3
Q

Neoadjuvant chemotherapy

A

giver prior to surgical intervention to reduce tumor size or to remove micrometastases

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4
Q

Cytotoxic Chemotherapy

A

Traditional

Toxic to all cells but more specific for rapidly dividing cells

Combination chemotherapy or regimen

Principles

  • Dose usually bas on body surface area
  • administered 14, 21, or 28 days most common
  • Dose density ; want to give same amount of chemo at the same amount of time
  • Alkylating agents
  • Antimetabolites
  • Natural products
  • Miscellaneous
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5
Q

Tumor Growth Kinetics

  • Doubling time
  • Gompertzian growth
A

Doubling time
- time needed for a tumor cell population to double in size

Gompertzian growth
- Early growth is exponential bus as tumor gets bigger, growth slows due to decreased nutrients/blood supply

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6
Q

Clinically undetectable tumor 10^ ?

Diagnosis possible first symptoms 10^?

Disease symptoms become incapacitating 10^?

A

10^0 - 10^9 = clinical undetectable

10^9 - 10^11 = diagnosis

10^11 - 10^12 = incapacitating

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7
Q

Alkylating Agents

A

Cytotoxic Chemotherapy

MOA: prevents cell division by cross linking DNA strands and decreasing DNA synthesis

  • Cell cycle non specific
  • Myelosuppresion** is generally the dose limiting toxicity

Common toxicities:

  • N/V (mostly acute, often moderately to highly emetogenic)
  • Myelosuppresion
  • Alopecia (normally don’t see until 3rd cycle)
  • Sterility / inhertility
  • Secondary malignancies
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8
Q

Cyclophosphamide / Ifosfamide

A

Alkylating Agents - Cytotoxic Chemotherapy

Hemorrhagic cystitis - due to toxic metabolite acrolein of ifosfamide and cyclophosphamide

Chemo-protection: Mesna binds metabolite

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9
Q

Cisplatin

A

Alkylating Agents - Cytotoxic Chemotherapy

Nephrotixicity

Nausea / vomitting (acute and delayed)

Ototoxicity

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10
Q

Oxaliplatin

A

Alkylating Agents - Cytotoxic Chemotherapy

Neurpathies

exacerbated by Cold temperatures

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11
Q

Antimetabolites

A

Antimetabolite - Cytotoxic Chemotherapy

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 RNA and DNA

most commonly active in the S phase

Common toxicities :

  • myleosuppression
  • Mucositis
  • mild N/V
  • Diarrhea

Methotrexate (Renal toxicity ; leucovorin rescue for high dose)

Cytarabine (high dose therapy - nervous system toxicity ; ocular irritation - eye drops)

Capecitabine - hand - foot syndrome

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12
Q

Methotrexate

A

Antimetabolite - Cytotoxic Chemotherapy

Renal toxicity
Leucovorin rescue for high dose

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13
Q

Cytarabine

A

Antimetabolite - Cytotoxic Chemotherapy

High dose therapy ; nervous system (cerebellar) toxicity

Occular irritation - eye drops

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14
Q

Capecitabine

A

Antimetabolite - Cytotoxic Chemotherapy

Hand - foot syndrome

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15
Q

Anthracyclines

A

Natural products - Cytotoxic Chemotherapy

Antitumor antibiotics

MOA: block DNA and RNA transcription

ADR: cardiotoxicity - CHF

  • Free radicals from FE – fibrosis of myocardium
  • Esp w/ Doxorubicin - RISK of CHF

Lifetime max dose

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16
Q

Mitomycin

A

Natural products - Cytotoxic Chemotherapy

Antitumor antibiotics

MOA: cross links DNA

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17
Q

Dactinomycin

A

Natural products - Cytotoxic Chemotherapy

Antitumor antibiotics

blocks RNA synthesis

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18
Q

Bleomycin

A

Natural products - Cytotoxic Chemotherapy

Antitumor antibiotics

MOA: inhibits DNA synthesis only cell cycle specific agent

ADR:

  • Lung toxicity - pulmonary fibrosis, interstitial pneumonitis
  • Lifetime max 400 units
  • caution in intubation pt
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19
Q

Antitumor antibiotics Toxicities

A

Nausea / vomitting

Alopecia

Stomatitis

Myelosuppresion

Myocardiotoxicity: Dose - dependent
- production of toxic free radicals, membrane lipid per oxidation leading to irreversible damage and replacement by fibrous tissue

20
Q

Microtubule agents

ADR

A

ADR:
significant neuropathy**

loss of fine motor control

21
Q

Microtubule agents - Taxanes

A

MOA: prevent microtubule disassembly

ADRs:
hypersensitivity rxn - for both

Neuro, edema (Doxetaxel),

(Paxitaxel) – premedicate
w/ H1/H2 blocker and steroid

22
Q

Microtubule agents - Vinca alkaloids

A

MOA: prevent microtubule assembly

ADRs: Neuropathy, constipation.

DO NOT GIVE VINCRISTINE INTRATHECALLY

23
Q

Toposisomerase I Inhibitors

A

Irinotecan: diarrhea in two phases:

Immediate = anti-cholinergic, treat with atropine.

Delayed, treat with Ioperamide.

24
Q

Toposisomerase II inhibitors

A

Etoposide: causes secondary cancers (AML).

25
Q

Enyzmes

A

Asparaginase:

Hypersensitivity reaction, hyperglycemia

26
Q

Marine based products

Eribulin

Trabectedin

A

Eribulin: Microtubule-like agent. Toxicity: peripheral neuropathy

Trabectedin: Alkylating-like agent.
Toxicity: hand-foot syndrome.

27
Q

Selective Estrogen Receptor Modulators (SERMs) -

tamoxafen

A

MOA:
Inhibits estrogen-R in breast tissue; used in pre-menopause (or post)

ADRs:
VTE (blood clots -> stroke), endometrial cancer, cataracts, hot flashes

28
Q

Aromatase inhibitor

Letrozole
Anastrozole
Exemestane

A

Aromatase Inhibitors (AIs)

MOA: Inhibits aromatase enzyme that converts androgen to estrogen

Used in post-menopause, preferred over SERMs

ADRs: osteoporosis, fractures, arthralgias, CV disease, hot flashes

29
Q

LHRH Agonists

Leuprolide
Goserelin
Triptorelin

A

MOA: Negative feedback mechanism: bind testicle, inhibits the pituitary from releasing LH and FSH which stimulates the testis to release testosterone.

ADRs: tumor flare: initial tumor growth due to binding to LHRH

30
Q

LHRH Antagoinsts

Degarelix

A

MOA: Directly inhibits the pituitary from releasing LH and FSH

31
Q

Antiandrogens

A

Blocks androgen receptor

32
Q

Targeted agents

A

ID certain features of a cancer that make it different from normal cell

  • prevents tumor cells from entering cell cycle

stops cancer growth , doesn’t;t kill it

33
Q

Monoclonal antibodies

A
  • mabs

MOA: block antigen on cancer cell surface

34
Q

Molecularly targeted therapies

A

blocking signaling inside cell

35
Q

VEGF-R inhibitor

A

Molecularly targeted therapies

ADR: hypertension, proteinuria, bleeding

Hypertension may indicate effectiveness

Treat with ACE-I.

36
Q

EGFR inhibitor

A

Molecularly targeted therapies

Acneiform rash

  • treat w/ clindamycin and by hydrating.

rash may indicate effectiveness

37
Q

mTOR inhibitors

A

Molecularly targeted therapies

ADR: hyperglycemia, dyslipidemia; caution in diabetes

Mucosal ulcers - dexamethasone

38
Q

BCR-ABL mutation inhibitor.

A

Molecularly targeted therapies

ADR: edema, N/V, neutropenia, cardiac, diarrhea; 3A4 ADRs

DOC for CML

39
Q

CD20

A

Specific targets

ADR: myelosuppression (decrease WBC), infusion reactions

40
Q

HER2 inhibition

A

ADR:

cardiotoxicity (trastuzumab, pertuzumab)

hand-foot syndrome (lapatinib)

41
Q

Targeted Agents Toxicities

A

Hair depigmentation

Dysphonia

Hyperthyroidism

42
Q

PD-1 and PD-L1 inhibitors

Pembrolizumab

Nivolumab

A

Immunological therapies

Pembrolizumab: melanoma
toxicities - fatigue, itching, rash

Nivolumab: melanoma, lung cancer.

toxicities - fatigue, malaise

43
Q

Immunological Therapies

A

Immunological Therapies

Activate immune system to help kill disease, at low tumor burden

ADR: fatigue

44
Q

National Cancer Institute Definition of Cancer

A

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues

Cancer is a process rather than specific disease

45
Q

Cancer Cell Characteristics

A
  • Uncontrolled Cell growth
  • Ability to invade adjacent structure and/or travel to distant areas
  • Incapable of physiologic functions of the mature tissue of origin
  • Altered proteins, enzyme systems, membrane characteristic and cytogenetics

Pharm Exam 3 (6 decks)

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