Anticancer and Immunosuppressants

Question 1

Process of altered cell differentiation and growth
 Uncoordinated
 Autonomous
 Lacks normal regulatory control

Answer 1

Neoplasia

Question 2

Disease resulting from altered cell differentiation and growth

Answer 2

Cancer

Question 3

Loss of differentiation

Answer 3

Anaplasia

Question 4

 Arise from the cells that cover external and internal body surfaces such as lung,
pancreatic, breast, and colon

Answer 4

Carcinoma

Question 5

 Arise from cells found in the supporting tissues of the body such as bone, cartilage,
fat, connective tissue, and muscle

Answer 5

Sarcoma

Question 6

 Arise in lymph nodes and tissues of the body’s immune system

Answer 6

Lymphoma

Question 7

 Cancers of the immature blood cells that grow in the bone marrow

Answer 7

Leukemia

Question 8

__% of breast cancer pts develop bone metastases

Answer 8

70%

Question 9

If the drug ends in -dronate, what kind of drug is it?

Answer 9

Bisphosphonate

Question 10

 Inhibit osteoclast
 Attach to bony surfaces undergoing
active resorption
 released during
resorption by osteoclasts impairs
ability of osteoclasts to form the
ruffled border, to adhere to the
bony surface
 Reduce osteoclast genesis and
recruitment
 Promoting osteoclast apoptosis

Answer 10

Bisphosphonates

Question 11

Inhibit osteoclast activation
 RANKL is secreted by bone
marrow cells and osteoblasts
RANKL binds to the RANK receptor on
osteoclasts and promotes osteoclast
differentiation and activity.
a fully human
monoclonal antibody that binds to
RANKL
Bound RANKL cannot attach to RANK
receptors (i.e. inhibiting activation of
osteoclast)

Answer 11

Denosumab

Question 12

Denosumab
Osteoporosis treatment
 60mg every 6months

Answer 12

 Prolia

Question 13

Denosumab:
Bone cancer treatment - same prevalence as bisphosphonate
 120mg every 4weeks

Answer 13

Xgeva

Question 14

Profound and prolonged inhibition of bone resorption with
oversuppression of bone remodeling (ie, low bone turnover), and
infection are the main mechanisms

Answer 14

MRONJ

Question 15

 Used in solid tumor cancers
 Specifically recognize and bind to VEGF.
Once bound, the complex is unable to activate the
VEGF receptor.
 Most effective when combined with additional
therapies, especially chemotherapy.
Do not necessarily kill tumors; they instead may
prevent tumors from growing.
 Reduce formation of new blood vessels; reduce
nutrient delivery
 Increases in bleeding and reduced wound healing

Answer 15

Bevacizumab

Question 16

 Directly damage cell DNA
Impairs replication & transcription= cell death
 Work in all phases of the cell cycle
Can be used in many different cancers
 Due to affect on DNA, big impact on bone marrow
Bone Marrow Suppression – reduce blood cell
production
Highly immunosuppressant
 Toxicity related to cumulative dose
Mucosal damage – oral mucosal ulceration
GI disturbance
Sterility
Acute non-lymphocytic leukemia

Answer 16

Alkylating agents

Question 17

 Drugs enter into the dorsal root ganglion
and binds to DNA, causing apoptosis.
Regardless of the mechanism, apoptosis
results in secondary damage to peripheral
nerves.
pain triggered by
exposure to cold liquids
 Cold-induced perioral paresthesias – 95%
 Cold-induced pharyngolaryngeal dysesthesia – 92%
 Dyspnea – 40%
 Muscle cramps – 34%
 Jaw stiffness – 34%
 Dysphagia – 30%
 Visible fasciculations – 30%
 Voice changes – 6%
 Ocular changes – 0.7%

Answer 17

Platinum compounds
Oxaliplatin

Question 18

 are structurally related to normal compounds that exist
within the cell
 interfere with DNA and RNA growth by substituting for
or competing with the normal building blocks of DNA and RNA
 i.e. the availability of normal purine or pyrimidine nucleotide precursors
 May either by inhibiting the synthesis of normal nucleotides or compete with them in
the formation of DNA or RNA
 Their maximal cytotoxic effects are in S-phase
 Synthesis – DNA replicates, yielding two separate sets

Answer 18

Antimetabolites

Question 19

Antimetabolites are specific to what phase of cell cycle

Answer 19

S phase

Question 20

Folate antagonist
 Antineoplastic; immunosuppressant (psoriasis; RA)
 Target S-phase (DNA replication), inhibit rapid proliferating cells
 Bone marrow and intestinal epithelium
 Myelosuppression risk for hemorrhage and infection
Dental Note: oral mucositis
 Oral pain; Erythema; Difficulty opening the mouth
 DNA cycle specific agents are most stomatotoxic
 Methotrexate, etoposide known to be secreted into the saliva
further increasing stomato toxicity potential

Can also be used for psoriasis and Rheumatoid arthritis

Answer 20

Methotrexate

Question 21

 Bind to and break DNA inside cancer cell to keep them from growing
and multiplying
 Groups:
 Anthracyclines: Doxorubicin, daunorubicin, epirubicin, idarubicin.
 Other: bleomycin, plicamycin, mitomycin.
 Oral Mucositis

Answer 21

Cytotoxic antibiotics

Question 22

 Work in M-Phase to prevent cell division
 Groups include:
 Vinca Alkaloids: Vincristine, Vinblastine
 Taxanes: Paclitaxel, Docetaxel

Answer 22

Mitotic inhibitors

Question 23

Mitotic inhibitor
 Derived from Madagascar periwinkle
 MOA: bind β tubulin & block its polymerization with α tubulin into
microtubules
 Cell division arrests in metaphase
 Absence of intact mitotic spindle, chromosomes
cannot align, disperse throughout the cytoplasm
 Apoptosis
 Toxicity-
 Peripheral neuropathy-numbness, tingling
Neurotoxicity may also be persistent, deep aching and burning pain that mimics
a toothache

Answer 23

Vincristine

Question 24

 Interfere with topoisomerase which is responsible for unwinding double
-stranded DNA
 Epipodophyllotoxins: Etoposide
 Camptothecins: Irinotecan, topotecan

Answer 24

Topoisomerase Inhibitors

Question 25

Disease states for ______
 Autoimmune, collagen, connective tissue and inflammatory disorders
 Systemic Lupus erythematosus
 Rheumatoid arthritis
 Chronic active hepatitis
 Inflammatory bowel disease
 Glomerulonephritis
 Nephrotic syndrome
 Myasthenia gravis
 …among others…
 Organ or tissue transplantation
 Prevent rejection

Answer 25

Immunosuppresion

Question 26

____ side effects:
 Gingival hypertrophy
 May be additive with CCBs (nifedipine,
amlodipine)
 Case reports suggest tx’d with 2-week
course metronidazole (750mg po TID)
while cyclosporine continued
 Infection risk
(immunosuppressant)
 Hypertension/Kidney Impairment
 Avoid NSAIDs and Bactrim
 DRUG INTERACTIONS!!!

Answer 26

Cyclosporine