Anticancer drug/transplant/toxicology Flashcards
Anticaner drugs follow zero or first order kinetics?
First order
Anticancer drugs target normal high growth fraction cells such as? and the resulting side effects?
Bone marrow/hair/GI
Bone marrow suppression/alopecia/nausea and vomiting
Non cell cycle specific and cell cycle specific anticancer drugs target high or low growth fraction tumors?
Cell cycle specific—>high growth fraction
Non cell cycle specific—>low or high growth fraction
Which anticancer drug is G2 phase specific?
Bleomycin
Which anticancer drugs are M phase specific?
Vincristine/Vinblastine/Paclitaxel
What are some anticancer drugs that are S phase specific?
Anything that sounds like a DNA or RNA 6-MP 5-FU Cytarabine 6-thioguanine Hydroxyurea Irinotecan Etoposide
What are some anticancer drugs that are non cell cycle specific?
Alkylating agents
Doxorubicin
Daunorubicin
Nitrosoureas
What are the 3 anticancer drugs that are not bone marrow suppressive? and what are their toxicities?
Cisplatin (renal)
Bleomycin (pul fibrosis)
Vincristine (peripheral neuropathy)
What metabolite of cyclophosphamide does it cause hemorrhagic cystitis? and what helps to prevent it?
Acrolein/MESNA and hydration
What type of anticancer drugs are most likely to cause cancer later on?
Alkylating agents (mutagen)
What cancer might Procarbazine cause down the road?
Leukemia
How does doxorubicin cause cardiac toxicity and what can you use to counter that?
Free radical damage/dexrazoxane (iron chelating agent)
What drug can you use to protect cells from methotrexate? and is it protective against 5-FU as well?
Leucovorin/no it makes it worse
Pyramidine analog anticancer drugs (5-FU/cytarabine) inhibit which enzyme? and prevent the production of ?
Thymidylate synthetase/thymine
6-MP has to be activated by what enzyme and which enzyme inactivate 6-MP, which results in what drug interaction?
Activated by HGPRT
xanthine oxidase inactivate 6-MP
Drug interaction with allopurinol—>inhibit xanthine oxidase
5-FU is converted into ___ , which is the active form?
5-FdUMP
Which drug targets BCR-ABL of CML?
Imatinib
What do Cetuximab and Trastuzumab target and what cancers do they treat?
Cetuximab—>ErbB1—>head and neck cancer (wear TUX, head and neck stick out)
Trastuzumab—>ErbB2 (HER2)—>breast cancer
Which ‘mab is a VEGF inhibitor that treats solid tumors?
Bevacizumab
Tyrosine kinase inhibitor treat? and they all end in?
Cancer/nib
What can we give cancer pts that are on anticaner drugs to reduce risk of infection and the need for antibiotics?
G-CSF (filgrastim)
GM-CSF (sargramastim)
EPO
Thrombopoietin
What is the role of thymidylate synthetase?
Convert dUMP to dTMP
What does cyclosporine and tacrolimus bind? what is their common mechanism?
Cyclosporine—>bind to cyclohilin
Tacrolimus—>bind to FK binding protein
They inhibit calcineurin—>inhibit activation of T cell
What are the side effects of cyclosporine and tacrolimus?
Renal toxicity
Cyclosporine—>gingival hyperplasia
What do azathioprine and mycophenolate inhibit?
Purine synthesis
What does azathioprine convert to?
6-MP
What do you give a Rh- mother to prevent Rh hemolytic disease of the new born?
Anti D immunoglobulin
What does abciximab targets and where does it used?
Targets GP2b/3a—>used in angioplasty procedure
What are the 2 common mab that are used to treat RA?
Infliximab (Crohn disease as well) and adalimumab
What are interferon alpha/beta/gamma commonly used for?
Alpha—>hep B and C/leukemia/melanoma
Beta—>MS
Gamma—>chronic granulomatous disease
What is DUMBBELSS and what is it from? and how do we counter it?
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle, Lacrimation, Sweating, Salivation
AChE inhibitor overdose
Counter with atropine and pralidoxime
What drug do we used to counter atropine overdose?
Physostigmine
How to treat CO poisoning?
Hyperbaric O2
Atropine and amphetamine overdose are similar except? and what to give for amphetamine overdose?
Atropine overdose has hot and dry skin
Amphetamine overdose has warm and sweaty skin/benzo
What do you see with opioid overdose and what drug to counter it?
Lethargy/sedation/decrease HR and BP/respiratory failure
Naloxone (IV)
What is the first sign of salicylate overdose? and how to treat it?
Tinnitus
Urine alkalization/hemodialysis
What drug to give for benzo overdose?
Flumazenil
SSRI combine with what can cause serotonin syndrome? and what drug is used for that?
TCA or MAOi/cyproheptadine (5-HT2 receptor blocker)
Which opioid can cause serotonin syndrome?
Meperidine—>metabolized into norperidine—>block reuptake of serotonin
What are the 3 Cs of TCA toxicity?
Convulsion/coma/cardiotoxicity
What are some clinical presentation of chronic arsenic poisoning? what drugs to use for that?
Raindrop skin pigmentation/stock glove neuropathy
Dimercaprol/Penicillamine
What do you see acute iron poisoning in children? and what is the antidote
Severe GI symptoms—>hematemesis and bloody diarrhea
Deferoxamine
What drugs can be used for lead poisoning?
Dimercaprol/Succimer
What does chronic mercury poisoning affect?
CNS affect—>ataxia/vision and hearing problem
What is the antidote for acetaminophen/theophylline/methanol or ethylene glycol/copper or Wilson’s/heparin poisoning?
Acetylcycsteine Esmolol Fomepizole Penicillamine or trientine Protamine
What are Echinacea/garlic/gingko/ginseng/saw palmetto/St john’s wort used for? and what are their interactions with other drugs (real drugs)?
Echinacea—>cold
Garlic—>hyperlipidemia (antiplatelet action—>caution with pt on anticoagulant)
Gingko—>improve memory (antiplatelet)
Ginseng—>improve physical/mental performance
Saw palmetto—>inhibit 5 alpha reductase (BPH)
St John’s wort—>increase serotonin—>antidepressant (Serotonin syndrome with SSRI/P450 inducer—>decrease effect of other drugs)
What are DHEA and melatonin used for?
DHEA—>for athlete to gain more muscle
Melatonin—>used for jet leg
Acute gastroenteritis/HoTN/rice water diarrhea/torsades, think what metal poisoning?
Arsenic
