antineoplastic

Question 1

cyclophosphamide

Answer 1

o Transferring alkyl group to cellular constituent (can be mon of bifunctional)
o Interstrnd DNA cross links
o Oxidized by CYP 450
o Alopecia
o Myelosuppression
o Hemorrhagic cystitis- acrolein metabolite irritates bladder lining (give water)
o Acute/delayed N/V

Question 2

cisplatin

Answer 2

o	platinum analog
Non-specific
o	DNA cross link
o	Hydration rqd to convert to active species
o	N/V is HUGE
o	Renal toxicity
o	Myelosuppression
o	Hepatotoxicity
o	Anaphylaxis

Question 3

antimetabolites

Answer 3

antifolates
fluopyrimidine
purine antagonist

Question 4

antifoliate (methotrexate)

Answer 4

o Irreversible binding to DHFR- dec reduced folates incorporated into purine bases

o Mucositis
o Diarrhea
o Myelosuppression
o CAUTION in renally eliminated drugs

Question 5

Fluopyrimidine (5-fluorouracil)

Answer 5

o False pyrimidine
o Inhibits thymidylate synthase- rate limiting step
o Myelosuppression
o Mucositis with continued infusion, diarrhea
o Skin- hand and foot syndrome
♣ Grade 1- numbness, discomfort in hands and feet
♣ Grade 2- painful erythema and swelling of hands/feet
♣ Grade 3- moist desquamation, ulceration, blistering, severe pain
o neurotoxicity

Question 6

Purine antagonist (6-MP)

Answer 6

o Pediatrics, immunosuppressant
o inhibit Inosinic acid to adenine and guanine to inhibit DNA syn.

o Myelosuppression
o Pulmonary fibrosis
o Pancreatitis
o DI- allopurinol-reduce 6-MP dose by 50-75%

Question 7

natural products

Answer 7

paclitaxel

docetaxel

Question 8

paclitaxel

Answer 8

o Yew tree
o Microtubule assembly results in inhibition of mitosis, cell division
o ACUTE
♣ N/V, arrhythmias, hypersensitivity
o DELAYED
♣ Myelosuppression, peripheral neuropathy

Question 9

docetaxel

Answer 9

o Semisynthetic from European yew tree
o ACUTE
♣ Hypersensitivity (pre medicate with steroid)
o DELAYED
♣ Neurotoxicity, fluid retention, myelosuppression

Question 10

Antitumor Ab (anthracyclines/doxorubicin)-

Answer 10

bind with DNA to produce irreversible complexes that inhibit cell division

Question 11

Vinca alkaloids (vincristine)

Answer 11

stop cell division by binding to tubulin (mitotic spindle)

Question 12

Hormones (tamoxifen, anastrazole)

Answer 12

both hormone agonists and antagonists used in breast and prostrate cancer

Question 13

Podophyllotoxins (etoposide)

Answer 13

inhibits topiosmerase 2

Question 14

Camptothecins (topotecan)

Answer 14

inhibits topoisomerase 1

Question 15

Tyrosine kinase inhibitor (imatinib)

Answer 15

interrupt intracellular signaling pathway

Question 16

Monoclonal Ab (rituximab)

Answer 16

bind to extracellular receptors to interrupt cell signaling

Question 17

Miscellaneous

Answer 17

( trans retionoic acid, asparginase)

Question 18

amifostine

Answer 18

prevention of SGD
•	FDA approved for mod-severe xerostomia
•	Oxygen free radical scavenger
•	IV administration
•	N/V
•	Hypotension- BP monitored