Antineoplastic Flashcards
List the major events happening in the cell cycle
G1-Cellular contents are copied-except chromosomes
S-DNA replication, chromosome duplication
G2-Grows, prepares for mitosis, checks for errors
M- Cells divide
Which phase is really good at proofreading and flagging cells for destruction?
G2
What are the three main ADE for chemotherapy for non targeted therapies?
Myelosuppression
Thrombocytopenia?
AND?
What phase does L-asparaginase work?
G1
What is L-asparaginases MOA?
deprives malignant cells of aspargine, leading to cell death
What cancers are L-asparaginase used in?
Lymphomas and leukemias
What is L-Asparaginases ADEs?
Hypersensitivity reactions common, clotting abnormalities, hyperglycemia, hypertryglyceridemia, immune suppression
What is the benefit of using pegaspargase? (thats L-asparaginase with a polyethylene tag
It causes less hypersensitivity
What are the S phase drugs?
Purine-6-mercaptopurine
Pyrimidine-5-FU, capecitabine, cytarabine, gemcitabine
Folate antagonists-Methotrexate, pemetrexed
What is the purine analog 6-mecaptopurines MOA?
Basically sneaks into the DNA synthesis because its similar to guanine, where it induces strand breaks and base mispairing. This makes it easy for the body to flag and destroy. So it inhibits de novo DNA synthesis
How is 6-mecaptopurine metabolized?
It uses the xanthine oxidase pathway for metabolism
But it must be metabolized by HGPRT to be active
What is 6-mecaptopurines ADEs?
(Mylosuppression (Bone marrow toxicity), hepatotoxic
What is the S phase pyrimidine, cytarabines, MOA?
Incorporates into DNA, inhibits DNA polymerase
What is cytarabines ADEs?
Myelosuppression, GI issues, hepatic enzyme elevation, pulmonary infiltrates
What is the single most effective agent in AML?
Cytarabine (NO ACTIVITY in solid tumors)
What is gemcitabines MOA?
Inhibits ribonucleotide reductase, inhibition of DNA polymerase, incorporated into DNA and causes it to be flagged
What is gemcitabines ADEs?
Myelosuppression, N/V, flu like symptoms
Can gemcitabine be used in solid tumors?
Yep
What is the MOA of 5-FU?
Generates FdUMP, decreases Thymidylate synthase
Generates FUTP. interferes with RNA
Generation pf FdUTP, inhibits DNA
What is important to know about 5-FUs phatmacokinetics?
It has to be activated
What is the other S phase Pyrimidine drug?
Capecitabine
What is the MOA of Capecitabine?
Prodrug of 5-FU
What is important to know about capectibatine?
It is well absorbed orally, which 5-FU is not
What is the MOA of folate?
I guess it just helps us, or the body, recognize which cells are using too much folate? Not sure on this
Which phase does methotrexate affect?
S phase
What is methotrexates MOA?
DHFR inhibitor, affects de novo synthesis
Cuz folate is required to build DNA/RNA, so it inhibits folate
Inhibits TS when polyglutamated
What is mtx ADEs?
Myelosuppression, GI problems, teratogenic, PGMTX
What is PGMTX? What drug is it related to?
Mtx, the drug is poluglutamated at high doses, leading to increase in efficacy and ADEs
How does lecuovorin rescue affect Mtx neurotoxicity?
Does not reverse it
Explain leucovorin rescue
Because Mtx is unselective, it will damage normal cells. Leucovorin will come in and resuce the healthy cells because it somehow has a higher affinity for them, and it provides them with folate to continue doing its thing. It can only resuce healthy cells, not lethally damaged cells
When should leucovorin be given?
Within 24-36 hours of starting HDMTX
What do topoisomerase enzymes do?
Reduce stress on DNA so that regions can be replicated, repaired, and/or transcribed
What is the MOA of Irinotecan?
Inhibits ability of DNA to replicate, repair, transcribe, by blocking TOPO 1
What is the ADEs of irinotecan?
DIARRHEA, myelosuppression
What are the Topo II inhibitors?
Etoposide, teniposide
What is Topo II inhibitors MOA?
Form complexes with Topo II and DNA to prevent resealing of the breakage
What phase do antitumor antibiotics work in?
G2 phase
What is the antitumor antibiotic G2 drug?
Bleomycin
What is bleomycins MOA?
Formation of iron complex that generates highly reactive free radical species on DNA, causing DNA breakage
What are the ADEs for bleomycin?
Pulmonary and skin toxicities
What are the two main M phase drug classes?
Vinca alkaloids and taxanes
What is the MOA of vinka alkaloids?
Bind to beta tubulin in microtubules, inhibits polymerization into tubules
Basically microtubules dont form, causing the cells not to be able to pull apart
What is taxanes MOA?
Bind to beta tubulin to stabalize the microtubule so it does not pull apart
Basically they superglue the cells together with the mictrotubules
What is the important fact to know about vinca alkaloids administration?
NEVER intrathecally, will cause imminent death
What is the vinka alkaloids metabolized by?
CYPs
What is the ADE for Vincristine?
CNS toxicity with vinCristine, also a vesicant
What is the ADEs for vinblastine?
Blood toxicity with vinBlastine, also a vesicant
What is paclitaxels ADEs?
Hypersensitivity, myelosuppression, myalgia, neuropathy
What are the nitrogen mustard drugs?
Bendamustine, cyclophosphamide
What are the nitrosoureas?
Carmustine, lomustine
What are the traizenes?
Dacarbazine, procarbazine
What is cyclophosphamides active metabolites?
Activated by CYP system
Phosphamide mustard and acreolein
What is the major ADE of cyclophosphamides?
Hemorrhagic cystitis
What is bendamustines MOA?
Alkylating agent that cross links DNA strands; inhibits mitotic checkpoints
What is the MOA of the nitrosoureas? Carmustine and Lomustine
Alkylating Agent
Which phrase is synonymous with “alkylating agent”?
Cross linking
What is the MOA of the triazenes? Dacarbazine and procarbazine
Methylates DNA and inhibits function/synthesis
Cross links DNA, flagging it for destruction
What is dacarbazine have an increased risk for? 2 things
Potent vesicant and increased risk of secondary cancer
What is unique about procarbazines active metabolites?
One is a weak MAO inhibitor
What are the platinum drugs?
Cisplatin, carboplatin, and oxaliplatin
What is the MOA of platinum drugs?
Specifics unknown, but same general concept as others. Flags DNA for destruction
What do patients taking cisplatin need to do while on this drug?
Aggressive hydration due to its nephrotoxicity
What is the ADE of carboplatin to know?
Myelosuppression
What is the ADE of Oxaliplatin?
Neurotoxicity triggered by cold exposure
Are tumors resistant to cis/carboplatin resistant to oxaliplatin?
NO
What are the four MOA of anthracycline?
Inhibits topo II
Generates free radicals-GENERATES CARDIOTOXICITY
Intercalate DNA
After membrane fluidity and iron transport
What are the Anthracyclines?
Doxorubicin, Daunorubicin, mitoxantrone
What is the important ADE of Antracycline?
Cardiotoxicity
What is anthracyclines max lifetime dose?
450mg/m
What is unique about the two “D” anthracyclines color?
It is red. Can turn urine red
What color is mitoxantrone?
Blue, can cause blue discoloration
What color is Daunorubicin?
Red as well, red urine