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Toxicology Final > Antineoplastic Agents > Flashcards

Antineoplastic Agents Flashcards

1
Q

What is cancer staging?

A
  • classifying patients according to the extent of their disease with high numbers indicating more extensive, serious disease and a poorer prognosis
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2
Q

What are the 2 staging systems used in cancer?

A

-AJC and TNM

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3
Q

What does cancer survival depend on?

A
  • tumour type, extent of disease, the treatment used and the constitution or performance status of the patient
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4
Q

What is cancer surgery useful for?

A
  • for reducing the tumour mass and in theory, would be curative if all the cancer cells were removed
  • can also be used as palliative tx to relieve conditions like spinal cord compression
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5
Q

What is radiation therapy useful for?

A
  • use of ionizing radiation to kill cancer cells and reduce tumour mass
  • the goal is to harm as many cancer cells as possible while limiting damage to the surrounding healthy tissues
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6
Q

What does the amount of radiation used depend on?

A
  • type of cancer, proximity of sensitive tissues or organs and the constitution of the patient
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7
Q

What is the action of chemotherapy?

A
  • involves tx with drugs which can destroy cancerous cells - affects rapidly dividing cells in general, so chemo will also harm healthy tissues (esp those with high turnover rate)
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8
Q

What is the only thing that brings some specificity into chemotherapy?

A
  • normal cells are able to repair DNA damage, while cancer cells cannot
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9
Q

Why are multiple drugs used in a chemotherapy regimen?

A
  • for synergy- it decreases the possibility of resistance developing and also reduced dose-related AE
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10
Q

What drug class cannot be administered via the intrathecal route?

A

vinca alkaloids

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11
Q

How do alkylating agents work?

A
  • earliest chemotherapy agents- inhibit DNA replication by causing cross linking and abnormal base pairing between DNA strands
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12
Q

What class of drugs contain a bifunctional nitrogen mustard moiety?

A

alkylating agents

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13
Q

Why are alkylating agents quite toxic?

A
  • immonium ions are able to react with any cell component containing neutrophilic functional groups such as hydroxyl, sulfhydryl, amino or carbonyl
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14
Q

What is the MOA in which cancer cells are resistant to alkylating agents?

A
  • increased ability to repair DNA lesions, decreased permeability to the agents or increased production of glutathione with agents with the alkylating agents
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15
Q

What are the AE associated with alkylating agents?

A
  • myelosuppression with granulocytopenia, thrombocytopenia and anemia, N/V, and reversible hair loss
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16
Q

What are the specific alkylating agents?

A
  • N mustards
  • alkyl sulfonates
  • nitrosoureas, triazenes
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17
Q

What are antimetabolites?

A
  • structural analogies of naturally occurring substrates for biochemical reactions occurring in the body
  • several of them act as false substitutions in the production of NA and interrupt and stop the replication process
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18
Q

What are the antimetabolites?

A
  • folic acid analogs
  • purine analogs
  • pyrimidine analogs
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19
Q

Most of the antitumour antibiotics are obtained from what?

A

streptomyces sp.

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20
Q

How do antibiotics work in cancer?

A
  • intercalation or by sliding between DNA base pairs and inhibiting DNA synthesis
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21
Q

What is the main class of drugs that are considered anti-tumour antibiotics?

A
  • anthracyclines
22
Q

What is the MOA of plant alkaloids?

A
  • prevent formation of the mitotic spindle and stop cell division- the podophyllotoxins inhibit topoisomerase(enzyme that is necessary for RNA transcription) and the taxanes stabilize microtubules, thereby promoting cell division
23
Q

What cells are the most sensitive to antineoplastic agents?

A
  • cells with high turnover rate, i.e. bone marrow, mucous membranes, and hair follicles (generally most sensitive)
    (myelosuppression, mucositis and alopecia)
24
Q

What organ systems are affected by cumulative toxicities

A
  • pulmonary
  • cardiovascular
  • urinary
  • neurological
25
Q

The extent of myelosuppression is_________

A

dose limiting

26
Q

What 3 effects does myelosuppression lead to?

A
  • neutropenia (WBC reduction)
  • thrombocytopenia (platelet reduction)
  • anemia
27
Q

How long does recovery of cell counts usually take?

A

-2-3 weeks

28
Q

What agents can be used to increase the rate at which neutrophil counts recover?

A
  • filgrastim (G-CSF)
29
Q

What can filgrastim prevent?

A
  • febrile neutropenia (usually indicates an infection, and may allow chemo to continue at full doses without delays in the tx schedule)
30
Q

What is the action of erythropoietin?

A
  • promotes the production of RBCs and may prevent or correct anemia
31
Q

Describe acute emesis

A
  • symptoms begin 1-2 hours after administration of an emetogenic chemotherapy drug
  • peaks: after 4-6 hours
  • begins to subside after 12-24 hours
32
Q

What is the cause of acute emesis?

A
  • stimulation of the chemoreceptor trigger zone through serotonin release (this is why serotonin antagonists are useful here)
33
Q

What is anticipatory nausea?

A
  • n/v triggered by stimuli with the therapy such as the smell or sight of the hospital
  • conditioned response
    (managed by relaxation techniques)
34
Q

What is delayed nausea?

A
  • n/v that begins at least 24 hours after chemotherapy administration- may persist for 2-5 days and the mechanism is not understood
  • usually seen with highly emetogenic drugs such as cisplatin
35
Q

Why do most chemotherapy agents cause diarrhea?

A
  • these drugs cause damage to the bowel lining (mucous membranes)
  • 5-FU is an example of this
36
Q

Mucositis can be used specifically by what?

A
  • 5-FU, methotrexate and doxorubicin
    (usually starts with burning of the lips and mouth, and then proceeds to ulcerations of the buccal mucosa, lips, floor of mouth and tongue)
37
Q

What is extravasation?

A
  • when a drug being given IV is adverted and infused into the tissue (number of antineoplastic drugs are vesicants and will do severe damage to tissues)
38
Q

What are the vesicant antineoplstic drugs?

A
  • dactinomycin
  • doxorubicin
  • mechlorethamine
  • paclitaxol
  • vinblastine
  • vincristine
39
Q

What are the drugs that often cause alopecia?

A
  • cyclophosphamide
  • 5-FU
  • doxorubicin
  • vincristine
  • epirubicin
  • bleomycin
  • paclitaxol
40
Q

How long after these drugs are given does hair loss happen?

A
  • 7-10 days after tx (begins)
  • peaks after 1-2 months
  • begins to regrow around a month after being stopped
41
Q

_______ and _______ can cause severe skin dryness and itch, as well as sensitivity to light

A

vincristine and 5FU

42
Q

What is the main drug that causes pulmonary toxicity?

A
  • bleomycin (causes a direct cytotoxic effect on pulmonary epithelium)
43
Q

What drugs are associated with cardiotoxicity?

A

anthracycline antibiotics (doxorubicin, epirubicin, mitoxantrone and danarubicin)

44
Q

Cardiotoxicity increases with _________

A

increased cululative dose

45
Q

What is the MOA behind cardiotoxicity

A

generation of free radicals with the simultaneous suppression of these enzymes which protect cells from free radical damage

46
Q

______ is a cardioprotective drug which may be useful to protect from cardiotoxicity

A

dexrazoxane

47
Q

What drugs have a high rate of neurotoxic effects

A
  • vinca alkaloids
  • vincristine, vindesine, anad vinblastine
    • also platinum compounds
48
Q

What are the main s/s associated with neurotoxicity

A
  • numbness of hands and feet, gait disturbances, and in severe cases, severe motor weakness
  • if drug stopped early enough, these effects are reversible
49
Q

What is the MOA of neurotoxicity associated with platinum compounds?

A
  • demyelination and typically manifests as sensory disturbance in the hands
50
Q

Nephrotoxicity is associated with what drugs?

A
  • cisplatin, ifosfamide and methotrexate
51
Q

Infertility is a SE of what drugs

A

cyclophosphamide, chlorambucil, mechlorethamine, melphan

Toxicology Final (14 decks)

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