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Heme/ Lymph > Antineoplastic drugs CIS > Flashcards

Antineoplastic drugs CIS Flashcards

1
Q

Differential Diagnosis of Eosinophilia

A 
Infectious diseases (most common worldwide)
- Helminths: Toxocara canis (dog roundworms), trichinella

Disorders of the immune system (2nd most common US)
- Allergy, lupus, rheumatoid arthritis, ulcerative colitis

Toxins, drugs, and environmental factors
- Phenytoin, carbamazepine, phenobarbital, sulfonamide antibiotics, filgrastim, pegfilgrastim, ingestion of aniline (C6H7N)

Endocrine abnormalities – adrenal insufficiency

Inherited disorders – familial eosinophilia

Hypereosinophilic syndromes
- Churg-Strauss syndrome, Kimura disease, Well syndrome, Castleman disease

Cancer

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2
Q

Acute lymphoblastic leukemia (ALL)

A

Main form of leukemia in childhood and the most common form of cancer in children

Generally, children with this disease have a relatively good prognosis

The combination of drugs currently utilized to induce remission does so in over 90% of patients with minimal toxicity

Circulating leukemic cells often migrate to sanctuary sites located in the brain and testes; prophylactic intrathecal methotrexate chemotherapy is often considered a standard component of the induction regimen to prevent CNS leukemia, a major mechanism of relapse

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3
Q

Agents from which drug class listed below act in a cell cycle specific manner?

Alkylating agents
Anthracyclines
Antimetabolites 
Glucocorticoids 
Monoclonal antibodies
A

antimetabolites

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4
Q

Cell Cycle Specific classes

A

Antimetabolites- S phase
Antitumor antibiotics- bleomycin (S-G2 phase)
Taxanes (M phase)
Vinca (M phase)
Topoisomerase I and II inhibitors (S-G2 phase)

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5
Q

Cell cycle non-specific classes

A

alkylating agents
anthracyclins
antitumor antibiotics (dactinomycin, mitomycin)
platinum agents

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6
Q

An agent known to cause delayed cardiotoxicity was added to this patient’s chemotherapy regimen due to his high-risk status. Which drug class best fits this description?

Alkylating agents
Anthracyclines
Enzymes 
Glucocorticoids 
Pyrimidine analogs

What is thought to be the mechanism of cardiotoxicity?

A

anthracyclines (doxorubicin)

free radicals that accumulate over a lifetime are thought to be the cardiotoxic effect

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7
Q

What agent is most likely administered in conjunction with systemic high-dose methotrexate to rescue healthy cells in this patient?

Bleomycin
Hydrocortisone
Interferon alpha
Leucovorin
Mesna
A

Leucovorin

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8
Q

What is the main advantage to high-dose intermittent administration?

A

permits recovery of normal cells

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9
Q

Which agent in this patient’s regimen is a cell-cycle inhibitor of mitosis?

Asparaginase
Cisplatin
Doxorubicin
Tretinoin 
Vincristine
A

Vincristine (inhibits microtubule assembly)

Taxanes also work against M phase– inhibit microtubule disassembly (stabilize them)

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10
Q

Tretinoin

A

differentiating agent
used in leukemias with RARa translocation (retinoic acid receptor)

headache, fever, dry skin and mucus membranes, skin rash, pruritis, conjunctivitis

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11
Q

why is aspariginase added to an ALL pt’s regimen?

A

ALL tumor cells lack asparagine synthetase.

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12
Q

Asparaginase

A

MOA: hydrolyzes circulating L-asparagine into aspartic acid and ammonia, effectively inhibiting protein synthesis

Cell cycle specific (G1)

Acute lymphoblastic leukemia tumor cells lack the enzyme asparagine synthetase adn require an exogenous source of L-asparagine, rendering them selective to and vulnerable to asparaginase

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13
Q 
Which of the following cytogenetic aberrations is most likely given the diagnosis of CML?
inv(16)
t(5;14)
t(8;13)
t(9;22)
t(15;17)
A

t(9;22)- philadelphia chromosome

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14
Q

What protein is newly created in patients with the Philadelphia chromosome translocation?

BCR-ABL 
CBFβ-MYH11
FGFR1-ZNF198
IL3-IgH
PML-RARα
A

BCR-ABL

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15
Q

Which chemotherapeutic agent is the first choice for this patient and acts by inhibiting the BCR-ABL fusion protein?

Erlotinib
Gefitinib 
Imatinib 
Lapatanib 
Sorafenib
A

Imatinib

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16
Q

Molecular testing reveals that a mutation has occurred in the BCR-ABL fusion protein. Which agent is most appropriate in this situation?

Bevacizumab
Bortezomib
Dasatinib
Erlotinib
Trastuzumab
A

Dasatinib

17
Q

Why is chemotherapy recommended after surgery?

Micrometastases may be present in distant tissues
Small populations of tumor cells may remain within the tissue
Surgery and radiation have only reduced her tumor burden
Surgery can stimulate dormant cells into the cell cycle
All of the above are possible reasons

A

all of the above

18
Q

Based on the fact that the tumor sample expresses the HER-2/neu epidermal growth factor receptor, which drug class listed may be used to target this receptor and is an appropriate choice to treat this patient?

Anthracyclines 
Antifolates 
Monoclonal antibodies
Platinum compounds
Taxanes
A

monoclonal antibodies

19
Q

Which agent below is a monoclonal antibody used to treat HER2/neu+ breast cancer?

Alemtuzumab 
Erlotinib
Imatinib
Lapatinib 
Trastuzumab
A

trastuzumab

20
Q

A patient is treated with a combination of cyclophosphamide, doxorubicin, paclitaxel, and trastuzumab over the course of 6 months. Following treatment, a PET scan shows she is in remission. At a one-year follow-up appointment, a bone scan reveals metastatic disease in the brain, liver, and lungs. Which is the most likely explanation for continued cancer growth during this time?

Drug-drug interactions
Drug resistance
Increased CYP450 enzyme activity 
Pharmacological sanctuary
Poor patient compliance
A

Drug resistance

21
Q

After treatment, a pulmonary function test indicates decreased pulmonary function compared to pre-treatment ability. Which treatment most likely accounts for the observed decrease in function?

Bleomycin
Cisplatin
Etoposide
Orchiectomy 
Radiation
A

Bleomycin, the only anti-tumor cell antibiotic that is cell cycle specific. It has pulmonary toxicity

22
Q

Which of these agents is cell cycle nonspecific?

Bleomycin
Cisplatin
Etoposide

A

Cisplatin

23
Q

What is the major dose-limiting toxicity of cisplatin?

Cardiotoxicity
Hemorrhagic cystitis
Nephrotoxicity
Hepatotoxicity
Pulmonary toxicity
A

Nophrotoxicity- also ototoxicity.

24
Q

Antitode for cyclopohosphamide-induced hemorrhagic cystitis?

A

mesna

25
Q

Vincristine is administered to a patient with a tumor that is likely to be responsive to the drug. Which is the most likely adverse effect?

Nephrotoxicity
Neutropenia
Peripheral sensory and motor neuropathy
Pulmonary damage
Thrombocytopenia
A

Peripheral sensory and motor neuropathy

26
Q

Which drugs from the same class as vincristine would be likely to cause neutropenia and thrombocytopenia

A

vinblastine

27
Q

A 65 y/o male develops severe, irreversible cardiomyopathy because the maximum lifetime dose of an anticancer drug was exceeded. Which agent is most likely responsible for this patient’s symptoms?

Asparaginase
Bleomycin
Cisplatin
Cyclophosphamide
Daunorubicin
A

daunorubicin

class: anthracyclins
mechanism: free radicals

28
Q

A 5 y/o male presents with Wilms tumor and is prescribed an agent that acts by intercalating into DNA strands. The drug is efficacious regardless of which stage of the cell cycle the tumor cells are in. Which of the following drugs best fits this description?

Cytarabine
Doxorubicin
Fluorouracil
Ifosfamide
Vinblastine
A

doxorubicin.

DNA intercalation does not involve covalent bonds between the drug and DNA

29
Q

A 55 y/o female recently diagnosed with chronic myelogenous leukemia (CML) is being treated with imatinib. Which of the following effects are anticipated in response to imatinib therapy?

A high rate of therapeutic failure, and the need to switch to interferon α2a and α2b
Hypotension and hypovolemia due to drug-induced diuresis
Interactions with other drugs that induce the CYP450 system
Significant toxicity to normal host cells due to profound inhibition of tyrosine kinase
Thrombocytosis with a high risk of intravascular clotting

A

INteractions with other drugs that induce the CYP450 system

30
Q

As a general rule, large solid tumors are more difficult to eradicate when chemotherapy is initiated. Which of the following tumor-based properties explains best the reason for this chemotherapeutic limitation?

A

Growth fraction slows, more cells enter G0

31
Q

A Hodgkin disease patient received mechlorethamine as part of his treatment plan. Which best describes the anticancer mechanism of action of this agent?

Alkylates DNA, causing cross-links between parallel DNA strands
Blocks microtubule assembly and mitosis during M-phase
Inhibits topoisomerase, preventing repair of DNA strand breaks
Intercalates in DNA strands
Stabilizes microtubules, thereby preventing mitosis

A

Alkylates DNA, causing cross-links between parallel DNA strands

Heme/ Lymph (15 decks)

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