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IHO week 4 > Antineoplastics IV > Flashcards

Antineoplastics IV Flashcards

1
Q

Mechanism of resistance for vinca alkyloids:

A

decreased accumulation via increased P-glycoprotein expression

changes in target proteins**mutations in tubulin that prevent binding

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2
Q

Chemo regimens and specific diseases for vincristine:

A

MOPP – Hodgkin’s disease

CHOP – non-Hodgkin’s lymphoma

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3
Q

Specific regimens and disease for vinblastine:

A

ABVD – Hodgkin’s disease

PVB – testicular cancer

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4
Q

Most significant toxicity of vincristine:

A

CNS toxicity

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5
Q

Most significant toxicity of vinblastine:

A

Bone marrow suppression

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6
Q

Why is depression of deep tendon reflexes seen within 2-3 weeks in 100% of patients being treated with vinca alkyloids?

A

This is used as an indication of sufficient dose

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7
Q

What is used as an indication to decrease the dose of vinca alkyloids?

A

severe paresthesias (pins and needles) and mild to moderate sensory loss

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8
Q

MOA for taxanes?

A

bind to tubulin and enhance and stabilize spindle assembly

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9
Q

Mechanism of tumor cell resistance to taxanes?

A

decreased accumulation via increased P-glycoprotein expression

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10
Q

Metabolism of taxanes?

A

CYP450

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11
Q

Unique toxicities of taxanes?

A

hypersensitivity

peripheral neuropathy

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12
Q

Vinca alkyloid used with Capecitabine (similar to 5-FU) as 3rd line tx of breast cancer?

A

Ixabepilone

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13
Q

Why is Ixabepilone 3rd line for bresat CA?

A

DOES NOT produce multidrug resistance

** used after pts have failed anthracycline abx and taxane tx

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14
Q

Main result of using glucocorticoids in chemo?

A

immunosuppression

**decreased IL-2 and TNF-a

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15
Q

Cyclosporine

Class:

MOA:

Result:

A

Immunosupressive antibiotic

binds cyclophilin to to inhibit calcineurin

decreased release of IL-2 –> decreased T-cell proliferation

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16
Q

Tacrolimus

Class:

MOA:

Result:

A

Immunosuppressive antibiotic

binds FK-binding protein to inhibit calcineurin

decreased release of IL-2 –> decreased T-cell proliferation

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17
Q

Two immunosuppressive abx that inhibit mTOR making them anti-angiogenic and anti-proliferative:

A

Everolimus

Temsirolimus

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18
Q

Antibodies targeting CD20 in B-cell non-Hodgkin’s lymphoma:

A

Rituximab

Ibritumomab (90Y)

Tositumomab (131I)

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19
Q

Anitbodies targeting CD52 in B-cell chronic lymphocytic leukemia:

A

Alemtuzumab

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20
Q

Fusion protein that has diptheria toxin coupled to IL-2

  • inhibits protein translation by inactivating EF2
  • goal is to kill IL-2 receptor expressing cells (activated T’s B’s and Mac’s)
  • approved for use in cutaneous T-cell lymphoma
A

Denileukin Diftitux

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21
Q

General half life length of antibodies?

A

LONG (3-6 mos)

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22
Q

Toxicities of antibody tx:

A

infusion rxn

hypersensitivity (ie. HAMA)

infections (ie. reactivation of latent TB)

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23
Q

Specific toxicities for anti-CD antibodies:

A

cardiac arrhythmias

tumor lysis syndrome

24
Q
  • short half lifes
  • not cytotoxic
  • recruit immune cells to do the actual killing
25
- induces T-cells - half life = 13 min - used to induce LAK or CIK cells
IL-2
26
Big side effects of IL-2?
cytokine storm palmar-plantar erythrodysesthesia fatal hypotension
27
Decrease production of fibroblast growth factor (FGF) inhibits cell division of both normal and tumor cells increases MHC I expression on tumor cells
IFN-a
28
What is a function of FGF?
angiogenesis
29
Side effects of INF-a?
depression (mechanism not understood) flu-like sx hypotension myelosuppression
30
- causes fibroblast proliferation - chemokine induction (IL-6, IL-8) and T/B cell activation - SHORT half life (1-2 min) * *intra-arterial administration -decreases proliferation of tumor cells while sparing normal cells
TNF-a
31
Dose limiting toxicity of TNF-a?
malaise and flu-like sx ---> hemorrhagic necrosis
32
Stimulates production of RBCs?
erythropoietin
33
Stimulates production of neutrophils?
Filgrastim (G-CSF)
34
Stimulates production of granulocytes, eosinophils, basophils and monocytes?
Sagramostim (GM-CSF)
35
Stimulates production of platelets?
IL-11 Thrombopoietin
36
Tyrosine kinase STIs of Bcr-Abl: Cancer type:
Bosutinib Dasatinib Imatinib Nilotinib **CML
37
Tyrosin kinase STIs of EGFR: Cancer type:
Cetuximab Erlotinib Gefitinib Panitumumab **epithelial derived (lung, pancreas, head and neck, breast, prostate, colon, stomach, ovaries and brain)
38
Tyrosine kinase STIs of HER2: Cancer type:
Pertuzumab Trastuzumab (ADO-Trastuzumab Emtansine) **breast
39
Tyrosine kinase STIs of PDGF-R, VEGF-R: Cancer type:
Pazopanib, Sorafenib, Sunitinib **many
40
Tyrosine kinase STIs of c-kit: Cancer type:
Dasatanib Imatinib Nilotinib Sunitinib **GIST
41
binding of the antibody interferes with HER2 signaling identifies HER2 overexpressing cells as foreign so they can be destroyed by the immune system
Trastuzamab
42
first DIMERIZATION inhibitor prevents HER2 from dimerizing with other HER2 receptors
Pertuzumab
43
internalized and undergoes lysosomal degradation to form two components:
ADO-Trastuzumab Emtansine forms: - trastuzumab - DM1 --- small molecule that disrupts microtubules by binding tubulin
44
Toxicities of antibodies:
Hypersensitivity rxns HAMA infx birth defects/fetal loss ***ventricular dysfunction and CHF
45
Deprives tumor cells (some ALL cells lacking asparagine synthase) of asparagine:
L-Asparaginase **cause hypersensitivity rxn
46
Reversible inhibitor of 26S proteasome triggering apoptosis:
Bortezomib
47
Irreversible inhibitor of 26S proteasome triggering apoptosis:
Carfilzomib
48
Side fx of Bortezomib and Carfilzomib:
thrombocytopenia, neutropenia, anemia peripheral neuropathy
49
HDAC inhibitors increase transcription and lead to cell cycle arrest and apoptosis:
Romidepsin Vorinostat
50
Side effects of HDAC inhibitors:
Pulmonary embolis, DVT Drug interactions (increase efficacy of Warfarin) N/V hypERglycemia fatigue, chills dysgeusia, dry mouth
51
Promotes cell differentiation (ie. APL w/ t(15;17)):
Tretinoin (ATRA) **doesn't kill cell, must be followed by arsenic trioxide or anthracycline abx
52
Toxicities of ATRA:
CNS (dizziness, anxiety, depression, confusion, agitation) Differentiation syndrome (fever, weight loss, dyspnea, pulmonary infiltrates) birth defects
53
heavy metal toxin promotes cell death through apoptosis and necrosis
Arsenic Trioxide (ATO)
54
Toxicities of ATO:
arrythmias leukocyte maturation syndrome
55
Selectively activates retinoid X receptors approved for cutaneous T-cell lymphoma metabolized by CYP3A4 (potential for many drug interactions)
Bexarotene
56
Side effects of Bexarotene:
lipid abnormalities in pancreas GI sx Teratogenic

IHO week 4 (13 decks)

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