Brain Tumors

Question 1

DNA methylator

Answer 1

temozolamide

Question 2

DNA alkylators

Answer 2

carmustine (BCNU)

Question 3

moa of temozolamide

Answer 3

non-enzymatically activated pro-drug yielding a DNA methylating agent

Question 4

resistance development of temozolamide

Answer 4

↑of MGMT activity & capacity –> ↑ability to repair DNA damage of tumor cells (contributes to heme malignancy – ↓MGMT)

Question 5

temozolomide AE

Answer 5

myelosuppresion, leukopenia & thrombocytopenia (mild-moderate), N/V (1-3 hours post-tx); chills, fever, malaise & myalgias

Question 6

pregnancy category of temozolomide

Answer 6

category X, teratogen

Question 7

on label use for temozolomide

Answer 7

astrocytoma, GBM

Question 8

moa of carmustine

Answer 8

DNA alkylator & decomposition products carbamolyate proteins which inhibit DNA repair (protein adducts contribute to toxicity)

Question 9

AE of DNA alkylators

Answer 9

∙ thrombocytopenia, leucopenia, N/V
∙ admin site reactions
∙ delayed pulmonary fibrosis/infiltrates
∙ endocrine dysfunction w/ irradiation
∙ ↑prolactin & hypothyroidism, ↓T4
∙ encephalopathy & seizures –> dementia
∙ ↑transaminases, alk phos & ↑bilirubin

Question 10

administration of DNA alkylators

Answer 10

carmustine - IV

Question 11

distribution of DNA alkylators

Answer 11

highly lipophilic & non-ionized @ physiologic pH – enters CNS

Question 12

uses for carmustine

Answer 12

astrocytoma, mets, malingnant glioma, medulloblastoma

Question 13

mechanism of chemo-fog

Answer 13

cytotoxics promote peripheral release of TNF-alpha in response to cellular damage (which accesses BBB) – TNF-a damages mitochondria AND produces reactive nitrogen species via a glial cell-related mechanism