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CA Pharm Flashcards

1
Q

Five main classes of cancer drugs

A

alkylating agents, antimetabolites, natural products, antibodies, miscellaneous

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2
Q

Oncogene

A

gene that positively influences tumor growth

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3
Q

Tumor suppressor

A

gene that negatively influences tumor growth

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4
Q

Activation of oncogenes overrides which check point?

A

G1 arrest

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5
Q

Inactivation of tumor suppressor genes overrides which check point?

A

G2 arrest

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6
Q

Treatment process for primary chemotherapy

A

chemo! for advanced CA and metastatic disease

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7
Q

Goals of primary chemotherapy

A

relieve tumor-related symptoms, improve quality of life, prolong time to tumor progression

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8
Q

CAs curable by primary chemotherapy

A

Hodgkin’s and NHL, Burkitt’s lymphoma, Wilms tumor, embyonal rhabodmyosarcoma, choriocarcinoma, germ cell cancer, acute lymphoblastic leukemia

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9
Q

Neoadjuvant chemotherapy treatment process

A

chemo -> surgery -> chemo

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10
Q

Goal of neoadjuvant chemo

A

reduce tumor size to make resection easier and more effective, follow up with chemo to prevent relapse

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11
Q

Adjuvant chemotherapy treatment process

A

surgery -> chemo

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12
Q

Goal of adjuvant chemo

A

reduce incidence of local and systemic recurrence, improve survival of patients

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13
Q

Growth fraction definition

A

ratio of proliferating to G0 cells

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14
Q

Growth fraction can determine what about a tissue?

A

responsiveness to chemotherapy; higher growth fraction, more curable

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15
Q

Cell types with high growth fraction

A

bone marrow, GI tract, hair follicles, sperm-forming cells

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16
Q

How can growth fraction of solid tumors be increased?

A

reducing tumor burden via surgery or radiation

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17
Q

Main challenge in achieving therapeutic balance during treatment

A

therapeutic without being too toxic

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18
Q

Pharmacokinetics of antineoplastic therapy

A

first-order, given dose of a drug destroys a constant fraction of cells rather than an absolute number

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19
Q

High-dose intermittent therapy allows what for normal tissues

A

recovery

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20
Q

Common routes of chemo administration

A

IV and PO

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21
Q

Why should alternative drug administration routes be considered for some patients?

A

can reduce systemic toxicity and increase drug delivery

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22
Q

Pharmacologic sanctuaries

A

regions where tumor cells are less susceptible to antineoplastic drugs (CNS)

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23
Q

Alternative chemo admin routes

A

intracavity, intrathecal, intraventricular, intraarterial, topical, isolated limb perfusion

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24
Q

Advantages of combination chemotherapy

A

provides maximal cell killing, effective against a broader range of cell lines in heterogenous tumors, may delay or prevent development of drug-resistant tumors

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25
Primary chemotherapeutic drug resistance
occurs in the absence of prior exposure, often due to the genetic instability of CA and p53 mutations
26
Acquired chemo drug resistance
develops in response to exposure to a given drug, due to genetic change
27
Examples of acquired drug resistance
decreased drug transport into cells, reduced drug affinity due to mutations in target, increased expression of enzyme that inactivates drug, increased expression of DNA repair enzymes for drugs that damage DNA
28
P-glycoprotein is present in which tissues?
tissues with barrier functions such as kidney, liver, GI tract; blood-brain barrier and placental-blood barrier
29
Role of PGP
pumps drug out of a cell, may indicate inherent or primary resistance or acquired resistance
30
Rapidly proliferating tissues that demonstrate major sites of toxicity
bone marrow, GI tract, hair follicles, oral mucosa, sperm forming cells
31
How can adverse drug effects be minimized?
choosing a route that minimizes systemic toxicity and providing pharmacologic agents that can decrease adverse effects
32
Hematopoietic agents can decrease what adverse effects?
neutropenia, thrombocytopenia, anemia
33
Serotonin receptor antagonists can decrease what adverse effects?
emetegoenicity
34
Bisphosphonates can delay what complications?
skeletal complications
35
Five major types of alkylating agents
nitrogen mustards, nitrosoureas, alkyl sulfonates, methylhydrazine derivatives, triazines **also platinum compounds
36
What type of alkylating agent is cyclophosphamide?
nitrogen mustard
37
What type of alkylating agent is carmustine?
nitrosourea
38
What type of alkylating agent is busulfan?
alkyl sulfonates
39
What type of alkylating agent is procarbazine?
methylhydrazine derivative
40
What type of alkylating agent is dacarbazine?
tirazines
41
What type of alkylating agent is cisplatin?
platinum compounds
42
Most widely used alkylating agent
cyclophosphamide
43
MOA of alkylating agents
form covalent linkages within DNA, prevents the unwinding of DNA so cells cannot make RNA and DNA; non cell cycle specific
44
What enzyme activates cyclophosphamide?
CYP2B
45
What are the cytotoxic metabolites of cyclophosphamide?
acrolein, phosphoramide mustard
46
Side effect of acrolein
hemorrhagic cystitis
47
Drug that inactivates acrolein
Mesna
48
Acute toxicity of alkylating agents
nausea and vomiting (may pretreat with zofran) and delayed toxicities such as bone marrow depression, alopecia, nephrotoxicity, mucosal ulceration, intestinal denudation
49
AE associated with cisplatin
renal tubular damage, ototoxicity
50
AE associated with busulfan
pulmonary fibrosis
51
Main categories of antimetabolites
folic acid analogs, pyrimidine analogs, purine analogs
52
MOA of antimetabolites
block or subvert pathways involved in cell replication, cell cycle specific
53
Methotrexate is an analog of what?
folic acid
54
Fluorouracil is an analog of what?
pyrimidines
55
Mercaptopurine is an analog of what?
purine
56
What enzyme does methotrexate inhibit?
dihydrofolate reductase
57
What other diseases can methotrexate be used to treat?
rheumatoid arthritis and psoriasis
58
What drug is used in combination therapy with methotrexate?
leucovorin, used to rescue normal cells
59
Leucovorin is an analog of what?
methylene FH4
60
Active compound of fluorouracil
FdUMP
61
FdUMP action
covalently binds thymidylate synthetase and blocks synthesis of thymidylate; incorporated into DNA synthesis
62
Enzyme that metabolizes mercaptopurine
hypo-xanthine-guanine phosphoribosyl transferase (HGPRT)
63
Active form of mercaptopurine
6-thioinosinic acid
64
Enzyme that biotransforms 6-thioinosinic acid
xanthine oxidase
65
What drug should be used in supportive care of leukemia to prevent hyperuricemia?
allopurinol
66
What portion of the cell cycle are antimetabolites specific to?
S-phase
67
Common administration routes of antimetabolites
oral, IV, intrathecal
68
Common toxicities of antimetabolites
diarrhea, myelosuppression, nausea, vomiting, immunosuppression, thrombocytopenia, leukopenia, hepatotoxicity
69
Where are natural antineoplastic agents found?
extracted from plants/trees, isolated from cultures of bacteria, enzymes
70
Vinca alkaloids MOA
bind to beta-tubulin and inhibit microtubule assembly (depolarization), specific to M phase
71
Common AE of vinca alkaloids
alopecia and bone marrow depression
72
AE of vinblastine vs vincristine
Vinblastine - myelosuppression | Vincristine - cumulative neuro toxicities
73
Taxanes MOA
Binds to beta-tubulin and stabilize microtubule formation, mitosis inhibition
74
Paclitaxel AE
hypersensitivity in hands and toes, change in taste
75
Docetaxel AE
hypersensitivity, neutropenia, hair loss
76
Function of topoisomerase I
cut one strand to dsDNA to relax and reanneal strand
77
Function of topoisomerase II
cut both strands of double-stranded DNA, coil and uncoil DNA supercoils
78
Drugs that inhibit topoisomerase I
camptothecins
79
Drugs that inhibit topoisomerase II
epipodophyllotoxins and anthracycline abx
80
What bacteria produce anticancer antibiotics?
Streptomyces
81
Anthracyclins MOA
topoisomerase II inhibitor and DNA intercalation, cell cycle nonspecific
82
Anthracyclins AE
Produces free radicals that can lead to cardiotoxicity -- dysrhythmias and heart failure
83
Bleomycin MOA
single and dsDNA breaks
84
Bleomycin AE
pulmonary toxicity resulting in pneumonitis with cough, dyspnea and inspiratory crackers
85
Dactinomycin MOA
intercalation of DNA
86
MOA asparaginase and pegaspargase
hydrolyzes circulating L-asparagine into aspartic acid and ammonia, inhibiting protein synthesis, works at G1
87
Toxicities associated with asparaginase and pegaspargase treatment
acute hypersensitivity (fever, chills, N/V, skin rash), increased risk of clotting and bleeding, pancreatitis, CNS toxicity
88
Acute promyelocytic leukemia translocation
t(15;17), creates PML-RARa fusion protein
89
Tretinoin MOA
binds PML-RARa and antagonizes inhibitory effect on gene transcription
90
BCR-ABL fusion protein results from which translocation?
t(9;22)
91
MOA Imatinib
inhibits ABL tyrosine kinase, inhibit RTKs PDGFR and KIT
92
MOA Erlotinib and gefitinib
inhibitors of EGFR, used for lung and pancreatic CA
93
Toxicities caused by erlotinib and gefitinib
dermatologic
94
Tyrosine kinase and growth factor inhibitors MOA
inhibit tyr kinase activity and growth factor receptor signaling
95
AE tyrosine kinase and growth factor inhibitors
acneform skin rash and hypersensitivity, N/V
96
Functions of interferons in CA response
inhibit cell growth, alter cell differentiation, interfere with oncogene expression, increase macrophage activity
97
AE of interferon therapy
bone marrow depression, neutropenia, anemia, renal toxicity, edema, arrhythmias
98
IL-2 MOA
increases cytotoxic killing by T cells and NK cells
99
Toxicity of IL-2
capillary leak syndrome
100
Rituximab antigen and ag function
CD20, proliferation and differentiation
101
Rituximab CA
NHL
102
Most active cytotoxic agents to malignant melanoma
dacarbazine, temozolomide, cisplatin
103
Biological agents used to treat malignant melanoma
IFN-a and IL-2
104
Nivolumab and pembrolizumab CA
malignant melanoma
105
Mucositis is commonly caused by which chemotherapies?
methotrexate, melphalan
106
Pulmonary fibrosis is commonly caused by which chemotherapies?
Bleomycin, busulfan
107
Peripheral neuropathy is commonly caused by which chemotherapies?
Vincristine
108
Ototoxicity is commonly caused by which chemotherapies?
cisplatin
109
Cardiotoxicity is commonly caused by which chemotherapies?
doxorubicin, daunorubicin
110
Nephrotoxicity is commonly caused by which chemotherapies?
cisplatin, cyclophosphamide
111
Hemorrhagic cystitis is commonly caused by which chemotherapies?
cyclophosphamide, ifosfamide

SBL (21 decks)

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