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Pharmacy312 > Cancer > Flashcards

Cancer Flashcards

1
Q

What is the pathogenesis of leukaemia?

A

Mutation of early haematopoietic progenitors, leading to excessive production of progenitors which replace normal bone marrow tissue. Loss of function erythrocytes, thrombocytes and leukocytes.

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2
Q

How can leukaemia be classified?

A

Acute or Chronic

Myeloid or Lymphoblastic

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3
Q

What is acute myeloid leukaemia?

A

Clonal proliferation of precursor cells which give rise to myeloid cells

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4
Q

What are the symptoms of acute myeloid leukaemia?

A

Pancytopaenia

  • thrombocytopaenia: easy bruising
  • neutropaenia: recurrent infection, slow wound healing
  • anaemia: fatigue
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5
Q

How is acute myeloid leukaemia diagnosed?

A

Anaemia that is normocytic and normochromic
Very low platelet count
Low leukocyte count

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6
Q

What is the principle of leukaemia treatment?

A
  1. Chemotherapy to induce remission
  2. Consolidation to destroy remaining leukaemia
  3. Maintenance to remain in remission
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7
Q

When is haematopoietic stem cell transplant considered?

A
  1. Younger patients
  2. When there is a suitable donor
  3. First or second remission
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8
Q

What is acute lymphoblastic leukaemia?

A

Clonal proliferation of stem cells of the lymphoid lineage

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9
Q

What are the symptoms of acute lymphoid leukaemia?

A

Splenomegaly
Hepatomegaly
*Due to excessive B and T lymphocyte progenitor formation

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10
Q

What is the difference between acute and chronic leukaemia?

A

Acute is more aggressive; chronic develops more slowly

Acute prevents blood stem cells from maturing, chronic prevents the development of mature/maturing blood cells

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11
Q

What is chronic myeloid leukaemia?

A

Myeloproliferative neoplasm categorised by the abnormal proliferation of mature/maturing granulocytes

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12
Q

What are the symptoms of chronic myeloid leukaemia?

A

Slow onset –> some patients are asymptomatic
Splenomegaly
Elevated WBC and platelets

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13
Q

What is the Philadelphia gene?

A

BCR region from chromosome 22 and ABL region from chromosome 9 undergo a fusion reaction to form the Philadelphia gene. This results in a tyrosine kinase signalling protein that is always “on”, resulting in uncontrolled cell divison.

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14
Q

What is the treatment of Chronic Myeloid Leukaemia?

A

Tyrosine Kinase Inhibitor: Imatinib

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15
Q

Imatinib MOA?

A

Competitively inhibits BCR-ABL tyrosine kinase by blocking the ATP binding site, preventing the conformation switch to the active form. this blocks the proliferation and induces apoptosis of BCR-ABL positive cell lines.

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16
Q

Imatinib ADR?

A 
ADR usually arise during a few months of treatment.
Neutropaenia, thrombocytopaenia
Gastrointestinal bleed
Nausea, vomiting --> take with food
Diarrhoea --> loperamide
Maculopapular rash
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17
Q

What should be monitored prior to initiating imatinib?

A 
Full blood count
Serum creatinine
Urea, electrolytes
Liver function test
TSH
INR
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18
Q

How often should patients taking imatinib be monitored?

A

Weekly for the first month
Biweekly for the second month
Every 2-3 weeks thereafter

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19
Q

What drugs interact with imatinib?

A

Imatinib is a CYP3A4, 2C9, 2D6 and 2C19 inhibitor, thus reacts with any drugs that are inducers or inhibitors of these enzymes.
Carbamezapine: CYP3A4 inducer
Azole antifungal: CYP3A4 inhibitor
Warfarin: metabolised by CYP2C9 and 3A4

20
Q

What is lymphoma?

A

Chronic malignancy of mature lymphocytes

21
Q

What is Hodgkin lymphoma?

A

Malignancy wherein Hodgkin Reed-Sternberg cells (a type of B cell) are mixed in with non-neoplastic cells

22
Q

What is the difference between Hodgkin and Non-Hodgkin lymphoma?

A

Hodgkin Lymphoma is diagnosed by the presence of Reed-Sternberg cells. Hodgkin lymphoma also typically begins in the upper body, Non-Hodgkin lymphoma begins anywhere/

23
Q

What are the symptoms of Hodgkin’s lymphoma?

A 
Asymptomatic lymphadenopathy
B symptoms
- fever
- night sweats
- unintentional weight loss
24
Q

How is Hodgkin’s Lymphoma staged?

A

Stage 1: single node
Stage 2: two nodes on one side of the diaphragm
Stage 3: bilateral nodes
Stage 4: extranodal (i.e. nodes on other parts of the body)

25
Q

What are the treatment options for Hodgkin Lymphoma?

A

Multi agent chemotherapy

  • ABVD
  • BEACOPP

Radiation therapy

26
Q

What is the best treatment option for early-stage Hodgkin lymphoma?

A

ABVD: doxorubicin, bleomycin, vincristine, darcapazine

27
Q

What is the best treatment for late-stage Hodgkin lymphoma?

A

BEACOPP: bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone

28
Q

When is radiation therapy considered in Hodgkin’s lymphoma?

A

Poor prognosis

Risk of relapse

29
Q

What is Non-hodgkin lymphoma?

A

Haematological malignancy arising from lymphocytes (B, T, NK)

30
Q

What are the subtypes of non-hodgkin lymphoma?

A

Aggressive/highly aggressie

Indolent

31
Q

What are the symptoms associated with aggressive NHL?

A

Fever, night sweats
Weight loss
Rapidly growing mass

32
Q

What are the symptoms associated with indolent NHL?

A

Waxing/waning lymphadenopathy
Hepatomegaly
Splenomegaly
Cytopaenia (loss of functional blood cells)

33
Q

What is the treatment of NHL?

A

R-CHOP:

  • rituximab
  • cyclophosphamide
  • doxorubicin
  • vincristine
  • prednisone
34
Q

Why is chemotherapy administered in cycles?

A

Chemotherapy only attacks cells that are currently dividing. By the time cancer is detected, those cells have stopped dividing and are in the G0 phase. Thus, chemotherapy is administered in a cycles to target cancer when it is dividing. Intermittent cycles also allow normal tissues time to recover.

35
Q

Rituximab MOA

A

rituximab is a monoclonal antibody that binds to transmembrane antigen CD20 to initiate cell lysis. This is done via 4 mechanisms:

  1. Antigen-dependent cell cytotoxicity
  2. Antigen-dependent cell phagocytosis
  3. Complement-dependent cytotoxicity
  4. Apoptosis
36
Q

How are chemotherapy doses calculated?

A

Body surface area:

root of height*weight over 3600

37
Q

What premedications are given for rituximab?

A

Loratadine and paracetamol to prevent hypersensitivity, for pain relief and to reduce infusion-related reactions.

38
Q

What happens if patients have rituximab-induced infusion reactions?

A

Treat symptoms of infusion reaction then administer at a reduced infusion rate.

39
Q

Rituximab ADR?

A

Serious infection
Infusion-related hypersensitivity reactions
CV AEs: exacerbation of angina, arrythmia, heart failure

40
Q

Cyclophosphamide MOA?

A

Alkylating agent, adds alkyl group to nucleic acids, proteins and amino acids, preventing strand separation by cross-linking DNA.

41
Q

Cyclophosphamide ADR?

A 
Haemorrhagic cystitis (bleeding from bladder)
Treat with fluids (unless fluid restricted) and MESNA.
42
Q

Doxorubucin MOA?

A

Anthracycline antibiotic, causes cell fragmentation by inhibiting DNA and RNA synthesis

43
Q

Doxorubicin ADR?

A

Cardiotoxicity
Hand-foot syndrome
Dehydration

44
Q

Vincristine MOA?

A

Vinca alkaloid, inhibits production of spindle fibres therefore inhibits mitosis in cancer cells.

45
Q

Vincristine ADR?

A

Constipation due to autonomic neuropathy

Treat with prophylactic laxatives

46
Q

Vincristine must be administered…

A

…via IV

47
Q

Prednisone MOA?

A

Glucocorticoid, reduces the number of circulating lymphocytes, eosinophils and monocytes and decreases inflammation.

Pharmacy312 (5 decks)

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