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Cancer and Chemotherapy Flashcards

1
Q

Chemotherapy can be used in combination with ______ to shrink tumor cells (adjuvant therapy)

A

Surgery

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2
Q

Challenges to Chemotherapy:

A
  • Toxicity
  • Need complete cell death
  • Poor response
  • Drug resistance
  • Limited drug access
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3
Q

Bone marrow suppression by chemotherapy:

A
  • Inhibits capacity to fight infection
  • Causes anemia
  • Can interfere with blood clotting resulting in bleeding

MONITOR BLOOD CELL COUNT*

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4
Q

Increase in uric acid can lead to acute kidney injury due to the destruction of the cancer cells being filtered through the kidney:

A

TUMOR LYSIS SYNDROME

-cells killed by chemotherapy dump their contents causing injury

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5
Q

TUMOR LYSIS SYNDROME:
Increases?
Decreases?

A
  • Increase in: Potassium, Phosphorus

- Decreases in: Calcium

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6
Q

What do patients need to do when experiencing Tumor Lysis Syndrome?

A

Drink, urinate, drink, urinate

-Uric acid (end product of purine metabolism) can cause kidney problems so patients must remain well hydrated

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7
Q

Strategies for cancer treatment

A
  • Multiple approaches: chemo, surgery, radiation therapy
  • Intermittent chemo (timing)
  • Combination chemo (multiple mechanisms simultaneously)
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8
Q

Label all chemotherapeutic drugs with a ______ biohazard label

A

YELLOW

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9
Q

Chemo stays in your body for __ hours!!

A

48 hours

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10
Q

ALKYLATING AGENTS include:

A
  • NITROGEN MUSTARDS
    • Cyclophosphamide (Cytoxan)
  • NITROSOUREAS
    • Carmustine (Gliadel)
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11
Q

ALKYLATING AGENTS

A
  • MOA: Cell kill results from alkylation of DNA
  • Resistance is common
  • Toxic to tissues that have high growth fraction
  • Vesicant (cause damage to tissues and veins if infiltrated)
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12
Q

Nitrogen Mustard includes:

class but still under alkylating agents

A

CycloPhosphamide (Cytoxan)

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13
Q

Cyclophosphamide (Cytoxan)

A
  • Broad spectrum: Hodgkin’s, non-Hodgkin’s, Multiple Myeloma, and solid tumors
  • Converts to active form in liver
  • IV or PO
  • Dose limiting toxicity: BONE MARROW SUPPRESSION*
  • S/E: Severe nausea, vomiting, & alopecia
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14
Q

Cyclophosphamide (Cytoxan) can cause***

A

ACUTE HEMORRHAGIC CYSTITIS

  • Report blood in urine/pink tinged
  • Give Mesna to protect against cystitis
  • Drink, urinate, drink, urinate
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15
Q

Nitrosoureas include:

A

Carmustine (Gliadel)

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16
Q

Carmustine (Gliadel)

A
  • Indications: BRAIN, Hodgkin’s, non-Hodgkin’s, MM, malignant melanoma, hepatoma, adenocarcinoma
  • Dose-limiting toxicity: Delayed bone marrow suppression
  • s/e: N/V, Injury to liver and kidneys, pulmonary fibrosis
  • Topical or IV
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17
Q

Platinum Compounds (Class)

A

Cisplatin (Platinol)

  • Produce cross-link to DNA
  • Cell-cycle phase nonspecific

-Very similar to alkylating agents

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18
Q

Cisplatin (Platinol)

A
  • Kills cells by forming cross-links between and within strands of DNA
  • Indications: Metastatic testicular and ovarian cancers and advanced bladder cancer
  • Dose limiting toxicity: KIDNEY DAMAGE
  • Highly emetogenic (100% N/V = give Zofran 1 hr before)
  • s/e: OTOTOXIC, bone marrow suppression, peripheral neuropathy
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19
Q

ANTIMETABOLITES include:

A

Folic Acid Analogs
Pyrimidine Analongs
Purine Analogs
Hypomethylating Agents

20
Q

Folic Acid Analogs (Class)

A

Methotrexate

  • MOA: blocks the conversion of folic acid to its active form
  • Uses: non-Hodgkin’s, leukemia, head and neck, RA and Crohn’s***
  • Crosses BBB
  • Given PO, IM, IV and intrathecally (in spine)
  • Dose limiting toxicities: bone marrow suppression, pulmonary infiltrates and fibrosis, & oral and GI ulceration
21
Q

Methotrexate cont.

A
  • S Phase specific
  • Avoid completely until after 6 months of treatment to get pregnant***
  • N/V starts soon after administration (prophylactically give antiemetic)
  • Alkalinize urine with sodium bicarbonate. Minimize kidney injury (MONITOR KIDNEYS CLOSELY)
  • LEUCOVORIN RESCUE: promote drug clearance to save normal cells
22
Q

Pyrimidine Analogs (Class)

A

Fluorouracil (Adrucil) - 5FU

  • MOA: Inhibits thymidylate synthetase depriving cells of thymidylate needed to make DNA
  • Uses: Solid tumors, some skin cancers (can be given topically), GI cancers
  • Continuous IV (can let pts go home w/ 5FU)
  • Dose limiting toxicity: Bone marrow suppression and oral and GI ulceration
23
Q

Fluorouracil (Adrucil) 5FU

A
  • S Phase specific
  • 7-10 days after, most risk for infection due to bone marrow suppression
  • Alopecia (temporary)
  • Hand Foot Syndrome: tingling, burning, etc. of palms and soles
  • URIDINE TRIACETATE: dampen the effects of 5FU at the cellular level (ANTIDOTE)***
24
Q

Antidote for Fluorouracil (Adrucil) 5FU

A

Uridine Triacetate

25
Purine Analogs (class)
Mercaptopurine (Purinethol) - MOA: Disrupts purine biosynthesis, nucleotide inter conversion, and biosynthesis of nucleic acid - Uses: Maintenance acute lymphocytic leukemia - Dose limiting toxicity: Bone marrow suppression - PO - Not used in pregnancy - S PHASE - MONITOR LIVER (MILD HEPATOXICITY)**
26
Hypomethylating Agents (New Class)
Azacitidine (Vidaza) - Becomes incorporated into DNA and then inhibits DNA methyltransferase - Indicated for MYELODYSPLASTIC SYNDROME (group of disorders caused when something disrupts the production of blood cells) - Toxicities: Myelosuppression, n/v, and CNS Depression
27
Antitumor Antibiotics:
- Cytotoxic drugs - Isolated from cultures of Streptomyces - Injure cells through direct interaction with DNA - 2 Major groups: Anthracyclines & Nonanthracyclines
28
Anthracycline | Class - under Antitumor Antibiotics
Doxorubicin (Adriamycin) - "Red Devil" - Broad spectrum - Kills cells by intercalation with DNA and inhibition of topoisomerase II - Administered intravenously - A/E: N/V, Red colored urine and sweat, extravasation injury to tissues - Dose limiting toxicity: Bone marrow suppression
29
Doxorubicin (Adriamycin) Cont.
- CARDIOTOXIC - Prior to administration: ECHO MUST BE DONE (monitor ejection fraction) - CAN ONLY RECEIVE 550 mg IN A LIFE TIME - Vesicant - Can be given IV Push: check for blood return often!! ZINECARD: can protect the heart while on this drug - possibly reduce effects of chemo and causes additional myelosuppression Decrease dose if pt has liver impairment
30
Mitotic Inhibitors
- Act during M Phase to prevent cell division | - Two groups: Vinca alkaloids and taxanes
31
Vinca Alkaloids (Class)
Vincristine (Oncovin) -MOA: Block mitosis during metaphase Indications: Hodgkin's, non-Hodgkin's, acute lymphocytic leukemia, Wilms' tumor, rhabdomyosarcoma, Kaposi's sarcoma, breast and bladder cancer -Dose limiting toxicity: Peripheral neuropathy
32
Vincristine (Oncovin) cont.
- At risk for falls due to peripheral neuropathy of feet - Constipation**** (hydrate pt and make sure pt ambulates) - Vesicant - N/V is uncommon - Usually a combination drug (Vincristine spares bone marrow suppression but other drugs cause bone marrow suppression)
33
Taxanes (Class)
Paclitaxel (Taxol) - MOA: acts during late G2 and M phases** - Toxicity: Severe hypersensitivity reactions* - Pre-medicate to prevent allergic rxns (steroids, benadryl) - Major dose limiting toxicity: Bone marrow suppression * Peripheral neuropathy, bradycardia, 2nd and 3rd degree heart block, fatal MI **CONTRAINDICATED IN CARDIAC PTS*
34
Miscellaneous Cytotoxic Drugs:
Asparaginase (Elspar) - MOA: Converts asparagine into aspartic acid - Toxicity: Limited almost exclusively to leukemic lymphoblasts - Fatal anaphylaxis - N/V
35
Asparaginase (Elspar) Cont..
- G1 phase, does not affect all cells - A/E: Coagulation deficiencies (by inhibiting the proteins), injury to liver, pancreas, kidneys, CNS Depression - NO bone marrow suppression, no alopecia, no oral mucositis, no intestinal ulceration, does not cross BBB***************************
36
Antiestrogens block the activity of normal estrogen, but only in _______ _______ __ cells
Estrogen sensitive (ER+) cells
37
Antiestrogens (class)
Tamoxifen (Nolvadex) - MOA: a prodrug that undergoes hepatic conversion to active metabolities then block ERs on breast cancer cells, and thereby prevent receptor activation by estradiol - For TREATMENT AND PREVENTION of breast cancer (gold standard) - Pregnancy risk category D - Risk for endometrial cancer* * Also risk for DVTs and pulmonary embolisms*
38
Tamoxifen (Nolvadex) Cont..
- Most common - SERM (selective estrogen receptor modulator)** - CYP2D6 inhibitors - NO SSRIs*** A/E: Postmenopausal symptoms, hot flashes, n/v
39
Aromatase inhibitors function:
- Used to treat ER+ breast cancer in postmenopausal women*** - Deprive breast cancer cells of estrogen by blocking the production of estrogen from androgenic precursors - Can increase risk of fractures and have been associated with moderate to severe myalgias - More effective than tamoxifen (no risk for endometrial cancer and rarely causes thromboembolism - more narrow range of patients)
40
Aromatase Inhibitors (class)
Anastrozole (Arimidex) - ER+ breast cancer in postmenopausal women - PO daily for about 2-5 yrs - A/E: MUSCULOSKELETAL PAIN**, headache, menopausal symptoms - At risk for osteoporosis
41
Interfering with the production of _________ reduces prostate cancer cell proliferation
Testosterone
42
Gonadotropin-Releasing Hormone Agonist (GnRH Agonists) function:
Suppress production of androgens by testes (not by the adrenal glands and prostate cancer cells)
43
GnRH Agonists (class)
Leuprolide (Lupron Depot) - Indications: advanced prostate cancer (does not cure prostate cancer, prolongs pt life) - A/E: hot flashes - Will cause TUMOR FLARE SYMPTOMS** (bone pain, numbness/weakness at arms and legs, decreased urination, hot flashes) - Heart attack and stroke are major warnings
44
Gonadotropin-Releasing Hormone Antagonist (Class)
Degarelix (Firmagon) - Same MOA of GnRH Agonists - do NOT produce an initial tumor flare - Indicated for palliative treatment of advanced prostate cancer - SUBQ administration - 10% develop antibodies to prevent drug from working - Monitor liver function, electrolytes, and cardiac (ECHO)
45
Androgen Receptor Blockers (Antiandrogens) indicated for...
Indicated only for advanced androgen-sensitive prostate cancer – and only in combination with surgical castration or chemical castration using a GnRH agonist
46
Androgen Receptor Blockers (class)
Flutamide -ONLY for prostate cancer - 2 purposes: 1. Prevent tumor flare when GnRH therapy is started 2. Block the effects of adrenal and prostatic androgens - Given orally (rapid and complete absorption) - A/E: Rectal bleeding** Liver function test needs to be monitored (rare chance of liver toxicity)

Pharmacology (17 decks)

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