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Pharmacology > Cancer Chemotherapy > Flashcards

Cancer Chemotherapy Flashcards

1
Q

Define neoplasm

A
  • Large tumors
  • Benign or malignant
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2
Q

Define cancer

A
  • Malignant forms of neoplastic disease
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3
Q

Define carcinogen**

A
  • Things that may cause cancer
  • Environmental, viral, genetic
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4
Q

Epidemiology of caner in the US

A
  • 2nd leading cause of death
  • One in every 4 deaths in the US is due to cancer
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5
Q

Approaches to treatment of cancer**

A
  • Surgery
  • Radiation
  • Chemotherapy: adjuvant vs neoadjuvant (chemo 1st) = chemo used in combination with surgery and/or radiation; palliative/curative
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6
Q

What are the general principles of chemotherapy

A
  • Cytotoxic strategy: drug should limit cell proliferation by killing or attenuating the growth of cancerous cells
  • Drug inhibits DNA/RNA synthesis & function: drug will be more effective against cells rapidly undergoing mitosis
  • **Collateral damage: damage to deathly cells, ideal chemo drugs limit this
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7
Q

Describe drug effects related to the cell cycle specific phases**

A
  • Drug effects specific phase of cell cycle
  • Drug will not be effective if cell is in G0 phase
  • Ex: Methotrexate
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8
Q

Define growth fraction**

A
  • Percentage of proliferating cells relative to total neoplastic cell population
  • Higher growth fraction = more cells are susceptible to treatment
  • Growth fraction decreases as tumor size increases
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8
Q

Describe drug effects related to the cell cycle nonspecific phases**

A
  • Drug effective regardless of cell phase
  • Ex: Alkylating agents
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9
Q

Define cell kill hypothesis

A
  • Each round of chemotherapy will kill a certain percentage of cancer cells
  • In theory you can never kill all of the cancer cells
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10
Q

What are anticancer drugs classified by

A
  • MOA
  • Chemical structure
  • Source
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11
Q

Describe alkylating agents (IV)

A
  • Cyclophosphamide & Ifosfamide
  • MOA: bind DNA strands to prevent DNA function & replication; cell cycle nonspecific
  • Commonly used in Leukemia & Carcinomas
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12
Q

Common side effects of alkylating agents

A
  • Blood disorders (-penias)
  • N/V (nausea/vomiting)
  • Loss of appetite
  • CNS toxicity
  • Hemorrhagic cystitis (cyclophosphamide)
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13
Q

Describe platinum coordination complexes (IV)

A
  • End in “-platins”
  • Cisplatin, Carboplatin, Oxaliplation
  • MOA: alkylating agents form cross links between & within DNA strands with platinum as opposed to alkyl side chains
  • Commonly used for Ovarian & Colon cancer
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14
Q

Common side effects of platinum coordination complexes

A
  • Blood disorders “penias”
  • N/V/D (Pukey platinums; most common)
  • Anaphylactoid reactions
  • Peripheral neuropathy (carbo, oxal)
  • Neurotoxicity (cisplatin)
  • Respiratory toxicity (oxaliplatin)
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15
Q

Describes antimetabolites (IV)

A
  • Interfere with normal metabolites during DNA/RNA synthesis
  • Incorporation into genetic material or occupying enzymes that synthesize genetic material
  • Cell cycle specific
  • Commonly used in Leukemias, breast & GI cancers
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16
Q

Where is leukemia and carcinomas

A
  • Leukemia: in the blood
  • Carcinomas: in epithelial cells/tissue
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17
Q

Common side effects of antimetabolites

A
  • Blood disorders “-penias”
  • N/V
  • Muscle pain, fatigue
  • Hair loss
  • Rash
  • Nephrotoxicity (methotrexate)
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18
Q

Describe anticancer antibiotics (IV)

A
  • End in “-mycins” and “-rubicins”
  • Block synthesis of RNA, DNA, or both leading to disruption in cell synthesis
  • Commonly used in Leukemia, Lymphoma, GI, & Carcinomas
19
Q

Symptoms of acute toxicity for anticancer antibiotics

A
  • N/V
  • Fever
  • Red urine: Daunorubicon & Doxorubicin; this is not hematuria
20
Q

Symptoms of delayed toxicity for anticancer antibiotics

A
  • Pulmonary fibrosis: Bleomycin
  • Skin & mucocutaneous
  • Cardiotoxicity: “-rubicins”
  • Blood disorders “-penias”
21
Q

Describe antimicrotuble agents (IV)

A
  • End in “-taxel” and “-istine”
  • Cell cycle specific (CCS) medications
  • Commonly used for Leukemias, Lymphomas, GI, breast, & ovarian cancers
22
Q

Common side effects of antimicrotuble agents

A
  • Blood disorders “-penias”
  • N/V/D
  • Cardiopulmonary toxicity (taxanes)
  • Peripheral neuropathies
23
Q

Describe topoisomerase inhibitors (IV)

A
  • Etoposide, Irinotecan
  • MOA: inhibit enzymes needed for DNA replication & leads to break in DNA double helix
  • Commonly used for lung, ovarian, colorectal cancers
24
Q

Common side effects of topoisomerase inhibitors

A
  • Severe diarrhea (I-RAN-To-The-Can)
  • Blood disorders “-penias”
  • N/V
25
Q

List injection hormonal agents

A
  • Steroids
  • Androgens
  • Antiandrogens
  • Gonadotropin releasing hormones
  • Used in hormone responsive cancers such as prostate
26
Q

List oral hormonal agents**

A
  • Aromatase inhibitors
  • Estrogens
  • Antiestrogens
  • Progestins
  • Used for hormone responsive cancers such as breast
27
Q

Describe targeted/biologic agents

A
  • Monoclonal antibodies (-mabs): mostly IV therapies; Alemtuzumab, bevacizumab, rituximab, trastuzumab
  • Cytokines: Interferon alfa-2b & interleukin-2; IV/SQ therapy
  • Tyrosine kinase inhibitors (-nibs): oral options; erlotinib, imatinib, sorafenib
  • All 3 work along side the immune system instead of attacking the DNA
28
Q

Describe monoclonal antibodies (MAb)

A
  • Not only used for cancers
  • Can be used for immunologic diseases such as Crohn’s, RA, allergies, & more
  • Side effects: infusion related reactions
29
Q

MOA of tyrosine kinase inhibitors (-nib)

A
  • Target therapy
  • Disrupt cell signal transduction of cancer specific proteins
  • Less damage to normal cells than traditional chemotherapy
30
Q

Slide 35/36 is good for an overview

A
31
Q

Important to know about combination chemotherapy regimens

A
  • Most of the time several chemo agents are administered at one time
  • Thought is to inhibit cell replication by more than one target
  • Increases likelihood of success
32
Q

What is the most common reason for treatment failure

A
  • Resistance
33
Q

What are the methods to overcome resistance

A
  • Increase dose
  • Increase treatment frequency
  • Adjust sequence
  • Clinical trials/alternative therapies
34
Q

Describe the prevalence of adverse effects

A
  • Common and predictable
  • Most impactful on therapy course
  • Normal cells undergoing rapid mitosis: hair follicles, bone marrow, immune cells, & epithelial cells (skin/GI)
35
Q

What are the common side effects of chemotherapy regimens

A
  • N/V
  • Fatigue
  • Lab problems
  • Hair loss
  • Pain
36
Q

Describe treatment of CINV

A
  • Treating GI side effects improves QOL
  • Steroids: dexamethasone or prednisone
  • **5-HT3 inhibitors (end in”-setron”)
  • Neurokini-1 receptor inhibitors: aprepitant or fosaprepitant
  • Alcohol swabs can potentially fix a patients nausea
37
Q

Describe treatment approaches for cancer related pain & fatigue

A
  • Analgesics: may be beneficial for pain
  • Non-pharmacologic approaches: exercise, stretching, massage, TENS, reassurance/support
  • Moderate fatigue associated with rehab programs improves capacity to tolerate pain, fatigue, and other cancer related side effects
38
Q

Describe anemia & neutropenia precautions**

A
  • Anemia common: review hemoglobin, hematocrit, & platelets before treating; expect reduced aerobic capacity, tachycardia
  • Neutropenia precautions: review WBCs, absolute neutrophil count (ANC); look for meds ending in “-stim” (filgrastim); implications for individual vs group therapy; potential isolation precautions
39
Q

Describe lymphedema

A
  • Results from lymph node removal during cancer surgery, radiation therapy, or obstructing tumor
  • Higher risk in breast, prostate, lymphoma, melanoma, head, & neck cancer
  • Most often occurs in the arms or legs
40
Q

What is the rehabilitation focus for all cancer patients

A
  • Continue for 6-8 wks after last treatment
  • Individualize
  • Pre-habilitation (if possible)
  • Daily to every other day
  • Expect/manage side effects
41
Q

What are the pediatric considerations for cancer PT rehabilitation

A
  • Stretching
  • Gait training
  • Exercise
  • Strength
  • Balance
  • Neuro or motor rehab
42
Q

Describe on cycle rehab**

A
  • When a patient is receiving treatment
  • Expect clinical deterioration
  • Provide reduced intensity plan
  • May need to be treated individually due to immunocompromised
43
Q

Describe off cycle rehab**

A
  • Patient is not actively receiving treatment
  • Rebuild what was lost on-cycle
  • Increase muscle force & aerobic capacity
44
Q

Describe the timeline of therapy in cancer patients

A
  • Cancer diagnosis
  • Pre-habilitation
  • On cycle rehab
  • Supportive therapy
  • Off cycle rehab
  • Restorative therapy
  • End of treatment
  • Palliative therapy or continued restorative therapy

Pharmacology (12 decks)

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