Cancer Chemotherapy Flashcards

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1
Q

Name some alkylating agents.

A
  • Platinum based: cisplatin, which is used to treat testicular cancer.
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2
Q

What is the mechanism of action of alkylating agents?

A
  • Forms cross links in the two DNA strands preventing a break and DNA replication.
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3
Q

What other chemotherapy class of drug prevents DNA replication?

A
  • Intercalating agents.
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4
Q

Why are alkylating agents less effective at targeting tumour cells?

A
  • Tumour cells have a pump that recognises alkylating agents and pumps it back out of the cell - target the pump.
  • Glutathione inside the cell mops is the active moiety of alkylating agent, neutralising it.
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5
Q

Name some anti metabolites.

A
  • Methotrexate

- 5-fluorouracil

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6
Q

Mechanism of action of methotrexate and 5-fluorouracil.

A
  • Methotrexate is used in haematological malignancies - inhibits DHFR so lack of folate production means no DNA synthesis.
  • 5-F inhibits thymidylate synthase causing DNA damage.
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7
Q

Name some spindle poisons?

A
  • Taxoids

- Vinca alkaloids

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8
Q

Mechanism of action of spindle poisons

A
  • Disrupt microtubule dynamics in pre-metaphase stage.
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9
Q

Mechanism of action of Taxoids

A

-Taxoids promote the assembly and prevent the disassembly, making the spindle fibres/ microtubules so rigid that the cell cannot divide.

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10
Q

Mechanism of action of Vinca Alkaloids

A
  • Prevent spindle formation by binding to tubulin and preventing polymerisation, arresting the cell in the M phase.
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11
Q

General side effects of chemotherapy drugs

A
  • Alopecia
  • Mucositis as gut renewal rapidly occurs. Usually in the oropharynx and presentation of sore throat, diarrhoea, GI bleed.
  • N + V
  • Inflammatory diarrhoea
  • Cystitis
  • Myelosuppression
  • Pulmonary fibrosis
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12
Q

Organ system side effects of chemotherapy drugs

A
  • Renal failure
  • Acute renal failure from hyperuricaemia caused by rapid tumour lysis leading to precipitation of urate crystals in renal tubules.
  • GI perforation at site of tumour - seen in lymphoma.
  • DIC - especially in acute myeloid leukaemia.
  • Skin toxicity - irritation and thrombophlebitis of veins.
  • Cardio-toxicity - arrhythmias, cardio-myopathy.
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13
Q

Contraindications

A
  • Antifungals = exacerbates neuropathy
  • Warfarin = risk of bleeding as chemo decreases platelet count
  • Penicillin
  • NSAIDs
  • Supplements Such as St Johns Wort

All these drugs increase the plasma level of the chemo drug - has a narrow therapeutic window.

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14
Q

What should you monitor when prescribing cancer chemo drugs?

A
  • Creatinine clearance to monitor renal function

- ECG to monitor heart function

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15
Q

What type of drugs should you avoid with chemotherapy drugs?

A
  • Cytotoxic drugs because they exacerbate the haematological toxicity = death.
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16
Q

How is the chemotherapy dose altered for individuals?

A
  • SA
  • BMI
  • Patient’s drug handling ability
  • General well being
17
Q

Route of admission of chemotherapy

A
  • Main route is IV via central line = Hickman line, especially for repeated cycles of chemo.
  • Could give IV chemo via PICC line (not ideal for repeated cycles of chemo).