Chemo

Question 1

3 M Phase Specific Drugs

Answer 1

Vincristine, vinblastine, taxanes

Question 2

Phase Non Specific Drugs

Answer 2

Alkylating Agents

Question 3

4 S Phase Specific (& which 2 are self limiting)

Answer 3

Cytarabine, hydroxyurea

Self Limiting: 6-MP, Methotrexate

Question 4

5 Classes of Alkylating Agents

Answer 4

Nitrogen mustards
Nitrosoureas (BCNU, CCNU)
Methane sulfonic acid esters (busulfan)
Triazenes (DTIC)
Ethylamines (thiotepa)

Question 5

Similar Side Chain in Nitrogen Mustards

Answer 5

2 chloro ethyl groups

Question 6

Alkylating Agents Mech

Answer 6

Add Cs to bases (like guanine base) so other elements can’t be added

Question 7

Main Side Effect for Nitrogen Mustards/Alkylating Agents

Answer 7

Myelosuppression, worst around day 10 (have 10 days of BM reserves). So neutropenic fever most at risk then. By 14 recovered enough to do again

Question 8

5 Nitrogen Mustards

Answer 8

Mechlorethamine
Melphalan
Chlorambucil
Cyclophosphamide
Ifosfamide

Question 9

3 Other Big Side FX for Ifosfamide

Answer 9

Hemorrhagic cystitis
Encephalopathy
Acquired Fanconi’s syndrome

Question 10

Nitrosoureas Structure

Answer 10

Just one chloro ethyl group. Lipophilic so for brain cancers

Question 11

4 Cancer Types and Alkylating Agent Use

Answer 11

Sarcoma - ifosfamide
HL - M in MOPP (mechlorethamine)
Breast - cyclophosphamide
Lymphoma - C in CHOP (cyclophosphamide)

Question 12

3 Antimetabolite Classes

Answer 12

Folate acid analogs (Methotrexate)
Purine analogs
Pyrimidine analogs (5-FU, Xeloda, Cytosine Arabinoside/Ara-C)

Question 13

Methotrexate Structure

Answer 13

Exactly like folate but with H->methyl and -OH->-NH2 replacements

Question 14

Methotrexate Mech

Answer 14

Blocks DHF Reductase, which catalyzes DHF into THF (C carrying version), so blocks both purine and pyrimidine synth

Question 15

Leukovorin

Answer 15

Reduced folic acid used for rescue from methotrexate

Question 16

Fludarabine

Answer 16

Purine analog. Has F bound so too strong to break

Question 17

5-Fluorouracil

Answer 17

Pyrimidine analogue that Has F bound so you can’t attach methyl group to convert U->T, irreversibly blocking thymidylate synthetase. Can’t make TMP

Question 18

Ara-C

Answer 18

Pyrimidine analog, put into DNA instead of dCTP. Unstable

Question 19

Methotrexate 3 Side Effects

Answer 19

Renal toxicity (precipitates, so hydrate and alkalinize urine)
Liver toxicity (chronic)
Leukoencephalopathy (can lead to dementia)

Question 20

5-FU 3 Side Effects

Answer 20

Myelosuppression, diarrhea, stomatitis

Question 21

Ara-C Side Effect

Answer 21

Myelosuppression, but it’s for leukemia so you want

Question 22

Methotrexate RoA (3)

Answer 22

PO/IV/IT

Question 23

5FU RoA (2)

Answer 23

IV/Topical (GI)

Question 24

Ara-C RoA (3)

Answer 24

IV/SQ/IT

Question 25

Xeloda (class, mech/clearance, side effect)

Answer 25

Pyrimidine analog, converted to 5-FU in liver so secreted over long time and can cause hand/foot syndrome skin toxicity

Question 26

Gemcitabine SFX

Answer 26

Thrombocytopenia

Question 27

Fludarabine 2 SFX

Answer 27

T cell depletion (need PCP prophylaxis Bactrim) | Interstitial pneumonia

Question 28

Antimetabolite Phase Specificity and General Contraind

Answer 28

S phase specific | Not during pregnancy, esp. 1st trimester

Question 29

2 Classes of Antitumor Antibiotics and 2/1 Drugs in Them

Answer 29

Intercalators - Adriamycin, Daunorubicin (H Idarubicin) | Strand Scission - Bleiomycin

Question 30

Adriamycin/Daunorubicin SFX

Answer 30

Local necrosis and CARDIOTOXICITY

Question 31

Big Antitumor Antibiotic Side Effect and which one is omitted

Answer 31

Skin damage except for bleiomycin so can give subcut

Question 32

Bleiomycin Side Effect

Answer 32

Pulmonary fibrosis, dose related, so increased FiO2 in anesthesia very toxic bc of free rads

Question 33

3 Antitumor Antibiotics NOT Cleared by Kidney

Answer 33

Adriamycin, Daunorubicin, Mitomycin, (Actinomycin D cleared by kidney and biliary)

Question 34

Vinca alkaloids

Answer 34

Disrupt MT function so most effective at metaphase arrest (but also at risk for neurotoxicity (cristine) bc neurons need MTs and myelosuppression (blastine))

Question 35

Etoposide

Answer 35

Podophyllotoxin plant alkyloid that blocks Topoisomerase II

Question 36

Taxanes

Answer 36

Derived from yew tree and block tubulin polymers stabilizing MTs

Question 37

Paclitaxel SFX

Answer 37

Neuropathy worse w/ short infusion schedules

Question 38

Docetaxel SFX

Answer 38

Capillary leak syndrome

Question 39

Irinotecan

Answer 39

Topoisomerase I inhibitor that requires conjugation to glucuronide so can't give with elevated BR or anything

Question 40

Cisplatin

Answer 40

Only one without carbon, binds DNA and forms adducts. Good for BRCA bc impaired repair but very nephrotoxic