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Basma Medical Oncology > Chemo > Flashcards

Chemo Flashcards

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USMLE® Step 1 flashcards
1
Q

2 main risk factors for chemo related cardio tox?

A

Age

Cumulative anthracycline dose

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2
Q

Cockroft gault equation

A

= (140-age)x weight) / 72x creat

Then multiply by 0.85 if female

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3
Q

Afatinib

A

Anti EGFR TKI NSCLC metastatic (NICE approved)

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4
Q

Aflibercept

A

Fake receptor with a antibody backbone
Binds VEGFA VEGFB and placental GF with a higher affinity than their endogenous receptors
Improves PFS and OS in mCRC when combine with folfiri 2nd line in patients who had folfox +- Bev in first line

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5
Q

Alemtuzumab

A

Aka CAMPATH
Anti CD52 monoclonal antibody
CD52 is on both T cells and B cells
Used for CLL in second line

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6
Q

Bevacizumab how does it work?

A

Binds VEGF, mostly VEGFA stopping it activating the VEGF receptor

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7
Q

Bortezemib (Velcade)

A

Small molecular proteasome inhibitor
Cell can’t clear toxic misfolded proteins
Suppresses NFkappaB (which normally promotes cell proliferation and survival)

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8
Q

Bosutinib

A

BCR-ABL inhibitor
CML in 3rd line
Is available on the CDF!

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9
Q

Treatment of CLL lines 1,2 and 3

A

First Imatinib
2nd nilotinib or dasatinib
3rd Bosutinib

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10
Q

Cabozantinib

A

MET and VEGFR2 inhibitor
MET unregulated in cells resistant to Antiangiogenics
Advanced medullary thyroid cancer and RCC

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11
Q

What kind of antibody is cetuximab?

A

Chimeric monoclonal antibody

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12
Q

Crizotinib

A

ALK and MET inhibitor

4-5% of NSCLC and majority of anaplastic large cell lymphomas

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13
Q

Dabrafenib

A

BRAF inhibitor inhibits V600E BRAF

BRAF Is mutated in 50% of melanomas

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14
Q

Erlotinib

A

Anti EGFR TKI

NSCLC

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15
Q

Everolimus

A

MTOR inhibitor

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16
Q

What is MTOR? What does MTOR inhibition do?

A

Intracellular serine-threonine kinase
Is downstream of the PI3K/AKT pathways which is often overactive in malignancy
Inhibiting MTOR lowers VEGF levels

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17
Q

Vismodeginib

A

Hedgehog pathway inhibitor - hedgehog pathway is overactive in BCC

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18
Q

Drug associated with Lhermitte’s syndrome? Tingling when bend neck

A

Cisplatin

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19
Q

Which protein do Taxanes stimulate the expression of in order to trigger apoptosis?

A

Bim

Bcl related pathway

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20
Q

How does Imatinib work?

A

Blocks the activity of the Bcr/abl fusion gene, restoring Bim and Bad apoptotic function

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21
Q

What are type 1 and 2 programmed cell death?

A

Type 1 apoptosis

Type 2 autophagy - MTOR PI3K/AKT regulated

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22
Q

What is the first stage in angiogenesis?

A

Localised degradation of the basement membrane of the parent venue

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23
Q

Does tamoxifen increase risk of endometrial cancer?

A

Yes

24
Q

Does raloxefine increase risk of endometrial cancer?

A

No- it’s still an agonist in the uterus but is not as active as tamoxifen in the uterus

25
Q

What vascular complication is raloxefine associated with?

A

Stroke

It does not increase risk of coronary artery disease

26
Q

In which group does bisphosphonate use reduce the recurrence rate of breast cancer?

A

Post menopausal women

27
Q

Monoclonal ab which causes both a early and delayed neutropenia

A

Rituximab

28
Q

Which lymphoma has germinal B and non germinal B subtypes with an impact on prognosis? Which is worse?

A

DLBCL can be divided into germinal B and non germinal B
Either gene profiling or Hans criteria
Non germinal centre has a worse prognosis only 30% 5 years survival

29
Q

What are two advantages denosumab has over bisphosphonates?

A

Less nephrotoxic

Longer time to first skeletal event

30
Q

% risk cardiomyopathy with doxorubicin?

A

3%

31
Q

Mechanism of action of Erubulin?

A

Microtubule inhibitor

32
Q

How many more times potent than hydrocortisone is:
Pred
Dex

A

4: 1 pred
25: 1 dex

33
Q

Ibrutinib use

A

Mantle cell lymphoma

34
Q

Afanatinib use

A

NSCLC

35
Q

Trametinib melanoma mechanism

A

MEK inhibitor melanoma

36
Q

Target of Imatinib

A

BCR/ABL

37
Q

When does the interstitial lung disease of TKIs usually present?

A

Within 1 month of starting

38
Q

Should Erlotinib be taken on full or empty stomach?

A

Empty stomach- if take with food absorb more and get more toxicity

39
Q

Which drug causes visual disturbances where when patient sees you walk they see a trail behind you?

A

Crizotinib (inhibits ALK and c met)

40
Q

What does carbamazepine do to pazopanib levels?

A

Carbamazepine induces CYP450 so will lower levels of pazopanib

41
Q

What does phenytoin do to pazopanib levels?

A

It induces CYP450 so levels of pazopanib will fall

42
Q

What does ketoconazole do to pazopanib levels?

A

It inhibits CYP450 so get higher levels of pazopanib don’t clear it as much

43
Q

What is the T790M mutation associated with?

A

Acquired resistance to anti EGFR TKIs

44
Q

What is the T315I mutation associated with

A

Acquired resistance to BCR-ABL TKIs

45
Q

Which chemo drug is affected by levels of TPMT deficiency?

A

6 mercaptopurine

Deficiency of TPMT get higher haematological toxicity which can be fatal

46
Q

Which drug metabolism is UGT1A1 associated with?

A

Irinotecan

Polymorphisms leading to reduced level of this enzyme lead to higher rates of Irinotecan toxicity

47
Q

When do you need to give mesna? (With which drugs?)

A

Everyone having ifosfamide

Only with high dose cyclophosphamide

48
Q

How does mesna prevent haemorrhagic cystitis?

A

Provides a S-H group which binds to toxic metabolites of ifosfamide and cyclophosphamide

49
Q

How do you know how much mesna to give?

A

60% of the dose of the alkylating agent in divided doses

every 4 hours

50
Q

What drug do you have to give b12 and folate to the patient before you start it and why? When do you give it?

A

Pemetrexed
Start it 1 week before chemo and continue for 21 days after finish
Minimises toxicities

51
Q

How can acute doxorubicin toxicity be minimised? Is it reversible or irreversible?

A

It is reversible

Can minimise by slowing down infusion rates

52
Q

What is the P-glycoprotein pump on cells?

A

It is a multi drug resistance efflux pump

53
Q

Which route of administration of Bortezemib minimises peripheral neuropathy?

A

SC Administration (it can be given IV or SC)

54
Q

Mechanism of action of Abiraterone?

A

Irreversible inhibitor of CYP17

55
Q

What is ofatumumab used for?

A

Refractory CLL

It’s anti CD20 like rituximab

Basma Medical Oncology (26 decks)

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