Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GYO Boards > Chemo > Flashcards

Chemo Flashcards

1
Q

Vesicant Chemos

A

Anthracyclines (Adria)
Act-D
Vincas (vincristine, vinblastine, vinorelbine)
Mitomycin-C

(Cisplatin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Need dose adjustment for hepatic function

A 
Anthracyclines (adriamycin)
Act-D
Texans (taxol, taxotere)
Vinca alkaloids (vincristine, vinblastine, vinorelbine)
Irinotecan
5-FU
Gemcitabine
MTX
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What chemos cause alopecia?

A 
Taxol (taxotere not as much)
Adriamycin/doxil not as much
Cyclophosphamide 
Etoposide
Vinca alkaloids
5-FU
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What causes CNS toxicity with Ifosfamide?

…Hemorrhagic cystitis?

A

Chloracetaldehyde (methylene blue)

Acrolein (Mensa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

3 hour taxol infusion

A

More neurotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

24 hour taxol infusion

A

More myelosuppresion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Taxol before cisplatin

A

Less myelosuppresion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which chemos require dose reduction for kidney function?

A 
Platinums
Bleomycin
Melphalan
Topotecan
Mitomycin-C
Hydroxyurea
Capecitabine
Cytoxan
MTX
Ifosfamide
Alimta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Topoisomerase I Inhibitors

A

Topotecan

Irinotecan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Topoisomerase II inhibitors

A

Etoposide
Adriamycin
Mitoxantrone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which chemos cause secondary malignancies?

A 
Etoposide
Cytoxan
Cisplatin
Melphalan
Ifosfamide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Calvert’s formula

AKA AUC

A

Carboplatin (4-6)

Dose = AUC * (GFR+25)

GFR is a function of weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vinca alkaloids:

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Vincristine, Vinorelbine

  • Prevent microtubule polymerization (M-phase specific)
  • Constipation/ileus, alopecia, peripheral neuropathy (ataxia, foot drop, muscle wasting), leukopenia; SIADH, ARDS
  • Not much nausea, VESICANT; vincristine can cause autonomic neuropathy

*Hepatic excretion/dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Taxol

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Taxane

  • Stabilizes microtubules, preventing cell division (M phase specific)
  • Myelosuppresion (increased with 24 vs 3 hour infusion), neurotoxic (increased with 3 hour vs 24 hour infusion), hypersensitivity (cremphor), alopecia, asymptomatic bradycardia, cough/dyspnea/pneumonitis
  • Premed with H2 blockers, H1 blocker and dexamethasone

*Hepatic dose reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Cytoxan/Cyclophosmamide

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Traditional alkylator - nitrogen mustard

  • Interstrand DNA cross links (N-7 on guanine) (cell cycle non-specific)
  • Myelosuppresion, SIADH, alopecia, secondary malignancy, hemorrhagic cystitis at high doses, cardiotoxicity (myocyte necrosis or myopericarditis), N/V, pulmonary fibrosis
  • Require activation in liver —> CANNOT USE IP

Renal dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ifosfamide

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Traditional alkylator - nitrogen mustard
-Interstrand DNA crosslinks (N-7 on guanine) (cell cycle non-specific)
-Hemorrhagic cystitis, myelosuppresion, neurotoxicity (CNS), renal failure,
Fanconi syndrome, N/V, constipation, alopecia, hepatotoxicity, SIADH
-PRODRUG; CNS toxicity more likely with low albumin, older age

*Renal/hepatic dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Melphalan

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Traditional alkylator - nitrogen mustard

  • DNA Interstrand crosslinks (N-7 on guanine)
  • myelosuppresion, alopecia, mucositis, diarrhea, interstitial pneumonitis/pulmonary fibrosis
  • Renal dose adjustment, secondary malignancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Methotrexate

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Antimetabolite - folate antagonist

  • Inhibits dihydrofolate reductase (DHFR) (S phase specific)
  • leukopenia, interstitial pneumonitis, alopecia (at high doses), stomatitis/mucositis, hepatotoxicity and renal toxicity
  • High dose crosses BBB; leukovorin rescue

*Hepatic and renal dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pemetrexed

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

AKA Alimta
Antimetabolite - folate antagonist
-Inhibits three enzymes in folate metabolism (thymidylate synthase, DHFR, glycinamide ribonucleotide formyltransferase)
-Fatigue, myelosuppression, rash, ocular toxicity
-Give with folate and B12

*renal and hepatic dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Fluorouracil (5-FU)

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Antimetabolite - pyrimidine analog

  • Inhibits thymidylate synthase (S phase specific)
  • Myelosuppresion, mucositis, hand-foot, diarrhea, skin discoloration, nail changes, cerebellar ataxia, cardiac ischemia
  • Give following HD; Efudex cream for vulvar; crosses blood-brain barrier

*Hepatic dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Capecitabine (Xeloda)

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Antimetabolite - pyrimidine analog

  • Prodrug of 5-FU —> inhibits thymidylate synthase (S phase specific)
  • hand-foot, diarrhea, N/V, rash, mucositis
  • Renal dose adjustment

ORAL form of 5-FU - converted intracellularly more efficiently in tumor cells than normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Gemcitabine

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Antimetabolite

  • Inhibits DNA replication (but not S phase specific)
  • Leukopenia, thrombocytopenia, N/V, mucositis, flu-like syndrome, edema; radiation recall, rare ARDS/pulmonary toxicity
  • Prodrug

*Hepatic dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Cisplatin

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Platinum

  • Intrastrand DNA crosslinks (N-7 of guanine) (cell cycle non-specific)
  • Very emetogenic, nephrotoxic, neurotoxicity (ototoxicity), hypomag/K, myelosuppression
  • HYDRATION with Mg and K

*Renal dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Carboplatin

  • Mechanism of action (cell cycle specificity)
  • Toxicity
  • Misc
A

Platinum

  • Intrastrand DNA crosslinks (N-7 of guanine) (cell cycle non-specific)
  • myelosuppression (esp thrombocytopenia), N/V
  • AUC

*Renal dose adjustment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Oxaliplatin - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Platinum - Intrastrand DNA crosslinks (N-7 of guanine) - Neuropathy (cold), hepatotoxicity - Colon cancer *Renal dose adjustment
26
Bleomycin - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Antitumor antibiotic - Inhibits DNA synthesis/repair (G2 specific) - Pulmonary fibrosis, hyperpigmentation, NOT myelosuppresive or emetogenic - Requires metal ion cofactor - primarily copper, but also nickel, manganese and cobalt *Check DLCO; max dose 400U
27
Dactinomycin/Act-D - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Antitumor antibiotic - Intercalates into DNA and inhibits transcription of RNA (cell cycle non-specific but most active in G1) - Nausea, diarrhea, alopecia, hyperpigmentation, mucositis/stomatitis, myelosuppresion, hepatotoxicity, radiation recall dermatitis - Vesicant *Hepatic dose adjustment
28
Mitomycin-C - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Antitumor antibiotic - Inhibits DNA synthesis - CHF (doses > 30 mg/m2), fever, alopecia, N/V, myelosuppresion, nail changes, HUS *Renal dose adjustment
29
Etoposide/VP-16 - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Epidophyllotoxin (from the Mandrake plant) - Topoisomerase II inhibitor (S-G2 specific); also binds tubulin - Myelosuppression, mucositis, N/V, alopecia, secondary malignancy (MLL 11q23 leukemia 1-3 years), vasospastic angina - Hypotension 2/2 polysorbate 80; irritant * Renal and hepatic dose adjustment* * Risk of leukemia increases after cumulative dose of > 2000
30
Irinotecan - Mechanism of action (cell cycle specificity) - Toxicity - Misc
- Topoisomerase I inhibitor - Diarrhea (severe), neutropenia, N/V, cholinergic rxn (rhinitis, salivation, diaphoresis, flushing), alopecia, hepatotoxicity - Prodrug? *Hepatic dose adjustment
31
Topotecan - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Camptothecin - Topoisomerase I inhibitor (M phase specific) - leukopenia/thrombocytopenia, N/V (mild), alopecia, mucositis, myalgia/arthralgia, rash, increased LFTs *Renal dose adjustment
32
Adriamycin/Doxorubicin - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Anthracyclines - Inhibit topoisomerase II, inhibits RNA/DNA synthesis (cell cycle non-specific) - Myelosuppresion, cardiac toxicity - CHF at doses > 450/550 mg (get pre-treatment MUGA), radiation recall, secondary malignancies (1-3 years), N/V, red urine/tears, mucositis, VESICANT - Requires IRON; dexrazoxane chelates iron and reduces cardiomyopathy risk; also use for extravisation; DOES NOT CROSS PLACENTA *Hepatic dose adjustment
33
Doxil/liposomal doxorubicin - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Anthracyclines - Inhibits topo II, DNA/RNA synthesis (cell cycle non-specific) - Less alopecia, myelosuppresion, nausea/vomiting, cardiotoxicity BUT MORE hand-foot syndrome (PPE), mucositis and infusion rxns; radiation recall dermatitis - Irritant rather than vesicant *Hepatic dose adjustment
34
Chemos effected by drug efflux pump
Doxorubicin, etoposide, vinca alkaloids, taxanes, topotecan, MTX
35
Skipper-Schabel-Wilcox Model (AKA Log-Kill Model)
Constant exponential rate of tumor cell growth (constant doubling time) therefore, cell should be killed at a constant exponential rate
36
Gompertzian Model
Cell growth is not constant —> initial tumor growth is first order, however later growth is much slower as tumor enlarges; therefore, log-kill greater for smaller tumors than larger ones
37
Norton-Simon Hypothesis
Smaller tumors regrow at a higher growth fraction **idea of increased intensity or sequential therapy/dose-dense schedule
38
Goldie Coldman Hypothesis
Populations of cells within a tumor are capable of randomly mutation and becoming resistant to chemotherapy —> occur at 1 in 10^6 (tumor is not yet detectable) **To avoid resistance, use non-cross-resistant chemotherapy or alternating
39
Hexalan (Altretamine) - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Alkylator - DNA crosslinker or anti-metabolite (cell-cycle non-specific) - myelosuppresion, N/V, neuropathy, renal toxicity, ataxia/seizures/mood disorder - Prodrug requires metabolism in liver
40
Taxotere (docetaxel) - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Taxane - Stabilizes microtubules, preventing cell division (M phase specific) - Myelosuppression (more than taxol), hypersensitivity, edema/fluid retention (2/2 polysorbate 80), less alopecia - Premed with dexamethasone to decrease edema *Hepatic dose reduction
41
Radiation recall chemotherapy
Anthracyclins Act-D Gemcitabine (Etoposide)
42
Bevacizumab/Avastin - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Humanized monoclonal antibody - Binds to VEGFA and prevents binding to the VEGFR - decreases angiogenesis - Hypertension, headache, delayed healing, thrombosis, fistulas - Hold for proteinuria
43
Bortezomib/Velcade - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Small molecule inhibitor - proteosome inhibitor - promotes apoptosis - peripheral neuropathy, thrombocytopenia, N/V/D, rash, sudden cardiac death - not really used in GYN
44
Cetuximab (IMC-C225) - Mechanism of action (cell cycle specificity) - Toxicity - Misc
Chimeric monoclonal antibody - Binds to extracellular EGFR, blocking tyrosine kinase activity - Nausea, rash, allergy - Not used in GYN
45
Erlotinib/Tarceva
Small molecule inhibitor - Inhibits EGFR tyrosine kinase leading to cell cycle arrest and inhibition of angiogenesis - Diarrhea, rash, interstitial lung disease - Not used in GYN
46
Evrolimus/Afinitor
Small molecule inhibitor - mTOR inhibitor —> mTOR is downstream in PI3K pathway and regulates cell growth and proliferation - Rash, stomatitis, infections, edema, fatigue - Endometrial cancer trials
47
Ipilimumab/Yervoy
Immune checkpoint inhibitor - Monoclonal antibody to CTLA-4, binding and preventing interaction of T cell CTLA-4 with tumor cell CD80 and CD86 - ‘itises (dermatitis, pneumonitis, enteritis/colitis, etc), inflammatory demyelinating polyneuropathy - Used in cervix cancer clinic trials with PDL-1 inhibitors; approved for melanoma
48
Nivolumab/Opdivo
Immune checkpoint inhibitor - monoclonal antibody to PD-1 on T cells, preventing interaction with PDL-1 on tumor cells - ‘itises (dermatitis, pneumonitis, GI-itises, thyroiditis, iris inflammation), fatigue, weakness, cardiac arrhythmia - Clinical trials in GYN; approved in melanoma, lung cancer, urothelial
49
Pembrolizumab/Keytruda
Immune checkpoint inhibitor - Monoclonal antibody against PD-1 on T cells, preventing interaction with tumor PDL-1 - itises (dermatitis, pneumonitis, GI-itises, pituitary inflammation, thyroiditis, pancreatitis, nephritis), fatigue, arthralgia - Approved for MSI high or MMR cancers, NSCLC, melanoma, head/neck cancers; just approved for PDL-1 high cervix cancer
50
Imatinib/Gleevac
Small molecular inhibitor - Tyrosine kinase inhibitor - designed to target Bcr-Abl fusion protein formed as a result of the PHL chromosome; also inhibits PDGF, SCR (stem cell receptor) and c-kit - Used in GIST and CML
51
MEK inhibitors
Selumetinib, trametinib - Inhibit MEK1/MEK2 - Used in LGSOC (clinical trial), BRAF mutated melanoma and KRAS/BRAF mutated colon cancers
52
Trastuzimab/Herceptin - Mechanism of action - Toxicxity - Misc
Humanized monoclonal antibody - Binds to extracellular Her-2 (AKA Neu, gene = ERBB2) and inhibits signaling - Heart failure - Serous HER2 expression uterine cancers
53
Gefitinib/Iressa
Small molecule inhibitor - Inhibits EGFR tyrosine kinase leading to cell cycle arrest and inhibition of angiogenesis - Rash, diarrhea, interstitial lung disease, corneal ulcer - Lung mostly
54
Types of antiemetics
5-HT3 receptor antagonists (ondansetron, granisetron, palonosetron (aloxi)) NK1 receptor antagonists (aprepitant (emend)) Dopamine blockade (Reglan, Phenothiazine (compazine), haldol/zyprexa) Benzodiazepine (anticipatory nausea) Steroids (dexamethasone)
55
Amifostine/Ethyol - Mechanism of action (cell cycle specificity) - Toxicity - Misc
- Free radical scavenger; binds to cisplatin metabolites and is used to treat platinum-associated toxicity; can also use for xerostomia associated with head and neck radiation - Nausea/vomiting, hypotension, hypocalcemia, SJS - May make chemoRT less effective; differential effects on normal/cancer cells due to different concentrations of activating alkaline phosphates energy
56
What chemos are prodrugs?
Capecitabine Irinotecan Ifosfamide
57
What chemos cause hand-foot syndrome (PPE)?
Doxil, 5-FU and capecitabine, docetaxel, vinorelbine
58
Which chemos are pulmonary toxic?
Checkpoint inhibitors cause pneumonitis Bleomycin, alkylating agents (mitomycin-C), nitrosoureas can cause pulmonary fibrosis Taxol can cause pneumonitis Gemzar can cause an ARDS-like syndrome
59
What chemos are cardiotoxic?
Cardiomyopathy: anthracyclines (adriamycin, daunomycin) Arrhythmia: anthracyclines and taxol (5-FU rare) Cardiac myocyte necrosis: Cytoxan Vasospastic angina: Etoposide
60
What chemos are GU toxic?
Kidney damage: cisplatin, MTX, nitrosoureas, mitomycin-C | Hemorrhagic cystitis: Ifosfamide, cytoxan
61
What chemos can cause SIADH?
Vincas, high dose cytoxan, cisplatin
62
What chemos are highly emetogenic?
Cisplatin (>50 mg/m2), cytoxan (>1500 mg/m2), carbo (AUC >4) **Treat with 5-HT3 and dexamethasone and NK-1
63
What chemos are moderately emetogenic?
Cisplatin (<50 mg/m2), cytoxan (750/1500 mg/m2), doxorubicin, MTX (>1000 mg/m2), Ifosfamide, high dose 5-FU **Treat with 5-HT3 and dexamethasone
64
AMG386/Trebananib
Monoclonal antibody -Binds to soluble antiopoietin 1/2 and prevents interaction with receptor Tie2 **Acts through a non-VEGF dependent angiogenesis pathway
65
Dexrazoxane
Cardioprotective agent used with adriamycin; can also use to treat Adria extravasation -chelates iron **Possible higher rate of secondary malignancies
66
Parp Inhibitors - Mechanism of action - Toxicity - Misc
Niraparib, olaparib, rucaparib - Inhibit single stranded DNA damage repair via nucleotide excision repair —> thus cells are dependent upon homologous recombination for repair of these lesions; more highly active in BRCA patients since they have a defect in HR - Myelosuppression, HTN, fatigue - “Synthetic lethality; approved for trx of BRCA mutation OC and maintenance after response to a platinum based regimen
67
What are SERMs? - Mechanism of action - Side effects
Tamoxifen and raloxifen - selective estrogen receptor modulators —> block the activity of E in the breast; tam is E agonist in the uterus - blood clots, stroke, leg swelling/pain/cramping, HA, vasomotor symptoms, fatigue, cataracts; Tam can lead to endometrial polyps/hyperplasia/carcinosarcoma; patients on raloxifene complain of worse sexual dysfunction
68
Aromatase inhibitors - Mechanism of action - Side effects
Anastrozole, letrozole, exemestane - block the conversion of androgens into estrogen - AES fewer than SERMS; heart disease, more bone loss, and more fractures; most common AE is joint stiffness or pain; can also see muscle pain, vasomotor symptoms, vaginal dryness, carpal tunnel syndrome, thinning hair, mood swings

GYO Boards (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions