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Hem/Onc > Chemo drugs > Flashcards

Chemo drugs Flashcards

1
Q

What are the folate antagonists?

A

methotrexate and pemetrexed

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2
Q

What is the MOA of methotrexate?

A

inhibits dihydrofolate reductase which results in blockage of thymidylate and purine synthesis

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3
Q

What is the MOA of pemetrexed?

A

multi-targeted antifolate

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4
Q

What are the ADRs of the folate antagonists?

A
  1. myelosuppression
  2. mucositis
  3. renal tubular necrosis with high dose MTX
  4. Hematologic toxicity - neutropenic sepsis
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5
Q

What other disease states are the folate antagonists used for?

A

rheumatoid arthritis

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6
Q

What should be supplemented with the folate antagonists?

A

folic acid and vitamin B12

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7
Q

What is the rescue medicine for MTX?

A

leucovorin

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8
Q

What are the pyrimidine antagonists?

A

fluorouracil, capecitabine, cytarabine, and gemcitabine

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9
Q

What is the MOA of 5-FU?

A

inhibits thymidylate synthase, which inhibits formation of thymidine (affects DNA and RNA)

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10
Q

What is the MOA of cytarabine?

A

pyrimidine analog incorporated into DNA, but primary action is inhibition of DNA polymerase resulting in decreased DNA synthesis and repair

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11
Q

What is the MOA of gemcitabine?

A

pyrimidine antimetabolite that inhibits DNA synthesis by inhibition of DNA polymerase and ribonucleotide reductase

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12
Q

What are the major ADRs of the pyrimidine antagonists?

A
  1. myelosuppression
  2. mucositis, stomatitis
  3. diarrhea
  4. hand-foot syndrome
  5. cytarabine cerebellar toxicity
  6. cytarabine rash and conjunctivitis
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13
Q

What is the only oral pyrimidine antagonist?

A

capecitabine

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14
Q

What is the reversal agent for 5-FU

A

uridine triacetate

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15
Q

How do you treat cytarabine conjunctivitis?

A

steroid eye drops

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16
Q

What is the major drug interaction with pyrimidine antagonists?

A

warfarin

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17
Q

What are the purine antagonists?

A

fludarabine, thioguanine, and mercaptopurine

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18
Q

What is the MOA of the purine antagonists?

A

analogues of purines which get incorporated into DNA to prevent functional DNA synthesis

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19
Q

What are the ADRs of purine antagonists?

A

myelosuppression and liver toxicity

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20
Q

What is the most immunosuppressive purine antagonist?

A

fludarabine

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21
Q

What prophylaxis is required with fludarabine?

A

antiviral and bactrim

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22
Q

What drug classes are the antimetabolites?

A

purine antagonists, pyrimidine antagonists, and folate antagonists

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23
Q

What drug classes are the alkylating agents?

A

nitrogen mustard derivatives, platinum analogs, alkyl sulfonates

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24
Q

What are the nitrogen mustard derivatives?

A

cyclophosphamide, ifosfamide, bendamustine, and mechlorethamine

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25
Q

What is the MOA of the nitrogen mustard derivatives?

A

form DNA cross-links resulting in inhibition of DNA synthesis and function

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26
Q

What are the ADRs of the nitrogen mustard derivatives?

A
  1. myelosuppression
  2. N/V
  3. alopecia
  4. infertility
  5. hemorrhagic cystitis (acrolein)
  6. infections (bendamustine)
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27
Q

What is the antidote for bladder toxicity associated with the cyclophosphamide or ifosfamide?

A

hydration or mesna

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28
Q

What other type of cancer can alkylating agents cause?

A

leukemia

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29
Q

What are the platinum analogs?

A

Cisplatin, carboplatin, and oxaliplatin

30
Q

What is the MOA of the platinum analogs?

A

form intrastrand and interstrand DNA cross-links; binds to nuclear and cytoplasmic proteins

31
Q

What are the ADRs of cisplatin?

A

nephrotoxicity, ototoxicity, severe N/V, neuropathy, and electrolyte depression

32
Q

What are the ADRs of carboplatin?

A

myelosuppression, moderate-severe N/V, and hypersensitivity

33
Q

What are the ADRs of oxaliplatin?

A

Neuropathy, moderate-severe N/V, myelosuppression, and hypersensitivity

34
Q

What is the antidote for cisplatin nephrotoxicity?

A

amifostine

35
Q

When should cisplatin be avoided?

A

CrCl < 50

36
Q

What can be used to treat platinum analog induced neuropathy?

A

duloxetine

37
Q

What can be done to reduce ADRs associated with platinum analogs?

A

reduce the dose

38
Q

What is the one alkylsulfonate?

A

busulfan

39
Q

What is the MOA of busulfan?

A

cleavage of alkyl-oxygen bond and formation of a butyl compound that forms crosslinks with DNA

40
Q

What are the ADRs of busulfan?

A

myelosuppression, pulmonary toxicity, and skin pigmentation

41
Q

What is the MOA of bleomycin and dacarbazine?

A

binds to DNA, breaks single strand and double stand, leads to free radical formation and inhibits DNA synthesis

42
Q

What are the ADRs of bleomycin?

A

pulmonary toxicity, hyperpigmentation, and febrile reactions

43
Q

What are the ADRs of dacarbazine?

A

myelosuppression and N/V

44
Q

What baseline test must be performed before initiating bleomycin?

A

pulmonary function test

45
Q

What drug classes are enzyme inhibitors?

A

anthracyclines, epipodophyllotoxins, and camptothecans

46
Q

What are the anthracyclines?

A

daunorubicin, doxorubicin, idarubicin, and epirubicin

47
Q

What is the MOA of the anthracyclines?

A
  1. topoisomerase II inhibition
  2. Intercalation of DNA
  3. Formation of free radicals
48
Q

What is the MOA of cardiotoxicity in the anthracyclines?

A

generation of semiquinone free radicals and oxygen free radicals

49
Q

What are the ADRs of the anthracyclines?

A

myelosuppression, cardiomyopathy, N/V, extravasation, red urine (daunorubicin and idarubicin)

50
Q

What tests should be monitored with anthracyclines?

A

EKG, BNP, and EF

51
Q

What is the antidote for doxorubicin for cardiotoxicity?

A

dexrazoxane

52
Q

What type of cancer can the anthracyclines cause?

A

leukemia

53
Q

What are the epipodophyllotoxins?

A

etoposide and tenoposide

54
Q

What is the MOA of the epipdodphyllotoxins?

A

topoisomerase II inhibition

55
Q

What are the ADRs of the epipodophyllotoxins?

A

myelosuppression, hypotension, and alopecia

56
Q

What is the for oral etoposide?

A

2 x IV dose (poor bioavailability)

57
Q

What other cancer can epipodophyllotoxins cause?

A

leukemia

58
Q

What are the camptothecans?

A

ironotecan and topotecan

59
Q

What is the MOA of camptothecans?

A

topoisomerase I inhibition which is responsible for cutting single DNA strands

60
Q

What are the ADRs of camptothecans?

A

myelosuppression, alopecia, and diarrhea

61
Q

What is the treatment for early onset diarrhea secondary to camptothecans?

A

atropine within 2-6 hours

62
Q

What is the treatment for late onset diarrhea secondary to camptothecans?

A

high dose loperamide

63
Q

What are the microtubule targeting drug classes?

A

taxanes and vinca alkaloids

64
Q

What are the taxanes?

A

paclitaxel, docetaxel, and cabazitaxel

65
Q

What are the vinca alkaloids?

A

vincristine, vinblastine, and vinorelbine

66
Q

What is the MOA of the taxanes?

A

bind to tubulin and stabilize microtubules. This prevents depolymerization (freezes cell in anaphase/telophase)

67
Q

What is the MOA of the vinca alkaloids?

A

binds to tubulin and interferes with microtubule assembly. Prevents spindle formation

68
Q

What are the ADRs of the taxanes?

A

myelosuppression, hypersensitivity, alopecia, and peripheral neuropathy

69
Q

What are the ADRs of the vinca alkaloids

A

myelosuppression, constipation, and extravasation

70
Q

What are the ADRs associated with vincristine?

A

less myelosuppression but dose-dependent neurotoxicity

71
Q

Which drug can not be given intrathecally?

A

vincristine

Hem/Onc (4 decks)

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