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2-Pharm Final > Chemo Drugs Part II > Flashcards

Chemo Drugs Part II Flashcards

1
Q

What do Topoisomerase Inhibitors correct?

A

Topoisomerases are enzymes which correct alterations in DNA that occur during replication & transcription

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2
Q

What are the characteristics of Topoisomerase Inhibitors?

A

Certain chemotherapeutic drugs inhibit either topoisomerase I or topoisomerase II

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3
Q

What does toxicity of Topoisomerase Inhibitors reflect?

A

Toxicity reflects effects of inhibition of topoisomerase enzymes on normal proliferating tissues (myelosuppression and mucositis)

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4
Q

What are examples of Topoisomerase II inhibitors?

A

include doxorubicin, daunorubicin, etoposide, and teniposide

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5
Q

What are examples of Topoisomerase I inhibitors?

A

topotecan and irinotecan

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6
Q

What anthracycline antibiotics used as chemotherapy agents?

A

Doxorubicin and Daunorubicin

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7
Q

What is the use of Daunorubicin?

A

To treat acute lymphocytic and myelocytic leukemia (Epocrates app says daunorubicin as solo tx is discontinued but can still be used in combination w/another drug)

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8
Q

What is the clinical use of Doxorubicin (Adriamycin)?

A

one of the most active single drugs for treating many cancers including metastatic adenocarcinoma of the breast, bronchogenic carcinoma, metastatic thyroid carcinoma, oat cell carcinoma, and osteogenic carcinoma

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9
Q

What are side effects of Doxorubicin and Daunorubicin?

A

cardiomyopathy, myelosuppression (leukopenia, thrombocytopenia, anemia), stomatitis, GI disturbances, alopecia

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10
Q

How is cardiomyopathy produced from Doxorubicin and Daunorubicin?

A

drug-induced injury to myocardial cells is dose-related & often irreversible side

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11
Q

What are the first types of cardiomyopathy that occur when Doxorubicin and Daunorubicin is administered?

A

acute form in 10% of patients; characterized by nonspecific ST-T changes and decreased QRS voltage, PVCs, SVT, cardiac conduction abnormalities & left axis deviation

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12
Q

What are the second types of cardiomyopathy that occur when Doxorubicin and Daunorubicin is administered?

A

slow onset of symptoms followed by rapidly progressing heart failure unresponsive to inotropic drugs & mechanical ventricular assistance

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13
Q

What is the occurance of 2nd form of cardiomyopathy?

A

•Occurs in 2% of treated patients and is fatal approximately 3 weeks after the onset of symptoms in nearly 60% of affected patients

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14
Q

What can increase the risk of cardiomyopathy?

A

Incidence of cardiomyopathy rises significantly when given with HER2+ breast CA treated with Herceptin (Antibody class of chemotherapy)

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15
Q

What is the properties of Dactinomycin?

A

Antibiotic with chemotherapeutic activity resulting from its ability to bind to DNA esp. in rapidly proliferating cells

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16
Q

What is the use of Dactinomycin?

A

Used in the treatment of Wilms tumor in children and rhabdomyosarcoma

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17
Q

What are the toxic effects of Dactinomycin?

A

early onset N&V, followed by myelosuppression (pancytopenia), glossitis, ulcerations of the oral mucosa, diarrhea, and alopecia

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18
Q

What is an example of Antitumor Antibiotics?

A

Bleomycin

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19
Q

What is the use of Bleomycin?

A

Effective in the treatment of testicular carcinoma and palliative treatment of squamous cell carcinomas of the head, neck, esophagus, skin, and GU tract

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20
Q

What is the most common side effect of Bleomycin?

A

include mucocutaneous reactions (stomatitis), alopecia, only causes minimal myelosuppression

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21
Q

What can patients with lymphonas develop when given Bleomycin?

A

Patients with lymphomas may develop an acute reaction characterized by hyperthermia, hypotension, and hypoventilation

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22
Q

What is the most serious side effect of Bleomycin?

A

dose-related pulmonary toxicity (most often pulmonary fibrosis) in 4% of patients

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23
Q

What is the concetration of Bleomycin?

A

is preferentially concentrated in the lungs and is inactivated by a hydrolase enzyme, which is relatively deficient in lung tissue

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24
Q

What is the MOA of Bleomycin: Pulmonary Toxicity?

A

Bleomycin produces pulmonary capillary endothelial damage, progressing to alveolar epithelial injury with necrosis of type I and proliferation of type II alveolar cells – interstitial fibrosis develops and may progress to involve the entire lung

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25
Q

What are inital signs of Bleomycin: Pulmonary Toxicity?

A

are cough, dyspnea, and basilar rales, which lead to either a mild form of toxicity (exertional dyspnea and a normal resting Pao2)

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26
Q

What is the CXR results of Bleomycin?

A

or a more severe form of arterial hypoxemia at rest with CXR indicative of interstitial pneumonitis and fibrosis

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27
Q

What are risk factors for Bleomycin: Pulmonary Toxicity?

A

Risk factors for developing chemotherapy-induced pulmonary toxicity are total drug dose, patient age, chest radiation, oxygen therapy, combination chemotherapy, preexisting pulmonary disease, genetic predisposition, tobacco abuse

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28
Q

What needs to be monitored with Bleomycin?

A

Monitor continuous SpO2 with ABG’s intermittently

29
Q

What needs to be given before anesthesia when the patient is on Bleomycin?

A

Immediately before anesthesia - preoxygenate with 100% for 1-4 minutes

30
Q

What needs to be done after inducation in a patient with Bleomycin?

A
  • After induction: Choose the lowest level of Fi02 to maintain adequate oxygenation (Sp02 88-92%)
  • Consider PEEP
31
Q

What needs to be administered carefully?

A

Careful administration of crystalloid administration- consider colloids if larger volumes of intraoperative fluids are needed

32
Q

What might the patient on Bleomycin may need?

A

Inform patient that postoperative ventilation may be needed

33
Q

What is true about postop FiO2 at lowest concentration possible with Bleomycin?

A

Maintain postop FiO2 at lowest concentration possible to maintain adequate oxygenation (not use if not necessary)

34
Q

What are examples of Tubulin-Binding Drugs: Vinca Alkaloids?

A

Vincristine, vinblastine, vinorelbine, vindesine

35
Q

What is the predominant side effect of Tubulin-Binding Drugs: Vinca Alkaloids?

A

Vincristine, vinblastine, vinorelbine, vindesine

•Myelosuppression (leukopenia, thrombocytopenia, anemia) are the predominant side effects, appearing 7-10 days after initiation of treatment

36
Q

What can Vincristine cause? When can this be lethal?

A
  • can cause symmetric peripheral sensory-motor neuropathy
  • Lethal if given intrathecally (Black box warning: never to be prepared in a syringe)
37
Q

What are side effects of Tubulin-Binding Drugs: Vinca Alkaloids?

A

Autonomic neuropathy with orthostatic hypotension, bowel motility dysfunction, and cranial nerve involvement (laryngeal nerve paralysis with hoarseness) present in 10% of treated patients

38
Q

What consideration of regional anesthetics and Tubulin-Binding Drugs: Vinca Alkaloids?

A

with neuroaxial anesthesia and PNBs, reduce concentration of local anesthetic, avoid epinephrine, and use nerve localization techniques to minimize the likelihood of intraneuronal injection

39
Q

What have Tubulin-Binding Drugs: Vinca Alkaloids been reported in worsening?

A

Reported worsening of neuropathies in perioperative period whether general or regional anesthesia is used

40
Q

What are examples of Taxanes?

A

Paclitaxel and docetaxel

41
Q

What are Paclitaxel and docetaxel used to treat?

A

used to treat breast, ovarian, lung, bladder cancers and lymphoid malignancies

42
Q

What are side effects of Paclitaxel and docetaxel?

A

Associated with myelosuppression, peripheral neuropathy, and alopecia

43
Q

What precludes the administration of high doses of taxanes?

A

Severe neurotoxicity

44
Q

What are side effects of Paclitaxel?

A

can cause dysrhythmias, myocardial ischemia, and transient asymptomatic bradycardia

45
Q

What are side effects of Docetaxel?

A

cause pulmonary edema, pleural effusions, and ascites

46
Q

What is associated with histamine release and taxanes?

A

Hypersensitivity reactions (flushing, bronchospasm, dyspnea, hypotension) caused by direct release of histamine can occur in 25-30% of patients treated with taxanes

47
Q

What do malignant changes often depend on?

A
  • hormones for their continued growth
  • Hormonal treatment of cancer disrupts growth factor receptor interactions
48
Q

What are examples of Signal Transduction Modulators
(Hormones)?

A
  • Progestins
  • Estrogen and androgens
  • Antiestrogens (tamoxifen)
  • Monoclonal antibodies
  • Aromatase inhibitors
  • Antiandrogens
49
Q

What are the properties of Antiandrogens?

A

Can cause skeletal muscle weakness and osteoporosis

50
Q

What is an example of Antiandrogens? What can it cause:

A

Flutamide can cause methemoglobinemia (overestimation of pulse oximetry readings)

51
Q

What is Carcinoid Syndrome?

A

Neuroendocrine tumor

52
Q

What are the characteristics of Carcinoid tumors?

A
  • are slow growing malignancies composed of enterochromaffin cells
53
Q

Where are carcinoid tumors located?

A

Tumors primarily in GI but can be found in other sites as lung, liver, etc. (problem when spread to liver)

54
Q

What do carcinoid tumors secrete?

A

a multitude of bioactive substances as serotonin, histamine, corticotropin, dopamine, neurotensin, prostaglandins, Substance P, somatostatin, bradykinin, etc

55
Q

What can diagnosis carcinoid tumor?

A

5-hydroxyindoleacetic acid (5-HIAA) metabolite of serotonin (test for elevated urine levels as biomarker of carcinoid tumor: >30mg/24 hr sample)

56
Q

What is the life threatening characteristics of Carcinoid tumors?

A

Release of substances from tumor manipulation or adrenergic stimulation (induction/intubation/meds) can cause sudden, profound intraoperative instability that can be fatal

57
Q

What are the characterisitcs of Carcinoid Syndrome?

A

Characterized by severe flushing, dramatic shifts in BP, arrythmias, bronchoconstriction

58
Q

What needs to be used preoperatively to Carcinoid Syndrome:
Prevention of Mediator Release?

A

Preoperative stress; use anxiolytic med without histamine releasing properties

59
Q

What needs to be minimized in Carcinoid Syndrome?

A

Minimize sympathetic response to laryngoscopy & intubation

60
Q

What needs to be provided withCarcinoid Syndrome:
Prevention of Mediator Release?

A

Provide adequate analgesia

61
Q

What needs to be prevented in Carcinoid Syndrome:
Prevention of Mediator Release?

A

Prevent hypotension / hypertension

62
Q

What should be avoided in Carcinoid Syndrome:
Prevention of Mediator Release?

A

Histamine releasing drugs (probably should be avoided in patients with carcinoid tumors)

63
Q

What is the treatment of Carcinoid Syndrome?

A

Octreotide(Somatostatin) immediately available

64
Q

What is the MOA of Octreotide (Somatostatin)?

A

high affinity for somatostatin receptor that may help relieve vasoactive symptoms and restore hemodynamic stability

65
Q

What is the dose of Octreotide (Somatostatin)?

A

150-200 mcg IV q 6-8 hrs for 24-48 hours (Nagelhout)

66
Q

What is best for the treatment of Carcinoid Syndrome?

A

Best to pretreat if known (50 mcg/hr 12 hours before surgery)

67
Q

What is other medications for Carcinoid Syndrome?

A
  • Ondansetron
  • Immediate availability of vasopressors (phenylephrine) & vasodilators
68
Q

Define Ondansetron.

A

Anti-serotonin action with potential benefit

69
Q

Review anesthetic considerations in carcinoid syndrome.

A

2-Pharm Final (10 decks)

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