chemo pharm Flashcards
anticancer agents
cytotoxic
hormonal - anti estrogen
biologicals - alter body’s response to cancer by increase immune response, flu like S
targeted drugs - target cancer cell directly
cytotoxic agents
alkylating agents
antimetabolics
antitumor abx
mitotic inhibitors
misc. cytotoxics
disrupt DNA synthesis and mitosis
for high cell growth fractions
vesicants - central line
immune checkpoint I
allow immune cells to respond more strongly to cancer
t cell transfer therapy
boost natural ability of t cells to fight cancer
t cells removed, grown in large batches, reintroduced to body
monoclonal antibodies
mark cancer cells so they are better seen by body’s immune s
treatment vaccine
boost immune s response to cancer, different from those that prevent disease
immune system modulators
enhance body’s immune system response against cancer - prevent or slow tumor growth and help prevent spread
biologics - types
Immune checkpoint I
T cell transfer therapy
Monoclonal antibodies
Treatment vaccines
Immune system modulators
biologics
Use body’s immune system to kill cancer cells
Leukemias/lymphomas
Breast, bladder, brain, colon, lung, pancreatic
Pain, swelling, soreness, flu like S, weight gain, d, risk of infeciton
Derived from or contain components of living organisms
IV, oral, topical, intravesical (bladder)
Cyclophosphamide
Alkylating agents
Non specific cell cycle phase (includes G0)
Usual tox – bone marrow suppression, n/v, hair loss + vesicant, hemorrhagic cystitis, sterility, discoloration of skin and nails
Resistance
Methotrexate
Antimetabolites
Cell cycle specific (S phase) – cancer cells need metabolites to replicate, they uptake this and this kills the cell
Folate antagonist
Leukemia and some lymphomas
Usual tox +
Nephrotox, hepatotox, fetal death and abn
Resemble natural metabolites
Resistance
doxorubicin
Antitumor abx
Nonspecific
Usual tox + cardiotox – dysR, EKG changes (sometimes fatal), acute and delayed rxn (min-yrs)
Turn urine and sweat red
HF – unresponsive to tm
vincristine
Mitotic I: vinca alkaloids
Cell cycle specific
No bone marrow suppression in some drugs
Peripheral neuropathy
Vesicant
Usual tox
Natural – periwinkle
Good combo therapy drug
ondanestron
Serotonin blocker
block serotonin receptors in trigger zone in brain and in afferent vagal nerves in stomach and SI
n/v, esp in chemo/radiation
common
mild HA, d, dizzy, c
serotonin S
be aware of other drugs that affect serotonin (SSRI, SNRI, TCA, MAOIs, buspirone, tramadol)
PO/IV
promethazine
Antiemetic: dopamine antagonist Block dopamine receptors in chemotherapy trigger zone
Chemo, post op, general n/v
Resp dep, drowsy, sedation bc also antihistamine
BB!: resp dep <2yr, gangrenous extravasation
IM/IVP
chemo
goals = kill every cancer cell, cure
if not, control growth and offer palliation
tm is complex with several therapies, different drugs can act on different parts of cell cycle
chemo: growth fraction
relation of proliferating cells to resting cells
chemo works better on high proliferating cells, most large tumors have low
initially high, then low
chemo: barriers to success
100% kill required
toxic: must use same dose throughout treatment for 100% kill, kill cancer w/o killing pt
late detection: metastasis, less responsive, pt more debilitated (cant get chemo)
tumor response
drug resistance: mutate constantly, natural selection
cell heterogeneity: hand in hand with drug resistance, increase with age, different response to drugs
solid tumors respond poorly -> decreased growth fraction, limited blood supply (necrotic)
intermittent chemo
let normal cells recover but not too long bc cancer recovers as well -> bone marrow, GI epithelium
graph
combo therapy chemo
decrease resistance and normal cell injury, increase will w/ less toxic levels (alter btw neutropenia and nephrotoxic)
optimal dosing
dosing schedule: cell cycle specific agents, keep active drug present in body
regional drug therapy: access to tumors, increase drug [], decrease systemic tox; ex: intraarterial, intrathecal, intraperitoneal, intravesical
chemo: usual tox
n/v for several days after (drug dependent)
1-2 wk after 1st round: low wbc, rbc, plt; d, allopecia (reversible 1-2 mo after chemo), fatigue
can poop out snake -> lining of GI
fetus (bc rapidly growing cells, no preg), germinal epithelium of testes (sterile, sperm bank)
hyperuricemia -> cell death/DNA destruction - kidney damage
extravasation -> vesicant (central line)
carcinogenesis -> normal cells to cancer cells, chemo is carcinogen
organ damage
chemo: usual tox - stomatitis
oral mucosa inflam, hard to take pills/eat
few days of therapy
lacerations, infected, painful
magic mouthwash -> swish and spit 5-10mL q6, not curative (swallow if esophageal involved)
viscous lidocaine, mylanta, diphenhydramine, nystatin, prednisone, distilled water
