chemo pharm

Question 1

anticancer agents

Answer 1

cytotoxic
hormonal - anti estrogen
biologicals - alter body’s response to cancer by increase immune response, flu like S
targeted drugs - target cancer cell directly

Question 2

cytotoxic agents

Answer 2

alkylating agents
antimetabolics
antitumor abx
mitotic inhibitors
misc. cytotoxics
disrupt DNA synthesis and mitosis
for high cell growth fractions
vesicants - central line

Question 3

immune checkpoint I

Answer 3

allow immune cells to respond more strongly to cancer

Question 4

t cell transfer therapy

Answer 4

boost natural ability of t cells to fight cancer
t cells removed, grown in large batches, reintroduced to body

Question 5

monoclonal antibodies

Answer 5

mark cancer cells so they are better seen by body’s immune s

Question 6

treatment vaccine

Answer 6

boost immune s response to cancer, different from those that prevent disease

Question 7

immune system modulators

Answer 7

enhance body’s immune system response against cancer - prevent or slow tumor growth and help prevent spread

Question 8

biologics - types

Answer 8

Immune checkpoint I
T cell transfer therapy
Monoclonal antibodies
Treatment vaccines
Immune system modulators

Question 9

biologics

Answer 9

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)

Question 10

Cyclophosphamide

Answer 10

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

Question 11

Methotrexate

Answer 11

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

Question 12

doxorubicin

Answer 12

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

Question 13

vincristine

Answer 13

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

Question 14

ondanestron

Answer 14

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

Question 15

promethazine

Answer 15

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

Question 16

chemo

Answer 16

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

Question 17

chemo: growth fraction

Answer 17

relation of proliferating cells to resting cells
chemo works better on high proliferating cells, most large tumors have low
initially high, then low

Question 18

chemo: barriers to success

Answer 18

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)

Question 19

intermittent chemo

Answer 19

let normal cells recover but not too long bc cancer recovers as well -> bone marrow, GI epithelium
graph

Question 20

combo therapy chemo

Answer 20

decrease resistance and normal cell injury, increase will w/ less toxic levels (alter btw neutropenia and nephrotoxic)

Question 21

optimal dosing

Answer 21

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

Question 22

chemo: usual tox

Answer 22

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

Question 23

chemo: usual tox - stomatitis

Answer 23

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