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AIM - Heme/Onc > Chemo Pharm > Flashcards

Chemo Pharm Flashcards

1
Q

Ondansetron

A
  • serotonin antagonist
  • acute antiemetic
  • blocks serotonin at CTZ 3 receptor
  • QT prolongation
  • headaches, hiccups, constipation, cardiotoxicity
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2
Q

aprepitant

A
  • NK-1 antagonist
  • acute and delayed antiemetic
  • blocks substance P
  • drug interactions (CYP inducer)
  • hiccups, fatigue
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3
Q

lorazepam

A
  • benzodiazepine
  • anticipatory antiemetic
  • GABA mediated

-sedation, retrograde amnesia

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4
Q

dexamethasone

A
  • glucocorticoid
  • delayed antiemetic
  • hormone
  • reduces number of lymphocytic cells
  • lymphocytic leukemias/lymphomas
  • ALL, NHL

-glucose intolerance, insomnia, agitation, HTN

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5
Q

Prochlorperazine

Metoclopramide

A
  • dopaminergic antagonists
  • acute and delayed antiemetic

-extrapyramidal, sedation

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6
Q

alkylators

A
  • cell cycle non specific
  • form DNA cross links that inhibit replication

side effects:

  • bone marrow suppression
  • N/V, diarrhea
  • sterility
  • amenorrhea
  • secondary malignancy
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7
Q

cyclophosphamide

A
  • nitrogen mustard
  • alkylator
  • prodrug, needs liver activation
  • binds to nucleophiles/purines
  • breast CA, leukemia, lymphoma
  • immunosuppressant
  • cardiac NECROSIS
  • delayed N/V
  • hemorrhagic cystitis (ACROLEIN)
  • neutropenia, lymphopenia, cardiotoxicity, SIADH
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8
Q

ifosfamide

A
  • nitrogen mustard
  • alkylator
  • isomer to cyclophosphamide, with longer half life
  • crosses BBB
  • prodrug, needs liver activation

-sarcomas, lymphomas, uterine CA

  • nephrotoxicity
  • neurotoxicity
  • hemorrhagic cystitis (ACROLEIN)
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9
Q

mesna

A
  • counteracts ifosfamide induced hemorrhagic cystitis caused by acrolein
  • binds acrolein in bladder
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10
Q

chlorambucil

A
  • nitrogen mustard
  • alkylating agent

AML
NHL
CLL

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11
Q

melphalan

A
  • nitrogen mustard
  • alkylating agent
  • multiple myeloma
  • primary myelofibrosis
  • AML
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12
Q

cisplatin

A
  • platinum analog
  • alkylator

-testicular, ovarian, lung CAs

  • severe acute and delayed N/V
  • nephrotoxicity
  • neurotoxicity (peripheral neuropathies, auditory impairment)
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13
Q

carboplatin

A
  • platinum analog
  • alkylator

-use if resistance develops to other analogs

  • neuropathies
  • increased toxicity if given before taxane
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14
Q

oxaliplatin

A
  • platinum analog
  • alkylating agent
  • DNA adducts between bases
  • colorectal, GI
  • if resistance to other platinum analogs
  • neurotoxicity triggered by COLD
  • electrolyte abnormalites, myelosuppression, hepatotoxicity
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15
Q

dacarbazine

procarbazine

A
  • triazenes
  • alkylator

ABVD/MOPP regimens for Hodgkin’s

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16
Q

antimetabolics/analogs

A
  • S phase specific

- block formation of DNA components

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17
Q

methotrexate

A

-antimetabolic
-S phase specific
-reversibly binds to dihydrofolate reductase
(no THF formed, no dTMP formed, no DNA synthesis)
-polyglutaminated form has higher efficacy

  • nephrotoxicity, GI toxicity, hepatotoxicity, mucositis, myelosuppression
  • methotrexate induced lung injury
  • leucovorin rescue
  • drain 3rd spaces
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18
Q

5-FU

A
  • antimetabolic
  • inhibits thymidylate synthase
  • S phase specific

-breast, colorectal, head/neck, basal cell carcinoma

  • myelosuppression
  • mucositis/diarrhea, hand-foot syndrome
  • CORONARY VASOSPASM (EKG changes)
  • neurotoxicity
  • PHOTOSENSITIVITY
  • synergistic with leucovorin
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19
Q

hydroxyurea

A
  • antimetabolic
  • inhibits ribonucleotide reductase
  • decreases WBC and platelet count
  • S phase specific
  • used for leukostasis in acute leukemia, sickle cell
  • myelosuppression
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20
Q

cytrabine (Ara-C)

A
  • pyrimidine analog
  • inhibits DNA polymerase
  • can cross BBB
  • S phase specific
  • AML, ALL, CML, NHL
  • intrathecally to treat lymphomatous meningitis
  • myelosuppression
  • mucositis
  • CNS toxicity (cerebellar, conjunctival)
  • pulmonary edema
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21
Q

gemcitabine

A
  • pyrimidine analog
  • inhibits DNA polymerase, ribonucleotide reductase
  • S phase specific
  • Pacreatic, NSCLC, bladder CA, sarcoma
  • myelosuppression, N/V, flu like sx, skin rash, proteinuria, hematuria
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22
Q

fludarabine

cladribine

A
  • purine analogs
  • interfere with DNA synthesis
  • CLL
  • immune damage to RBC causes hemolytic anemia
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23
Q

prednisone

A
  • glucocorticoid
  • homrone
  • decreases lymphocytes
  • lymphocytic leukemias/lymphomas
  • glucose intolerance, insomnia, agitation, appetite, wight gain, fluid retention
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24
Q

Danazol

Dihydrotestosterone

A
  • androgen hormone
  • suppress pituitary output of FSH, LH
  • used for bone marrow failure syndromes, myelodysplasia
  • NHL, leukemia, testicular

-edema, flushing, HTN, hirsuitism, voice changes

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25
flutamide | bicalutamide
- anti androgen (receptor antagonist) - prostate cancer - hot flashes, decr libido, gynecomastia
26
tamoxifen | raloxifene
competes with estrogen for binding to receptor - breast CA - menopausal sx, edema - tumor flare - DVT/PE - endometrial hyperplasia
27
anastrozole
- aromatase inhibitor - selective, reversible - used in post menopausal women with breast CA - hot flashes, tumor flare, edema, asthenia
28
letrozole
- aromatase inhibitor - selective, reversible -causes arthralgias, musculoskeletal pain, hot flashes, LFTs
29
leuprolide
-LHRH agonist - -inhibits gonadotropin via negative feedback inhibition of the pituitary -surge of estrogen, testosterone, then none - premenopausal women with breast CA - testicular CA - tumor flare - pain, flushing, peripheral edema, asthenia, hot flashes, gynecomastia, changes in serum lipids, bone loss long term
30
exemestane
- aromatase inhibitor - IRreversible -hot flashes, fatigue, headache
31
goserelin
-LHRH agonist breast, prostate CA
32
danorubicin
- anti tumor antibiotic - cell cycle non specific - intercalates between DNA base pairs, breakage - inhibits Topo II - releases Fe to make free radicals -leukemia - myelosuppression - alopecia - N/V - tissue necrosis (vesicant) - cardiotoxicity (systolic HF) - Fe release --> ROS
33
doxorubicin
- anti tumor antibiotic - cell cycle non specific - intercalates between DNA base pairs, breakage - inhibits Topo II - releases Fe to make free radicals -lymphoma, solid tumors - myelosuppression - alopecia - N/V - tissue necrosis (vesicant) - cardiotoxicity (systolic HF) - Fe release --> ROS
34
bleomycin
- anti tumor antibiotic - G2 phase specific - binds to DNA - free radical formation -Hodgkins - interstitial pneumonitis - pulmonary fibrosis - skin toxicity
35
vincristine
- vinca alkaloids - inhibits microtubules NHL, ALL -neuropathies (paresthesias, decreased autonomic function --> constipation) vinCristine = Constipation
36
vinblastine
- vinca alkaloids - inhibits microtubules Hodgkins, Testicular CA -bone marrow suppression vinBlastine = Bone marrow
37
vinorelbine
- vinca alkaloids - inhibits microtubules - NSCLC, breast CA - bone marrow suppression
38
paclitaxel
- plant alkaloid - Taxane - enhances microtubule formation (cannot break down -- stuck in metaphase) -breast, lung, ovarian - myelosuppression - neuropathy (long nerves) - hypersensitivity - HAND FOOT syndrome
39
docetaxel
- plant alkaloid: taxane - enhances microtubule formation (cannot break down, stuck in metaphase) -breast, lung, ovarian - myelosuppression - neuropathy - hypersensitivity - HAND FOOT syndrome
40
irinotecan | topotecan
- plant alkaloid - camptothecin - TOPO I INHIBITOR - S to G2 phase specific -colon, ovarian, prostate, esophageal, non Hodgkins - myelosuppression, neutropenia, thrombocytopenia - diarrhea (leads to vol depletion) ATROPINE (anticholinergic) helps early onset SLUDD sx LOPERAMIDE helps with late onset SLUDD Sx
41
atropine
- anticholinergic | - helps with early onset SLUDD (diarrhea) sx of camptothecans
42
loperamide
-helps with late onset SLUDD (diarrhea) sx of camptothecans
43
trastuzamab
- mAb - anti HER2 -breast CA - infusion related (bronchospasm, dyspnea, angioedema, hypotension) from cytokine release - myelosuppression - cardiotoxicity
44
bevacizumab
- mAb - anti VEGF - blocks angiogenesis -solid tumors - impaired wound healing - hypertension - thrombotic events - bleeding episodes - GI perf
45
rituximab
- mAb - anti CD20 - apoptosis, ADCC, complement activation -CD20+ NHL, CLL, autoimmune diseases - immunosuppressive - HEP B REACTIVATION - infusion related (hypotension, SOB, diaphoresis) due to cytokines - tumor lysis - skin reactions - N/V
46
cetuximab
- mAb - anti EGFR (tyrosine kinase receptor) - decreases cell growth/differentiation -solid tumors - acneiform rash - N/V - hepatotoxicity
47
eculizumab
- mAb | - anti complement C5
48
imatinib
- tyrosine kinase inhibitor - BCR-ABL inhibitor - limits cell proliferation -CML - edema - cytopenia - elevated LFTs - cardiotoxicity
49
erlotinib
- tyrosine kinase inhibitor - EGFR inhibitor - limits cell growth/proliferation -lung cancer - acneiform rash - diarrhea - interstitial lung disease
50
thalidomide
- imid - antiangiogenesis (inhibit VEGF) - immunomodulatory (inhibits TNF, induces apoptosis) -multiple myeloma - teratogenic - neurotoxicity - sedation - depression
51
lenalidomide
- imid - unknown MOA - more potent than thalidomide -multiple myeloma - cytopenia - thrombotic events - teratogenic?
52
azacytidine
- demethylating agent - un silences tumor suppressor genes -MDS - myelosuppression - N/V - diarrhea
53
decitabine
- demethylating agent - un silences tumor suppressor genes -MDS - myelosuppression - N/V - diarrhea
54
bortezomib
- protease inhibitor - disrupts normal protein metabolism, downregulation of NF-kB - multiple myeloma - NHL - fatigue, malaise - myelosuppression - peripheral neuropathy
55
ATRA
-vitamin A analog - acute promyelocytic leukemia - allows differentiation of RAR - curative
56
ipilimumab
- immune checkpoint inhibitor - blocks CTLA-4 - augments T cell activation/proliferation -AE: immune related (every "itis") Tx: corticosteroids
57
nivolumab
- mAb - anti PD1 - allows immune system to recogniza and kill tumor AE -hepatitis, gastritis, nephritis, thyroidits (Tx: corticosteroids)
58
leucovorin
- rescue for methotrexate | - synergistic with 5 FU
59
glucarpidase
- enzyme - cleaves MTX - absurdly expensive
60
L-asparaginase
- decreases MTX toxicity | - prevents cells from entering S phase
61
intrathecal drugs
- methotrexate - C Ara - Thiotepa (alkylator)
62
dexrazoxane
- iron chelator - limits cardiotoxicity - w/i 30 min of daunorubicin/doxorubicin
63
atropine
-for acute N/V for irinotecan
64
loperamide
-for delayed N/V for irinotecan

AIM - Heme/Onc (9 decks)

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