Chemotherapeutic Agents

Question 1

Use of medications to kill or inhibit the growth and spread of disease.

Answer 1

Chemotherapy

Question 2

Drugs that harm or destroy malignant cells.

Answer 2

Antineoplastic

Question 3

Agents that can harm or kill living cells.

Answer 3

Cytotoxic

Question 4

Doses are based on ______.

Answer 4

BSA

Question 5

Set percentage of cells are killed with each dose of chemotherapy.

Answer 5

Cell Kill Theory

Question 6

Exert activity in particular phase of cell division cycle.

Answer 6

Cell cycle specific

Question 7

Cytotoxic activity unrelated to cell cycle.

Answer 7

Cell cycle nonspecific

Question 8

Apoptosis signals a cell to enter G1 phase of cell division.

Answer 8

Feedback system

Question 9

What happens in cancer patients in regard to the feedback system?

Answer 9

Cells enter division cycle independently of body’s feedback system.

Question 10

postmitotic phase

Answer 10

G1

Question 11

premitotic phase

Answer 11

G2

Question 12

synthesis phase

Answer 12

S

Question 13

Resting phase

Answer 13

G0

Question 14

Phase that cell-cycle specific agents do not work in

Answer 14

G0

Question 15

Plant derivatives and antimetabolites are classes of what type of agents?

Answer 15

Cell Cycle Specific Agents

Question 16

Vinca alkaloids and etoposide are examples of what class?

Answer 16

Plant derivatives (cell cycle specific)

Question 17

Folate antagonists and pyrimidine analogues are examples of what class?

Answer 17

Antimetabolites (cell cycle specific)

Question 18

Interfere with DNA and RNA formation; specific to cells undergoing DNA synthesis (S phase)

Answer 18

Antimetabolites

Question 19

Structural analog of folic acid. Inhibits dihydrofolate reductase. High dose leads to low bioavailability. Accumulates in fluid collections (risk of ascites or pulmonary effusions).

Answer 19

Methotrexate (antimetabolite)

Question 20

Hepatotoxicity is an adverse effect of what?

Answer 20

Methotrexate

Question 21

What drug rescues toxicity of methotrexate and minimizes adverse effects?

Answer 21

Leucovorin

Question 22

True or false: Close patient monitoring is required in patients taking methotrexate.

Answer 22

True

Question 23

True or false: Hydration with acidic fluids is recommended in patients taking methotrexate.

Answer 23

False: alkalinized fluids

Question 24

Penicillin, cephalosporins, salicylates, and folic acid are drug drug interactions with what drug?

Answer 24

Methotrexate

Question 25

Which drug is incorporated into DNA as a false base, inhibiting DNA polymerase?

Answer 25

Cytarabine (antimetabolite)

Question 26

Ara-C syndrome is an adverse effect of what drug?

Answer 26

Cytarabine

Question 27

What are symptoms of ara-C syndrome?

Answer 27

Rash on palms and soles of feet, fever, malaise, flu-like symptoms

Question 28

What drug binds to tubulin and inhibits microtubule formation?

Answer 28

Vincristine (Vinca Alkaloid, plant derivative)

Question 29

Is vincristine cell cycle specific?

Answer 29

Yes

Question 30

Is Cytarabine cell cycle specific?

Answer 30

Yes

Question 31

Is methotrexate cell cycle specific?

Answer 31

Yes

Question 32

What drugs have hepatic metabolism by CYP 3A4?

Answer 32

Both plant derivatives (Cincristine and Etoposide)

Question 33

Which chemotherapeutic agent does NOT cause myelosuppression?

Answer 33

Vincristine (plant derivative)

Question 34

Which drug causes constipation, vesicant, and SIADH?

Answer 34

Vincristine

Question 35

Which drug inhibits topoisomerase II and causes DNA strand breaks?

Answer 35

Etoposide

Question 36

Which drug should be given via IV for over 30 minutes to minimize risk of hypotension?

Answer 36

Etoposide

Question 37

Which drug has secondary malignancies as a toxicity?

Answer 37

Etoposide

Question 38

Cell kill is concentration dependent (proportional to dose)

Answer 38

Cell cycle nonspecific agents

Question 39

What are the classes of cell cycle nonspecific agents?

Answer 39

Alkylating agents and antitumor antibioitcs

Question 40

Cyclophosphamide and ifosfamide are examples of what class?

Answer 40

Alkylating agents

Question 41

Which alkylating agent has a narrow therapeutic index?

Answer 41

Cyclophosphamide

Question 42

What does mesna do?

Answer 42

Prevents hemorrhagic cystitis in patients taking cyclophosphamide or ifosfamide by binding acrolein.

Question 43

Which agent has dose-limiting toxicity of myelosuppression and hemorrhagic cystitis, SIADH, and cardiotoxicity?

Answer 43

Cyclophosphamide

Question 44

Which agent is recommended to be taken with cyclophosphamide and ifosfamide? What does it do?

Answer 44

Mesna -- binds acrolein in the bladder, which is a product of the drugs' metabolism.

Question 45

Hepatic metabolism to active metabolites and acrolein

Answer 45

Cyclophosphamide and ifosfamide

Question 46

What side effects differ from cyclophosphamide and ifosfamide?

Answer 46

Ifosfamide also has risk of CNS toxicity and renal electrolyte wasting (phoshorus, bicarbonate, potassium).

Question 47

Which agent has non-enzymatic metabolism and requires pretreatment IV hydration?

Answer 47

Cisplatin

Question 48

Toxicities: N/V is severe and delayed.

Answer 48

Cisplatin

Question 49

Peripheral neuropathy, renal toxicity, ototoxicity, hepatotoxicity, mild myelopsuppression

Answer 49

Cisplatin

Question 50

Which agent is not protein bound and has NO hepatic metabolism?

Answer 50

Carboplatin

Question 51

Which agent uses AUC dosing? What is AUC dosing?

Answer 51

Dose based on target exposure; takes GFR into consideration. Carboplatin uses this.

Question 52

N/V less severe, but more myelosuppression.

Answer 52

Carboplatin

Question 53

Cisplatin and Carboplatin are examples of what class?

Answer 53

Alkylating Agents (cell cycle nonspecific)

Question 54

Doxorubicin and daunorubicin are examples of what?

Answer 54

Anthracyclines (antitumor antibiotics) They are highly pigmented, planar molecules,

Question 55

What is the MOA of anthracyclines?

Answer 55

Multifactorial. DNA intercalation and topoisomerase II inhibition.

Question 56

Which agent has biliary excretion?

Answer 56

Anthracyclines

Question 57

Which agent requires dose adjustment for hepatic dysfunction but NOT for renal dysfunction?

Answer 57

Anthracyclines

Question 58

Which agent has toxicities: cardiotoxicity (acute, early chronic (within 1 year) or late chronic (5-20 years), vesicant, and urine discoloration?

Answer 58

Anthracyclines

Question 59

What are the benefits of combination chemotherapy? (3)

Answer 59

1. Increases number of cells exposed to cytotoxic effects 2. Allows for use of lower doses of each component 3. Decreases development of drug resistance

Question 60

Methotrexate drug interactions: Compete for renal excretion (2)

Answer 60

Cephalosporins, penicillin

Question 61

Methotrexate drug interactions: Displacement of methotrexate from protein binding sites (2)

Answer 61

Salicylates and sulfonamides

Question 62

Methotrexate drug interactions: Decreased cellular transport (1)

Answer 62

Penicillin

Question 63

Which antimetabolite has urinary excretion as metabolites?

Answer 63

Cytarabine

Question 64

Rash on palms of hands and soles of feet and flu-like symptoms are a sign of what?

Answer 64

Ara-C syndrome from cytarabine

Question 65

Which agent is fatal if given intrathecally?

Answer 65

Vincristine

Question 66

What should you do when giving etoposide to minimize hypotension?

Answer 66

IV infusion over at least 30 minutes