Chemotherapeutics

Question 1

What happens in the M stage of the cell cycle

Answer 1

mitosis

Question 2

What happens in the G0 stage of the cell cycle

Answer 2

resting

Question 3

What happens in the S stage of the cell cycle

Answer 3

synthesis - doubling of cell’s DNA

Question 4

list the 6 major categories of anticancer drugs

Answer 4

alkylating agents
antimetabolites
antitumor antibiotics
topoisomerase inhibitors
tubulin binding drugs
signal transduction modifiers

Question 5

How does intermittent chemotherapy work?

Answer 5

allow for breaks from chemo for highly proliferative cells to regrow

**malignant cells must grow slower than normal cells for this to be effective

Question 6

How do phase specific chemotherapeutic agents work?

Answer 6

they only work during a specific phase of the cell cycle

Question 7

How do phase non-specific agents work?

Answer 7

work during several phases of the cell cycle

Question 8

List the tissues that are highly damaged from chemotherapeutics

Answer 8

rapidly proliferating cell types

• bone marrow
• GI tract
• hair
• reproduction

Question 9

List some symptoms of extravasation of chemotherapeutics

Answer 9

pain
burning
swelling
redness
lack of blood return

Question 10

List some alkylating agents

Answer 10

nitrogen mustards (Cyclophosphamide)
nitrosureas (Carmustine)
platinum compounds (Cisplatin, Carboplatin)

Question 11

How do alkylating agents work?

Answer 11

reactive alkyl groups form covalent bonds with nucleotide bases in RN/DNA –> DNA cannot uncoil to replicate

Question 12

Major AE of alkylating agents

Answer 12

bone marrow suppression

Question 13

Unique serious AE of carmustine

Answer 13

pulmonary toxicity

Question 14

List some platinum compounds

Answer 14

Cisplatin
Carboplatin
Oxaliplatin

Question 15

Mechanism of action of platinum compounds

Answer 15

similar to alkylating agents (often classified with them)

cross links DNA –> cannot uncoil –> cannot replicate

Question 16

Major toxicities for platinum compounds

Answer 16

nephrotoxicity
peripheral neuropathy
severe N/V
bone marrow suppression
otoxocity

Question 17

List some antimetabolites

Answer 17

folate analogues (methotrexate)
pyrimidine analogues (fluorouracil)
purine analogues (mercaptopurine)

Question 18

mechanism of action of antimetabolites

Answer 18

structural analogues of endogenous metabolites. Inhibit DNA via one of:
- direct enzyme inhibition
- incorporation directly into DNA

Question 19

What phase of the cell cycle do antimetabolites target

Answer 19

S

Question 20

mechanism of action of methotrexate

Answer 20

binds dihydrofolate reductase w/ higher affinity than folate. Thus prevents formation of FH4 which is required for nucleoside synthesis

(results in decreased DNA/RNA/protein synthesis)

Question 21

Toxicities that are SPECIFIC to methotrexate

Answer 21

pulmonary fibrosis/edema
renal toxicity
hepatic toxicity

Question 22

Toxicities that are SPECIFIC to fluorouracil

Answer 22

increased risk of MI x1 week post-admin
neurologic defects
hand & foot syndrome

Question 23

Mechanism of action of topoisomerase inhibitors

Answer 23

inhibit topoisomerase, thus DNA cannot uncoil –> replication cannot occur

Question 24

List some topoisomerase inhibitors

Answer 24

topotcan
irinatecan
etoposide
teniposide

anthracycline (doxorubicin, danorubicin)

non-anthracyclines (bleomycin)

Question 25

Toxicities SPECIFIC to doxoubicin/daunorubicin

Answer 25

red/orange urine & sweat
cardiotoxicity!!!

Question 26

Toxicities SPECIFIC to bleomycin

Answer 26

pulmonary toxicity **keep FiO2 <30%

(myelosuppression is rare)

Question 27

List some vinca alkaloids

Answer 27

vincristine
vinblastine
vinorelbine

Question 28

mechanism of action of vinca alkaloids

Answer 28

bind tubulin & blocks microtubule assembly –> mitosis cannot occur

Question 29

What phase of the cell cycle do vinca alkaloids target

Answer 29

M

Question 30

Toxicities specific to vincristine

Answer 30

peripheral neuropathy

(very little bone marrow suppression!)

Question 31

List some taxanes

Answer 31

paclitaxel
docetaxel

Question 32

mechanism of action of taxanes

Answer 32

prevents disassembly of microtubule bundles –> inability to continue w/ cell division

Question 33

toxicities specific to taxanes

Answer 33

peripheral neuropathy
muscle & joint pain
cardiac toxicities
severe hypersensitivity reactions

Question 34

list some signal transduction modifiers

Answer 34

antiestrogens (tamoxifen)
antiandrogens (flutamide)
monoclonal antibodies
aromatase inhibitors

Question 35

How does bevacizumab work?

Answer 35

inhibit VEG-F (vascular endothelial growth factor)

blocks angiogenesis, tumors don’t have adequate blood flow to survive

Question 36

handling of chemotherapeutics for nurses

Answer 36

gloves
avoid contact w/ skin/eyes/mucus membranes
don’t break/crush
follow hospital protocols

Question 37

ok for patients to get pregnant on chemotherapeutics?

Answer 37

no

Question 38

ok for patients to breastfeed while on chemotherapeutics?

Answer 38

no