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Chemotherapy Flashcards

1
Q

List of alkylating agents

A
  • Cyclophosphamide (cytoxan), ifosfamide
  • Dacarbazine, procarbazine
  • Bendamustine, lomustine, carmustine (BCNU)
  • Mephalan, temozolomide, busulfan, Trabectedin
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2
Q

Alkylating agents MOA

A
  • Attaches an alkyl group to DNA and prevents the cell from reproducing by damaging its DNA.
  • NOT cell cycle specific
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3
Q

Side effects of alkylating agents? and treatment?

A

Common:
Pancytopenia, n/v, mucositis, alopecia

Warnings:

  • Hemorrhagic cystitis (cyclophosphamide and ifosfamide)- tx w/ Mesna
  • Neurotoxicity (ifosfamide) - tx w/ Methylene blue
  • Delayed Myelosuppression and pulm fibrosis (carmustine)
  • Secondary malignancy- MDS/AML 5-7 years later
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4
Q

What ppx is required for temozolomide

A

Bactrim for PCP

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5
Q

Renal/Hepatic dosing for alkylating agents

A
  • Cyclophosphamide - renal and hepatic adjustment
  • ifosfamide- renal and hepatic adjustment
  • Dacarbazine - renal adjustment
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6
Q

How is Mesna dosed

A

80% of total ifosfamide dose (20% initial infusion then 60%)

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7
Q

Name the vesicants

A

Vesicants NEED a central line

  • Anthracylines
  • Vinka alkaloids
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8
Q

Name irritants

A
  • Platinums (but at higher concentrations cisplatin is a vesicant)
  • Taxanes
  • Ara-C
  • Irinotecan/Topotecan/Etoposide
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9
Q

List of anthracyclines

A 
Doxorubicin (Adriamycin)
Daunorubicin
Epirubicin
Idarubicin
Mitoxantrone
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10
Q

Anthracyclines MOA

A
  • direct binding to DNA (intercalation) and inhibition of DNA repair (topoisomerase II inhibition) result in blockade of DNA and RNA synthesis
  • works in G1 of cell cycle
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11
Q

Side effects of anthracyclines

A

Common:
Pancytopenia, severe n/v, diarrhea, mucositis, alopecia, neuropathy

Warnings:

  • dose-dependent irreversible cardiac toxicity
  • secondary malignancies AML and MDS within 1 to 3 years
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12
Q

At what dose does cardiotoxicity occur for Doxorubicin

A

450-500mg/m2

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13
Q

Renal/Hepatic dosing for anthracyclines

A

Doxorubicin (Adriamycin) - hepatic adjustment
Daunorubicin- hepatic adjustment
Epirubicin - hepatic adjustment
Idarubicin - hepatic and renal adjustment
Mitoxantrone- hepatic adjustment

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14
Q

List of platinum agents

A

carboplatin
cisplatin
oxaliplatin

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15
Q

Platinum agents MOA

A
  • inhibits DNA synthesis by the formation of DNA cross-links

- cell cycle non specific

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16
Q

Side effects of Platinums

A

Common:
Pancytopenia, n/v, diarrhea, mucositis, alopecia

Warnings:
Anaphylaxis/ Hypersensitivity reactions
Cisplatin- renal toxicity, ototoxicity, peripheral neuropathy, K/Mg wasting
Oxalipatin- cold sensory neuropathy

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17
Q

Renal/Hepatic dosing for platinums

A

carboplatin- renal adjustment
cisplatin- renal adjustment
oxaliplatin- renal adjustment

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18
Q

List of taxanes

A

Docetaxel (taxotere)
Paclitaxel (Taxol)
Nab-paclitaxel (abraxane)

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19
Q

Taxanes MOA

A
  • disruption of microtubule function by promoting microtubule assembly- thus inhibiting cell division
  • Work in M (mitosis) phase
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20
Q

Side effects of taxanes

A

Common:
Pancytopenia, n/v, diarrhea, mucositis, alopecia, NEUROPATHY

Warnings:
Hypersensitivity reactions
Docetaxel - fluid retention premedicate with steroids
Paclitaxel- bradycardia

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21
Q

Renal/Hepatic dosing for taxanes

A

Docetaxel - hepatic adjustment
Paclitaxel - hepatic adjustment
Nab-paclitaxel- hepatic adjustment

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22
Q

List of Vinca alkaloids

A

Vinblastine

Vincristine (Oncovin)

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23
Q

Vinca alkaloids MOA

A

Inhibit microtubule assembly

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24
Q

Side effects of vinca alkaloids

A

Common:

Neutropenia, n/v, CONSTIPATION, mucositis, alopecia, neuropathy (both sensory and motor)

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25
Renal/Hepatic dosing for vinca alkaloids
Vinblastine- hepatic adjustment | Vincristine- hepatic adjustment
26
List of anti-folates anti-metabolites
Methotrexate Pemetrexed Pralatrexate
27
Anti-folates MOA
- inhibition of dihydrofolate reductase (DHFR), a critical enzyme in intracellular folate metabolism necessary for DNA synthesis, and thymidylate synthetase - Works in S phase (DNA replication)
28
Side effects of Anti-folates
Common: Pancytopenia, n/v, diarrhea, mucositis, alopecia, HEPATIC DYSFUNCTION, AKI Warnings: Clear any effusions prior to treatment (effect clearance of MTX) Leukoencephalopathy
29
Renal/Hepatic dosing for anti-folates
MTX and Pralatrexed- renal and hepatic adjustment | Pemetrexed - renal adjustment
30
How to mitigate/ treat MTX toxicity
Leukovorin (reduces toxicity including myelosuppression) | Glucarpidase (given if MTX levels >30)
31
List of fluoropyrimidines anti-metabolites
Fluorouracil (5-FU) | Capecitabine (xeloda)
32
Fluoropyrimidines MOA
inhibits thymidylate synthetase and interferes with DNA and RNA synthesis -Works in S phase (DNA replication)
33
Side effects of Fluoropyrimidines
Common: Pancytopenia, n/v, diarrhea, mucositis, alopecia Warnings: Cardiac toxicity (angina, MI, vasospasm, arrhythmia) increased with infusional 5-FU also seen with xeloda Hand-foot mouth syndrome (5-FU and xeloda) Neurotoxicity (5-FU) Hepatoxocity (xeloda)
34
Renal/Hepatic dosing for Fluoropyrimidines
5-FU - hepatic adjustment | Xeloda- renal adjustment needed
35
Why is leukovorin given with 5-FU
enhances inhibition of thymidylate synthetase
36
Deficiency of what enzyme causes 5-FU toxicity
DPD (dihydropyrimidine dehydrogenase)- pancytopenia, diarrhea, mucositis
37
List of pyrimidine analogues anti-metabolites
Cytarabine | Gemcitabine
38
Pyrimidine analogues MOA
- inhibits DNA synthesis by inhibition of DNA polymerase | - Works in S phase (DNA replication)
39
Side effects of Pyrimidine analogues
Common: Pancytopenia, n/v, diarrhea, mucositis, alopecia Warnings: Leukoencephalopathy, desquamation (Ara-C) PRESS, HUS, Pulm toxicity (Gemcitabine)
40
Renal/Hepatic dosing for Pyrimidine analogues
Cytarabine- renal and hepatic adjustment | Gemcitabine- hepatic adjustment
41
List of topoisomerase inhibitors
topoisomerase 1 inhibitor: topotecan, and irinotecan | topoisomerase 2 inhibitor: etoposide, doxorubicin, mitoxantrone
42
Topoisomerase inhibitors MOA
bind reversibly to topoisomerase DNA complex preventing religation of the cleaved DNA strand
43
Side effects of Topoisomerase inhibitors
Common: NEUTROPENIA, n/v, DIARRHEA, mucositis, alopecia Warning: secondary malignancies AML and MDS within 1 to 3 years Hypersensitivity reactions (topotecan, irinotecan, etoposide) ILD (topotecan, irinotecan)
44
Renal/Hepatic dosing for topoisomerase inhibitors
Topotecan (renal adjustment) Irinotecan (hepatic adjustment) Etoposide (renal and hepatic adjustment)
45
Deficiency of what enzyme causes Irinotecan toxicity
UGT1A1 (neutropenia, diarrhea)
46
Bleomycin MOA
inhibits synthesis of DNA; binds to DNA leading to single- and double-strand breaks -Works on G2 phase
47
Side effects of Bleomycin
Common: mucositis, alopecia, dermatologic (darkening/ thickening of skin) Warning: Pulm toxicity, renal/hepatic toxicity
48
Renal/Hepatic dosing for Bleomycin
Renal adjustment
49
List the purine analogues anti-metabolites
``` fludarabine cladribine pentostatin 6-MP Azathioprine ```
50
Purine analogues MOA
inhibits DNA synthesis by inhibition of DNA polymerase and ribonucleotide reductase
51
Side effects of Purine analogues
Common: Pancytopenia, n/v, diarrhea, Warning: Infection CNS toxicity
52
Renal/Hepatic dosing for purine analogues
fludarabine (renal adjustment) cladribine (renal adjustment) pentostatin (renal adjustment)
53
Ppx required for purine analogues
Bactrim for PCP ppx for at least 1 year | Acyclovir for HSV ppx
54
List of hypomethylating agents antimetabolites
decitabine | azacitidine
55
Hypomethylating agents MOA
causes hypomethylation and subsequent cell death | -works in S phase (DNA replication)
56
Side effects of Hypomethylating agents
Common: Pancytopenia, n/v, diarrhea, mucositis, alopecia Warning: Severe bone marrow suppression
57
Renal/Hepatic dosing for Hypomethylating agents
decitabine (renal and hepatic adjustment) | azacitidine (renal adjustment)
58
List of hdac inhibitor
Histone deacetylase inhibitor Vorinostat Romidepsin
59
hdac inhibitor MOA
Inhibition of HDAC results in accumulation of acetyl groups, causing termination of cell growth -induces arrest in cell cycle at G1 and G2/M phase
60
Side effects of hdac inhibitor
Common: | thrombocytopenia, anemia, n/v, diarrhea, xerostomia,

HK_Pharmacology (6 decks)

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