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HK_Pharmacology > Chemotherapy > Flashcards

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
Q

Renal/Hepatic dosing for vinca alkaloids

A

Vinblastine- hepatic adjustment

Vincristine- hepatic adjustment

26
Q

List of anti-folates anti-metabolites

A

Methotrexate
Pemetrexed
Pralatrexate

27
Q

Anti-folates MOA

A
  • 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
Q

Side effects of Anti-folates

A

Common:
Pancytopenia, n/v, diarrhea, mucositis, alopecia, HEPATIC DYSFUNCTION, AKI

Warnings:
Clear any effusions prior to treatment (effect clearance of MTX)
Leukoencephalopathy

29
Q

Renal/Hepatic dosing for anti-folates

A

MTX and Pralatrexed- renal and hepatic adjustment

Pemetrexed - renal adjustment

30
Q

How to mitigate/ treat MTX toxicity

A

Leukovorin (reduces toxicity including myelosuppression)

Glucarpidase (given if MTX levels >30)

31
Q

List of fluoropyrimidines anti-metabolites

A

Fluorouracil (5-FU)

Capecitabine (xeloda)

32
Q

Fluoropyrimidines MOA

A

inhibits thymidylate synthetase and interferes with DNA and RNA synthesis
-Works in S phase (DNA replication)

33
Q

Side effects of Fluoropyrimidines

A

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
Q

Renal/Hepatic dosing for Fluoropyrimidines

A

5-FU - hepatic adjustment

Xeloda- renal adjustment needed

35
Q

Why is leukovorin given with 5-FU

A

enhances inhibition of thymidylate synthetase

36
Q

Deficiency of what enzyme causes 5-FU toxicity

A

DPD (dihydropyrimidine dehydrogenase)- pancytopenia, diarrhea, mucositis

37
Q

List of pyrimidine analogues anti-metabolites

A

Cytarabine

Gemcitabine

38
Q

Pyrimidine analogues MOA

A
  • inhibits DNA synthesis by inhibition of DNA polymerase

- Works in S phase (DNA replication)

39
Q

Side effects of Pyrimidine analogues

A

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

Warnings:
Leukoencephalopathy, desquamation (Ara-C)
PRESS, HUS, Pulm toxicity (Gemcitabine)

40
Q

Renal/Hepatic dosing for Pyrimidine analogues

A

Cytarabine- renal and hepatic adjustment

Gemcitabine- hepatic adjustment

41
Q

List of topoisomerase inhibitors

A

topoisomerase 1 inhibitor: topotecan, and irinotecan

topoisomerase 2 inhibitor: etoposide, doxorubicin, mitoxantrone

42
Q

Topoisomerase inhibitors MOA

A

bind reversibly to topoisomerase DNA complex preventing religation of the cleaved DNA strand

43
Q

Side effects of Topoisomerase inhibitors

A

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
Q

Renal/Hepatic dosing for topoisomerase inhibitors

A

Topotecan (renal adjustment)
Irinotecan (hepatic adjustment)
Etoposide (renal and hepatic adjustment)

45
Q

Deficiency of what enzyme causes Irinotecan toxicity

A

UGT1A1 (neutropenia, diarrhea)

46
Q

Bleomycin MOA

A

inhibits synthesis of DNA; binds to DNA leading to single- and double-strand breaks
-Works on G2 phase

47
Q

Side effects of Bleomycin

A

Common:
mucositis, alopecia, dermatologic (darkening/ thickening of skin)

Warning:
Pulm toxicity, renal/hepatic toxicity

48
Q

Renal/Hepatic dosing for Bleomycin

A

Renal adjustment

49
Q

List the purine analogues anti-metabolites

A 
fludarabine 
cladribine
pentostatin 
6-MP
Azathioprine
50
Q

Purine analogues MOA

A

inhibits DNA synthesis by inhibition of DNA polymerase and ribonucleotide reductase

51
Q

Side effects of Purine analogues

A

Common:
Pancytopenia, n/v, diarrhea,

Warning:
Infection
CNS toxicity

52
Q

Renal/Hepatic dosing for purine analogues

A

fludarabine (renal adjustment)
cladribine (renal adjustment)
pentostatin (renal adjustment)

53
Q

Ppx required for purine analogues

A

Bactrim for PCP ppx for at least 1 year

Acyclovir for HSV ppx

54
Q

List of hypomethylating agents antimetabolites

A

decitabine

azacitidine

55
Q

Hypomethylating agents MOA

A

causes hypomethylation and subsequent cell death

-works in S phase (DNA replication)

56
Q

Side effects of Hypomethylating agents

A

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

Warning:
Severe bone marrow suppression

57
Q

Renal/Hepatic dosing for Hypomethylating agents

A

decitabine (renal and hepatic adjustment)

azacitidine (renal adjustment)

58
Q

List of hdac inhibitor

A

Histone deacetylase inhibitor
Vorinostat
Romidepsin

59
Q

hdac inhibitor MOA

A

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
Q

Side effects of hdac inhibitor

A

Common:

thrombocytopenia, anemia, n/v, diarrhea, xerostomia,

HK_Pharmacology (6 decks)

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