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Chemo/Radiation Tx > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

Stages of primary chemotherapy?

A

Induction - intensely scheduled initial treatments
(greatest chance of response, higher risk of toxicity).
Consolidation - end of induction (using unrelated, effective drugs to further reduce cancer cells)
Maintenance - less intense, using drugs already used in induction, may prolong time to relapse
Rescue - when drugs used in other phases no longer effective. Unrelated drugs (often alklylating bc they are less likely to show cross-resistance)

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2
Q

When is nadir or peripheral neutrophil counts after myelosuppresive insult?

A

5 to 10 days after insult. Timing of myelosuppressive drug therapy is therefore every 2 to 3 weeks. Nadir less than 1000 neutrophils prompts 20-25% dose reduction.

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3
Q

What is Neupogen, what are its indications?

A

human recombinate granulocute colony-stimulation factor (hr-G-CSF). Carries risk of induction of anticanine G-CSF antibodies. Practical use after inadvertent lethal chemo overdose.

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4
Q

When do GI signs occur following chemotherapy?

A

3-5 days following treatment. 20 to 25% dose reduction is very unlikely to cause subsequent toxicity

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5
Q

What drugs are particulary associated with anorexia in cats?

A

DOX and vincristine (may result in ileus). Cyproheptidine an megestrol acetate may stimulate appetite. Caution can cause DM in cats.

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6
Q

What chemo drug is associated with cardiotoxicity?

A

DOX. Irreversible tox and carries poor to grave prognosis. End result resembles DCM and CHF.

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7
Q

What is the primary dose-limiting toxicity of cisplatin?

A

nephrotoxicity in dogs. Causes acute fatal pulmonary edema in cats. Do not use in CATS!

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8
Q

What specific toxicity is associated with cyclophosphamide and ifosamide in dogs?

A

sterile hemorrhagic cystitis. Drugs metabolized in liver to active form, results in production of acrolein metabolite which induces disease on contact of bladder mucosa.

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9
Q

CCNU causes what kind of organ damage?

A

Hepatotoxicity. Can cause irreversible liver damage.

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10
Q

What chemo drugs are associated with hypersensitivity reactions?

A

DOX (during administration can cause release of histamine from MCTs, result of too rapid admin), True anaphylaxis can occur with L-asparaginase (more so with IV, than IM, SQ)

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11
Q

What chemo is specifically contraindicated in cats?

A

Cisplatin - fatal, acute pulmonary edema. 5-flurouracil -fatal nephrotoxicity.

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12
Q

MOA for alkylating agents?

A

Create cross links in DNA, causing strand breaks. This group has lack of cross-resistance between different alkylating agents or with other classes of drugs?

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13
Q

Examples of alkylating agents?

A

Nitrogen mustards (mechlorethamine, cyclophosphamide,ifosfamide, chlorambucil, melphalan). Nitrosoureas (lomustine (CCNU), streptozocin). Others (procarbazine, decarbazine)

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14
Q

Indications for cyclophosphamide?

A

Lymphoma cats and dogs. PO or IV. Monitor CBC.

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15
Q

Indications for chlorambucil?

A

Treatment of chronic lymphocytic leukemia or low grade lymphoma in dogs and cats. Substitute for cyclophosphamide if hemorrhagic cystitis occurs. PO. Monitor: CBC, myelosuppression can occur. Monitor liver enzymes

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16
Q

Indications for melphalan?

A

Treatment of multiple myeloma in dogs and cats. PO. Monitor CBC.

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17
Q

Indications for mechlorethamine?

A

Used in MOPP protocol for LSA in dogs and cats. IV (caution extravasation). Monitor CBC.

18
Q

Indications for procarbazine?

A

Used in MOPP protocol for LSA in dogs and cats. PO. Monitor CBC.

19
Q

Indications for CCNU?

A

Used in treatment of lymphoma, MCTs, brain tumors (gliomas, meningioma), malginant histiocytosis. PO. Leukopenia and thrombocytopenia expected (dose limiting). Potential hepatic and renal toxicities.

20
Q

MOA antitumor antibiotics?

A

DNA intercalation, interfers with topoisomerases and other mechs.
Can exhibit cross-resistance with other drugs (mediated by MDR drug efflux pump)”

21
Q

Examples of antitumor antibiotics?

A

Doxorubicin, mitoxantrone, actinomycin-D

22
Q

Indications for Doxorubicin?

A

Most active single agent in canine lymphoma. Highly effective combination for
lymphoma in dogs and cats. Treatment of solid tumors (esp OSA), and in combo
with cyclophosphamide. Monitor CBC, GI signs, liver function, ECG/Echo. Cats-renal. IV

23
Q

Indications for mitoxantrone?

A

Efficacious in combo with piroxicam for TCC in dogs. Moderate efficacy canine lymphoma, low in cats. Substitute for DOX in dogs at risk for cardiotox and cats
at risk for nephrotox. Monitor CBC. IV

24
Q

Indications for Actinomycin-D?

A

Alternative to DOX for canine lymphoma. Monitor CBC and GI signs. IV

25
Q

MOA for antimetabolites?

A

Inhibit the use of cellular metabolities in course of cell growth and division.

26
Q

Examples of antimetabolites?

A

Cytosine arabinoside, methotrexate, gemcitabin, 5-flurouracil

27
Q

Indications for cytosine arabinoside?

A

Infrequent component of combo therapy for leukemia and lymphoma in dogs and cats. Used if CNS involvement. IV or SQ.

28
Q

Indications for methotrexate?

A

Folate analog - inhibits enzymes dihydrofolate reductase, therefore decreases folate pools require for purine and thymidylate biosynthesis. Rarely used bit was in original multiagent tx of lymphoproliferative dz in cats and dogs. Oral

29
Q

Indications for gemcitabine?

A

MOA attributes to its incorporation into DNA and ultimate inhibition of DNA replication. Little evaluation but has had some reposnise in LSA, malignant melanoma, and SCC. Synergy with carboplatin in human med. IV

30
Q

Indications for 5-flurouracil?

A

Infrequenetly used for epithelial tumors (hepatic, pancreatic, renal, mammary). IV, topically, intralesionary.

31
Q

MOA for antimicrotubule agents?

A

Inhibit assembly of mitotic spindle

32
Q

Examples of antimicrotubule agents?

A

Taxanes (paclitaxel, docetaxel). Vinca alkaloids (vinblastine, vincristine)

33
Q

Indications for taxanes?

A

Requires signficant pre-treatment with antihistamines, steroids, long -effusion, to minimize acute hypersenstivity. Not evaluated well. Paclitaxel drug carrier is Cremophor EL, sobulizes drugs bit is highly allergenic. Less issues with docetaxil because no Cremophor EL.

34
Q

Indications for vinca alkaloids?

A

Vincristine - multiagent in dog and cats lymphoma, single agent for dogs with TVT. Vinblastine most often used to manage canine MCT, as single or multiagent. Vinorelbine - used in vareity of tumors but not thorughly evaluated yet.

35
Q

Indications and Moa for epipodophyllotoxins?

A

Inhibits topoisomerase II. Hypersentivity in dogs IV. Low oral bioavaliability. Not recommended for use in dogs. More studies needed in cats.

36
Q

MOA for platinum drugs?

A

Create cross-links in DNA. Similar to alkylating agents. No cross-resistance with other classes of drugs.

37
Q

Examples of platinum drugs?

A

Cisplatin, carboplatin.

38
Q

Indications for cisplatin?

A

Canine OSA, other carcinomas. Contraindicated in cats. Precede and follow with diuresis due to nephrotox. IV.

39
Q

Indications for carboplatin?

A

Similar to cisplatin with out renal tox and safe in cats. Monitor creatinine during treatment. IV.

40
Q

Indications of L-asparaginase?

A

used in combo for lymphoma in dogs (not as single agent due to rapid resistance). SQ or IM. Anaphylasis if given IV.

41
Q

Indications for hydroxyurea?

A

inhibits ribonucleotide reductase which decreases deoxyribonucleotides. Dosed orally. Used for treatment of bone marrow disorders such as polycythemia vera and granulocutic leukemias. Toxicities include GI effects, myelosuppression, onycholysis, pulmonary fibrosis.

Chemo/Radiation Tx (2 decks)

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