Chemotherapy

Question 1

5FU

Answer 1

fluropyrimidine
prodrug, used for T
interferes with FA absorption
SE FA deficiency

Question 2

Capecitabine

Answer 2

fluropyrimidines
prodrug, used for U
toxic: neutropenia, thrombocytopenia, anemia
SE: bleeding if also no coumadin, hand-foot syndrome, diarrhea

Question 3

Cytarabine

Answer 3

cytidine analogue
analogue of C
inhibits DNA polymerase
Toxic: cerebellar syndrome, bone suppression, N/V, abd pain, oral ulceration, hepatic dysfunction

Question 4

Gemcitabine

Answer 4

cytidine analogue

inhibits DNA polymerase and ribonucleotide reductase

Question 5

Azacytidine, Decitabine

Answer 5

nucleoside analogue
stops progression of myelodysplastic syndrome
reduces transfusion needs
toxic: myelosuppression

Question 6

Mercaptopurine, Thioguanine

Answer 6

purines
metabolized by TPMT (decrease dose 6-MP)
SE: hepatotoxicity, BM suppression
-If gout txed with allopurinol, reduce merc. dose by 75%

Question 7

Fludarabine

Answer 7

interferes with DNA polymerase

toxic: myelosuppression, increase infection

Question 8

Cladribine, Pentostatin

Answer 8

purine nucleoside analogue
clad–> resists deactivation by adenosine deaminase
pent–> inhibits adenosine deaminase; don’t use with fludarabine (toxicity to bone, lung, liver, brain)
SE: myelosuppression, increase risk of infection

Question 9

Methotrexate, Demetrexed

Answer 9

antifolate
supplement prn with B12 and FA
SE: neutropenia, thrombocytopenia, mucusitis, hepatotoxicity, N/V
RTN with high dose MTX= water, increase pH urine

Question 10

Vinca alkaloids

Answer 10

mitotic inhibitor–> inhibits microtubule assembly
resistnat cancer develops w/ Pgp
extravasatoin–> apply heat packs

Question 11

Taxanes

Answer 11

anti-mitotic
interfere with microtubule disassembly (use corticosteroids before use)
SE myelosuppression
*give corticosteroids before using either of the following…
Doxetaxel: increase fluid retention
Paclitaxel: increase neurotoxicity, give anti-histamines before use, don’t give if bilirubin >ULN or SGOT/SGPT 1.5x ULN

Question 12

Epothilone

Answer 12

used in paclitaxel resistant lines
Ixabepilone used to tx metastatic breast cancer
premedicate with anti-histamines

Question 13

Estramustine

Answer 13

alkylating agent nor-N2 mustard with estradiol

inhibits microtubule assembly

Question 14

Camptothecin

Answer 14

inhibit TIase I

toxic: diarrhea (tx with imodium), neutropenia

Question 15

Etoposide, Teniposide

Answer 15

inhibit TIase II

toxic: myelosuppression, bleeding

Question 16

Mitoxantrone

Answer 16

intercalalting TIase II, but potential for free radicals less than anthracenes
used in MS
toxic: cardiotoxicity, AML

Question 17

Anthracene

Answer 17

Doxorubicin, daunorubicin, idarubicin, epirubicin
intercalating TIase inhibitors
generates free radicals
if at risk for cardiomyopathy apply cold pack 15 min before dexrazoxane (apply within 6 hours)
Toxic: AML, fatal CHF if dose>400 (doxo)

Question 18

Cisplatin

Answer 18

nephrotoxicity, ototoxicity, peripheral neuropathy, emesis, anemia

Question 19

Carboplatin

Answer 19

limited by hematologic toxicity (less likely than cisplatin for SE)

Question 20

Oxaliplatin

Answer 20

moderately emetogenic, peripheral neuropathies, unique cold-induced neuropathies

Question 21

N2 mustards

Answer 21

cyclophosphamide and ifosfamide
tx solid tumors and hematologic malignancies
infuse MENSA to reduce risk of hemorrhagic cystitis
encephalopathy following ifosfamide infusion d/t increase risk of CNS toxicity

Question 22

Bendamustine

Answer 22

active against dividing cells

tx lymphoid malignancies

Question 23

Nitrosourea

Answer 23

DNA alkylating agent

BCNU (IV drug impregnated biodegradable wafer following sx) and CCNU

Question 24

Bleomycin

Answer 24

anti tumor abx
inactivated within cells by enzyme aminohydrolase (low concentration in lungs, skin)
toxic: pulmonary fibrosis

Question 25

Hydroxurea

Answer 25

inhibits RNA reductase

toxic: clastogenicity, mutagenicity

Question 26

Asparaginase

Answer 26

depletes supplies and inhibits protein synthesis

tx: acute leukemia

Question 27

Arsenic Trioxide

Answer 27

induces apoptosis

used for some leukemias

Question 28

Vorinostat

Answer 28

histone deacetylase inhibitor
used for skin cancer
SE: PE and DVT

Question 29

Rituximab

Answer 29

CD20
B cell non-Hodgkins lymphoma
SE: transient fever, chills, N, headache, asthenia

Question 30

Ibritumomab

Answer 30

CD20
non-Hodgkin lymphoma
SE: infusion related rxs, anaphylaxis, thrombocytopenia, neutropenia

Question 31

Alemtuzumab

Answer 31

CD52

SE: black box opportunistic infections

Question 32

Cetuximab

Answer 32

EGFR
used alone or in combo for metastatic colon cancer, head and neck cancers
SE: fatigue, GI complaints, abd pain, reports of death/CP arrest

Question 33

Panitumumab

Answer 33

EGFR ligand

Question 34

Trastuzumab (Herceptin)

Answer 34

HER-2
tx metastatic breast cancer
risk of cardiac failure (esp with anthracyclins)

Question 35

Erlotinib

Answer 35

selective EGFR tyrosine kinase inhibitor

SE: rash and diarrhea

Question 36

Lapatinib

Answer 36

inhibits EGFR and HER-2

SE: diarrhea, rash, hepatotoxicity, increase QT interval

Question 37

Bevacizumab

Answer 37

prevents activation and promotion of angiogenesis

SE: HTN, bleeding episodes, not recommended 28 days after sx

Question 38

Sunitinib, Soraferib

Answer 38

inhibits VEGFR-2 and platelet derived GFR

Sun= CHF, Sora= hand-foot syndrome