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🄼💊Chemotherapy/AntiViral/Botanicals > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

Cyclophosphamide MOA

A

[Bifunctionally Alkylates (via Phosphoramide Mustard) N7 of [DNA Guanine]–> forms inter and intrastrand crosslinks

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2
Q

Is Cyclophosphamide CCS or CCNS?

A

CCNS

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3
Q

Cyclophosphamide SE (3)

A

Hematuria

Myelosuppression

NVH

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4
Q

Cyclophosphamide Indications (2)

A
  1. Non-Hodgkins Lymphoma
  2. Breast CA
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5
Q

Ifosfamide MOA

A

Monofunctionally Alkylates N7 of [DNA Guanine]

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6
Q

Is Ifosfamide CCS or CCNS?

A

CCNS

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7
Q

Ifosfamide SE (4)

A
  1. Hematuria –> Hemorrhagic Cystitis
  2. [Myelosuppression DL (dose limiting)]
  3. [Lethargy & Confusion @ High dose]
  4. NVH
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8
Q

Ifosfamide Indication (2)

A

(Relapsed) Testicular CA

Sarcoma

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9
Q

Temozolomide MOA

A

Monofunctionally Methylates DNA

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10
Q

Is Temozolomide CCS or CCNS?

A

CCNS

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11
Q

Temozolomide SE (3)

A

Myelosuppression

NVH

[Pneumocystis PNA when given prolonged]

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12
Q

Temozolomide Indication

A

[Glioblastoma (1° Brain Tumor)]

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13
Q

[Cis-DDPlatinum] MOA

A

Bifunctionally Alkylates DNA

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14
Q

Is [Cis-DDPlatinum] CCS or CCNS?

A

CCNS

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15
Q

[Cis-DDPlatinum] Considerations (2)

A
  1. Give with Hydration & [mannitol diuresis] = Chloruresis
  2. Dose reduction for Renal Insufficient pts
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16
Q

[Cis-DDPlatinum] Indications (6)

A
  1. Testicular CA: CURATIVE
  2. Ovarian CA
  3. Bladder CA
  4. SOLC
  5. Non-SOLC
  6. Head & Neck CA
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17
Q

Carboplatin MOA

A

Bifunctionally Alkylates DNA

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18
Q

Is Carboplatin CCS or CCNS?

A

CCNS

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19
Q

Carboplatin SE

A

[Myelosuppression DL]

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20
Q

Carboplatin Indication (6)

A

Same as [cis-DDPlatinum]

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21
Q

What is the dosing of Carboplatin based on? (2) How easy is it to administer?

A

Creatinine Clearance and AUC Target; Easy to administer

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22
Q

Oxaliplatin MOA

A

Bifunctionally Alkylates DNA

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23
Q

Is Oxaliplatin CCS or CCNS?

A

CCNS

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24
Q

Oxaliplatin SE (3)

A

“O O O how mya gets on my nerves”

  1. [Acute Cold induced Neuropathy DL]
  2. [Chronic Sensory Neuropathy DL]
  3. Myelosuppression
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25
Q

Oxaliplatin Indication

A

GI CA (cOlOrectal vs. gastric vs. pancreas)

Doubles Survival in Metastatic cOlOrectal CA

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26
Q

Vincristine MOA

A

Prevents Tubulin polymerization

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27
Q

Is Vincristine CCS or CCNS?

A

CCS (M phase)

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28
Q

Vincristine SE (2)

A
  1. [Neuropathy DL]
  2. Vesicant
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29
Q

Vincristine Indications (2)

A

“Cristy helps ALL the Non Kids”

[Non-Hodgkin’s Lymphoma]

ALL- Acute Lymphoblastic Leukemia

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30
Q

[T or F] Vincristine does NOT cause myelosuppression

A

TRUE

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31
Q

Which pts require dose reduction with Vincristine AND VinBLastine?

A

Jaundice pts (elevated bilirubin); since these drugs are excreted via bile

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32
Q

VinBLastine MOA

A

Same as Vincristine (Prevents Tubulin Polymerization)

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33
Q

Is VinBLastine CCS or CCNS?

A

CCS (M phase)

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34
Q

VinBLastine SE (2)

A

Myelosuppression

[Vesicant Blistering agent]

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35
Q

VinBLastine Indications (2)

A

B for Boob Area

Lung CA

Breast CA

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36
Q

Paclitaxel MOA

A

Prevents Tubulin Disassembly

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37
Q

Is Paclitaxel CCS or CCNS?

A

CCS (M phase)

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38
Q

Paclitaxel SE (6)

A

VHIMMS

  1. Sensory Neuropathy
  2. [Myelosuppression DL] & Myalgia
  3. Infusion rxn from rxn to solvent
  4. [Vesicant Blistering Agent]
  5. HairLoss
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39
Q

Paclitaxel Indications (4)

A

Non-SOLC

Breast CA

Ovarian CA

Gastroesophageal CA

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40
Q

Pts taking Paclitaxel should be premedicated with ____ (3)

A

Steroids

Diphenhydramine

H2 Blockers

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41
Q

Which pts require dose reduction with Paclitaxel?

A

Hepatic Dysfunction pts

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42
Q

Etoposide MOA

A

E2oposide

[Topoisomeriase 2 inhibitor] –> Double stranded breaks in DNA

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43
Q

Is Etoposide CCS or CCNS?

A

CCS (S - G2)

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44
Q

Etoposide SE (3)

A

E2oposide made Mya and Leuk Nauseous

[Myelosuppression DL]

Leukemogenic (Leukemia promotor)

NVH (Nausea/Vomiting/Hairloss)

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45
Q

Etoposide Indications (3)

A

Testicular CA

Lymphoma

SOLC

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46
Q

Which pts require dose reduction with Etoposide? (2)

A

Hepatic AND Renal Dysfunction pts

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47
Q

Doxorubicin MOA

A

[Topoisomeriase 2 inhibitor] –> Double stranded intercalations in DNA base pairs

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48
Q

Is Doxorubicin CCS or CCNS?

A

CCNS

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49
Q

Doxorubicin SE (5)

A
  1. Myelosuppression: Dose Limiting
  2. Congestive Cardiomyopathy! (Schedule dependent cumulative)
  3. [Vesicant Blistering Agent]
  4. NVH
  5. Stomatitis
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50
Q

Doxorubicin Indications (5)

A

Rubi Says Her Love Beats Neoplasia!

Breast CA

Leukemia

Sarcoma

Hodgkin’s Lymphoma

Non-Hodgkin’s Lymphoma

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51
Q

Which pts require dose reduction with Doxorubicin?

A

Jaundice pts (Doxo is metabolized by Liver)

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52
Q

Irinotecan MOA

A

[Topoisomeriase 1 inhibitor] –> single stranded breaks in DNA

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53
Q

Is Irinotecan CCS or CCNS?

A

CCNS; Bioactivated

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54
Q

Irinotecan SE (5)

A

[Myelosuppression DL (dose limiting)]

[Acute Cholinergic Diarrhea (tx: atropine)]

[Late Secretory Diarrhea (tx: Imodium)]

NVH

Stomatitis

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55
Q

Irinotecan Indications

A

Colon CA

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56
Q

Which pts require dose reduction with Irinotecan and why?

A

Jaundice pts

since [hepatic UGT1-A1] clears [glucuronidation of Irinotecan] along with bile. A Jaundice pt indicates [hepatic UGT1-A1] underexpression

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57
Q

Bleomycin MOA

A

Binds to iron and then –>binds to DNA–> [single and double DNA breaks]

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58
Q

Is Bleomycin CCS or CCNS?

A

CCS (G2-M phase)

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59
Q

Bleomycin SE (6)

A

“Bleomycin will start to smell like Poop, Fart & HASH”

  1. [Pulm Tox DL] (lungs lack Bleomycin hydrolase)
  2. Hyperpigmentation
  3. Stomatitis
  4. HairLoss
  5. Fever & Chills
  6. Anaphylaxis with 1st dose in Lymphoma pts
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60
Q

Bleomycin Indications

A

Testicular CA

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61
Q

Pts taking Bleomycin should avoid ______

A

[High inspired concentrations of O2]

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62
Q

[T or F] Bleomycin causes myelosuppression

A

FALSE

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63
Q

Prednisone CA Indications (2)

Dosage?

A

At HIGH DOSES ( >100 mg/day):

Lymphoma (Hodgkins and Non-Hodgkins)

Multiple Myeloma

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64
Q

Dexamethasone CA Indications (3)

A
  1. Reduces Cerebral Edema
  2. Spinal Cord Compression initial tx
  3. Chemotherapy-Emesis (used with other agents)
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65
Q

Tamoxifen Indication

A

Pre AND POSTMenopausal Breast CA that are (ER/PR +).

Tx and Px

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66
Q

Tamoxifen SE (6)

A
  • Endometrial Malignant Neoplasia (includes Polyps) = no administration duration > 5 years
  • Cataracts
  • PE
  • Hot Flashes
  • Amenorrhea
  • Vaginal Discharge
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67
Q

Tamoxifen MOA

A

SERM

E2 modulator in Endometrium; E2 Blocker in Breast

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68
Q

Anastrozole MOA

A

Aromatase inhibitor

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69
Q

Anastrozole SE

A

[Fractures & Arthralgia]

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70
Q

Anastrozole Indications

A

[ER+ Breast CA (Tx and Px)]

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71
Q

Flutamide MOA

A

[Androgen R Blocker] –> prevents DHT & Testosterone from binding

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72
Q

Flutamide SE (5)

A
  • Hepatotoxicity
  • Hematopoietic disorders
  • Rash
  • Constitutional (HA/Nausea)

-Diarrhea

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73
Q

Flutamide Indications (2)

A

Metastatic Prostate CA

BPH

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74
Q

How can Flutamide be used to prevent SE from Leuprolide

A

Pretx with Flutamide can block Flare rxn that occurs when taking [GnRH R agonist]

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75
Q

Leuprolide MOA

A

GnRH R agonist

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76
Q

Leuprolide Indication (4)

A
  1. Endometriosis & Uterine Fibroids
  2. Central Precocious Puberty
  3. Keeps LH surge low –> multiple mature oocytes for reproductive technology
  4. [Androgen dependent Prostate CA] adjunct
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77
Q

What happens initially when giving Leuprolide? How is this circumvented?

A

Exacerbation of Prostate CA & Bone pain initially, 2° to [FSH & LH Flare].

Pretx with [Flutamide 2-4 Wks prior] can prevent this

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78
Q

Methotrexate MOA

A

After being polyglutamated (along with folic acid) it Reversibly Binds and inhibits [Dihydrofolate Reductase] –> [INC Dihydrofolate] and [DEC Tetrahydrofolate].

Since Tetrahydrofolate is associated with thymidylate synthesis and is a [carbon donor for purine ring] –> DEC DNA synthesis

Enters cell via folate carrier protein

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79
Q

Is Methotrexate CCS or CCNS?

A

CCS (S phase)

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80
Q

Methotrexate Indications (6)

A
  1. Brain Tumor - HIGH IV DOSES
  2. [Meningitis: carcinomatous vs. lymphomatous]
  3. Leukemia
  4. Lymphoma
  5. Psoriasis
  6. Rheumatoid Arthritis
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81
Q

Which pts require dose reduction with Methotrexate?

A

Renal Insufficiency pts

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82
Q

Methotrexate has been approved for ____ administration. Solubility of Methotrexate INC in ___ pH

A

Methotrexate has been approved for intrathecal (arachnoid space) administration–>treats [Meningitis: carcinomatous vs. lymphomatous]

Solubility of Methotrexate INC in Alkaline pH. (So Alkalinizing Urine INC excretion)

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83
Q

What’s the Volume of Distribution for Methotrexate?

A

Total Body Water

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84
Q

When does Methotrexate become toxic?

A

When co-administered with drugs that displace methotrexate from albumin OR DEC its urine excretion

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85
Q

Describe the High Dose Strategy for Methotrexate. Which organs is this useful in? (2)

A

Co-administer with [Leucovorin THF] (THF rescue) to prevent Myelosuppression SE.

Only for Bone marrow and Intestine

86
Q

Cytarabine MOA

A

Converted to [ARA-CTP Triphosphate] –> incorporates into DNA –> inhibits chain elongation.

87
Q

Is Cytarabine CCS or CCNS?

A

CCS (S phase)

88
Q

Cytarabine SE (6)

A

[Cerebellar Tox with High dose–>Coma–>Death]

[Conjunctivitis with High Dose] (secreted in tears)

Hepatotoxic

[Myelosuppression DL]

NVH

Stomatitis

89
Q

Cytarabine Indications (2)

A

Acute Myeloid Leukemia

[3 Days of (Dauna vs. DoxoRubicin)] –> [7 days Cytarabine Continuous infusion]

and

[Meningitis: carcinomatous vs. lymphomatous]

90
Q

Cytarabine has ____dependent cytotoxicity. What is the Dose Regimen for treating [Acute Myeloid Leukemia]

A

Schedule Dependent Cytotoxicity

[3 Days of (Dauna vs. DoxoRubicin)] –> [7 days Cytarabine Continuous infusion]

91
Q

[5-FluoroUracil] MOA (2)

A
  1. Inhibits [Thymidylate Synthase]. Accumulation of FdUMP–> [FdUMP + ch2THF] ALSO binds/inhibits [thymidylate synthase] –> thymineless death
  2. Sequential phosphorylation & incorporation into RNA & DNA
92
Q

Is [5-Fluorouracil] CCS or CCNS?

A

CCS (S phase); Bioactivated

93
Q

[5-FluoroUracil] SE (8)

A

5 CHEMS Can Destroy Hair

  1. [Myelosuppression: mild]
  2. Stomatitis
  3. Diarrhea - also w/ Capecitabine
  4. Hand-Foot syndrome -also w/ Capecitabine
  5. [Hyperpigmentation with photosensitivity]
  6. [Coronary Vasopasm]
  7. Epiphora (Lacrimation)
  8. Cerebellar Ataxia
94
Q

[5-FluoroUracil] Indications (4)

A

“F Ur Face, ur Breast and ur SixPack. I’m sensitive! “

  1. [Head & Neck] CA
  2. Breast CA
  3. GI CA
  4. Radiation Sensitizer (concomitant with radiation tx)
95
Q

Pts deficient in ______ are at greater risk of [5-FluoroUracil] Toxicity

A

DihydroPyrimidine Dehydrogenase (Auto recessive)

96
Q

What is the oral prodrug of [5-FluoroUracil]

A

Capecitabine

(This is hydrolyzed by thymidine phosphorylase into 5FU inside the tumor)

97
Q

[6-Mercaptopurine] MOA

A

[6-thioINOsinic acid] inhibits enzymes of [de novo purine synthesis] by incorporating into DNA

98
Q

Is [6-Mercaptopurine] CCS or CCNS?

A

CCS (S phase); Bioactivated

99
Q

[6-Mercaptopurine] SE

A

Myelosuppression DL

100
Q

[6-Mercaptopurine] Indications

A

ALL-Acute Lymphoblastic Leukemia

101
Q

Which pts require dose reduction with [6-Mercaptopurine], by how much and why?

A

Pts taking Allopurinol must have [6-Mercaptopurine] dose reduced by 50-75%, since [6-Mercaptopurine] is inactivated by [Xanthine Oxidase]

102
Q

Asparaginase MOA

A

Bacterial product that inhibits Asparagine Hydrolysis –> Inhibits Protein synthesis

103
Q

Asparaginase SE (4)

A

“Tht Asparagus made me feel like TAPE!”

  • Thromboembolism (from DEC in AT3)
  • Pancreatitis
  • Elevated Liver enzymes
  • Allergic rxn
104
Q

Asparaginase Indications

A

ALL- Acute Lymphoblastic Leukemia

105
Q

Hydroxyurea MOA

A

Inhibits [Ribonucleotide Reductase] –> inhibits [DNA thymine] synthesis

106
Q

Hydroxyurea Indication

A

Rapidly DECREASES High [WBC Blast count] in pts with [Acute Myeloid Leukemia] and [Chronic Granulocytic Leukemia w/blast crisis]

107
Q

Why is it dangerous for [Acute Myeloid Leukemia] pts to have High WBC counts?

A

High WBC counts can–> Leukostasis in capillaries –> Organ Damage and Death

108
Q

Tretinoin MOA for CA

A

Induces terminal differentiation of leukemia cells

109
Q

Describe the ____ syndrome caused by Tretinoin (3). What other SE occurs that’s not in this syndrome

A

[Retinoic Acid Differentiation Syndrome]

Fever

Pulm infiltrates

Effusion (Pleural & Pericardial)

+

Dry Skin

110
Q

Tretinoin Indications

A

Acute Promyelocytic Leukemia

111
Q

What type of compound is Tretinoin

A

All trans retinoic acid

112
Q

[Arsenic Trioxide] MOA for CA

A

Allows Myeloid differentiation to continue and apoptosis to occur

113
Q

[Arsenic Trioxide] SE (2)

A

[Retinoic Acid Differentiation Syndrome]

Prolonged QT

114
Q

[Arsenic Trioxide] Indications

A

Acute Promyelocytic Leukemia

115
Q

Imatinib MOA

A

Inhibits BcrAbl, which is upstream and required for Tyrosine Kinase

Tyrosine Kinase Inhibitor

116
Q

[Imatinib Mesylate] SE (5)

A

“Use Tough MACE to deal with Iman’s SE!”

Edema

[Musculoskeletal Pain & Cramps]

[Anemia/Neutropenia/Thrombocytopenia]

CHF (rare)

DEC Thyroid Hormone (by INC clearance)

117
Q

[Imatinib Mesylate] Indications (2)

A

Iman Caught my GIST

  1. [Chronic Myelogenous Leukemia]
  2. GIST (Gastrointestinal Stromal Tumor)
118
Q

[Imatinib Mesylate] consideration

A

Metabolized by CYP3A4 system

119
Q

Cetuximab MOA (2)

A

Inhibits [Epidermal Growth Factor Receptor]

and

Sensitizes cell to chemotherapy

120
Q

Cetuximab SE (3)

A

“SE of a Dusty, Ugly, Stankin**’ Tux”

  • Dusty = Hypersensitivity (Rash)
  • Ugly DEC the Chick Magnet = hypOMagnesemia
  • Stinky smell = Diarrhea
121
Q

Cetuximab Indications (3)

A

“I got my Tux from H &/L M

Lung CA

Head & Neck CA

[Metastatic Wildtype KRAS and NRAS colorectal CA]

122
Q

ERLotinib MOA

A

small molecule inhibitor of [Tyrosine Kinase Domain] associated with [EGFR: Epidermal growth factor receptor]

123
Q

ERLotinib SE

124
Q

ERLotinib Indications

A

[Metastatic Lung ADC with EGFR activating mutation]

125
Q

Trastuzumab MOA

A

Binds to Extracell domain of [Her2Neu EGFR Receptor]

126
Q

Trastuzumab SE

A

Cardiotoxic (mostly when coadministered with doxorubicin)

127
Q

Trastuzumab Indications (2)

A

[(Her2Neu+) Breast CA]

[(Her2Neu+) Gastric CA]

128
Q

Bevacizumab MOA

A

J Bev hates Veggies

Binds & inhibits VEGF

Bev-a-Siz-zu-mab

129
Q

Bevacizumab SE (6)

A

J Bev Prays 4 a CHAIR

  1. HTN
  2. PrOteinuria
  3. [Arterial Clots and bleeding]
  4. Infusion rxn
  5. Colon Perforation
  6. [Reversible POST LeukoEncephalopathy syndrome]
130
Q

Bevacizumab Indications (2)

A

Lung CA

[Metastatic Colorectal CA]

131
Q

Crizotinib MOA

A

Binds to [ALK- Anaplastic Lymphoma Kinase]

132
Q

Crizotinib SE

A

Interstitial Lung Dz

133
Q

Crizotinib Indications

A

[Metastatic Lung ADC with ALK rearrangement]

134
Q

Vemurafenib Indication

A

[Melanoma with BRAFv600e mutation]

135
Q

Explain which 2 tissue you can use [Leucovorin THF Rescue] and why this is?

A

Bone Marrow and Intestine do not contain [folylpolyglutamate synthetase] which means Methotrexate won’t be polyglutamated(activated). Giving [Leucovorin THF] can resuce the normal cells in these tissue from [THF deficiency]

136
Q

Why are [alkylating CA agents] cell cycle Non-specific (CCNS)?

A

They bind covalently to DNA producing inter and intrastrand crosslinkage

This group = BisChoroethylamines

137
Q

List the 2 mechanisms of resistance for [Alkylating CA agents]

A

[Nucleotide excision repair enzymes]

[Alkylating agents] may incidentally bind to [Sulfur containing compounds]

138
Q

Describe Bioactivation for [Cyclophosphamide & Ifosfamide]

A

Must be activated by [microsomal P450 enzymes] to Aldophosphamide –> non-enzymatically cleaved to Acrolein and [phosphoramide mustard]. PM alkylates

139
Q

How is the SE of Hematuria in Cyclophosphamide circumvented (3)?

A
  1. [Administer in morning + Urinate frequently (6-8 glasses of water/day)]
  2. Continuous bladder irrigation (when giving High dose)
  3. Mesna (Uroprotective agent)
140
Q

Cyclophosphamide Route of Admin (2)

141
Q

[Chlorambucil & Melphalan] Indication (2)

A

These are Alkylating Agents that tx

Chronic Lymphocytic Leukemia

Multiple Myeloma

142
Q

Why does Ifosfamide HAVE to be co-administered with Mesna?

A

Ifosfamide SE= Hematuria –> Hemorrhagic Cystitis

143
Q

How does Mesna help prevent Hemorrhagic Cystitis?

A

Mesna is a monomer in urine that binds to alkylating agents and prevents their toxic urothelium effect

144
Q

Describe the bioactivation of Temozolomide

A

Spontaneous hydrolysis to DNA reactive species –> [monofunctionally methylates DNA]

145
Q

What are Coordination Compounds?

A

Bifunctional Alkylating agents which bind to [N7 of Adenine & Guanine] while Pt is in 2+(from Aquation) –> leaving groups are cis

146
Q

[Cis-DDPlatinum] SE (5)

A

“Cissys Never Never Never Have Moxie!”

  1. NV
  2. Neuropathy
  3. hypOMagnesmia
  4. [High Freq. Hearing loss]
  5. Nephrotoxic
147
Q

Is Carboplatin nephrotoxic?

148
Q

Name the Plant Alkaloids (4)

A

Vincristine: natural

VinBLastine: natural

Paclitaxel: natural

Etoposide: SemiSynthetic

149
Q

Cabazitaxel Indication

A

Prostate CA

Ca-Bazi-taxel

150
Q

Docetaxel Indication

A

Prostate CA

151
Q

Why would [Albumind Bound Paclitaxel] be beneficial? (3)

A

SE = VHIMMS… you’d have less I / M / S

  • No Infusion rxn due to rxn against solvent
  • Less [Myelosuppression DL]
  • Less [Sensory Neuropathy]
152
Q

Is Etoposide an intercalator or [non-intercalator]

A

Non-Intercalator

153
Q

Function of Topoisomerase 1

A

Repairs single strand DNA breaks by relaxing strand and reannealing

154
Q

Function of Topoisomerase 2

A

Repairs DOUBLE strand DNA breaks by relaxing strand and reannealing

155
Q

Doxorubicin metabolism

A

Liver metabolism and then excreted as thiol adduct into bile

Dose Reduction in Jaundice pts

156
Q

How does the [P-glycoprotein] cause [MultiDrug Resistance] and how do we cirvumvent this?

A

[P-glycoprotein]= membrand bound efflux pump that makes cells resistant to [All Topo 2 inhibitors] and Tubulin inhibitors

Giving these drugs as continuous infusions downregulates [P-glycoprotein efflux pump]

157
Q

Name the drugs that block (reverse MDR) the [P-Glycoprotein Efflux Pump] (3)

A

QVC blocks the [P-G E P]

Quinine

Verapamil

Cyclosporine

158
Q

Describe Cumulative Toxicity

A

Irreversible damage to small part of an organ, that with repeated admin–>drug accumulation–>specific Total Dose threshold –> Total damage

159
Q

Lifetime Dose of Doxorubicin should not exceed ____. This is to avoid _____

A

Lifetime Dose of Doxorubicin should not exceed 400. This is to avoid Congestive Cardiomyopathy

160
Q

Doxorubicin has schedule (dependent vs. independent) ______ cytotoxicity, which means what?

A

Doxorubicin has [schedule independent cytotoxicity], which means altering admin dose schedule won’t affect cytotoxicity

161
Q

A: MOA for why Doxorubicin causes Congestive Cardiomyopathy

B: How should it be administered to avoid this

A

A: Complexes with iron –> Free Radical Damage

C: Admin over 96 hours to avoid high plasma levels, which is fine since Doxorubicin has [Schedule INdependent Cytotoxicity]

162
Q

What events INC risk of Cardiotoxicity from anthracyclines? (2)

A

Prior Mediastinal radiation

Long standing Uncontrolled HTN

163
Q

Doxorubicin and Daunomycin are in the same class. What’s the difference? (2)

A
  • Daunomycin is less cardiotoxic
  • Daunomycin is not effective against solid tumors
164
Q

Daunomycin Indication

A

Leukemia but not solid tumors

165
Q

What are [Idarubicin & epirubicin] analogs of, and what are they used for?

A

Analogs of Doxorubicin. Leukemia only. Less Cardiotoxic than Doxorubicin.

166
Q

What SE does all the anthracylcine drugs have in common?

A

Myelosuppression: dose Limiting

167
Q

Name the 2 Demographics that have mutation which DEC Glucoronidation and which drug this puts them at risk for

A

Caucasian and Africans have INC risk of Irinotecan Tox

168
Q

Topotecan is in the same class as ____ and is used for what?

A

Irinotecan;

Ovarian CA resistant to carboplatin & paclitaxel

169
Q

Bleomycin Metabolism

A

Inactivated by [bleomycin hydrolase] in Liver & kidneys with 50% urine excretion

170
Q

Lifetime Dose of Bleomycin should not exceed ____. This is to avoid _____

A

Lifetime Dose of Bleomycin should not exceed 400. This is to avoid Pulm Tox

171
Q

Tamoxifen Metabolism

A

Liver; metabolized –> [4Hydroxytamoxifen]

172
Q

[T or F] Anastrozole requires dose reduction in Liver or Renal Dysfunction pts

A

FALSE

Although Anastrozole is extensively metabolized by Liver, it does not require dose reduction

A for Alright in All pts

173
Q

What are [Bicalutamide & Nilutamide] analogs of? What’s the difference between them and the analog?

A

Analogs of Flutamide. They have Less Diarrhea

174
Q

Leuprolide Route of Admin (2)

A

IM vs. Depot injections

175
Q

What color is MTX and where is it excreted?

A

Yellow; Urine

176
Q

Which drugs are Contraindicated with Methotrexate and why (4)

A

“No Maple SAPP, with my chex MTX”

  1. Sulfonamides - highly protein bound
  2. ASA - highly protein bound AND also interferes with excretion
  3. PCN- highly protein bound AND also interferes with excretion
  4. Probenacid blocks organic acid transport –> interferes with excretion
177
Q

[MTX SE - normal dose] (3)

A
  1. [Myelosuppression DL]
  2. NV
  3. Stomatitis
178
Q

SE of HIGH DOSE MTX Therapy (6)

A
  • NOT Myelosuppression

but even so… SERCH for help!

  • Stomatitis
  • Enteritis
  • Conjunctivitis
  • Renal Failure
  • Hepatic Failure (rare)
179
Q

Describe the [HIGH DOSE MTX with Leucovorin rescue] regimen (5 steps)

A

1st: [IV hydration + NaHCO3 to alkalinize urine]
2nd: Do not administer MTX unless urine pH>7
3rd: Give MTX
4th: [IV vs. PO Leucovorin admin]
5th: Monitor MTX and stop when level is [<5x10-7 at 48 hours]

180
Q

Pemetrexed MOA

A

Antifolate that’s polyglutamated after entering cell and then –> inhibits thymidylate synthesis

181
Q

Pemetrexed Indication (2)

A

PeMetrexed : PulM

Lung CA

Mesothelioma

182
Q

Pemetrexed SE (5)

A

Mya’s PemP used his Hand to give her a R**ash, [Bloody Mouth] &Diarrhea

[Myelosuppression DL] (Mya)

[Hand Foot Syndrome]

Rash

Stomatitis

Diarrhea

183
Q

How can the [Myelosuppresion DL] SE of Pemetrexed be reduced?

A

Pretx with [Parenteral VitB12] and [PO Folic Acid]

184
Q

Explain how long you should use Cytarabine and what this has to do with [Schedule dependent cytotoxicity]

A

Tumor needs to be exposed to Cytarabine for at least 4 hours, and since half life is short (2 hours), Cytarabine has [Schedule Dependent Cytotoxicity]

185
Q

Cytarabine is a ___ ____ antimetabolite

A

Cytarabine is a Cytosine Arabinoside antimetabolite

186
Q

What is the difference between Cytarabine and Gemcitabine?

A

Similar MOA to Cytarabine (including [Myelosuppression DL] SE) but can be used in palliative tx of Pancreatic vs. Lung CA

187
Q

Describe the interaction between [5 FluroUracil] and Leucovorin when co-administered?

A

[5FU] + Leucovorin –> INC 5FU Cytotoxicity

BUT

[Stomatitis and Diarrhea SE] will be worse!

188
Q

Capecitabine [Route of Admin] and [Indications (2)]

A

Capecitabine is a PO drug that treats Breast and GI CA

189
Q

Which analog of [6-Mercaptopurine] can be concomitantly given with Allopurinol?

A

6-thioguanine can be used at full dose with allopurinol (has no interaction with xanthine oxidase)

190
Q

Methotrexate is a ______ analog

A

Methotrexate is a Folic Acid analog

191
Q

[Imatinib Mesylate] Metabolism

A

CYP3A4 (avoid administering with St.john’s Wort or grapefruit juice)

192
Q

How is Cetuximab prescribed

A

[Chimeric monoclonal Ab given IV qweek or every other week] usually in combination with other chemo

193
Q

Erlotinib Metabolism

A

CYP3A4 (avoid administering with St.john’s Wort or grapefruit juice)

194
Q

[Sorafenib, Pazopanib and Sunitinib] are _______ that have a SE of ______ (4). They all treat ____ CA, but Sorafenib can be used in ____ and Sunitinib in ____

A

[Sorafenib, Pazopanib and Sunitinib] are [VEGF R tyrosine kinase inhibitors] that have a SE of [Hand foot syndrome, rash, HTN and Reversible POST leukoencephalopathy syndrome] (4).

They all treat [Clear Renal Cell CA], but Sorafenib can be used in Hepatocellular CA and Sunitinib in [Pancreatic Neuroendocrine CA & GI Stromal tumors]

195
Q

Name the 2 other antibodies in the Trastuzumab class

A

“Tra to Lap Per” (Try to Lap Her)

Lapatinib (small molecular inhibitor of RTK)

Pertuzumab (Ab against Her2Neu)

196
Q

CA localized to organ of origin are treated with ____ therapies such as ____ (2)

A

CA localized to organ of origin are treated with local therapies such as surgery vs. radiation (2)

197
Q

Chemotherapy is a _____(local vs. systemic) therapy that is given in what 3 circumstances?

A

Systemic

  1. pt who’ve had CA removed but still at risk for micrometastasis (return of CA even after removal) = Adjuvant Chemo
  2. Curative/Palliative tx in clinically apparent metastatic Dz = Chemo
  3. Cytoreduction prior to surgery = N**eoadjuvant Chemo
198
Q

Describe the 5 Levels of Chemotherapy Tolerance

A

Pt is…

  • 0 = fully active
  • 1 = Ambulatory and able to carry out light work but restricted in physically strenuous stuff
  • 2 = Ambulatory (up and about > 50% of waking hours) but unable to carry out any work activities
  • 3 = Limited selfcare, confined to bed/chair > 50% of waking hours
  • 4 = Completely Disabled
  • 5 = Dead
199
Q

Our ability to cure CA is based on _____

A

Our ability to cure CA is based on Chemoresistance. Combining drugs provides broader coverage of de novo resistant cell lines

200
Q

What are the 5 major rules for Creating Chemotherapy Combination

A
  1. Both drugs should have activity against the CA when given alone
  2. No overlapping toxicities (except for NVH and myelosuppression)
  3. Different MOA
  4. Combine CCS with CCNS
  5. Opitmal Dose, Optimal schedule with Dose response relationship
201
Q

Adjuvant therapy post surgery is indicated in which CA (8)

A

You’ll need several [Tall & Beautiful CLOMPS], after this surgery!

Testicular CA

Breast CA - NODE POSITIVE vs. selective node neg.

Colorectal CA - NODE POSITIVE

Lung CA

Osteogenic Sarcoma

Melanoma - selected pts

Pancreatic CA

Stomach CA

202
Q

Define the [Stage of CA] and how it’s determined (3)

A

Uniform system that indicates extent of Dz at time of Dx. Physical exam/Blood test/Imaging are used to determine the [CA stage]

203
Q

[Staging of CA] is often combined with [TMN Classification]. Describe the [TMN Classification]

A

T =Tumor description (size, penetration into wall)

M= Metastasis present?

N= Nodes (regional) involved

204
Q

Growth Fraction

A

[# of cells actually dividing]

_____________

Total Cell #

205
Q

Skipper Hypothesis

A

The ability of chemo to cure CA is inversely proportional to the tumor burden

(INC Tumor Burden = DEC chance of chemo cure)

206
Q

Chemocurable CA never develop ____. Name the Chemocurable CA (4)

A

Chemocurable CA never develops Resistance.

  1. Testicular CA
  2. Some Lymphomas
  3. Some Leukemia
  4. Hodgkin’s Dz
207
Q

Scheduling of Chemotherapy is based on what 3 things

A

Dose

Route of Admin

[Length of Tx cycle]

208
Q

[Formula for Absolute Neutrophil Count] and why it is important

A

ANC= [Total WBC] x [PMN fraction + fraction of bands]

If ANC is < 500 = neutropenia = pt is at risk for endogenous bacteria

209
Q

Which 2 drugs can be given to Chemotherapy pts ___ hours after admin to shorten duration of neutropenia

A

Given 24 hours post chemo admin

[Filgrastim QD] and [Peg-Filgrastim q3 week] SubQ injections

210
Q

Platelet counts should be maintained above ____. If not, ___ is given. When does platelet count recover?

A

Platelet counts should be maintained [>10K]. If not, platelet transfusion is given. Platelet count recovers between 21-28 Days

211
Q

[Oprelvekin IL11] Indication

A

DEC frequnecy of platelet transfusions post chemo.

(SE = Fluid retention & arrhythmia)

212
Q

The Chemotherapeutic effect of MTX can be overcome by

A

[Leucovorin THF] rescue

🄼💊Chemotherapy/AntiViral/Botanicals (4 decks)

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