Chemotherapy Flashcards
Cyclophosphamide MOA
[Bifunctionally Alkylates (via Phosphoramide Mustard) N7 of [DNA Guanine]–> forms inter and intrastrand crosslinks
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/799/537/a_image_thumb.png?1460325016)
Is Cyclophosphamide CCS or CCNS?
CCNS
Cyclophosphamide SE (3)
Hematuria
Myelosuppression
NVH
Cyclophosphamide Indications (2)
- Non-Hodgkins Lymphoma
- Breast CA
Ifosfamide MOA
Monofunctionally Alkylates N7 of [DNA Guanine]
Is Ifosfamide CCS or CCNS?
CCNS
Ifosfamide SE (4)
- Hematuria –> Hemorrhagic Cystitis
- [Myelosuppression DL (dose limiting)]
- [Lethargy & Confusion @ High dose]
- NVH
Ifosfamide Indication (2)
(Relapsed) Testicular CA
Sarcoma
Temozolomide MOA
Monofunctionally Methylates DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/474/a_image_thumb.png?1460325325)
Is Temozolomide CCS or CCNS?
CCNS
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/476/a_image_thumb.png?1460325325)
Temozolomide SE (3)
Myelosuppression
NVH
[Pneumocystis PNA when given prolonged]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/478/a_image_thumb.png?1460325326)
Temozolomide Indication
[Glioblastoma (1° Brain Tumor)]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/480/a_image_thumb.png?1460325326)
[Cis-DDPlatinum] MOA
Bifunctionally Alkylates DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/672/a_image_thumb.png?1460325491)
Is [Cis-DDPlatinum] CCS or CCNS?
CCNS
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/673/a_image_thumb.png?1460325491)
[Cis-DDPlatinum] Considerations (2)
- Give with Hydration & [mannitol diuresis] = Chloruresis
- Dose reduction for Renal Insufficient pts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/674/a_image_thumb.png?1460325492)
[Cis-DDPlatinum] Indications (6)
- Testicular CA: CURATIVE
- Ovarian CA
- Bladder CA
- SOLC
- Non-SOLC
- Head & Neck CA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/803/675/a_image_thumb.png?1460325492)
Carboplatin MOA
Bifunctionally Alkylates DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/145/a_image_thumb.png?1460325859)
Is Carboplatin CCS or CCNS?
CCNS
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/146/a_image_thumb.png?1460325860)
Carboplatin SE
[Myelosuppression DL]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/147/a_image_thumb.png?1460325860)
Carboplatin Indication (6)
Same as [cis-DDPlatinum]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/148/a_image_thumb.png?1460325861)
What is the dosing of Carboplatin based on? (2) How easy is it to administer?
Creatinine Clearance and AUC Target; Easy to administer
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/204/a_image_thumb.png?1460325932)
Oxaliplatin MOA
Bifunctionally Alkylates DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/350/a_image_thumb.png?1460326103)
Is Oxaliplatin CCS or CCNS?
CCNS
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/351/a_image_thumb.png?1460326104)
Oxaliplatin SE (3)
“O O O how mya gets on my nerves”
- [Acute Cold induced Neuropathy DL]
- [Chronic Sensory Neuropathy DL]
- Myelosuppression
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/352/a_image_thumb.png?1460326105)
Oxaliplatin Indication
GI CA (cOlOrectal vs. gastric vs. pancreas)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/353/a_image_thumb.png?1460326105)
Doubles Survival in Metastatic cOlOrectal CA
Vincristine MOA
Prevents Tubulin polymerization
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/618/a_image_thumb.png?1460326232)
Is Vincristine CCS or CCNS?
CCS (M phase)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/619/a_image_thumb.png?1461290081)
Vincristine SE (2)
- [Neuropathy DL]
- Vesicant
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/620/a_image_thumb.png?1460326233)
Vincristine Indications (2)
“Cristy helps ALL the Non Kids”
[Non-Hodgkin’s Lymphoma]
ALL- Acute Lymphoblastic Leukemia
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/621/a_image_thumb.png?1460326234)
[T or F] Vincristine does NOT cause myelosuppression
TRUE
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/848/a_image_thumb.png?1460326398)
Which pts require dose reduction with Vincristine AND VinBLastine?
Jaundice pts (elevated bilirubin); since these drugs are excreted via bile
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/804/861/a_image_thumb.png?1460326431)
VinBLastine MOA
Same as Vincristine (Prevents Tubulin Polymerization)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/815/354/a_image_thumb.png?1460336842)
Is VinBLastine CCS or CCNS?
CCS (M phase)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/815/355/a_image_thumb.png?1461290105)
VinBLastine SE (2)
Myelosuppression
[Vesicant Blistering agent]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/815/356/a_image_thumb.png?1460336958)
VinBLastine Indications (2)
B for Boob Area
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/815/357/a_image_thumb.png?1460336086)
Lung CA
Breast CA
Paclitaxel MOA
Prevents Tubulin Disassembly
Is Paclitaxel CCS or CCNS?
CCS (M phase)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/263/a_image_thumb.png?1461290060)
Paclitaxel SE (6)
VHIMMS
- Sensory Neuropathy
- [Myelosuppression DL] & Myalgia
- Infusion rxn from rxn to solvent
- [Vesicant Blistering Agent]
- HairLoss
Paclitaxel Indications (4)
Non-SOLC
Breast CA
Ovarian CA
Gastroesophageal CA
Pts taking Paclitaxel should be premedicated with ____ (3)
Steroids
Diphenhydramine
H2 Blockers
Which pts require dose reduction with Paclitaxel?
Hepatic Dysfunction pts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/571/a_image_thumb.png?1460337440)
Etoposide MOA
E2oposide
[Topoisomeriase 2 inhibitor] –> Double stranded breaks in DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/613/a_image_thumb.png?1460337491)
Is Etoposide CCS or CCNS?
CCS (S - G2)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/614/a_image_thumb.png?1461604526)
Etoposide SE (3)
E2oposide made Mya and Leuk Nauseous
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/615/a_image_thumb.png?1460337492)
[Myelosuppression DL]
Leukemogenic (Leukemia promotor)
NVH (Nausea/Vomiting/Hairloss)
Etoposide Indications (3)
Testicular CA
Lymphoma
SOLC
Which pts require dose reduction with Etoposide? (2)
Hepatic AND Renal Dysfunction pts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/880/a_image_thumb.png?1460337694)
Doxorubicin MOA
[Topoisomeriase 2 inhibitor] –> Double stranded intercalations in DNA base pairs
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/890/a_image_thumb.png?1460337738)
Is Doxorubicin CCS or CCNS?
CCNS
Doxorubicin SE (5)
- Myelosuppression: Dose Limiting
- Congestive Cardiomyopathy! (Schedule dependent cumulative)
- [Vesicant Blistering Agent]
- NVH
- Stomatitis
Doxorubicin Indications (5)
Rubi Says Her Love Beats Neoplasia!
Breast CA
Leukemia
Sarcoma
Hodgkin’s Lymphoma
Non-Hodgkin’s Lymphoma
Which pts require dose reduction with Doxorubicin?
Jaundice pts (Doxo is metabolized by Liver)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/816/894/a_image_thumb.png?1460337740)
Irinotecan MOA
[Topoisomeriase 1 inhibitor] –> single stranded breaks in DNA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/573/a_image_thumb.png?1460338318)
Is Irinotecan CCS or CCNS?
CCNS; Bioactivated
Irinotecan SE (5)
[Myelosuppression DL (dose limiting)]
[Acute Cholinergic Diarrhea (tx: atropine)]
[Late Secretory Diarrhea (tx: Imodium)]
NVH
Stomatitis
Irinotecan Indications
Colon CA
Which pts require dose reduction with Irinotecan and why?
Jaundice pts
since [hepatic UGT1-A1] clears [glucuronidation of Irinotecan] along with bile. A Jaundice pt indicates [hepatic UGT1-A1] underexpression
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/577/a_image_thumb.png?1460338484)
Bleomycin MOA
Binds to iron and then –>binds to DNA–> [single and double DNA breaks]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/785/a_image_thumb.png?1460338516)
Is Bleomycin CCS or CCNS?
CCS (G2-M phase)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/786/a_image_thumb.png?1461486687)
Bleomycin SE (6)
“Bleomycin will start to smell like Poop, Fart & HASH”
- [Pulm Tox DL] (lungs lack Bleomycin hydrolase)
- Hyperpigmentation
- Stomatitis
- HairLoss
- Fever & Chills
- Anaphylaxis with 1st dose in Lymphoma pts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/787/a_image_thumb.png?1460338517)
Bleomycin Indications
Testicular CA
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/788/a_image_thumb.png?1460338517)
Pts taking Bleomycin should avoid ______
[High inspired concentrations of O2]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/789/a_image_thumb.png?1460338518)
[T or F] Bleomycin causes myelosuppression
FALSE
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/817/928/a_image_thumb.png?1460338684)
Prednisone CA Indications (2)
Dosage?
At HIGH DOSES ( >100 mg/day):
Lymphoma (Hodgkins and Non-Hodgkins)
Multiple Myeloma
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/022/a_image_thumb.png?1460338744)
Dexamethasone CA Indications (3)
- Reduces Cerebral Edema
- Spinal Cord Compression initial tx
- Chemotherapy-Emesis (used with other agents)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/102/a_image_thumb.png?1460338761)
Tamoxifen Indication
Pre AND POSTMenopausal Breast CA that are (ER/PR +).
Tx and Px
Tamoxifen SE (6)
- Endometrial Malignant Neoplasia (includes Polyps) = no administration duration > 5 years
- Cataracts
- PE
- Hot Flashes
- Amenorrhea
- Vaginal Discharge
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/398/a_image_thumb.png?1460339192)
Tamoxifen MOA
SERM
E2 modulator in Endometrium; E2 Blocker in Breast
Anastrozole MOA
Aromatase inhibitor
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/920/a_image_thumb.png?1460339439)
Anastrozole SE
[Fractures & Arthralgia]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/922/a_image_thumb.png?1460339573)
Anastrozole Indications
[ER+ Breast CA (Tx and Px)]
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/818/923/a_image_thumb.png?1460339629)
Flutamide MOA
[Androgen R Blocker] –> prevents DHT & Testosterone from binding
Flutamide SE (5)
- Hepatotoxicity
- Hematopoietic disorders
- Rash
- Constitutional (HA/Nausea)
-Diarrhea
Flutamide Indications (2)
Metastatic Prostate CA
BPH
How can Flutamide be used to prevent SE from Leuprolide
Pretx with Flutamide can block Flare rxn that occurs when taking [GnRH R agonist]
Leuprolide MOA
GnRH R agonist
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/380/a_image_thumb.jpg?1460340008)
Leuprolide Indication (4)
- Endometriosis & Uterine Fibroids
- Central Precocious Puberty
- Keeps LH surge low –> multiple mature oocytes for reproductive technology
- [Androgen dependent Prostate CA] adjunct
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/653/a_image_thumb.jpg?1460340034)
What happens initially when giving Leuprolide? How is this circumvented?
Exacerbation of Prostate CA & Bone pain initially, 2° to [FSH & LH Flare].
Pretx with [Flutamide 2-4 Wks prior] can prevent this
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/750/a_image_thumb.jpg?1460340102)
Methotrexate MOA
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
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/868/a_image_thumb.png?1460625019)
Is Methotrexate CCS or CCNS?
CCS (S phase)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/869/a_image_thumb.png?1460625082)
Methotrexate Indications (6)
- Brain Tumor - HIGH IV DOSES
- [Meningitis: carcinomatous vs. lymphomatous]
- Leukemia
- Lymphoma
- Psoriasis
- Rheumatoid Arthritis
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/871/a_image_thumb.png?1460340412)
Which pts require dose reduction with Methotrexate?
Renal Insufficiency pts
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/819/872/a_image_thumb.png?1460340500)
Methotrexate has been approved for ____ administration. Solubility of Methotrexate INC in ___ pH
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)
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/820/200/a_image_thumb.png?1460340528)
What’s the Volume of Distribution for Methotrexate?
Total Body Water
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/820/263/a_image_thumb.png?1460340582)
When does Methotrexate become toxic?
When co-administered with drugs that displace methotrexate from albumin OR DEC its urine excretion
![](https://s3.amazonaws.com/brainscape-prod/system/cm/185/820/275/a_image_thumb.png?1460340603)