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CPT > Chemotherapy > Flashcards

Chemotherapy Flashcards

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1
Q

What are the principles behind fractional cell kill hypothesis for chemotherapy?

A

Chemo given as a bolus
Kills all cells - tumour and bone marrow
Bone marrow cells recover more quickly

Next bolus is given when bone marrow cells have recovered, but tumour cells haven’t

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2
Q

What are the different sites of action for chemotherapy agents?

A

DNA synthesis - antimetabolites
DNA - alkylating agents
DNA transcription and duplication - intercalating agents
Mitosis - spindle poisons

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3
Q

What is the method of action of alkylating agents?

A

Formation of covalent bonds with DNA nucleosides => disruption of DNA structure => prevents replication

Difficult to repair DNA due to platinum agent

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4
Q

How do tumour cells become resistant to alkylating agents?

A

Decreased entry or increased exit of chemo agent - pumps on cell surface recognising agent then expelling it

Inactivation of agent in cell

Enhanced repair of DNA lesions

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5
Q

What are some examples of anti-metabolite chemo agents?

A

5-flurouracil

Methotrexate

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6
Q

How does 5-flurouracil act as a chemo agent?

A

Inhibits thymidylate synthase

Inhibits DNA synthesis

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7
Q

How does methotrexate act as a chemotherapy agent?

A

Inhibits dihydrofolate reductase
Inhibits folate synthesis => inhibits purine synthesis
Therefore inhibits DNA synthesis

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8
Q

How do spindle poisons act as chemotherapy agents?

A

Target microtubules in mitosis
Chromosomes can’t align and separate properly

Inhibit polymerisation
Stimulate polymerisation and inhibit depolymerisation

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9
Q

How can a pts response to chemotherapy be predicted?

A

Performance score
Clinical stage of tumour
Prognostic factors - involving biological factors
Molecular/cryogenic markers

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10
Q

What are some route of administration for chemo?

A 
IV - most common 
PO - depends on bioavailability 
SC - convenient in community 
Into body cavity - bladder
Intralesional - directly into cancerous area 
Intrathecal - lumbar puncture or omayya reservoir 
Topical 
IM
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11
Q

What is a PICC line?

A

IV into the arm
Connected to a pump
Can be done as an outpatient

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12
Q

What is a Hickman line?

A

IV into SVC
Tunnelling through the skin prevents from infection
Connected to chemo pump

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13
Q

What are some side effects of chemotherapy?

A 
Mucositis
Alopecia 
Pulmonary fibrosis 
Nausea and vomiting 
Diarrhoea 
Cardiotoxicity 
Local reaction 
Renal failure
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14
Q

What is a cause of acute renal failure from chemotherapy?

A

Rapid tumour lysis => hyperuricaemia => precipitation of urate crystals in renal tubules

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15
Q

What is a cause of vomiting from chemotherapy?

A

Direct action on CTZ

Also multifactorial
Unusual to not to be able to control the vomiting

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16
Q

What causes local skin reactions from chemo?

A

If chemo doesn’t go into the vein properly

Causes irritation and thrombophlebitis

17
Q

How does mucositis present as a side effect from chemo?

A

Sore mouth/throat
Diarrhoea
GI bleeds
Secondary infection eg thrush

18
Q

What causes abnormalities in absorption of chemo agents?

A

Nausea and vomiting
Compliance
Gut problems

19
Q

What cause abnormalities in distribution of chemo agents?

A

Weight loss
Reduced body fat
Ascites

20
Q

What causes abnormalities in elimination of chemo agents?

A

Liver and renal dysfunction

Taking other meds

21
Q

What causes abnormalities in protein binding of chemo agents?

A

Low albumin

Taking other drugs

22
Q

Describe the effects of haematological toxicity from chemo

A

Most frequent cause of death from toxicity

Neutropenia => increased risk of sepsis
Also affects platelet levels

23
Q

What are some important drug interactions of chemotherapy?

A

Vincristine and itraconazole (anti-fungal) => neuropathy
Methotrexate and penicillin/NSAIDs
Capecitabine and warfarin, St John’s Wort or grapefruit juice

24
Q

How is chemotherapy treatment monitored?

A

Response of cancer:
Radiology
Tumour markers
Bone marrow

Monitoring of drug levels

Checks for organ damage:
Creatinine clearance
Echocardiogram

25
Q

What is neoadjuvant treatment?

A

Chemo given before surgery/radiotherapy

26
Q

What is adjuvant treatment?

A

Chemo given after surgery to remove the primary cancer

Aims to reduce relapse

27
Q

What is palliative care?

A

Treats current or anticipated symptoms without intention to cure

28
Q

What is primary treatment of cancer?

A

1st line treatment
In many haematological cancers this is with a curative intent
Initially aiming for remission

CPT (21 decks)

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