Chemotherapy Flashcards

1
Q

Explain why cancer kills people so soon after detection. (2)

A

The difference between detectable cancer and cancer that will kill you is only three orders of magnitudes in terms of cell number.

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2
Q

Explain the type of drug commonly given with chemotherapy / radiotherapy. (3)

A

Chemo and radiotherapy only work if the cell is replicating (ie not in stage G0), so drugs are commonly given to keep cells in the replicatory phase.

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3
Q

Describe the fractional kill hypothesis. (2)

A

The next dose of chemo needs to be times when the bone marrow has had enough time to recover, but the cancer has not.

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4
Q

Name one example of a cancer that is highly sensitive, moderately sensitive and not sensitive to chemotherapy. (3)

A

High - lymphomas
Moderate - lung
Low - prostate

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5
Q

Describe the clinical indications for chemotherapy. (2)

A

Cancer, but also other inflammatory conditions eg RA.

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6
Q

Describe how the predicted response to chemotherapy is worked out. (4)

A

Depends on malignancy type, clinical stage, cytogenetic markers, performance score (4= bedbound, 0= active).

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7
Q

Describe the MoA of antimetabolites. (3)

A

Interfere with DNA synthesis by inhibiting synthesis of bases by changing folate metabolism.

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8
Q

Describe the MoA of alkylating agents. (3)

A

Interfere with the DNA within the cell by forming inter-strand bonds and attaching bulky side groups to mess up future replications.

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9
Q

Describe the MoA of spindle poisons. (3)

A

Interfering with mitosis by inhibiting spindle polymerisation or preventing depolymerisation.

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10
Q

Describe the MoA of intercalating agents. (2)

A

Interfere with DNA transcription or DNA replication.

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11
Q

Describe the mechanisms of resistance to alkylating agents. (3)

A

Decreased entry of increased exit of the agent.
Inactivation of the agent within the cell (eg by glutathione)
Enhanced repair of DNA lesions.

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12
Q

Describe the methods of administration of chemotherapy. Explain the indications for each. (7)

A
IV - most common - bolus, bag, pump 
PO - only if bioavailability is high
SC - convenient in community 
Body cavity - pleural, bladder
Intralesional - directly into cancer
Intrathecal - into CSF
Topical - onto skin.
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13
Q

Describe the renal side effects of chemotherapy. (3)

A

Acute renal failure - hyperuricamia cause by rapid tumour cell lysis leading to urate precipitation in renal tubules.

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14
Q

Describe the GI complications of chemotherapy for GI cancer. (3)

A

Perforation and peritonitis - all the tumour cells get listed and there is a hole.

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15
Q

Describe the commonest cause of chemotherapy-induced DIC. (1)

A

Acute myeloid leukaemia.

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16
Q

Describe the causes of vomiting induced by chemo. Describe the types. (4)

A

Direct CTZ trigger.

Acute (4-12h), delayed (2-5 days), or chronic (up to 12 days)

17
Q

Describe the common skin toxicity reactions to chemotherapy. (4)

A

Local - irritation and thrombophlebitis of veins, extravasation.
General - hyperkeratosis, hyperpigmentation, ulcerated pressure sores.

18
Q

Explain why chemotherapy induced skin toxicity effects are often severe before they present. (2)

A

Over-compliance - people put up with the skin effects because they’re worried the chemo would have to be stopped.

19
Q

Describe the common mucosal effects of chemotherapy. (3)

A

Mucusitis causing sore mouth / throat, diarrhoea, and bleeds.

20
Q

Describe the common cardiac effects of chemotherapy. (2)

A

Cardiomyopathy and arrhythmias

21
Q

Describe the common respiratory effects of chemotherapy. (1)

A

Severe pulmonary fibrosis.

22
Q

Describe the common haematological toxicity. (3)

A

Neutropenia is most common, but can be any; neutropenia can lead to sepsis.

23
Q

Describe the events that would cause absorption anomalies for chemotherapy. (3)

A

N+V
Gut problems
Low compliance

24
Q

Describe the events that would cause distribution abnormalities for chemotherapy. (3)

A

Weight loss
Reduced body fat
Ascites

25
Q

Describe the things that would cause elimination abnormalities for chemo. (2)

A

Liver or renal dysfunction

DDIs.

26
Q

Describe the things that would cause abnormalities in protein binding of chemotherapy. (2)

A

DDIs

Low albumin.

27
Q

Describe 3 important drugs that have DDIs with chemotherapy. (6)

A

Antifungals - neuropathy.
Capecitabine (anti-metabolite) - Warfarin, St Johns Wort, grapefruit juice.
Methotrexate - penicillin and NSAIDs.

28
Q

Describe how the monitoring of drugs occurs in chemotherapy. (6)

A

Response of cancer - tumour markers and radiology
Drug levels - serial assays to ensure clearance
Checks for organ damage - echo, creatinine clearance.