Chemotherapy

Question 1

Name an antimetabolite

Answer 1

Methotrexate

5-Florouracil

Question 2

What is the MoA of antimetabolites?

Answer 2

Stops the synthesis of thiamine by folate

Question 3

Name an alkylating agent

Answer 3

Oxaliplatin

Cisplatin

Question 4

What is the MoA of alkylating agents?

Answer 4

Formation of intra- and inter-strand adducts to inhibit DNA replication, or cause the DNA to try and repair itself but damage itself in the process

Question 5

How can cancer cells develop resistance to alkylating agents?

Answer 5

• Neutralising agents within the cell using GSH
• Pumping the agent out of the cell
• Enhancing DNA repair

Question 6

Name a vinca alkaloid

Answer 6

Vincristine

Question 7

What is the MoA of vinca alkaloids?

Answer 7

Prevent the assembly of microtubles

Question 8

Name a taxane

Answer 8

Paclitaxel

Question 9

What is the MoA of taxanes?

Answer 9

Prevent the depolymerisation of microtubules

Taxes go up but never come down

Question 10

Name five possible routes of administration of chemo

Answer 10

IV - most common
PO
SC
Into body cavity e.g. pleura, bladder
Intralesional - directly into cancerous area
Intrathecal - into CSF
Topical

Question 11

Mucositis of the GI tract is a common side effect of chemo. State two further complications of this

Answer 11

Sore mouth/throat
GI bleed
Darrhoea

Question 12

What is the main reason for limiting dose of chemo?

Answer 12

Bone marrow cell depletion.

These cells are most susceptible to chemo damage, and are most dangerous if depleted.

Question 13

Describe the common time-frame for alopecia

Answer 13

Hair thins at 2-3wks.
Can lead to total hair loss.
Hair can begin to grow back during therapy.

Question 14

Patients on bleomycin regularly have chest X-Rays to assess pulmonary fibrosis. What should you NOT give patients who have ever had bleomycin?

Answer 14

High doses of oxygen.

Can cause pulmonary fibrosis

Question 15

Bleomycin can cause skin toxicity. State two common features of this

Answer 15

Hyperpigmentation (also caused by cyclophosphamide)
Hyperkeratosis
Ulcerated pressure sores

Question 16

What is the mechanism for chemo to cause N+V?

Answer 16

Directly effects the CTZ.

Usually managed with antiemetics.

Question 17

Name five side effects of chemo

Answer 17

Alopecia
Mucositis
Pulmonary fibrosis
Cardiotoxicity
N+V
Renal failure
Cystitis
Diarrhoea
Sterility
Myalgia
Myelosuppression
Phlebitis
Neuropathy
Skin toxicity
Local skin reaction

Question 18

Same a drug-drug interaction involving chemo drugs

Answer 18

• Methotrexate and NSAIDs (displacement of methotrexate from proteins)
• Vincristine and itraconazole causes neuropathy
• Capecitabine (prodrug of 5-FU) and warfarin (inhib of CYP2C9)

Question 19

Name three ways to monitor chemo, both its effectiveness and safety

Answer 19

• Response of the cancer: imaging, markers on BTs
• Drug levels in the blood
• Check for organ damage: creatinine clearance, echo