Chemotherapy

Question 1

Name the purines

Answer 1

Adenine and Guanine

Question 2

Name the Pyridimines

Answer 2

Cytosine and Thymine

Question 3

What is a nucleotide ?

Answer 3

sugar phosphate base

Question 4

why is the prognosis of cancers so bad ?

Answer 4

short window between detection and death due to exponential growth - need early detection

Question 5

what must cells do in order for chemo to work ?

Answer 5

be in the cell cycle not in G0

Question 6

What are the steps in the cell cycle ?

Answer 6

M-Mitosis
G1- Metabolic changes prepare the cell for division. At a certain point - the restriction point - the cell is committed to division and moves into the S phase.
S- DNA Synthesis
G2- Metabolic changes assemble the cytoplasmic materials necessary for mitosis and cytokinesis.

Question 7

what is the fractional cell kill hypothesis ?

Answer 7

Every time chemo is administered the cells of bone marrow is allowed to regrow to stop side effects but quick enough to reduce tumour cell growth

Question 8

what is Imantinib ?

Answer 8

Tyrosine kinase inhibitor competitively for CML

Question 9

how do alkylating agents work ?

what compounds are good at this ?

Answer 9

creates Bond within the Double strand so it cannot unzip and replicate = apoptosis

platinium compouns - cisplatin

Question 10

how is DACH platinum adducts even more effective ?

Answer 10

Bulky side groups attached

Question 11

how does 5-Fluorouracil work ?

Answer 11

Antimetabolite

Inhibit thymidylate synthase used to synthesise pyrimidines into DNA

Question 12

how does methotrexate work ?

Answer 12

Antimetoblite

Dihydrofolate reductase inhibitor , used in folate cycle . Folate cycle makes purines.

Question 13

how do 2 types of spindle poisons work?

Answer 13

vinca alkoloids - stops assembly of spindle formations

Taxoids - promotes assembly , cell too ridge to divide

Question 14

how to cells develop resistance to alkylating agents ?

Answer 14

Tumour cells can pump out the alkylating agent

Inactivation of agent via GSH

Question 15

how do we predict response to chemo?

Answer 15

performance score
clinical stage
molecular changes

Question 16

what are IV procedures for chemo?

Answer 16

PICC line - can go home
hickman line (Central line)

Question 17

what are side effects of chemo ?

Answer 17

alopecia 
nausea and vomting 
sterility 
renal failure 
myelosurpression

Question 18

what is seen in complications of high sensitive tumour of chemo ?

Answer 18

acute renal failure - Urea increase due to rapid breakdown of tumour= Urate crystals in renal tubules
GI perforation at site of tumour = Lymphomas
DIC within hours of acute myeloid leukaemia

Question 19

why does vomiting occur ? what is the pattern ?

Answer 19

action on central CTZ
Acute pahse = 4-12 hours
Delayed onset = 2-5 days
Chronic phase = persist up to 14 days

Question 20

what skin problems do you see in Chemo?

Answer 20

Local - irritation and thrombophlebitis
General -
hyperpigmentation

Question 21

where is mucosits seen worse in chemo ? presents as ?

Answer 21

Oropharynx 
sore mouth 
diarrhoea 
GI bleed 
can lead to infections

Question 22

what kind of cadrio toxicity is seen in chemo ?

Answer 22

cardio myopathy

arrhythmias

Question 23

what drug is lung toxic ?

what can you not give ?

Answer 23

Bleomycin
Fibrosis
oxygen

Question 24

what haematological toxicity is the worse ? why ?

Answer 24

neutrophil - White cell

neutropenic sepsis

Question 25

what causes variability in absorption ?

Answer 25

N+v , compliance , Gut problems

Question 26

what causes variability in Distribution ?

Answer 26

weight loss, reduce body fat , ascites

Question 27

what causes variability in elimination ?

Answer 27

Liver and renal dysfunction

Question 28

what causes variability in protein binding ?

Answer 28

low albumin

Question 29

what chemo have paritcally interactions ?

Answer 29

Capecitabine - (5FU) and warfarin / St John’s wort

Methotrexates with penicillin