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MD3001 - Respiratory Pharmacology and Treatment > Chemotherapy > Flashcards

Chemotherapy Flashcards

1
Q

What characteristics do cancer cells exhibit not seen in normal cells?

A
  • uncontrolled proliferation
  • Invasiveness
  • Metastases
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2
Q

Main causes of cancer

A
  1. Mutations in DNA - production of altered cells which have changes in proliferating mechanisms
  2. Changes in DNA caused by covalent modifcation
  • spontaneous or genetic predisposition
  • ionising radiation or UV radiation
  • chemical carcinogens
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3
Q

What are the 3 types of treatment of cancer

A
  • sugrical excision
  • radiotherapy
  • chemotherapy
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4
Q

What are the 4 traditional agents of chemotherapy?

A
  • alkylating agents
  • antimetabolites
  • cytotoxic antibiotics
  • plant derivatives
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5
Q

What is the mechanism of action of alkylating agents?

A

forming covalent bonds eith suitable nucelophilic substances un the cell causing intrastand linking and cross-liking of DNA. Damage to the DNA of the cells triggers cell death by apoptosis

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6
Q

What are the 6 major groups of alkylating agents and give an example of each

A
  1. Nitrogen mustards - e.g. cyclophosphhamide
  2. Ethyleimines - e.g. thiotepa
  3. Alkylsuphonate - e.g. busulphan
  4. Hydrazines and Triazines - e.g. Temozolomide
  5. Nitrosoureas - e.g. lomustine, carmustine
  6. Platinum based compounds - e.g. cisplatin
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7
Q

What are the 3 major groups of antimetabolites and give an example of each?

A
  1. Antifolates - e.g. methotrexate
  2. Antipyrumudines - e.g. 5-UF, gemcitabine
  3. Antipurines - e.g. mercaptopurine, thioguiane
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8
Q

What is the mechanism of action of antifolates?

A

Folate analogue so inhibits normal metabolic pathways in cancer cells

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9
Q

What is the mechanism of action of antipyrimidines?

A

5-UF = inhibits thymidylate synthesis (metabolic pathways)

inhibits DNA polymerase

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10
Q

What is the mechanism of action of antipurines?

A

Fradulent nucleotide so prevents DNA replication

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11
Q

Give the 4 main cytotoxic antibiotics and what is their main mechanism of action?

A

direct action on DNA

  • Anthrayclines - Doxorubicin (inhibits DNA and RNA synthesis)
  • Dactinomycin (interfers with the movement of RNA polyermase)
  • Bleomycins (chain fragmentation and release of free bases)
  • Mitomycin (cross-links DNA)
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12
Q

What is the mechanism of action of chemotherapy plant derivatives?

A

spindle poisons - affect microtubule function and prevent miotic spindke formation or topoisomerase I/II inhibitors

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13
Q

What are the 4 main chemotherapy plany derivatives

A
  1. Vinca alkaliids - vincaristinen, vinblastine (spindle)
  2. Taxanes - paclitaxel, docetaxel (spindle)
  3. Camptothecins - irinotecan (top I)
  4. etoposide (top II)
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14
Q

Give three examples of monoclonal antibodies as anticancer drugs with novel targets

A
  1. Rituximab - targets B cell surface protein and is used for B cell lymphomas
  2. Trastuzumab (Herceptin) - targets epidermal growth factor receptor and is used for breast cancer
  3. Imatinib (gleevac) - inhibits bcr-abl gene signalling pathways and is used for CML
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15
Q

Other examples of novel targeted agents in treating cancer

A
  • hromones
  • protein kinase inhibitors
  • miscellaneous agents
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16
Q

What are the major drawbacks of the current cancer chemotherapy treatment

A
  • target cell proliferation not more lethal properties
  • non-specific
  • resistance is developing
  • total elimination of cancer cells is not possible with theraputic doses
  • bone marrow, hair, GI mucosa and skin are mainly affected
  • Side effects occur 7-14 days post treatment and can be accumulative
  • reduced patient compliance due to side effects
17
Q

Describe Tumour lysis syndrome

A
  • acute side-effect and metabolic emergency
  • occurs due to rapid cell lysis and large amounts of metabolites in the blood
  • characterised by hyperuricaemia, hyperphosphatemia, hyperkalaemia and hypocalcaemia
  • Can lead to acute renal failure, cardiac arrest and death
18
Q

What is myelosuppression?

A

reduced production of cells which provide immunity, oxygen transport and clotting

*common with many chemotherapy agents

Side effect that affects the bone marrow and short lived cells

19
Q

GI side effects of chemotherapy

A
  1. Nausea and vomitting
  2. Loss of appetite
  3. Constipation
  4. Diarrhoea
  5. Ulcerationm dry mouth, pain, taste alterations
20
Q

Other specific side effects assoicated with chemotherapy

A
  • fatigue
  • body image
  • peripheral neuropathy
  • altered renal function
  • delayed effects
21
Q

Give an example of a highly, moderate and mild emetogenic cancer drug and how would this be treated?

A
  • High = cisplatin
  • Moderate = doxorubicin
  • Mild = etoposide

lorazepam (pre treatment), steroids (dexamethazome), anti-emetics (ondersartan, metoclopramide)

22
Q

What does personalised medicine take into account?

A
  • genomic/genetic testing
  • proetomic profiling
  • metabolomic analysis
23
Q

What are the 4 Ps of personalised medicine?

A

Predicitive

Personalised

Preventative

Participatory

24
Q

What did doctors traditionally use for prescribing treatment?

A
  • family history
  • socio-economic circumstances
  • environmental factors
25
Q

Aims of the NHS with regards to personalised medicine

A
  • prediction of disease and targted prevention
  • early identification
  • precise diagnosis
  • targeted interventions
  • imrpoves outcomes
  • reduce costs
26
Q

Personalised medicine drugs for NSCLC

A
  • AKL rearrangements are mutally exclsuive with EGFR and KRAS mutations
  • activating mutation = locks on activity of mutant action
  • EGFR = erlontinib
  • KRAS = no drug
  • ALK rearrangement = crizontinib
27
Q

Personalised medicine drugs for colorectal cancer

A
  • cetuximab - anti-EGFR monoclonal antibody therapy
  • RAS mutation = lack of response to thearpy
28
Q

Personalised medicine drugs for Melanoma

A

BRAF -= vermurafenib; inhibitor of mutated B-Raf

NRAS mutations: MEK inhibitors/ KIT (c-kit) mutations; imatinib

29
Q

Personalised medicine drugs for Brain tumours (high grade glioblastomas)

A

Temozolomide: alkylatin agent (+ radiation)

if there is MGMT promoter gene methylation (DNA repair enzyme)

30
Q

What is FISH analysis used for?

A
  • Ewing’s sarcomas
  • alveolar rhabdomucosarcomas
  • leiomycosarcomas
  • fibromyxoid sarcomas

MD3001 - Respiratory Pharmacology and Treatment (6 decks)

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