Chemotherapy Agents Flashcards
1
Q
why are fruits and veggies important for cancer prevention?
A
antioxidants
2
Q
disappearance of any evidence of tumor for 5 years and a high actuarial probability of a normal life span.
A
cancer cure
3
Q
three methods to try to cure cancer
A
surgery
radiotherapy
chemotherapy
4
Q
what does chemo do
A
inhibit rate of growth
kill cancerous cells
minimal effects on non-neoplastic host cells
5
Q
what do cytotoxic chemo agents affect?
A
DNA synthesis
6
Q
when is cytotoxic chem most active?
A
cycling/ proliferating cells
7
Q
what cells does chemo affect
A
GI
bone marrow
reproductive
immune systems
8
Q
do normal cells or cancer cell recover faster from chemo
A
normal cells
9
Q
what are potential MOA or resistance to cytotoxic chemo
A
Abnormal transport Decreased cellular retention Increased cellular inactivation (binding/metabolism) Altered target protein Enhanced repair of DNA Altered processing
10
Q
what is more difficult to treat w/ chemo
A
tumors past the blood brian barrier
large solid tumor w/ low blood supply and diffusion
11
Q
what are the 5 types of cytotoxic agents for chemo?
A
Alkylating agents Antimetabolites Cytotoxic antibiotics Mitotic (Microtubule) inhibitors Miscellaneous agents
12
Q
Capable of introducing alkyl groups into nucleophilic sites on other molecules through the formation of covalent bonds.
A
alkylating Agents
13
Q
what are the nucleophillic targets of alkylating agents
A
Sulfhydryl Hydroxyl
Amino Carboxyl
Phosphate Imidazole
14
Q
alkylating agent that is a deriviative of the war gas sulfur mustard. First modern anticancer drug
A
mechlorethamine (Mustargen)
15
Q
indications for mechlorethamine
A
Hodgkin’s disease
16
Q
is there any intact drug in urine w/ mechlorethamine
A
No, 1/2 life of only 10 minutes
17
Q
WHat is the combo therapy used to treat Hodgkin’s dz?
A
MOPP meclorethamine (Oncovin) vincristine procarbazine prednisone
18
Q
what is a dose limiting toxicity of mechlorethamine
A
myelosuppression (occurs 10-14 days after admin) recovery in 21-28 days
can activate latent herpes zoster
19
Q
ADRs w/ mechlorethamine
A
blistering
oral ulcerations
N/V (really bad)
reproductive toxicities (sterile after 6 months)
20
Q
Most versatile and useful nitrogen mustard
Broadest spectrum of antitumor activity of all alkylating agents.
A
Cyclophosphamide (Cytoxin)
21
Q
what does cyclophosmaide require to be activated
A
P450 enzyme system
22
Q
Dose limiting toxicities w/ cyclophosphamide
A
bone marrow suppression impaired immune system cystitis w/ chronic treatment can become sterile impairment of renal function w/ high doses
23
Q
alkylating agent that is an analogue of cyclophosphamide
A
ifosfamide
24
Q
ADRs of ifosafmide
A
less myelosupression
most toxic to bladder
still have alopecia, potential sterility
25
what can you administer w/ ifosafmide to avoid hemorrhagic cystitis
mesna
26
what are the three types of antimetabolites
folic acid antagonist (methotrexate)
antipyrimidine (fluorouracil cytarabine)
antipurines (mercaptopurine)
27
what is the MOA of antimetabolites
Analogues of normal metabolites acting through competition, replacing the natural metabolite, subverting the cellular processes.
28
what must you administer w/ methotrexate
folic acid 1 mg daily
29
indicatiosn for methotrexate
```
Acute lymphoblastic leukemia
Non-Hodgkin’s lymphoma
Burkitt’s lymphoma
Rheumatoid arthritis
Psoriasis
```
30
what should you monitor w/ methotrexate
chest x-ray q 6 months (infiltrates)
LFTS q 6 months
CBC
31
Contraindicaitons w/ methotrexate
```
pregnancy (abortificaient) breast feeding
liver dz
impaired renal function
immunodeficiency syndrome
pre-existing blood dyscrasias
```
32
ADRs w/ methotrexate
pulmonary fibrosis
hepatic fibrosis
neurotoxicity
33
ROA of 5-FU
usually IV, but can be oral or topical
34
contraindications for 5-FU
bone marrow suppression
| impaired renal function
35
ADRs w/ 5-FU
confusion, disorientation, euphoria
MI
nystagmus
N/V/D
36
what are the 4 cytotoxic antibiotics
Dactinomycin (actinomycin D)
Bleomycin (Blenoxane)
Doxorubicin (Adriamycin)
Daunorubicin (Cerubidine)
37
what is primarily used in peds cancer (cytotoixic antibiotics)
dactinomycin
38
cytotoxic abx used for acute leukemias, lymphomas and various solid tumors.
doxorubicin
39
what can doxorubicin cause?
cardiotoxicity as result of irreversible free radial damage to the myocardium
40
what toxicity can bleomycin cause
pulmonary fibrosis
41
what are Mitotic inhibits?
plant derived
etoposide
vinca alkaloids
42
ROA of vinac alkaloids
IV
| etoposide PO or IV
43
what are mitotic inhibitors used for
Acute leukemia
Lymphomas
Some solid tumors
44
ADRS w/ mitotic inhibitor
phlebitis or cellulitis if drug extravastaes (expeciallyw / vinca alkaloids)
45
what vinca alkaloid do you not see bone marrow supression but does cause neuro effects (recovery does occur but takes longer)
vincristine
46
Contraindications w/ vinca alkaloids
Don't give them intrathecally (usually fatal)
47
what is a mitotic inhibitor that is often used in tx of ovarian and breast cancer
paciltaxel
48
what must you pre-medicated w/ before giving paciltaxel
benadryl and dexamethasone
49
dose limiting toxicities w/ paciltaxel
neutropenia (will treat this versus stop therapy)
50
how do you treat neutropenia (often seen w/ paciltaxel)
filgastim (granulocyte colony-stimulating factor)
51
Drug that is a misc. agent, given orally, used for hodgkin's disease (part of MOPP)
procarbazine
52
ADRs w/ procarbazine
Disulfiram-type reaction with ETOH
| N/V/D, neurotoxic (hallucinations to paresthesias), bone marrow depression
53
misc agent that comes from E.Coli. Used for ALL, some types of lymphoma
l-asparaginase
54
why is L-Asparaginase particuarlly useful
not a lot of resistance
lack of bone marrow toxicity
some naseau, but no vomitting, diarrhea
no alopecia
55
there is larger risk of developing what w/ L-Asparaginase
allergic reaction
| hyperglycemia
56
what is an Inorganic complex w/a broad range of antitumor activity that works on a lot of types of tumor. 90% protein bound, doesn't cross BBB, renally excreted
Cisplatin
57
when cisplastin is combined w/ bleomycin and vinblastine or etoposide it can cure what?
metastatic testicular cancer or germ cell cancer of the ovary
58
ADRs w/ cisplastin
```
renal toxicity
very severe N/V
mild bone marrow toxicity
hearing loss
excessive urinary excretion of Mg
```
59
Analogue of cisplastin, shorter 1/2 life, no significant protein binding, still renally excreted (but less toxic) and no peripheral nerve damage/ hearing loss, less N/V
Carboplastin
60
most cancers that are resistance to cisplastin are also resistant to what?
carbopalstin
61
what is a bigger issue w/ carboplastin?
more myelosupression than cisplastin
62
ADRs w/ carbopastlin
anemia
abnormal liver fxn tests
occ. allergic rxns
63
what is the major dose limiting toxicity for chemo agents
myelosupression
| limits chemo regimens to dosing every 2-3 weeks
64
what are colony stimulating factors what stimulate neutrophils
sargramostim
| filgrastim
65
what are colony stimulating factors that stimulate RBCs
EPO
| darbepoetin
66
ADRs w/ colony stimulating factors
bone pain
| GM-CSF can cause rashes, fever, pulmonary edema
67
What is febrile neutropenia?
ANC 38.3
68
When are CSFs indicated to prevent febrile neutropenia?
patient is receiving chemo regimen w/ significant (>40%) risk of febrile neutropenia.
69
what are good broad spectrum abx to treat febrile neutropenia.
Cefpime
Piperacillin + tazobactam
Imipenem or meropenem
Aminoglycoside + antipseudomonal penicillin (e.g. piperacillin)
70
how are CSFs used for prophylaxis of febrile neutropenia?
continuation until ANC recovery for patients receiving a chemo regimen with high potential of causing FN
71
when is antifungal therapy considered for febrile neutropenia?
patients w/ febrile neutropenia who are still febrile and neutropenic after 4-7 days on broad spectrum abx or who develop sepsis
72
What organisms cause most invasive fungal infections in people w/ febrile neutropenia
candidiasis or aspergillosis
73
Tx for fungal infections associated w/ febrile neutropenia
Amphotericin B (conventional or Liposomal)
74
what is Escape of chemotherapy agents into subcutaneous tissue, resulting in tissue injury
extravasation injury
75
what drugs are concerning to cause an extravasation injury. These drugs cause immediate tissue damage but are quickly metabolized (similar to a burn). Do not bind to tissue nucleic acids
```
vinca alkaloids (vincristine, vincblastine)
mechlorethamine and carmustine
```
76
what drugs bind to nucleic acids and cause an extravasation injury.
```
antibiotic class of chemo
Anthracyclines (daunorubicin, doxorubicin), dactinomycin, mitomycin C
```
77
how to you prevent extravasation injury
indwelling centra venous catheters
admin through free flowing IV (piggy back on saline)
stop infusion upon burning, stinging, local swelling
78
what are antidotes used for extravasation injuries
DMSO- dimethyl sulfoxide
| hyaluronidase- vinca alkaloid extravasation
79
name of Mucosal injury from chemotherapy
mucositis
80
when is mucositis commonly seen w/ chemo
5-7 days after
| usually lasts 3-5 days
81
what is musocisits most commonly associated w/
high dose methotrexate
5-FU
anthracyclines
82
virtually all patients who receive radiation to the _______ and ________ experience mucositis.
head and neck
83
what mucosa is most often affected by mucositis
non-keratinized (labial, buccal, soft palate, floor of mouth, ventral surface of tongue)
84
how do you prevent mucositis
correction of oral disease
CSFs following myelosuppressive chemo
(doesn't treat mucositis but may help)
85
what 2 Drugs are used to prevent mucositis
amifostine
| palifermin
86
drug for mucositis that is a prodrug that decreases nephrotoxicity, ototoxicity, myelosuppression from ciplastin.
amifostine
87
ADRs of amifostine
HPOTN
N/V
decrease effect of chemo or radiation
88
drugs for mucositis that is a synthetic keratinocyte growth factor. Very expensive
Palifermin
89
what is an adrenalcorticol steroid that is used for cancer of lymphoid tissues and blood. Also used to tx complications associated w/ cancer (inflammation)
prednisone
90
Synthetic antiestrogen used in the treatment of breast cancer. Estrogen antagonists. Works to help breast cancer patients.
Tamoxifen
91
ADRs of tamoxifen
hot flashes
vaginal dryness or discharge
exacerbation of bone pain and hypercalcemia
nausea
92
Does tamoxifen work better on ER-positive or ER-negative tumors
ER-positive
93
Non-steroidal anti-androgen. Prevents tumor growth that may occur as a result of testosterone. usually administer after leuprolide therapy (GnRH releasing agonist). used for prostate caner
Flutamide
94
ADRs of flutamide
Hot flashes
Loss of libido
Impotence
N/D
95
what 2 drugs are luteinizing hormone- release hormone which causes the patient to run out of gonadotropin release (decreased estrogen and testosterone)
Buserelin (Suprefact)
| Leuprolide (Lupron)
96
what is luprolide used for in females
endometriosis
97
what is an estrogen that has an antiandrogenic effect used to suppress androgen-dependent prostatic cancers
diethylstilbestrol
98
Recent advance derived from the nineteenth century observation that ___________ ____________sometimes provoked the regression of cancer.
bacterial infections
99
what are immunomodulating agents that Can reduce the rate of some cancerous tumors and leukemias
interfersons
100
what immunomodulating agents activate lymphocytes to destroy cancer cells
interleukins
101
Recombinant DNA derived from the interferon alfa-2b gene of human WBCs
Used in hairy cell leukemia, lyphoma, multiple myeloma, melanoma, renal cell carcinoma, ovarian carcinoma.
Interferon Alfa-2b (Intron A)
102
ADRs w/ Interferon Alfa-2b (Intron A)
fever
flulike syndrome
leukopenia
dizziness
103
what immunomodulating agents induce natural killer cells and induction of interferon gamma production
Aldesleukin
| human recombinant interleukin-2 protein
104
ADRs w/ interleukins
severe HPOTN
| avoid in patients w/ cardiac, pulmonary, renal hepatic or CNS conditions
105
what to give for nausea related to chemo
ondansetron (Zofran)
| dexamethasone
