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*OldPharm > Chemotherapy Agents > Flashcards

Chemotherapy Agents Flashcards

1
Q

why are fruits and veggies important for cancer prevention?

A

antioxidants

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2
Q

disappearance of any evidence of tumor for 5 years and a high actuarial probability of a normal life span.

A

cancer cure

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3
Q

three methods to try to cure cancer

A

surgery
radiotherapy
chemotherapy

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4
Q

what does chemo do

A

inhibit rate of growth
kill cancerous cells
minimal effects on non-neoplastic host cells

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5
Q

what do cytotoxic chemo agents affect?

A

DNA synthesis

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6
Q

when is cytotoxic chem most active?

A

cycling/ proliferating cells

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7
Q

what cells does chemo affect

A

GI
bone marrow
reproductive
immune systems

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8
Q

do normal cells or cancer cell recover faster from chemo

A

normal cells

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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
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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

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11
Q

what are the 5 types of cytotoxic agents for chemo?

A 
Alkylating agents
Antimetabolites
Cytotoxic antibiotics
Mitotic (Microtubule) inhibitors 
Miscellaneous agents
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12
Q

Capable of introducing alkyl groups into nucleophilic sites on other molecules through the formation of covalent bonds.

A

alkylating Agents

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13
Q

what are the nucleophillic targets of alkylating agents

A

Sulfhydryl Hydroxyl
Amino Carboxyl
Phosphate Imidazole

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14
Q

alkylating agent that is a deriviative of the war gas sulfur mustard. First modern anticancer drug

A

mechlorethamine (Mustargen)

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15
Q

indications for mechlorethamine

A

Hodgkin’s disease

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16
Q

is there any intact drug in urine w/ mechlorethamine

A

No, 1/2 life of only 10 minutes

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17
Q

WHat is the combo therapy used to treat Hodgkin’s dz?

A 
MOPP
meclorethamine
(Oncovin) vincristine
procarbazine
prednisone
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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

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19
Q

ADRs w/ mechlorethamine

A

blistering
oral ulcerations
N/V (really bad)
reproductive toxicities (sterile after 6 months)

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20
Q

Most versatile and useful nitrogen mustard

Broadest spectrum of antitumor activity of all alkylating agents.

A

Cyclophosphamide (Cytoxin)

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21
Q

what does cyclophosmaide require to be activated

A

P450 enzyme system

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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
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23
Q

alkylating agent that is an analogue of cyclophosphamide

A

ifosfamide

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24
Q

ADRs of ifosafmide

A

less myelosupression
most toxic to bladder
still have alopecia, potential sterility

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25
Q

what can you administer w/ ifosafmide to avoid hemorrhagic cystitis

A

mesna

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26
Q

what are the three types of antimetabolites

A

folic acid antagonist (methotrexate)
antipyrimidine (fluorouracil cytarabine)
antipurines (mercaptopurine)

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27
Q

what is the MOA of antimetabolites

A

Analogues of normal metabolites acting through competition, replacing the natural metabolite, subverting the cellular processes.

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28
Q

what must you administer w/ methotrexate

A

folic acid 1 mg daily

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29
Q

indicatiosn for methotrexate

A 
Acute lymphoblastic leukemia
Non-Hodgkin’s lymphoma
Burkitt’s lymphoma
Rheumatoid arthritis
Psoriasis
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30
Q

what should you monitor w/ methotrexate

A

chest x-ray q 6 months (infiltrates)
LFTS q 6 months
CBC

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31
Q

Contraindicaitons w/ methotrexate

A 
pregnancy (abortificaient) breast feeding
liver dz
impaired renal function
immunodeficiency syndrome
pre-existing blood dyscrasias
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32
Q

ADRs w/ methotrexate

A

pulmonary fibrosis
hepatic fibrosis
neurotoxicity

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33
Q

ROA of 5-FU

A

usually IV, but can be oral or topical

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34
Q

contraindications for 5-FU

A

bone marrow suppression

impaired renal function

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35
Q

ADRs w/ 5-FU

A

confusion, disorientation, euphoria
MI
nystagmus
N/V/D

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36
Q

what are the 4 cytotoxic antibiotics

A

Dactinomycin (actinomycin D)
Bleomycin (Blenoxane)
Doxorubicin (Adriamycin)
Daunorubicin (Cerubidine)

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37
Q

what is primarily used in peds cancer (cytotoixic antibiotics)

A

dactinomycin

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38
Q

cytotoxic abx used for acute leukemias, lymphomas and various solid tumors.

A

doxorubicin

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39
Q

what can doxorubicin cause?

A

cardiotoxicity as result of irreversible free radial damage to the myocardium

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40
Q

what toxicity can bleomycin cause

A

pulmonary fibrosis

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41
Q

what are Mitotic inhibits?

A

plant derived
etoposide
vinca alkaloids

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42
Q

ROA of vinac alkaloids

A

IV

etoposide PO or IV

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43
Q

what are mitotic inhibitors used for

A

Acute leukemia
Lymphomas
Some solid tumors

44
Q

ADRS w/ mitotic inhibitor

A

phlebitis or cellulitis if drug extravastaes (expeciallyw / vinca alkaloids)

45
Q

what vinca alkaloid do you not see bone marrow supression but does cause neuro effects (recovery does occur but takes longer)

A

vincristine

46
Q

Contraindications w/ vinca alkaloids

A

Don’t give them intrathecally (usually fatal)

47
Q

what is a mitotic inhibitor that is often used in tx of ovarian and breast cancer

A

paciltaxel

48
Q

what must you pre-medicated w/ before giving paciltaxel

A

benadryl and dexamethasone

49
Q

dose limiting toxicities w/ paciltaxel

A

neutropenia (will treat this versus stop therapy)

50
Q

how do you treat neutropenia (often seen w/ paciltaxel)

A

filgastim (granulocyte colony-stimulating factor)

51
Q

Drug that is a misc. agent, given orally, used for hodgkin’s disease (part of MOPP)

A

procarbazine

52
Q

ADRs w/ procarbazine

A

Disulfiram-type reaction with ETOH

N/V/D, neurotoxic (hallucinations to paresthesias), bone marrow depression

53
Q

misc agent that comes from E.Coli. Used for ALL, some types of lymphoma

A

l-asparaginase

54
Q

why is L-Asparaginase particuarlly useful

A

not a lot of resistance
lack of bone marrow toxicity
some naseau, but no vomitting, diarrhea
no alopecia

55
Q

there is larger risk of developing what w/ L-Asparaginase

A

allergic reaction

hyperglycemia

56
Q

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

57
Q

when cisplastin is combined w/ bleomycin and vinblastine or etoposide it can cure what?

A

metastatic testicular cancer or germ cell cancer of the ovary

58
Q

ADRs w/ cisplastin

A 
renal toxicity 
very severe N/V
mild bone marrow toxicity
hearing loss 
excessive urinary excretion of Mg
59
Q

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

A

Carboplastin

60
Q

most cancers that are resistance to cisplastin are also resistant to what?

A

carbopalstin

61
Q

what is a bigger issue w/ carboplastin?

A

more myelosupression than cisplastin

62
Q

ADRs w/ carbopastlin

A

anemia
abnormal liver fxn tests
occ. allergic rxns

63
Q

what is the major dose limiting toxicity for chemo agents

A

myelosupression

limits chemo regimens to dosing every 2-3 weeks

64
Q

what are colony stimulating factors what stimulate neutrophils

A

sargramostim

filgrastim

65
Q

what are colony stimulating factors that stimulate RBCs

A

EPO

darbepoetin

66
Q

ADRs w/ colony stimulating factors

A

bone pain

GM-CSF can cause rashes, fever, pulmonary edema

67
Q

What is febrile neutropenia?

68
Q

When are CSFs indicated to prevent febrile neutropenia?

A

patient is receiving chemo regimen w/ significant (>40%) risk of febrile neutropenia.

69
Q

what are good broad spectrum abx to treat febrile neutropenia.

A

Cefpime
Piperacillin + tazobactam
Imipenem or meropenem
Aminoglycoside + antipseudomonal penicillin (e.g. piperacillin)

70
Q

how are CSFs used for prophylaxis of febrile neutropenia?

A

continuation until ANC recovery for patients receiving a chemo regimen with high potential of causing FN

71
Q

when is antifungal therapy considered for febrile neutropenia?

A

patients w/ febrile neutropenia who are still febrile and neutropenic after 4-7 days on broad spectrum abx or who develop sepsis

72
Q

What organisms cause most invasive fungal infections in people w/ febrile neutropenia

A

candidiasis or aspergillosis

73
Q

Tx for fungal infections associated w/ febrile neutropenia

A

Amphotericin B (conventional or Liposomal)

74
Q

what is Escape of chemotherapy agents into subcutaneous tissue, resulting in tissue injury

A

extravasation injury

75
Q

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

A 
vinca alkaloids (vincristine, vincblastine) 
mechlorethamine and carmustine
76
Q

what drugs bind to nucleic acids and cause an extravasation injury.

A 
antibiotic class of chemo
Anthracyclines (daunorubicin, doxorubicin), dactinomycin, mitomycin C
77
Q

how to you prevent extravasation injury

A

indwelling centra venous catheters
admin through free flowing IV (piggy back on saline)
stop infusion upon burning, stinging, local swelling

78
Q

what are antidotes used for extravasation injuries

A

DMSO- dimethyl sulfoxide

hyaluronidase- vinca alkaloid extravasation

79
Q

name of Mucosal injury from chemotherapy

80
Q

when is mucositis commonly seen w/ chemo

A

5-7 days after

usually lasts 3-5 days

81
Q

what is musocisits most commonly associated w/

A

high dose methotrexate
5-FU
anthracyclines

82
Q

virtually all patients who receive radiation to the _______ and ________ experience mucositis.

A

head and neck

83
Q

what mucosa is most often affected by mucositis

A

non-keratinized (labial, buccal, soft palate, floor of mouth, ventral surface of tongue)

84
Q

how do you prevent mucositis

A

correction of oral disease
CSFs following myelosuppressive chemo
(doesn’t treat mucositis but may help)

85
Q

what 2 Drugs are used to prevent mucositis

A

amifostine

palifermin

86
Q

drug for mucositis that is a prodrug that decreases nephrotoxicity, ototoxicity, myelosuppression from ciplastin.

A

amifostine

87
Q

ADRs of amifostine

A

HPOTN
N/V
decrease effect of chemo or radiation

88
Q

drugs for mucositis that is a synthetic keratinocyte growth factor. Very expensive

A

Palifermin

89
Q

what is an adrenalcorticol steroid that is used for cancer of lymphoid tissues and blood. Also used to tx complications associated w/ cancer (inflammation)

A

prednisone

90
Q

Synthetic antiestrogen used in the treatment of breast cancer. Estrogen antagonists. Works to help breast cancer patients.

91
Q

ADRs of tamoxifen

A

hot flashes
vaginal dryness or discharge
exacerbation of bone pain and hypercalcemia
nausea

92
Q

Does tamoxifen work better on ER-positive or ER-negative tumors

A

ER-positive

93
Q

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

94
Q

ADRs of flutamide

A

Hot flashes
Loss of libido
Impotence
N/D

95
Q

what 2 drugs are luteinizing hormone- release hormone which causes the patient to run out of gonadotropin release (decreased estrogen and testosterone)

A

Buserelin (Suprefact)

Leuprolide (Lupron)

96
Q

what is luprolide used for in females

A

endometriosis

97
Q

what is an estrogen that has an antiandrogenic effect used to suppress androgen-dependent prostatic cancers

A

diethylstilbestrol

98
Q

Recent advance derived from the nineteenth century observation that ___________ ____________sometimes provoked the regression of cancer.

A

bacterial infections

99
Q

what are immunomodulating agents that Can reduce the rate of some cancerous tumors and leukemias

A

interfersons

100
Q

what immunomodulating agents activate lymphocytes to destroy cancer cells

A

interleukins

101
Q

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.

A

Interferon Alfa-2b (Intron A)

102
Q

ADRs w/ Interferon Alfa-2b (Intron A)

A

fever
flulike syndrome
leukopenia
dizziness

103
Q

what immunomodulating agents induce natural killer cells and induction of interferon gamma production

A

Aldesleukin

human recombinant interleukin-2 protein

104
Q

ADRs w/ interleukins

A

severe HPOTN

avoid in patients w/ cardiac, pulmonary, renal hepatic or CNS conditions

105
Q

what to give for nausea related to chemo

A

ondansetron (Zofran)

dexamethasone

*OldPharm (12 decks)

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