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Pharmacology > Chemotherapy - Dra. Alabastro > Flashcards

Chemotherapy - Dra. Alabastro Flashcards

1
Q

Etiology of cancer

A

characterized by a shift in the control mechanisms that govern cell proliferation and differentiation

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2
Q

PHASE OF CELL CYCLE: nuclear membrane breaks down, mitotic spindle forms, chromosomes condense

A

Mitotic Phase - Prophase

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3
Q

PHASE OF CELL CYCLE: chromosomes condense at the center

A

Mitotic Phase - Metaphase

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4
Q

PHASE OF CELL CYCLE: chromosomes separate into chromatids

A

Mitotic Phase - Anaphase

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5
Q

PHASE OF CELL CYCLE: cells divide into parent and daughter cells

A

Mitotic Phase - Telophase

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6
Q

PHASE OF CELL CYCLE: Resting phase

A

G0 Phase

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7
Q

PHASE OF CELL CYCLE: RNA synthesis

A

G1 Phase

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8
Q

PHASE OF CELL CYCLE: DNA Replication

A

Synthesis Phase

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9
Q

PHASE OF CELL CYCLE: Preparation for mitosis

A

G2 Phase

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10
Q

Crucial component of cells’ machinery for organizing and dividing chromosomes

Forms spindles during mitosis

A

Microtubules

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11
Q

Basis for advanced treatment therapy for cancer

A

Proteins in control of cell growth

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12
Q

Class 1 proteins

A

growth factors

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13
Q

Class 2 proteins

A

Receptors for growth factors and hormones

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14
Q

Class 3 proteins

A

Intracellular signal transducers

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15
Q

Class 4 proteins

A

Nuclear transcription factors

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16
Q

Class 5 proteins

A

cell-cycle control proteins

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17
Q

Factors affecting tissue growth

A
  1. Cell cycle time
  2. Growth fraction
  3. Total # of cells in the population
  4. Increased cell death rate
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18
Q

Stages of tumor growth

A

Lag Phase: cells try to accustom themselves
Log Phase: cells repeatedly double in number
Plateau Phase: leveling off of cell doubling

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19
Q

Causes of cancer cells overproduction

A
  1. Failure of abnormal cells to undergo apoptosis
  2. Inappropriate stimulation of cell proliferation by genetic abnormalities
  3. Abnormalities of tumor suppressor gene (p53)
  4. Tumor angiogenesis
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20
Q

Factor of tissue growth that determines MAXIMUM GROWTH RATE of tumor

A

Cell Cycle Time

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21
Q

Factor of tissue growth that determines portion of cells sensitive to drug

A

Growth Fraction

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22
Q

Factor of tissue growth that gives an index of how advanced the cancer is.

A

Total # of cells in population

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23
Q

Indications for Chemotherapy

A
  1. Cure certain malignancies
  2. Palliate symptoms
  3. Treat asymptomatic patients
  4. Allow less mutilating surgery
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24
Q

Contraindications to Chemotherapy

A
  • Inadequate facilities
  • Survival unlikely even if tumor shrinkage is accomplished
  • Unlikely to obtain benefits because of severe debilitation
  • Asymptomatic patient with slow growing incurable tumors
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25
Q

Primary treatment for advanced cancer for which no alternative treatment exists

A

Primary Induction

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26
Q

Patients with localized cancer for which alternative therapies exit but less than completely effective

A

Neoadjuvant example: CT, RT

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27
Q

Reduces the incidence of both local and systemic recurrence and to improve the overall survival

A

Adjuvant

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28
Q

CLASSIFICATION OF CELL-CYCLE SPECIFIC CHEMOTHERAPEUTIC DRUGS

A
  1. Antimetabolites
  2. Antitumor antibiotic
  3. Vinca alkaloids
  4. Epipodophyllotoxins
  5. Taxanes
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29
Q

CLASSIFICATION OF CHEMOTHERAPEUTIC DRUGS

A

Cell Cycle Specific Drugs

Cell Cycle non-specific drugs

Phase Specific Drugs

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30
Q

CLASSIFICATION OF CELL-CYCLE NON-SPECIFIC CHEMOTHERAPEUTIC DRUGS

A
  1. Alkylating Agents
  2. Anthracyclines
  3. Antitumor antibiotics
  4. Camptothecins
  5. Platinum Analogs
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31
Q

GOALS OF CANCER THERAPY

A
  1. Damage the DNA of the affected cancer cells
  2. Inhibit the synthesis of new DNA strands to stop the cell from replicating
  3. Stop mitosis
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32
Q

Why are combinations effective?

A 
Prevents resistant clones
Less cytotoxicity
Biochemical enhancement of effects
To have sanctuary access
Rescue
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33
Q

Neutrophil count and platelet count should be modified when?

A

Absolute neutrophil count <120,000/mL

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34
Q

General Adverse Effects of CT drugs

A

Nausea & vomiting
Mucositis; Stomatitis
Baldness
Myelosuppression

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35
Q

When to modify drug dose in terms of renal toxicity?

A

Drugs that cause renal toxicity not administered unless creatinine clearance >55 ml/min (MTX; Cisplatin; Streptozocin)

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36
Q

Which drugs should have their dose reduced in cases of hepatic impairment

A

Vinca alkaloids

Anthracyclines

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37
Q 
ALKYLATING AGENTS (give most commonly used drug):
Nitrogen mustard
A

cyclophosphamide

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38
Q 
ALKYLATING AGENTS (give most commonly used drug):
Ethylenemelamine derivatives
A

Thiotepa

Altretamine

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39
Q 
ALKYLATING AGENTS (give most commonly used drug):
Alkyl Sulfonate
A

Busulfan

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40
Q 
ALKYLATING AGENTS (give most commonly used drug):
Triazene
A

Dacarbazine

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41
Q 
ALKYLATING AGENTS (give most commonly used drug):
Platinum Analogs
A

Cisplatin

Oxaloplatin

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42
Q

Adverse effects of platinum analogs

A

Nephrotoxicity
Ototoxicity
Neurotoxicity

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43
Q

Mechanism of action of ALKYLATING AGENTS

A

Attachment of alkyl groups to DNA bases at N7 guanine forms fragmented DNA

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44
Q

Characteristics of alkylating agents

A

Cell cycle non-specific

Phase non-specific

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45
Q

What should not be given in the administration of alkylating agents and why?

A

Do not give GLUTATHIONE as it can inactivate an alkylating agent

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46
Q

Which among alkylating agents has a direct vesicant effect on the skin?

A

Nitrogen mustard

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47
Q

Which alkylating agents are irritants?

A

Cisplatin

Dacarbazine

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48
Q

Indication of Chlorambucil (nitrogen mustard)

A

Chronic Lymphocytic Leukemia

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49
Q

Indication of cyclophosphamide IV/PO (nitrogen mustard)

A

BREAST

LYMPHOCYTIC LEUKEMIA

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50
Q

AE of cyclophosphamide IV/PO (nitrogen mustard)

A

Severe N/V
Alopecia
Hemorragic cystitis

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51
Q

Indication of THIOTEPA (ETHYLENEMELAMINE DERIVATIVE)

A

Breast and ovarian CA

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52
Q

Indication of Busulfan (alkyl sulfonate)

A

(CML) Chronic Myelogenous Leukemia

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53
Q

AE of Busulfan (alkyl sulfonate)

A

Pulmonary fibrosis

Interstitial Pneumonitis

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54
Q

Indication of Dacarbazine (triazene)

A

Melanoma
Hodgkin’s
Soft tissue sarcoma

55
Q

AE of Dacarbazine (triazene)

A

CNS depression

56
Q

Platinum analog that causes ototoxicity

A

Cisplatin

57
Q

Platinum analog that causes severe N/V

A

carboplatin

58
Q

Platinum analog indicated for COLON CA

A

Oxaliplatin IV

59
Q

Oxaliplatin is resistant to?

A

Cisplatin

60
Q

Alkylating Agent that causes SEVERE N/V

A

Cyclophosphamide

61
Q

Alkylating agent that causes alopecia

A

Cyclophosphamide

62
Q

Alkylating agent that causes hemorrhagic cystitis

A

Cyclophosphamide

63
Q

Alkylating agent that causes REVERSIBLE neuropathy

A

Oxaliplatin

64
Q

Alkylating agent that causes IRREVERSIBLE ototoxicity

A

Cisplatin

Carboplatin

65
Q

MOA of NITROSOUREAS

A

alkylation and carbamoylatio

66
Q

Characteristic of nitrosoureas

A

Highly lipid soluble allowing them to cross BBB

Has delayed myelosuppressive effects (6 - 8 weeks)

67
Q

Nitrosourea with minimal bone marrow toxicity

A

Streptozocin

68
Q

Irritant nitrosourea

A

Carmustine (BCNU)

69
Q

Newest nitrosourea that is sugar-containing and indicated for insulin secreting islet cell pancreatic CA

A

Streptozocin

70
Q

Prototype of antifolate (antimetabolite)

A

Methotrexate IV/PO

71
Q

MOA of antimetabolites

A

inhibits critical enzymes involved in nucleic acid (NA) synthesis or become incorporated into the NA and produces incorrect codes

72
Q

Antimetabolite that does not have a non-linear dose response curve

A

5-FU

73
Q

Antimetabolites with both IV/PO preparation

A

Methotrexate

Mercaptopurine

74
Q

Antifolate Methotrexate indication

A

Acute Lymphoblastic Anemia

75
Q

Antifolate Methotrexate AE

A

Megaloblastic anemia

76
Q

5-Fluorouracil mainly indicated for?

A

Breast and colorectal CA

77
Q

5-Fluorouracil AE

A

Megaloblastic anemia

78
Q

DEOXYCYTIDINE ANALOG Cytarabine indication

A

Acute Myelogenous Leukemia (AML)

79
Q

PURINE ANTAGONIST mercaptopurine indication

A

Childhood acute leukemia

AML

80
Q

MOA of VINCA ALKALOIDS (NATURAL PRODUCTS)

A

Inhibits tubulin polymerization resulting to metaphase arrest and inhibition of mitosis

81
Q

common toxicity of vinca alkaloids

A

Leukopenia

Areflexia (neurotoxic)

82
Q

Prototype of vinca alkaloid which is indicated for Acute Lymphoblastic Leukemia

A

Vincristine

83
Q

Natural product that stabilizes microtubule polymer

A

Taxane

84
Q

Taxanes can only be given via?

A

IV

85
Q

How many percent of taxanes are excreted in the urine?

A

10% only

86
Q

Main toxicity of taxanes

A

bone marrow /myelosuppression

Peripheral sensory neuropathy

87
Q

Paclitaxel mainly indicated for?

A

Breast and lung CA

88
Q

Toxicity of Paclitaxel

A

Myalgia

arthralgia

89
Q

EPIPODOPHYLLOTOXIN MOA

A

Inhibits topoisomerase II to promote DNA breakage and arrest in S and early G2 phase

90
Q

Characteristic of EPIPODOPHYLLOTOXIN

A

Cell cycle specific

91
Q

EPIPODOPHYLLOTOXIN given as IV only

A

Teniposide

92
Q

Most common ADR of EPIPODOPHYLLOTOXIN

A

diarrhea

93
Q

EPIPODOPHYLLOTOXIN indicated for small and non-small lung CA

A

Etoposide

94
Q

EPIPODOPHYLLOTOXIN indicated ALL

A

Teniposide

95
Q

Natural product Topoisomerase I inhibitor which cuts and re-ligates ssDNA to cause damage

A

CAMPTOTHECINS

96
Q

How is IRINOTECAN (IV CAMPTOTHECIN) eliminated from the body?

A

Through bile and feces

97
Q

CAMPTOTHECIN for lung and ovarian CA

A

Toptecan

98
Q

CAMPTOTHECIN for colorectal CA

A

IRINOTECAN (IV)

99
Q

ANTICANCER ANTIBIOTICS that cause Topoisomerase II-dependent DNA cleavage & intercalate with DNA double helix

A

Anthracycline and Dactinomycin

100
Q

ANTICANCER ANTIBIOTIC that complexes with Mg++ to DNA & Blocks DNA/RNA synthesis

A

Plicamycin

101
Q

ANTICANCER ANTIBIOTIC that causes cross links between complementary strands of DNA that impair replication

A

Mitomycin

102
Q

ANTICANCER ANTIBIOTIC that causes strand scission by interacting with O2 and iron

A

Bleomycin

103
Q

ANTICANCER ANTIBIOTIC that poorly crosses BBB

A

Bleomycin

104
Q

Cardiotoxic ANTICANCER ANTIBIOTICS

A

anthracyclines (DOXORUBICIN & DAUNOROBUCIN)

105
Q

ANTICANCER ANTIBIOTICS that cause pukmonary fibrosis

A

Bleomycin

106
Q

ANTICANCER ANTIBIOTIC that is hepatotoxic

A

Plicamycin

107
Q

ANDROGEN ANTAGONIST for prostatic CA

A

Flutamide

108
Q

AE of FLUTAMIDE

A

Hot flashes
impotence
loss of libido

109
Q

Androgen hormone drug that causes cholestatic jaundice

A

Fluoxymesterone

110
Q

AE of estrogen antagonist TAMOXIFEN

A

Hot flashes

Osteoporosis

111
Q

AE of steroids

A

Immunosuppression

112
Q

AE of ANASTROZOLE (aromatase inhibitor)

A

Myelosuppression

113
Q

Indication of ANASTROZOLE

A

Advanced ER/PR (+) non-tamoxifien responsive breast cacner

114
Q

Antiangiogenesis drug for colon CA

A

Bevacizumab

115
Q

Treatment for ADR of cisplatin or cytoprotective against cisplatin

A

AMIFOSTINE

116
Q

Serotonin antagonist for mgt of N/V during CT

A

ONDANSETRON

117
Q

Management for myelosuppression AE

A

Give hematopoietic growth factors

118
Q

Drug combination for Cervical Cancer

A

Cisplatin or Carboplatin + 5FU

119
Q

Drug combination for Colon CA

A

FOLFIRI: 5-FU + Leucovorin + IRInotecan/Topotecan

FOLFOX: 5-FU + Leucovorin + OXaliplatin

CapeOx:
Capecitabine + Oxaliplatin
CapeOx +/- bevacizumab

120
Q

Drug combination for Acute Lymphocytic Leukemia (ALL) REMISSION

A

Vincristine + Prednisone

121
Q

Drug combination for Acute Lymphocytic Leukemia (ALL) maintenance

A

6-mercaptopurine + Methotrexate + Cyclophosphamide

122
Q

Drug combination for Acute Myeloid Leukemia (AML)

A

Cytarabine + Doxorubicin

123
Q

Drug combination for Chronic Lymphocytic Leukemia (CLL)

A

Chlorambucil + Prednisone

124
Q

Drug combination for Chronic Myeloid Leukemia (CML)

A

Busulfan

125
Q

Drug combination for adjuvant therapy to prevent relapse of BREAST CA

A

Anastrozole or letrozole/tamoxifen

126
Q

Drug combination for BREAST CA with METS

A

AC: doxorubicin (Adriamycin) + cyclophosphamide + Paclitaxel/Docetaxel

127
Q

Drug combination for BREAST CA

A

CAF: cyclophosphamide + doxorubicin (Adriamycin) + 5-FU

AC: doxorubicin (Adriamycin) + cyclophosphamide

CMFP: cyclophosphamide + methotrexate + 5-FU + prednisone

128
Q

Drug combination for LUNG CA

A

Etoposide + cisplatin/carboplatin

Topotecan + other agents

129
Q

Most popular breakthrough in cancer therapy

A

Nanotechnology

130
Q

MOA of non-classic alkylating agents

A

DNA alkylation; methylates DNA and inhibits DNA synthesis and function

131
Q

MOA of Platinum Analogs

A

Forms intrastrands and interstrand DNA cross-links; binds to nuclear and cytoplasmic proteins

132
Q

Common AE of Nitrosoureas

A

Nausea and vomiting

133
Q

Common toxicity of anthracyclines

A

Vesicant

134
Q

Aromatase inhibitors that cause myelosuppression

A

Anastrozole
Aminoglutethimide
Letrozole

Pharmacology (8 decks)

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