Chemotherapy drugs Flashcards
Alkylating drugs (including platinum)
Cyclophosphamide, Ifosfamide, cisplatin, carboplatin, oxaliplatin
Mechanism of alkylating drug class
Cell cycle NON specific. Causes cross linking of base pairs
Toxicities from typical alkylating agents?
- Myelosuppression
- Nausea/vomitting
- Secondary malignancies
- Infertility/impaired fertility
- Hemorrhagic cystis
- Ifosfamide produces more acrolein than cyclophosphamide. So need to give Mesna to prevent renal issues
Toxicities from atypical alkylating agents (platinum compounds)
- Peripheral neuropathies
- Oxaliplatin: cold sensitivity - Nephrotoxic (cisplatin)
- Prevention with forced diuresis, mannitol.
- Increased creatinine 3-6 days after administartion
- Magnesium wasting - Nausea/vomiting (cisplatin)
- Thrombocytopenia (carboplatin)
Roles of methotrexate? Toxicities?
Works as a folate antagonist inhibiting DHFR. Toxicity: Mucositis, myelosuppression
Role of 5-fluorouracil? Toxicities?
Works as a pyrimidine analogue by inhibiting thymidylate synthase. Toxicities: Continuous infusion leads to GI symptoms (mucositis, diarrhea). Bolus dose leads to myelosuppression
Role of Capecitbatine? Toxicities?
Works as a pyrimidine analogue. Toxicities: Hand-foot syndrome
Role of cytarabine (Ara-C)? Toxicities?
Works as a pyrimidine antagonist. Continuous infusion and high dose. Toxicities with high dose: Cerebellar toxicity (increased incidence with renal dysfunction, cr>2), conjunctivities
Role of 6-mercaptopurine? Toxicities?
Works as a purine antagonist. Toxicities: Not mentioned??
Types of microtubule targeting agents?
- Vincas
- Taxanes
- Topoisomerase I inhibs
- Topoisomerase II inhibts
Mechanism of vincas? Examples? Toxicities?
Mechanism: M-phase Microtubular destruction
Examples: Vincristine, vinblastine
Toxicities: Cumulative neurotoxicities, variable myelsuppresion (vinblastine>vincristine), FATAL IF GIVEN INTRATHECALLY
Mechanism of Taxanes? Examples? Toxicities?
Mechanism: M-phase Microtubular stabilization
Examples: Abraxane (paclitaxel protein-bound particles) paclitaxel, docetaxel
Toxicities: Myelosuppresion, peripheral neuropathies, hypersensitivity. Cremaphor diluent in paclitaxel>Tween80 in docetaxel
Mechanism of Topoisomere I inhibitors? Examples? Toxicities?
Mechanism: Inhibits enzyme responsible for relaxing supercoiled DNA, preventing transcription
Examples: Topetecan, irinotecan
Toxicities: Myelosuppresion, Diarrhea (early onset is self-limiting-give atropine, late onset is life threatening-give as much loperamide as you need)
Mechanism of Topoisomere II inhibitors? Examples? Toxicities?
Mechanism: Inhibits enzyme responsible for recoiling DNA after transcription
Examples: Etoposide
Toxicities: Myelosuppresion, secondary malignancies (AML11q23), dose dependent mucositis
Mechanism of Anthracyclines? Examples? Toxicities?
Mechanism: Intercalates DNA and inhibits topoisomerase. Secondary mechiansm includes free radical damage and perhaps some alkylation
Examples: Doxorubicin (most solid tumors), daunorubicin (acute leukemias), idarubicin, epirubicin (breast cancer)
Toxicities: All cause cumulative, dose-dependent biventricular heart failure. Extravasation. Myelosuppresion, mucositis
What are 2 Differentiating agents? Toxicities?
- All trans retinoic acid
- Arsenic trioxicde
Toxicities: Cardiotoxicity with electrolyte abnormalities (Arsenic) Differentiation syndrome
Examples of antitumor antibiotics? Toxicities?
Examples: Bleomycin and Proteasome inhibitor (Bortezomib)
Toxicities: Pulmonary toxicity (Bleomycin); Proteasome inhibitor: Fatigue, weakness, malaise, neuropathy, thrombocytopenia
Mechanism of immunomodulating agents (atypical therapeutics) (Imids)? Examples? Toxicities?
Mechanism: Antiangiogenesis through inhibition of VEGF
Example: Thalidomide and lenalidomide
Toxicities: Neuropathy, thromboembolism
Mechanism of biologic response modifiers? Examples? Toxicities?
Mechanism: Modulation of host immune system to enchance recognition and antineoplastic effects
Examples: Interferon and IL-2
Toxicities: Flu-like symptoms, depression/psychiatric symptoms
Example of hormonal therapy anti-estrogens (2)
Tamoxifen and fulvestrant (used for Breast cancer)
Example of hormonal therapy aromatase inhibitors (3)
Anastrozole, letrozole, and Exemestane (irreversible) (used for Breast cancer)
Example of hormonal therapy for antiandrogens (3)
Flutamide, Bicalutamide, Nilutamide (used for prostate cancer)
Example of hormonal thearpy LHRH agonists (2)
Leuprolide, Goserelin (Used for tumor “flare and prostate cancer)
Example of hormonal thearpy GnRH anatognists (1)
Degarelix (Used for prostate cancer)
