Chemotherapy Flashcards
Mechanism of action of Asparaginase
Inhibits protein synthesis
Uses of Leuprolide acetate and treatment considerations
Leuprolide acetate is used for Prostate Cancer; Considerations include: With first treatment FSH and LH are increased leading to increased testosterone production. This can cause tumor to worsen and increase bone pain (flare reaction). Pretreatment with flultamide can block the flare reaction. Subsequently the GnRH receptors are downregulated leading to decrease FSK and LH and testosterone.
Mechanism of action of 6-mercaptopurine
Incorporation into DNA
Mechanism of action of 5-Fluorouracil (5-FU)
Incorporation into RNA and DNA. Conversion to 5- DUMP and binding to thymidylate synthetase leads to “thymineless death” of cells
Mechanism of action of Paclitaxel and cell cycle specificity
Prevents tubulin disassembly; Specificity: CCS (M-phase)
Uses of Carboplatin and treatment considerations
Carboplatin is used for Same spectrum of activity as cis-DDP, but without nephrotoxicity; Considerations include: Dosing based on creatinine clearance and AUC target; myelosuppression
Easy to administer
Uses of Tamoxifen and treatment considerations
Tamoxifen is used for ER+ breast cancer Chemoprevention; Considerations include: Increased incidence of endometrial cancer and blood clots
Mechanism of action of Hydroxyurea
Inhibits ribonucelotide reductase leading to inhibition of DNA synthesis
Mechanism of action of Tamoxifen
Binds to estrogen receptor (selective estrogen receptor modulator)
Uses of Bevacizumab and treatment considerations
Bevacizumab is used for Lung cancer and metastatic colorectal cancer; Considerations include: Hypertension Proteinuria Posterior reversible encephalopathy syndrome
Mechanism of action of Trastuzumab
Binds to Her-2-neu recetor (epidermal growth factor receptor)
Mechanism of action of Flutamide
Inhibits uptake and binding of testosterone to prostate cancer cells
Mechanism of action of Cytarabine
Converted to triphosphate and inhibits DNA polymerase; incorporation into DNA and inhibits chain elongation
Uses of Ifosfamide and treatment considerations
Ifosfamide is used for Testicular cancer, soft tissue sarcoma; Considerations include: Hematuria, myelosuppression Coadminister with mesna
Uses of Trastuzumab and treatment considerations
- Trastuzumab is used for Her-2neu overexpressed breast cancer and gastric cancer
- Considerations include: Measure Her-2Neu overexpression in breast cancer and gastric cancer
- Cardiac toxicity
Uses of Anastrozole and treatment considerations
Anastrozole is used for Hormone receptor positive breast cancer; Considerations include: Arthralgias, bone pain, bone loss
Mechanism of action of Imatinib mesylate
Tyrosine kinase inhibitor
Uses of Hydroxyurea and treatment considerations
Hydroxyurea is used to emergently decrease high white blood cell counts in acute myeloid leukemia.; Considerations include: Can rapidly decrease blast count in patients with leukemia and high white blood cell count. High white counts in myeloid leukemias can produce leukostasis in capillaries and lead to organ damage and death.
Uses of Irinotecan and treatment considerations
Irinotecan is used for GI tract cancers;
Considerations include:
- Myelosuppression
- Acute cholinergic diarrhea treated with atropine
- Late secretory diarrhea
- Dose reduction for jaundice
Uses of Crizotinib and treatment considerations
Crizotinib is used for If anaplastic lymphoma kinase is rearranged crizotinib is treatment of choice for metastatic adenocarcinoma of lung; Considerations include: Intestitial lung disease Perform mutational analysis on adenocarcinoma of lung.
Uses of Cytarabine and treatment considerations
Cytarabine is used for Acute myeloid leukemia (3 + 7 regimen: 3 days of doxorubicin or daunorubicin and 7 days of continuious infusion of cytarabine)
Considerations include:
- Schedule dependent cytotoxicity
- High dose strategy (cerebellar toxicity)
- Hepatic toxicity Myelosuppression
Mechanism of action of Bleomycin and cell cycle specificity
Binds to DNA and causes breaks in DNA via free radical damage
Specificity: CCS for G2-M phase
Mechanism of action of Oxaliplatin and cell cycle specificity
Aklyates DNA; Specificity: CCNS
Uses of Bleomycin and treatment considerations
Bleomycin is used for Testicular cancer;
Considerations include:
- Pulmonary toxicity is a cumulative toxicity
- No myelosuppression
- Avoid high inspired concentrations of oxygen
Mechanism of action of Erlotinib
Small molecule inhibitor of the tyrosine kinase domain associated with epidermal growth factor receptor
Mechanism of action of Ifosfamide and cell cycle specificity
Alkylates N-7 of guanine; Specificity: CCNS
Mechanism of action of Arsenic trioxide
arsenic trioxide therapy allows myeloid differentiation to continue and apoptosis to occur
Uses of All trans retinoic acid (tretinoin) and treatment considerations
All trans retinoic acid (tretinoin) is used for Acute promyelocytic leukemia; Considerations include: Differenitation syndrome (retinoic acid syndrome):fevers, pulmonary infiltrates, dyspnea and pleural/pericardial effusions.
Uses of Doxorubicin and treatment considerations
Doxorubicin is used for Breast cancer, leukemia, sarcoma, Hodgkin’s and non-Hodgkin’s lymphoma; Considerations include: Myelsuppression Schedule dependent cumulative cardiac toxicity Vesicant Dose reduction for jaundice
Mechanism of action of Etoposide and cell cycle specificity
Topoisomerase II inhibitor and produces double stranded breaks in the DNA
Specificity: CCS, G1-S
Mechanism of action of Vincristine and cell cycle specificity
Prevents polymerization of tubulin; Specificity: CCS (M phase)
Uses of Temozolomide and treatment considerations
Temozolomide is used for Brain tumors; Considerations include: Myelosuppression Pneumocystis pneumonia
Mechanism of action of Cyclophosphamide and cell cycle specificity
Alkylates N-7 of guanine (DNA alkylating agent); Specificity: CCNS
Mechanism of action of Irinotecan and cell cycle specificity
Toposiomerase I inhibitor (single strand breaks in DNA); Specificity: CCNS
Mechanism of action of Methotrexate and cell cycle specificity
Binds to and inhibits dihydrofolate reductase; Specificity: CCS, S phase
Mechanism of action of Carboplatin and cell cycle specificity
Alkylates DNA; Specificity: CCNS
Mechanism of action of Doxorubicin and cell cycle specificity
Topoisomerase II inhibitor inhibitor and produces double stranded breaks in the DNA; Specificity: CCNS
Uses of Paclitaxel and treatment considerations
Paclitaxel is used for Ovarian, gastroesophageal, breast and non-small cell lung cancers; Considerations include: Dose reduce for hepatic dysfunction Sensory neuropathy Myelosuppression Infusion reactions due to reaction to solvent. Premedicate with steroids Vesicant
Uses of Cyclophosphamide and treatment considerations
Cyclophosphamide is used for Lymphoma, breast cancer; Considerations include: Bioactivation Hematuria Myelosuppression
Uses of 6-mercaptopurine and treatment considerations
6-mercaptopurine is used for Acute lymphoblastic leukemia; Considerations include: Must reduce dose by 50-75 % if given to patient also on allopurinol Myelosuppression
Uses of Etoposide and treatment considerations
Etoposide is used for Small cell lung cancer Testicular cancer Lymphoma; Considerations include: Dose reduce for hepatic or renal dysfunction Myelosuppression Drug is leukemogenic
Uses of 5-Fluorouracil (5-FU) and treatment considerations
5-Fluorouracil (5-FU) is used for Gastrointestinal cancer; breast cancer; head and neck cancer; radiation sensitizer
Considerations include:
- Coadministration with leucovorin enhances cytotoxicity and toxicity of 5-FU
- Stomatitis and diarrhea
- Dihydropyrimidine deficiency will produce severe toxicity if 5-FU administered
- Hand-Foot syndrome
- Oral prodrug of 5-FU: capecitabine
Uses of Oxaliplatin and treatment considerations
Oxaliplatin is used for GI (colorectal, gastric and pancreas); Considerations include: Acute cold induced neuropathy Chronic sensory neuropathy
Mechanism of action of Bevacizumab
Binds to vascular endothelial growth factor
Mechanism of action of Leuprolide acetate
GnRH receptor agonist
Mechanism of action of All trans retinoic acid (tretinoin)
Induces terminal differentiation of the leukemia cells
Uses of Asparaginase and treatment considerations
Asparaginase is used for Acute lymphoblastic leukemia; Considerations include: Allergic reactions, pancreatitis and clots due to reduction in antithrombin III levels. Elevation of liver enzymes
Mechanism of action of Temozolomide and cell cycle specificity
Alkylates DNA; Specificity: CCNS
Uses of Arsenic trioxide and treatment considerations
Arsenic trioxide is used for Acute promyelocytic leukemia; Considerations include: Prolonged QT interval Differentiation syndrome (see all transretinoic acid)
Mechanism of action of Crizotinib
Binds to anaplastic lymphoma kinase
Uses of Prednisone Dexamethasone and treatment considerations
Prednisone in high doses for lymphoma and multiple myeloma Dexamethasone: reduce cerebral edema and initial treatment for spinal cord compression Dexamethasone: in combination with other agents to treat chemotherapy related emesis
Mechanism of action of Vinblastine and cell cycle specificity
Prevents tubulin polymerization
Specificity: CCS (M-phase)
Uses of Flutamide and treatment considerations
Flutamide is used for Prostate cancer
Considerations include: Diarrhea, elevation of liver enzymes Can block a “flare reaction
Uses of Vinblastine and treatment considerations
Vinblastine is used for Lung and breast cancer; Considerations include: Dose reduction for jaundice Myelosuppression Vesicant
Uses of Imatinib mesylate and treatment considerations
Imatinib mesylate is used for Chronic myelogenous leukemia and gastrointestinal stromal tumor; Considerations include: Metabolized by CYP3A4 system Edema and musculoskeletal pain
Mechanism of action of Cetuximab
Inhibits epidermal growth factor receptor
Uses of Erlotinib and treatment considerations
Erlotinib is used if the tumor has an “activating mutation” of epidermal growth factor receptor, erlotinib and NOT chemotherapy is the treatment of choice for metastatic adenocarcinoma of lung.; Considerations include: Rash Metabolized by CYP3A4 system Perform mutational analysis of epidermal growth receptor in adenocarcinoma of lung
Mechanism of action of Cis- diaminedichloroplatinum (II) (cis-DDP) and cell cycle specificity
Alkylates DNA; Specificity: CCNS
Uses of Vincristine and treatment considerations
Vincristine is used for Non-Hodgkin’s lymphoma, Acute lymphoblastic leukemia; Considerations include: Neuropathies (sensory and autonomic); Vesicant No myelosuppression Dose reduction in presence of jaundice
Uses of Methotrexate and treatment considerations
Methotrexate is used for Leukemia, Lymphoma, Rheumatoid arthritis, and Psoriasis
Considerations include:
- Dose reductions necessary in renal insufficiency
- Approved for intrathecal administration
- High dose strategy with leucovorin (tetrahydrofolate rescue)
- Volume of distribution is total body water
- Solubility increases in alkaline pH
- Enhanced toxicity if given with drugs that displace methotrexate from albumin binding site and/or decrease excretion of drug in urine
- High dose strategy is NOT myelosuppressive
Uses of Cis- diaminedichloroplatinum (II) (cis-DDP) and treatment considerations
Cis- diaminedichloroplatinum (II) (cis-DDP) is used for Testicular cancer Bladder cancer Head and neck cancer Ovarian cancer Small cell and non small cell lung cancer; Considerations include: Administer with hydration and mannitol diuresis Dose reduction for renal insufficiency
Mechanism of action of Anastrozole
Aromatase inhibitor
Uses of Cetuximab and treatment considerations
Cetuximab is used for Lung cancer Useful in metastatic wildtype K-RAS and N-RAS colorectal cancers ; Considerations include: Rash and hypomagnesemia Perform K-RAS and N-ras mutational analysis on colorectal cancers
