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Hematology-Oncology > Chemotherapy for assessment 1 > Flashcards

Chemotherapy for assessment 1 Flashcards

1
Q

List 5 drugs that are S phase specific.

-separate by class

A

Antimetabolites

  1. Cytarabine -> Pyrimidine antagonists
  2. Methotrexate -> folic acid antagonists
  3. Fludarabine -> purine antagonist
  4. 5-FU -> pyrimidine antagonists

Topoisomerase I interacting agent
1. Irinotecan

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2
Q

List the only S/G2 phase specific agent discussed

-class?

A

Bleomycin -> antibiotics

-free radical formation leading to breaks in DNA strands

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3
Q

Alkylating agents

  • are inactive until?
  • MoA?
A

metabolized by P450 system

form electrophils that react w/ nucleophilic groups cross linking DNA and interfering w/ its fx (i.e. blocks transcription and translation)

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4
Q

Classical alkylating agents

-break down by type

A

Nitrogen mustards (-amide/-amine)

  • cyclophosphamide
  • ifosphamide
  • nitrogen mustard (mechlorethamine)

Nitrosoureas
-Carmustine

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5
Q

Which drug needs to be administered every 6 weeks due to delayed nader?

A

Carmustine

-delayed nader (21-28 days)

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6
Q

Hemorrhagic cystitis is seen with which 2 agents?

  • What’s the etiology?
  • How do you reduce the risk?

What other toxicity associated?

A
  1. Cyclophosphamide and Ifosfamide
    - acrolein -> toxic byproduct
    - MESNA -> cytoprotectant
  2. Bone marrow suppression (8-14 days), cardiac toxicity (high doses), Immunosuppression
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7
Q
  1. non-classical alkylating agents
    - which one is a MAO-I inhibitor?
    - which 2 are platinum coordination complexes?
A
  1. Procarbazine - MAO-I inhibitor
  2. Dacarbazine
  3. Temazolamide
  4. Bendamustine
  5. Carboplatin and Cisplatin - platinum coordination complexes
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8
Q

Compare the toxicities between cisplatin and carboplatin

A

Cisplatin

  • nephrotoxic
  • nausea/vomiting -> immediate and delayed
  • neuropathy

Carboplatin

  • Myelosuppression
  • lower risk of the 3 toxicities seen with cisplatin
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9
Q

List the antimetabolites by type (4 total)

A

Methotrexate -> antifolate

5-FU -> fluoropyrimidines

Cytarabine -> deoxycitadine analog

Fludarabine -> purine antagonists

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10
Q

MTX

  • contraindicated in
  • ways to tx MTX intoxication
A

-contraindicated in patients with dec kidney fx b/c exclusively cleared by kidneys

MTX intoxication txed by

  • Leucovorin rescue (bypasses THF reductase step which is blocked by MTX)
  • Hemodialysis/hemofiltration
  • Thymidine infusion
  • Glucarpidase infusion (carboxypeptidase) -> lowers serum MTX levels
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11
Q

5-FU

  • mech
  • toxicity
  • effects modulated by
A

Mech -> pyrimidine analog

  • complexes to folic acid and inhibits thymidylate synthase
  • blocks DNA and protein synthesis

Toxicity

  • hand foot syndrome at high doses (painful)
  • GI toxicity (mucositis)
  • myelosuppression

Modulated by -> leucovorin

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12
Q

Cytarabine

  • mech
  • indications
  • toxicity
A
  • mech -> chain terminator
  • indications -> AML and NHL
  • toxicity -> neurotoxic at high doses
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13
Q

Irinotecan

  • class
  • indication
  • toxicity
A

-class -> topoisomerase I inhibitor

-indication -> colorectal cancer
“I ran to the can”

Toxicities/side effects

  1. Diarrhea -> MAJOR
    - acute -> tx w/ atropine
    - delayed -> tx w/ loperamide
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14
Q

Microtubule inhibitors

  • which ones hyperstabilize (block disassembly)?
  • which ones prevent polymerization?
  • toxicities?
  • premedicate with?
A
  1. Docetaxel and Paclitaxel
    - block disassembly of MTs
  • cardiotoxic, myelosuppressive, hypersensitivity
  • premedicate w/ antihistamines and steroids to prevent hypersensitivity
  • indications -> breast, lung and ovarian cancer
  1. Vincristine and vinblastine
    - block MT polymerization
  • toxicity for vincristine -> neuropathy including constipation “crusty poop”
  • toxicity for vinblastine -> bone marrow suppression “blasts the bone marrow”
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15
Q

Anthracyclines

  • MoA
  • name one and give its:
    1. toxic effect
    2. max lifetime dosage
    3. way to reduce the major toxic effect
A

MoA

  • intercalates b/w DNA base pairs
  • generates free oxygen radical which cut DNA

DOXORUBICIN

  • cardiotoxicity
  • lifetime dose of 550 mg/m^2

-dexrazoxane -> metal chelator which blocks free radical generation; used to prevent cardiotoxicity

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16
Q

Bleomycin

  • composed of
  • mech
  • toxicity
A
  • collection of fungal peptides
  • Binds near DNA on iron atom and generates free oxygen radical

Toxicity

  • pulmonary fibrosis
  • hypersensitivity
  • fever, chills
  • mucositis
17
Q

Which drug can cause APL differentiation syndrome? what happens? how can you reduce the risk?

A

All-trans-retinoic acid -> used to tx acute promyelocytic leukemia

  • dyspnea, fever, weight gain, hypoTN, pulmonary infiltrates
  • give chemo BEFORE giving APL differentiating agents
18
Q

Erlotinib targets?

A

EDFR - non-small cell lung, pancreatic cancer

19
Q

Imatinib targets

A

Bcr-Abl, PDGFR - CML and GI stromal tumor

  • Inhibits Bcr-Abl tyrosine kinase activity by binding to ATPase site and inhibiting ATP cleavage and transphosphorylation.
  • Induces apoptosis and decreases proliferation of Bcr-Abl positive cells.
20
Q

Imatinib toxicities

A 
Nausea/vomiting
diarrhea 
edema
rash
hepatotoxicity
arthralgia
myalgia
hemorrhage
myelosuppressio
21
Q

Erlotinib toxicities

A

Diarrhea,
acneform rash - MAJOR but good prognostic sign
gastric perforation (rare)
interstitial pneumonitis (incidence 1%; 0.5% fatal) hemorrhage

22
Q

List 4 monoclonal antibodies

A
  1. Rituximab
  2. Cetuximab
  3. Trastuzumab
  4. Bevacizumab
23
Q

Rituximab

  • target
  • indications
  • type of Ab
  • adverse effect
A

targets CD20

NHL

  • low grade follicular B-cell
  • diffuse large b-cell

Chimeric IgG1 Ab

ADVERSE
-cytokine release syndrome/tumor lysis syndrome

24
Q

Cetuximab

  • target
  • which mutation will not respond
  • adverse events
A

• Targets EC domain of EGFR
-epidermal growth factor receptor

• K-ras mutation cancers will not respond to this drug

ADVERSE
-hypomagnesemia (underlined)

-Severe anaphylaxis, skin rash, acne, folliculitis, diarrhea, abdominal pain, lung inflammation

25
Q

Trastuzumab

  • target
  • adverse effect
A

• Targets HER-2/neu

  • Overexpressed in 20-30% of breast cancers
  • Best effect in high levels of expression
  • KITNA EXPENSIVE
  • Used with chemotx

ADVERSE

  • CHF
  • diarrhea
26
Q

Bevacizumab

  • targets
  • adverse effect
A

-neutralized VEGF -> blocks angiogenesis

ADVERSE
– Hypertension, impaired wound healing, bowel perforation, proteinuria, pulmonary hemorrhage, CHF, deep venous and arterial thrombosis, pulmonary embolism, other thromboembolic events, reversible posterior leukoencephalopathy syndrome (RLS)

27
Q

List 2 anti-angiogenic drugs

  • indications
  • toxicity
A

– Thalidomide
• Oral agent
• Indication: Multiple myeloma
• Toxicity: Teratogenic, neurotoxic

– Lenalidomide
• Oral agent
• Indication: Myeloma and myelodysplastic syndromes
• Toxicity: Teratogenic, myelosuppression, risk of second cancers

“hal and lena don’t like angie”

28
Q

Name the first cancer vaccine

  • used for?
  • adjuvant ot therapeutic?
A

Sipuleucel-T

  • castrate-resistant metastatic prostate cancer
  • therapeutic -> after cancer is established

-dendritic cell vaccine

29
Q

Name a proteosome inhibitor

  • what is it approved for (2 cancers)
  • toxicities?
A

– Bortezomib
• Inhibits 26S proteosome and decreases nuclear NF-κB activity

  • Indication: Multiple myeloma, B-cell mantle cell lymphoma
  • Toxicity: Neuropathy, nausea, vomiting, myelosuppression, orthostatic hypotension
30
Q

List 4 drugs that are M-phase specific

-separate by class

A

Microtubule stabilizers

  • Paclitaxel
  • Docetaxel

Microtubule inhibitors

  • Vincristine
  • Vinblastine

Hematology-Oncology (3 decks)

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