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Pharm > Chemotherapy III > Flashcards

Chemotherapy III Flashcards

1
Q

Topoisomerase II Inhibitors: Intercalators

A

Daunomycin
Doxorubicin
Mitoxantrone
Dactinomycin

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2
Q

Topoisomerase II Inhibitors:

Non-intercalators

A

Etoposide

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3
Q

Topoisomerase I Inhibitors

A

Topotecan

Irinotecan

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4
Q

Which drugs are cross resistant due to MDR?

A 
Non-intercalating topo II inhibitors
Intercalating topo II inhibitors
Tubulin Inhibitors (alkaloids)
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5
Q

What is one way to reverse MDR resistance?

A

Give drugs as continuous infusions > downregulate the P glycoprotein

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6
Q

What is the P glycoprotein?

A

Membrane bound efflux pump

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7
Q

Which drugs can block the efflux pump and reverse resistance?

A

Quinine
Verapamil
Cyclosporine

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8
Q

Which anticancer drugs are MDR cells resistant to?

A

Vinca alkaloids (Vinblastine, Vincristine)

Anthracyclines (Daunorubicin, doxorubicin, mitroxantrone)

Epipodophyllotoxins (Etoposide, Teniposide)

Mitomycin C
Actinomycin D
Taxol
Topotecan

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9
Q

Doxorubicin MOA

A

Cell cycle non-specific

Intercalates into DNA and inhibits topo II producing double stranded DNA breaks

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10
Q

When should you dose reduce doxorubicin?

A

Jaundice (excreted in bile)

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11
Q

Doxorubicin SE

A

Nausea, vomiting, hair loss, stomatitis

MYELOSUPPRESSION = d-l

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12
Q

What can the cumulative toxicity of doxorubicin cause? What is the max life time dose?

A

Cardiomyopathy
400 mg/M^2
Schedule dependent

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13
Q

What should you obtain before administering doxorubicin?

A

EJECTION FRACTION

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14
Q

How can you reduce the cardiac toxicity of Doxorubicin?

A

Give longer infusion times (96 hour)

Pretreat with an iron chelator (dexrazoxane)

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15
Q

Irinotecan MOA

A

Topoisomerase I inhibitor

Requires bioactivation

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16
Q

When should you dose reduce Irinotecan?

A

Jaundice

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17
Q

Irinotecan SE

A

Early diarrhea (during infusion or first 24 hours)

Late diarrhea (7-10 days after)

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18
Q

How can you treat the early and late diarrhea of Irinotecan?

A

Early: treat with atropine (cholinergic)

Late: treat with imodium, hydration

19
Q

What genetic mutation/Syndrome will cause increase myelosuppression and diarrhea with Irinotecan?

A

UGT1A1*28
(decreases glucoronidation)
Gilbert’s Syndrome

20
Q

Irinotecan Indication

A

Colon cancer

21
Q

Bleomycin MOA

A

Cell cycle specific

Free radical damage to DNA

22
Q

When should you dose reduce bleomycin?

A

Renal insufficiency

23
Q

Which organs can inactivate Bleomycin?

Which organs cannot?

A

Liver and kidney

Lungs and Skin

24
Q

Bleomycin SE

A

Skin hyperpigmentation

PULMONARY TOXICITY = d-l
(cumulative toxicity)

Anaphylactoid reactions

25
Q

What should you monitor in a patient taking Bleomycin?

A 
Pulmonary function
(Diffusion capacity of carbon monoxide-DLCO)

Obtain baseline pulm function tests prior to administration

26
Q

What should you avoid administering in a patient taking Bleomycin?

A

High oxygen concentrations

27
Q

Bleomycin Indication

A

Testicular Cancer

28
Q

Hormone dependent cancers

A

Breast cancer

Prostate cancer

29
Q

Prednisone Indication

A

Myeloproliferative or Lymphoproliferative Disorders:

Multipl Myeloma, Hodgkin’s disease, non-hodgkin’s lymphoma, leukemia (some)

30
Q

Prednisone SE

A

Weight gain, HTN, edema, carb intolerance, suppression of pituitary-adrenal axis, weakness, euphoria, increased appetite

31
Q

Dexamethasone Indications

A

Chemotherapy related nausea and vomiting (use with 5-HT3 inhibitors)

Cerebral edema, spinal cord edema due to spinal cord compression

32
Q

Tamoxifen

A

Oral selective estrogen receptor modulator (SERM)

33
Q

Tamoxifen MOA

A

Agonist-antagonist with respect to estrogen receptor (antagonist in cancer cell)

34
Q

Tamoxifen SE

A

Hot flashes
Thrombosis
Endometrial cancer
Decreases rate of bone loss

35
Q

Tamoxifen Indication

A

Prevents breast cancer in high risk women who take for 5 years

36
Q

Aromatase Inhibitors MOA

A

Rapidly decrease estrogen levels

37
Q

Aromatase Inhibitors Indication

A

Estrogen receptor positive breast cancers

38
Q

Aromatase Inhibitors SE

A

Arthralgias, bone pain, bone loss, osteoporosis, hot flashes

39
Q

Aromatase Inhibitors

A

Anastrozole, Letrozole, Exemestane

40
Q

Goal of Prostate Cancer treatment

A

decrease testosterone production > Androgen deprivation therapy

41
Q

Flutamide/ Bicalcutamide MOA

A

Inhibit cancer cell uptake of testoterone

42
Q

Leuprolide acetate MOA

A

Decrease levels of androgens by decreasing FSH and LH by using a gonadotropin releasing hormone agonist

43
Q

What can you pretreat with to avoid the tumor flare of Leuprolide acetate?

A

Flutamide

Bicualutamide

44
Q

Side effects of Androgen Deprivation Therapy?

A 
Weakness
Decreased libido
Erectile dysfunction
Loss of muscle mass Gynecomastia
Change in body fat distribution

Pharm (20 decks)

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