Chemotherapy Of Neoplastic Diseases 1 Flashcards

1
Q

Primary chemotherapy

A

Chemotherapy indicated when neoplasms are disseminated and not amenable to surgery.

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2
Q

Adjuvant chemotherapy

A

Chemotherapy used to attack micrometastases following surgery and radiation.

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3
Q

Neoadjuvant chemotherapy

A

Chemotherapy given prior to surgery to shrink the cancer.

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4
Q

Log kill

A

a given dose of drug destroys a constant fraction of cells.

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5
Q

• A 1-log kill reduces the number of cancer cells by ___ %.
• A 2-log kill by ___ %.
• A 3-log kill by ___ %
A 5 log kill by___ %

A

• A 1-log kill reduces the number of cancer cells by 90 %.
• A 2-log kill by 99 %.
• A 3-log kill by 99.9 %
5 log kill 99.999%. However, there would still be 0.0001% of 10^6 cells (10^4 tumor cells) remaining in the body.

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6
Q

_____________are more sensitive to anticancer drugs, whereas nonproliferating cells usually survive their effects.

A

Rapidly dividing cells are more sensitive to anticancer drugs, whereas nonproliferating cells usually survive their effects.

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7
Q

Cell cycle-specific drugs

A

Exert their action on cells traversing the cell cycle.

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8
Q

Cell cycle-nonspecific drugs

A

can kill tumor cells whether they are cycling or resting in the G0 compartment.

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9
Q

CELL CYCLE-SPECIFIC AGENTS examples

A
Antimetabolites
Bleomycin
Microtubule inhibitors
Epipodophyllotoxins
Camptothecins

Remember BEAMC

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10
Q

Cell cycle non specific examples

A

APA

Alkylating agents
Platinum coordination complexes
Antitumor Antibiotics

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11
Q

Primary vs acquired resistance

A

PRIMARY RESISTANCE
• No response to the drug on the first
exposure.

ACQUIRED RESISTANCE
• Single drug resistance
- Due to increased expression of one or
more genes.
• Multidrug resistance (MDR)
- Resistance emerges to several different drugs after exposure to a single agent.
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12
Q

Multi drug resistance is mainly due to membrane effluent pumps. Which effluent pump is most responsible

A

P-glycoprotein

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13
Q

Common adverse effects of toxicity

Remember BATSS

A
  • Severe vomiting
  • Stomatitis
  • Bone marrow suppression
  • Alopecia
  • tumor lysis syndrome
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14
Q

Manifestations seen in tumor lysis syndrome

A
  • Hyperuricemia
  • Hyperkalemia
  • Hyperphosphatemia
  • Hypocalcemia (due to precipitation of calcium phosphate).
  • Uric acid and calcium phosphate crystals may precipitate in the kidney and lead to renal failure.
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15
Q

How to manage tumor lysis syndrome

A

IV hydration with normal saline and allopurinol

or rasburicase.

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16
Q

Relative myelosuppression correlation to drugs

A
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17
Q

COMMON ADVERSE EFFECTS: EMETOGENIC POTENTIAL

A
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18
Q

Adverse effect of Doxorubicin & Daunorubicin

A

Cardio toxicity

19
Q

Adverse effect of Cyclophosphamide & Ifosfamide

A

Hemorrhagic cystitis

20
Q

Adverse effect of Cisplatin

A

Nephrotoxicity, Ototoxicity & Peripheral neuropathy

21
Q

Adverse effect of Bleomycin & Busulfan

A

Pulmonary fibrosis

22
Q

Adverse effects of Vincristine & Paclitaxel

A

Peripheral neuropathy

23
Q

Adverse effect of Asparaginase

A

Hypersensitivity

24
Q

Which drugs Reduce chemotherapy-induced nausea and vomiting (CINV)

A

5-HT3, NK-1 antagonists & dexamethasone

25
Which drug Rescues bone marrow from methotrexate.
Leucovorin
26
Which drug Reduces hemorrhagic cystitis caused by cyclophosphamide & ifosfamide.
Mesna
27
Which drug Reduces anthracycline-induced cardiotoxicity.
Dexrazoxane
28
Which drug reverses neutropenia
Filgrastim and sargramostin
29
Which drug reduces anemia
Erythropoietin
30
Which drug reverses thrombocytopenia
IL-11
31
Which drug Reduces renal toxicity caused by cisplatin.
Amifostine
32
Which drug prevents hyperuricemia of tumor lysis syndrome
Allopurinol or rasburicase
33
Example of a 5-HT3 antagonist for CINV
Ondansetron
34
NK-1 antagonist for CINV
Aprepitant
35
Corticosteroid for CINV
Dexamethasone
36
Adjunct therapy for CINV.
Benzodiazepines (Lorazepam or alprazolam)
37
Treatment-induced neoplasms are especially a problem after therapy with _______________
Treatment-induced neoplasms are especially a problem after therapy with alkylating agents.
38
Anti metabolite is an anti cancer drug. List the categories
FOLATE ANALOGS- methotrexate PURINE ANALOGS PYRIMIDINE ANALOGS
39
MOA of antimetabolites
* Antimetabolites target pathways related to nucleotide and nucleic acid synthesis. * They are cycle-specific. * Maximal cytotoxic effects are in the S-phase.
40
``` Methotrexate is: - structurally related to _______ • Inhibits____________ • The cell is deprived of folate • The synthesis of ____________ decrease; consequently, synthesis of DNA, RNA, and protein decreases—>cell death. ```
``` Methotrexate is: - structurally related to folate • Inhibits dihydrofolate reductase • The cell is deprived of folate • The synthesis of dTMP and purine nucleotides decrease; consequently, synthesis of DNA, RNA, and protein decreases—>cell death. ```
41
Which enzyme catalyzes the conversion of methotrexate to polyglutamates
folylpolyglutamate synthase (FPGS). • PGs are strongly charged and cross cellular membranes poorly: polyglutamation serves as a mechanism of ion trapping within the cell.
42
METHOTREXATE: ADVERSE EFFECTS
* Common: Stomatitis, mucositis, myelosuppression, alopecia, nausea, vomiting. * Renal Damage: Uncommon. Complication of high-dose methotrexate. * Hepatic fibrosis and cirrhosis. * Pneumonitis. * Neurologic Toxicities. With IT administration.
43
_________ provides the normal tissues with the reduced folate, thus circumventing the inhibition of DHFR.
Leucovorin (N5-formyl- THF) provides the normal tissues with the reduced folate, thus circumventing the inhibition of DHFR. • Antidote to drugs that decrease levels of folic acid, such as methotrexate, to rescue the bone marrow.