Conventional Chemotherapy

Question 1

Cyclophosphamide/Acrolein/MENSA

Answer 1

• crosslinks DNA
  Toxicity: acute: GI; delayed: depression of blood count, over-dosing leads to pancytopenia
  -Alkylating agent

Question 2

Procarbazine

Answer 2

-inhibits DNA, RNA and protein synthesis
Toxicity: acute: GI; delayed: myelosupression, CNS toxicity with MAOI, high risk of secondary malignancy
-Alkylating agent

Question 3

Cisplatin

Answer 3

• crosslinks DNA

Toxicity: acute: GI (BAD for emesis); delayed: nephrotoxicity, ototoxicity, peripheral neuropathy (irreversible)

Question 4

Carboplatin

Answer 4

• crosslinks DNA
  Toxicity: acute: GI; chronic: myelosupression, peripheral sensory neuropathy, nephrotoxicity (less than cisplatin), liver dysfunction

Question 5

Oxaliplatin

Answer 5

• crosslinks DNA and effective in cells with MMR defects
  Acute: GI, neurotoxicity (cold triggered swallowing issues)
  Delayed: neurotoxicity: reversible peripheral neuropathy, diarrhea

Question 6

Bleomycin

Answer 6

• causes breaks G2 arrest

Pulmonary Tox

Question 7

Methotrexate

Answer 7

- inhibits DHFR 
Tox: mucositis, diarrhea, then myelosupression: neutropenia and thrombocytopenia
RESISTANCE CAN DEVELOP
-Purine synth inhibitor
-reverse with leukovorin

Question 8

5-FU

Answer 8

• inhibits TS, DNA synthesis and RNA translation
  Tox: If dihydropyridine DH deficient toxicity is severe
  Myelosupression, GI, Neuro, Derm: “Hand-foot syndrome” with con’t infusion

-Purine synth inhibitor

Question 9

Capecitabine

Answer 9

• inhibits TS, DNA synthesis and RNA translation
  Tox: If dihydropyridine DH deficient toxicity is severe
  GI Hand-foot syndrome

-Purine synth inhibitor

Question 10

Hydroxyurea

Answer 10

-inhibits ribonucleotide reductase
-use for MPD
Tox: BM

Question 11

6-Mercaptopurine/Azothiaprine

Answer 11

• inhibits purine synthesis, incorporated into DNA/RNA
  Deactivated by xanthine oxidase (give allopurinol)
  Tox: thiopurine methyl transferase deficiency can lead to myelosupression and diarrhea

Question 12

Cytarabine (Ara-C)-

Answer 12

Competitive inhibition of DNAPs, into DNA

Tox: Acute: GI; delayed: PANCYTOPENIA

Question 13

Gemcitabine

Answer 13

Competitive inhibition of DNAPs, into DNA

NEUTROPENIA

Question 14

Irinotecan

Answer 14

• impaired DNA replication and S phase arrest
  Tox: DIARRHEA
  -Topo I inhib

Question 15

topotecan

Answer 15

impaired DNA replication and S phase arrest
Tox: GI, bald, BM esp. neutropenia
-Topo I inhib

Question 16

Doxorubicin

Answer 16

Tox: myelosupression w/ neutropenia, mucositis, CARDIOTOX: arrhythmia, dilated CM, reduce risk with iron chelator: Dexrazoxane
Topo II

Question 17

Daunorubicin

Answer 17

Tox: myelosupression w/ neutropenia, mucositis, CARDIOTOX: arrhythmia, dilated CM, reduce risk with iron chelator: Dexrazoxane
Topo II

Question 18

Etoposide

Answer 18

Tox: GI, hypotension, BM, bald

Topo II

Question 19

Vincristine

Answer 19

inhibit polymerization by binding beta-tubulin to inhibit assembly; mitotic arrest in metaphase
Tox: potent vesicant + GI, BM, bald
-destabilizes MTs

Question 20

Vinblastine

Answer 20

• inhibit polymerization by binding beta-tubulin to inhibit assembly; mitotic arrest in metaphase
  Tox: peripheral neuropathy and ANS (orthostatic hypotension, urinary retention, paralytic ileus) and SIADH
  -destabilizes MTs

Question 21

Paclitaxel

Answer 21

• enhances microtubule proliferation
  Acute tox: GI, hypotension and HYPERSENSITIVITY to cremophor formulations give dexamethasone or diphenhydramine
  Chronic tox: NEUROTOX, marrow

Question 22

docetaxel

Answer 22

• enhances microtubule proliferation
  Acute tox: GI, hypotension and HYPERSENSITIVITY to cremophor formulations give dexamethasone or diphenhydramine
  Chronic tox: NEUROTOX, marrow