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Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology > Cytotoxic Drugs > Flashcards

Cytotoxic Drugs Flashcards

1
Q

Cytotoxic drugs have both ______________ activity and the potential to damage normal tissue; most cytotoxic drugs are ______________

A

anti-cancer

teratogenic

  • All cytotoxic drugs cause side-effects and a balance has to be struck between likely benefit and acceptable toxicity
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2
Q

Chemotherapy (cytotoxic drugs) may be given with a _____________ intent or it may aim to _______________ or to _____________

A

curative

prolong life

palliate symptoms

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3
Q

What is neoadjuvant therapy?

A

initial chemotherapy aimed at shrinking the primary tumour, thereby rendering local therapy less destructive or more effective

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4
Q

What is adjuvant treatment?

A

follows definitive treatment of the primary disease when the risk of subclinical metastatic disease is known to be high

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5
Q

Cytotoxic drugs fall into a number of classes, each with characteristic _______________ activity, _______________, and ______________. A knowledge of sites of metabolism and excretion is important because impaired drug handling as a result of disease is not uncommon and may result in enhanced toxicity

A

antitumour

sites of action

toxicity

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6
Q

Many side-effects of cytotoxic drugs often do not occur at the time of administration, but _____________ later

A

days or weeks

  • It is therefore important that patients and healthcare professionals can identify symptoms that cause concern and can contact an expert for advice
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7
Q

A number of cytotoxic drugs will cause severe local tissue necrosis if ____________________ occurs

A

leakage into the extravascular compartment

*To reduce the risk of extravasation injury it is recommended that cytotoxic drugs are administered by appropriately trained staff

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8
Q

A sore ________________ is a common complication of cancer chemotherapy; it is most often associated with fluorouracil, methotrexate, and the anthracyclines

A

mouth (oral mucositis)

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9
Q

Oral mucositis is most often associated with which cytotoxic drugs? (3)

A
  1. Fluorouracil
  2. MTX
  3. Anthracyclines
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10
Q

What measures can be taken to minimize oral mucositis during chemotherapy? (2)

A
  1. Rinsing mouth frequently and effective brushing of teeth with a soft brush 2-3 times daily
  2. For fluorouracil, sucking ice chips during short infusions of the drug is also helpful
    * Once a sore mouth has developed, treatment is much less effective
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11
Q

In general, mucositis is self-limiting but with poor oral hygiene it can be a focus for ________________.

A

blood-borne infection

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12
Q

What is the cause of tumor lysis syndrome?

A

Spontaneous or treatment-related rapid destruction of malignant cells; pre-existing hyperuricemia, dehydration, and renal impairment are also predisposing factors

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13
Q

Which patients are at risk of tumor lysis syndrome? (5)

A
  1. Non-Hodgkin’s lymphoma (especially if high grade and bulky disease)
  2. Burkitt’s lymphoma
  3. ALL
  4. AML (particularly if high white blood cell outs or bulky disease)
  5. Occasionally those with solid tumors
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14
Q

What are the features of tumor lysis syndrome? (6)

A
  1. Hyperkalemia
  2. Hyperuricemia
  3. Hyperphosphatemia
  4. Hypocalcemia
  5. Renal damage
  6. Arrhythmias
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15
Q

Hyperuricaemia, which may be present in high-grade _____________ and _____________, can be markedly worsened by chemotherapy and is associated with _______________

A

lymphoma

leukaemia

acute renal failure

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16
Q

How is hyperuricemia prevented in patients receiving chemotherapy for high grade lymphoma and leukemia? (2)

A
  1. Allopurinol started 24 hours before treatment (or febuxostat started 2 days before cytotoxic therapy)
  2. Adequate hydration
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17
Q

______________, a recombinant urate oxidase, is licensed for hyperuricaemia in patients with haematological malignancy

A

Rasburicase; It rapidly reduces plasma-uric acid concentration and may be of particular value in preventing complications following treatment of leukaemias or bulky lymphomas.

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18
Q

All cytotoxic drugs except _______________ and _______________ cause bone-marrow suppression

A

vincristine sulfate

bleomycin

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19
Q

All cytotoxic drugs except vincristine sulfate and bleomycin cause _________________

A

bone-marrow suppression

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20
Q

_________________ commonly occurs 7 to 10 days after administration, but is delayed for certain drugs, such as carmustine, lomustine, and melphalan.

A

Bone-marrow suppression

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21
Q

Bone-marrow suppression commonly occurs ________________ after administration, but is delayed for certain drugs, such as carmustine, lomustine, and melphalan.

A

7 to 10 days

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22
Q

________________ must be checked before each treatment with cytotoxic drugs, and doses should be reduced or therapy delayed if _______________ has not recovered.

A

Peripheral blood counts

bone-marrow

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23
Q

Cytotoxic drugs may be contra-indicated in patients with acute ______________

A

Infection

*any infection should be treated before, or when starting, cytotoxic drugs.

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24
Q

Fever in a neutropenic patient (neutrophil count less than 1.06×109/litre) requires __________________

A

immediate broad-spectrum antibacterial therapy;

Appropriate bacteriological investigations should be conducted as soon as possible

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25
Q

Fever in a neutropenic patient (neutrophil count less than ______________) requires immediate broad-spectrum antibacterial therapy.

A

1.06×109/litre

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26
Q

Patients taking cytotoxic drugs who have signs or symptoms of ______________ should be advised to seek prompt medical attention.

A

infection

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27
Q

In selected patients, the duration and the severity of neutropenia can be reduced by the use of ____________________

A

recombinant human granulocyte-colony stimulating factors

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28
Q

Symptomatic anaemia caused by cytotoxic drugs is usually treated with ____________________

A

red blood cell transfusions

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29
Q

Reversible _______________ is a common complication of cytotoxic therapy, although it varies in degree between drugs and individual patients. No pharmacological methods of preventing this are available

A

hair loss

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30
Q

Are there available mechanisms of preventing alopecia secondary to cytotoxic therapy?

A

No pharmacological methods available

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31
Q

_________________ can be a complication of cancer itself, but chemotherapy increases the risk

A

Venous thromboembolism

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32
Q

Venous thromboembolism can be a complication of cancer itself, but ______________ increases the risk

A

chemotherapy

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33
Q

Most cytotoxic drugs are teratogenic and should not be administered during pregnancy, especially during the ________ trimester

A

first

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34
Q

Are cytotoxic drugs safe to use during pregnancy?

A

No; teratogenic, especially during the first trimester

  • Considerable caution is necessary if a pregnant woman presents with cancer requiring chemotherapy, and specialist advice should always be sought
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35
Q

Exclude ______________ before treatment with cytotoxic drugs

A

pregnancy

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36
Q

_______________ advice should be given before cytotoxic therapy begins- women of childbearing age should use effective contraception during and after treatment

A

Contraceptive

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37
Q

Regimens that do not contain an alkylating drug or procarbazine may have ____________ (more/less) effect on fertility

A

Less

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38
Q

Regimens that do not contain an ____________ drug or _______________ may have less effect on fertility

A

alkylating

procarbazine

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39
Q

Cytotoxic therapies containing alkylating drugs or procarbazine carry the risk of causing permanent ________________

A

male sterility (there is no effect on potency); Pretreatment counselling and consideration of sperm storage may be appropriate

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40
Q

Are women more or less affected by the sterilizing effects of alkylating drugs or procarbazine?

A

Compared to men, women are less severely affected, though the span of reproductive life may be shortened by the onset of premature menopause

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41
Q

Is there an increase in fetal abnormalities or abortion rates recorded in patients who remain fertile after cytotoxic chemotherapy?

A

No

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42
Q

Nausea and vomiting cause considerable distress to many patients who receive ________________ and to a lesser extent _______________, and may lead to refusal of further treatment

A

chemotherapy

abdominal radiotherapy

*prophylaxis of nausea and vomiting is therefore extremely important

43
Q

Nausea and vomiting associated with chemotherapy or abdominal radiotherapy may be ___________ (occurring within 24 hours of treatment), ___________ (first occurring more than 24 hours after treatment), or ____________ (occurring prior to subsequent doses)

A

acute

delayed

anticipatory

44
Q

Chemo-related nausea and vomiting: ______________ and ______________ symptoms are more difficult to control than ___________ symptoms and require different management

A

Delayed

anticipatory

acute

45
Q

Patients vary in their susceptibility to drug-induced nausea and vomiting; those affected more often include _____________, patients under ___________ years of age, ____________ patients, and those who experience ____________. Susceptibility also increases with repeated exposure to the cytotoxic drug.

A

women

50

anxious

motion sickness

46
Q

Which cytotoxic therapies have MILD emetogenic potential? (5)

A
  1. Fluorouracil
  2. Etoposide
  3. MTX (low dose)
  4. Vinca alkaloids
  5. Abdominal radiotherapy
47
Q

Which cytotoxic therapies have MODERATE emetogenic potential? (5)

A
  1. Taxanes
  2. Doxorubicin
  3. Cyclophosphamide (intermediate and low dose)
  4. Mitoxantrone
  5. MTX (high dose)
48
Q

Which cytotoxic therapies have HIGH emetogenic potential? (3)

A
  1. Cisplatin
  2. Dacarbazine
  3. Cyclophosphamide (high dose)
49
Q

____________ emetogenic treatment: fluorouracil, etoposide, methotrexate (less than 100 mg/m2, low dose in children), the vinca alkaloids, and abdominal radiotherapy.

A

Mildly

50
Q

______________ emetogenic treatment: the taxanes, doxorubicin hydrochloride, intermediate and low doses of cyclophosphamide, mitoxantrone, and high doses of methotrexate (0.1– 1.2 g/m2).

A

Moderately

51
Q

_______________ emetogenic treatment: cisplatin, dacarbazine, and high doses of cyclophosphamide.

A

Highly

52
Q

Prevention of acute symptoms:

For patients at low risk of emesis, pretreatment with ______________ or ______________ may be used.

A

dexamethasone

lorazepam

53
Q

Prevention of acute symptoms:

For patients at high risk of emesis, a _______________, usually given by mouth in combination with ______________ and the neurokinin receptor antagonist _____________ is effective.

A

5HT3-receptor antagonist

dexamethasone

aprepitant

54
Q

What is the first line drug regimen for prevention of chemo-related nausea in low risk patients?

A

Pretreatment with:

  • Dexamethasone

OR

  • Lorazepam
55
Q

What is the first line drug regimen for prevention of chemo-related nausea in high risk patients?

A

5HT3-receptor antagonist (eg ondansetron) given orally
+ dexamethasone
+ aprepitant (nerokinin receptor antagonist)

56
Q

How are delayed symptoms of moderately emetogenic chemotherapy treated?

A

Dexamethasone + 5HT3-receptor antagonist

57
Q

How are delayed symptoms of highly emetogenic chemotherapy treated?

A

Dexamethasone + aprepitant

Rolapitant and metoclopramide are also licensed for delayed chemo-induced N/V

58
Q

Prevention of anticipatory symptoms related to chemotherapy:

Good _____________ is the best way to prevent anticipatory symptoms. Lorazepam can be helpful for its amnesic, sedative, and anxiolytic effects.

A

symptom control

59
Q

Prevention of anticipatory symptoms of chemotherapy:

Good symptom control is the best way to prevent anticipatory symptoms. _______________ can be helpful for its amnesic, sedative, and anxiolytic effects.

A

Lorazepam

60
Q

The _______________ cytotoxic drugs are associated with dose-related, cumulative, and potentially life-threatening cardiotoxic side-effects

A

anthracycline

61
Q

The anthracycline cytotoxic drugs are associated with dose-related, cumulative, and potentially life-threatening ____________ side-effects

A

cardiotoxic

62
Q

______________ is used to counteract the folate-antagonist action of methotrexate and thus speed recovery from methotrexate-induced mucositis or myelosuppression

A

Folinic acid (given as calcium folinate)

  • ‘folinic acid rescue’
63
Q

_______________ is also used in the management of methotrexate overdose, together with other measures to maintain fluid and electrolyte balance, and to manage possible renal failure

A

Folinic acid

64
Q

Does folinic acid counteract the antibacterial activity of folate antagonists such as trimethoprim?

A

Nope

65
Q

Folinic acid does not counteract the antibacterial activity of folate antagonists such as ______________

A

trimethoprim

66
Q

When folinic acid and fluorouracil are used together in metastatic colorectal cancer the _________________ improves compared to that with fluorouracil alone

A

response-rate

67
Q

When folinic acid and ________________ are used together in metastatic colorectal cancer the response-rate improves compared to that with ______________ alone

A

fluorouracil

fluorouracil

68
Q

When ______________ and fluorouracil are used together in metastatic colorectal cancer the response-rate improves compared to that with fluorouracil alone

A

folinic acid

69
Q

The calcium salt of levofolinic acid, a single isomer of folinic acid, is also used for rescue therapy following methotrexate administration, for cases of methotrexate overdose, and for use with fluorouracil for colorectal cancer. The dose of calcium levofolinate is generally _____________ that of calcium folinate

A

half

70
Q

___________________ is a common manifestation of urothelial toxicity which occurs with the oxazaphosphorines, cyclophosphamide and ifosfamide

A

Haemorrhagic cystitis

71
Q

Haemorrhagic cystitis is a common manifestation of urothelial toxicity which occurs with the oxazaphosphorines, cyclophosphamide and ifosfamide; it is caused by the metabolite ___________

A

acrolein

72
Q

Which cytotoxic drugs are associated with the development of hemorrhagic cystitis? (3)

A
  1. Oxazaphosphorines
  2. Cyclophosphamide
  3. Ifosfamide
73
Q

______________ reacts specifically with this acrolein in the urinary tract, preventing hemorrhagic cystitis

A

Mesna

74
Q

Mesna is used routinely (preferably by mouth) in patients receiving ____________, and in patients receiving ____________ by the intravenous route at a high dose (e.g. more than 2 g) or in those who experienced urothelial toxicity when given cyclophosphamide previously

A

ifosfamide

cyclophosphamide

75
Q

Which drugs are considered cytotoxic antibiotics? (4)

A
  1. Daunorubicin
  2. Doxorubicin
  3. Epirubicin
  4. Idarubicin
76
Q

Many cytotoxic antibiotics (anthracyclines) act as ______________ and simultaneous use of radiotherapy should be avoided because it may markedly increased toxicity

A

radiomimetics

77
Q

Many cytotoxic antibiotics (anthracyclines) act as radiomimetics and simultaneous use of _______________ should be avoided because it may markedly increased toxicity

A

radiotherapy

78
Q

Doxorubicin hydrochloride is available as both ____________ and ____________ formulations

A

conventional

liposomal

  • The different formulations vary in their licensed indications, pharmacokinetics, dosage and administration, and are NOT interchangeable
79
Q

What are the indications of conventional doxorubicin? (5)

A
  1. Acute leukemias
  2. Hodgkin’s lymphoma
  3. Non-Hodgkin’s lymphoma
  4. Pediatric malignancies
  5. Some solid tumors including breast cancer
80
Q

Epirubicin hydrochloride is structurally related to doxorubicin hydrochloride and can be used to treat ____________ cancer

A

breast

81
Q

Epirubicin hydrochloride is structurally related to _______________ and can be used to treat breast cancer

A

doxorubicin hydrochloride

82
Q

Idarubicin hydrochloride has general properties similar to those of _______________; it is mostly used in the treatment of haematological malignancies

A

doxorubicin hydrochloride

83
Q

Idarubicin hydrochloride has general properties similar to those of doxorubicin hydrochloride; it is mostly used in the treatment of _______________

A

haematological malignancies

84
Q

Daunorubicin also has general properties similar to those of ______________

A

doxorubicin hydrochloride

85
Q

Bleomycin is given ____________ or ___________ to treat metastatic germ cell cancer and, in some regimens, non-Hodgkin’s lymphoma

A

intravenously

intramuscularly

86
Q

Bleomycin is given intravenously or intramuscularly to treat ______________ cancer and, in some regimens, ______________

A

metastatic germ cell

non-Hodgkin’s lymphoma

87
Q

Dactinomycin is principally used to treat ____________ cancers. Its side-effects are similar to those of doxorubicin, except that cardiac toxicity is not a problem

A

paediatric

88
Q

Dactinomycin is principally used to treat paediatric cancers. Its side-effects are similar to those of doxorubicin, except that _______________ toxicity is not a problem

A

cardiac

89
Q

What are the indications for mitomycin? (5)

A
  1. Gastrointestinal cancer
  2. Breast cancer
  3. Non-small cell lung cancer
  4. Metastatic pancreatic cancers
  5. Bladder tumors (superficial)

(All IV except bladder tumors which are administered via bladder instillation_

90
Q

Mitomycin causes delayed _______________ toxicity

A

Bone marrow

91
Q

Which drugs are in the class of vinca alkaloids? (4)

A
  1. Vinblastine
  2. Vincristine
  3. Vindesine
  4. Vinorelbine (semi-synthetic)
92
Q

Vinca alkaloids are used to treat which cancers? (4)

A
  1. Leukemias
  2. Lymphomas
  3. Some solid tumors
  4. Vinorelbine also used to treat breast cancer
93
Q

What is the mechanism of action of anti metabolites?

A

Antimetabolites are incorporated into new nuclear material or combine irreversibly with cellular enzymes, preventing normal cellular division

94
Q

Which drugs fall in the class of alkylating drugs? (7)

A
  1. Cyclophosphamide
  2. Ifosfamide
  3. Melphalan
  4. Lomustine
  5. Carmustine
  6. Estramustine
  7. Mitobrornitol
95
Q

What is the mechanism of action of alkylating drugs?

A

Damage DNA, thus interfering with cell replication

96
Q

Cyclophosphamide is used mainly in combination with other agents for treating a wide range of malignancies, including some ______________, ____________, and _____________

A

leukaemias

lymphomas

solid tumours

97
Q

Cyclophosphamide is given ___________ or ____________; it is inactive until metabolized by the ____________

A

Orally

Intravenously

Liver

98
Q

____________ is licensed for the treatment of multiple myeloma, polycythaemia vera, childhood neuroblastoma, advanced ovarian adenocarcinoma, and advanced breast cancer

A

Melphalan

  • However, in practice, melphalan is rarely used for ovarian adenocarcinoma; it is no longer used for advanced breast cancer
99
Q

What are the indications of melphalan? (5)

A
  1. MM
  2. PCV
  3. Childhood neuroblastoma
  4. Advanced ovarian adenocarcinoma (rarely used)
  5. Advanced breast cancer (no longer used)
100
Q

_______________ implants are licensed for intralesional use in adults for the treatment of recurrent glioblastoma multiforme as an adjunct to surgery

A

Carmustine

101
Q

Carmustine implants are also licensed for high-grade ______________ as adjunctive treatment to surgery and radiotherapy

A

malignant glioma

102
Q

Estramustine phosphate is a combination of an _______________ and _____________ used predominantly in prostate cancer

A

oestrogen

chlormethine

103
Q

Estramustine phosphate is a combination of an oestrogen and chlormethine used predominantly in ______________ cancer

A

prostate

104
Q

_______________ is a combination of an oestrogen and chlormethine used predominantly in prostate cancer

A

Estramustine phosphate

Roomies Collab Deck 5: Rheumatology, Immunology, and Dermatology (27 decks)

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