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Haematology > Cytotoxic Drugs > Flashcards

Cytotoxic Drugs Flashcards

1
Q

Never make treatment worse than the disease

A

T

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2
Q

What is remission?

A

When the disease is no longer detectable, but it is still there

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3
Q

In what stages does do cells differentiate/remain quiescent?

A

G0/G1

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4
Q

What can cytotoxic drugs be classified as?

A

Either cell cycle specific or non-cell cycle specific

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5
Q

What are the characteristics of cell cycle specific drugs?

A
  • Relatively tumour specific.

* DURATION of exposure more important than dose.

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6
Q

Name 2 cell cycle specific drugs.

A
  • Antimetabolites.

* Mitotic spindle inhibitors.

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7
Q

How do antimetabolites work?

A

By impairing nucleotide synthesis/incorporation

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8
Q

Give the most common example of an antimetabolite?

A

Methotrexate

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9
Q

How does methotrexate work?

A

Inhibits dihydrofolate reductase.

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10
Q

Name 3 antimetabolites, and how each of these works.

A
  • Methotrexate - inhibits dihydrofolate reductase.
  • 6-Mercaptopurine / Cytosine arabinoside / Fludarabine - incorporated into DNA.
  • Hydroxyurea - Impaired deoxynucleotide synthesis (ribonucleotide reductase).
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11
Q

What enzyme is responsible for:

i) folate metabolism?
ii) nucleotide synthesis?
iii) unwinding DNA?

A

i) Dihydrofolate reductase.
ii) Ribonucleotide reductase/adenosine deaminase.
iii) Topoisomerase II (non-cell-cycle specific).

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12
Q

What do mitotic spindle inhibitors arise from? Give an example of one.

A

Plant derivatives – vinca alkaloids (vincristine) / vinblastine

  • Taxotere – Taxol
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13
Q

What are the characteristics of non-cell cycle specific agents?

A
  • Non-tumour specific; damage normal stem cells.

* Cumulative dose more important than duration.

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14
Q

Give examples of 3 non-cell cycle specific agents.

A
  • Alkylating agents.
  • Platinum derivatives.
  • Cytotoxic antibiotics.
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15
Q

Give examples of alkylating agents.

A
  • Chlorambucil

* Melphalan

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16
Q

How do alkylating agents work?

A

Bind covalently to bases of DNA (adducts), producing DNA strand breaks (mutation) by free radical production.

BASICALLY, interrupt DNA

17
Q

Give examples of platinum derivatives.

A
  • Cis-platinum

* Carboplatinum

18
Q

Give examples of cytotoxic antibiotics.

A
  • Anthracyclines: daunorubicin/doxorubicin/idarubicin
19
Q

Explain how cytotoxic antibiotics work.

A
  • DNA intercalation: reversible.
  • Impairs RNA transcription.
  • Strand breaks in DNA (free radicals).
20
Q

Outline the general side effects of cytotoxic drugs.

A

Affects rapidly dividing organs:

  • Bone marrow suppression (neutropenic sepsis is a major concern)
  • Gut mucosal damage.
  • Hair loss (alopecia).
21
Q

What is the long term side effects of alkylating agents?

A

Infertility, secondary malignancy.

22
Q

What is the long term side effects of anthracyclines?

A

Cardiomyopathy

23
Q

What is the main side effect associated with cis-platinum?

A

Nephrotoxicity

24
Q

What is the main side effect associated with Vinca alkaloids?

A

Neuropathy

25
Q

Why does chemotherapy fail?

A
  • Slow tumour doubling time.
  • Tumour ‘sanctuaries’ e.g. tumour cells can evade the immune system in areas like the testis and brain (because of BBB and blood-testis barrier).
26
Q

Suggest specific mechanisms of drug resistance.

A
  • Decreased drug accumulation; MDR-1 / PGP
  • Altered drug (pro-drug) metabolism: cyclophosphamide
  • Increased DNA repair; cis-platinum resistance
  • Altered gene expression: reduced topoisomerase II
27
Q

What is intensifying chemotherapy limited by?

A

Myelosuppression

28
Q

How can myelosuppression be overcome?

A
  • Use haematopoietic growth factors.
  • Combine myelosuppressive/non-myelosuppressive agents.
  • Intensify doses of active drugs (log-linear tumour kill) + stem (progenitor) cell rescue.
29
Q

How can a source of stem cells for transplantation be reached?

A

Either through BLOOD or BONE MARROW

30
Q

What are the options for patient source of stem cells?

A
  • Autologous. (from pt themselves)

* Allogenic – sibling, unrelated.

31
Q

What chromosome is chronic myeloid leukaemia associated with?

A

The Philadelphia chromosome

32
Q

What is the result of the philadelphia chromosome?

A

A balanced translocation between chromosomes 9 and 22

Haematology (26 decks)

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