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Pharm- oncology/anemia > day 1 oncology > Flashcards

day 1 oncology Flashcards

1
Q

Most common types of cancer?

A

Breast, prostate, lung, colon, lymphoma

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2
Q

Most common cancer deaths?

A

Lung, colon, breast, prostate, pancreas

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3
Q

What is cancer?

A

• Disease caused by accumulated mutations in DNA that alter cell function
this gives cancer cells growth advantages over nml cells

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4
Q

Why is cancer bad?

A

As cancers grow they invade other areas/ organs of the body

becomes a burden which causes organ failure/ death

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5
Q

What is a primary tumor

A

original mass of cancer cells of solid tumor in a body orgam

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6
Q

benign tumors

A

are abnormal tumor growth but is not as invasive or fatal as malignant

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7
Q

How is cancer treated?

A 
localized therapy treatment
systemic therapies (2)
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8
Q

2 types of localized therapy treatments?

A
  • Surgery

* Radiation

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9
Q

3 types of chemotherapy

A

– Traditional chemo
monoclonal antibodies
targeted angents

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10
Q

What is immunomodulation

A

Stem cell transplantation

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11
Q

What are 3 goals if treating with surgery?

A

– Hope for complete removal of tumor
sometime remove tumor/organ
remove troublesome metastases
cant use in hematologic malignancies

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12
Q

What is radiation therapy

A

alone or combo therapy with surgery or chemo

exposes the patients to radioactive energy that destroys cancer cells

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13
Q

Chemotherapy involves what?

A

Involves use of drugs with various MOA that disrupts cancer cell functions
IV or oral

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14
Q

Why is chemotherapy used?

A

Many types of chemo target mechanisms of cell function that block cancer cell growth and division
most active against rapidly growing tumors that have active growth mechanics

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15
Q

Traditional chemotherapy targets what?

A

mechanics of cell divisions

DNA, RNA, spindle fiber formation

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16
Q

newer chemotherapy targets what?

A

Newer target specific proteins that are required for various cancer cell functions

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17
Q

Principles of cancer chemotherapy– Log cell kinetics

A

– A given treatment kills a constant fraction of cells
subsequent doses reduce the cancer burden proportionally over time
more cells killed= the higher chance for cure

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18
Q

Principles of cancer chemotherapy– Gompertzian model

A

Growth fraction of a tumor is not constant
growth fraction decreases as tumor gets larger
results in decrease number of cells susceptible to chemo

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19
Q

1st line primary therapy

A

Used in advanced cancer cases in which other treatments would not be effective

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20
Q

Neoadjuvant chemotherapy

A

Used prior to the use of local therapies to improve their effect by reducing the size of the tumor

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21
Q

Adjuvant chemotherapy

A

Used after local therapies to improve their long term effect by eliminating any remaining undetected cancer cells

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22
Q

Dose density is what?

A

Giving repeated doses of multiple chemotherapy agents over a period of time
regular exposure gives a wave like approach to killing cancer cells over time

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23
Q

Definition of cure

A

a sustained cancer free period

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24
Q

Defition of control

A

reduce cancer burden
prevent extension of cancer
extend survival
cure unlikely

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25
Q

Definition of palliation?

A

reduce symptoms of disease
improve QOL
prolong survival
cure not likely

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26
Q

Defition of remission?

A

when we cant detect cancer we call this REMISSION. if remission last about 5 yrs we call it a cure BUT doesnt mean the cancer cant come back

27
Q

4 responses to treatment?

A

complete remission
cure
partial response
treatment failure/progression of disease

28
Q

How do you determine the response of treatment

A

Physical exam
tests: xray, CT scan, MRI
blood tests
tumor markers/ proteins in blood

29
Q

Mutations within cancer cells could?

A

– Block chemo actions
block uptake of chemo into the cells
facilitate excessive transport of drug back out of the cell

30
Q

Difference between primary and acquired resistance to chemotherapy

A 
primary= cancer was never susceptable to the chemo
acquired= cancer changed and no longer responds
31
Q

Chemotherapy resistances

A

mutations
drug interactions could decrease exposure to chemo within the patients body
Calculated dose does not match pts body characteristics (obese pt)

32
Q

What are the 3 treatment options if primary treatment is unsuccessful?

A

salvage treatment–> giving second line agent
stem cell transplant
investigational therapies

33
Q

What are the 2 types of stem cell transplant?

A

autologous SCT

allogenic SCT

34
Q

Autologous SCT

A

high dose chemo followed by reinfusion of patients own stem cells

35
Q

Allogenic SCT

A

completely changing the pts immune system—give them stem cells from a healthy donor

36
Q

2 targets of new chemotherapy

A

• Tyrosine kinase

growth factor receptors

37
Q

3 targets of traditional chemotherapy?

A

• DNA/RNA
mechanics of cell division
DNA polymerase

38
Q

Alkalating agents are what?

A

groups of molecules that trasfer an alkalating group to other molecules
disrupt normal DNA structure by altering atomic interactions and prevents use of DNA as a blueprint for cell division

39
Q

What do alkalating agents target?

A

sulfydryl, amino, hydroxyl

phosphate group on DNA

40
Q

What are some examples of alkalating agents?

A 
Lomustine
Cyclophosphamide
Mechlorethamine
Bendamustine
Melphalan
Temozolomide
Thiotepa
Dacarbazine
Procarbazine
41
Q

What are the uses of alkalating agents?

A

Cyclophosphamide: breast CA, lymphoma, leukemia, myeloma

melphalan: myeloma
procarbazine: lymphoma

42
Q

Mechanisms that reduce susceptibility to alkalayting agents

A

– Increase repair of damaged DNA

decrease transport of alkalating agent into cell

43
Q

Common Adverse effects of alkalating agents

A 
– Bone marrow toxicity
mucositis
N/V 
sterility
tissue damage following extravasation 
risk of secondary malignancies
44
Q

MOA of platinum analogs

A

binding DNA and form intra and interstrand crosslinks

bind to cytoplasmic and nuclear proteins required for cell function

45
Q

3 examples of platinum analogs

A

Cisplatin
Carboplatin
Oxaliplatin

46
Q

uses of platinum analogs

A

• Cisplatin and carboplatin- lung, esophagus, ovary, head, neck, bladder
oxaliplatin- more commonly used for colorectal

47
Q

Adverse effects of Cisplatin

A

renal toxicity,
N/V
anemia
ototoxicity

48
Q

carboplatin adverse effect

A

myelosuppression

49
Q

oxaliplatin adverse effects (3)

A

neurotoxicity, diarrhea, myelosuppression

50
Q

What is antimetabolite?

A

Antimetabolites are molecules that substitute for actual components of metabolic process

  • inhibits cell processes that produce components of DNA
  • *S phase specific
51
Q

examples of antimetabolites?

A 
methotrexate
5-FU
6-MP
Fludarabine
Gemcitabine
cytarabine
capecitabine
52
Q

Uses of antimetabolites

A 
• Methotrexate: leukemia, lymphoma, breast CA, RA
pemetrexed- lung CA
5-FU- colorectal, breast CA
cytarabine- leukemia, lymphoma
gem- pancreas, bladder, breast
capecitabine- breast cancer
53
Q

Leucovorin

A

no anticancer action
reduced form of folic acid
mimics action of tetrahydrofolate

54
Q

2 key uses of Leucovorin

A

– Reduce methotrexate toxicity by rescuing normal cells

increase 5-FU activity against colon cancer

55
Q

Adverse effects of animetabolites

A

Methotrexate: diarrhea, mucositis, myelosupprssion
pemetrexed- rash, diarrhea, PPE
5-FU- diarrhea, mucositis, myelosupprssion
cytarabine- N/V, pulmonary toxicity
gem- diarrhea, N/V, myelosupprssion
capecitabine- PPE N/V, diarrhea

56
Q

What is palmar plantar erythrodysesthesia treated with?

A

dexamethazone

57
Q

Chemo derived from natural products

A

– Vinca alkaloids
taxanes
epipodophyllotoxins
camptothecins

58
Q

MOA of vinca alkaloids

A

Inhibit tubulin polymerization required for microtubule assembly
blocks cell division during metaphases and causes cell death

59
Q

Uses of vinca alkaloids

A

• Vincristine: leukemia, lymphoma, rhabdomyosarcoma
vinblastin- germ cell cancer, leukemia, lymphoma
vinorelbine- lung breast ovary

60
Q

Adverse effects of vinca alkaloids

A 
• Alopecia
• Neurotoxicity 
constipation
myelosuppression
vesicant action of extravasation
61
Q

MOA of taxanes

A

Act by promoting microtubule formation
prevents spindle fibers from retracting
blocks completion of cell division causing cell death

62
Q

Uses of taxanes

A

• Paclitaxel: ovary, lung, prostate, breast
cabazitaxel- prostate
ixabepilone- breast

63
Q

adverse effects of taxanes

A

• Myelosuppression
• Hypersensitivity reactions
peripheral neuropathy
fluid retention

Pharm- oncology/anemia (3 decks)

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