DIT Part 3 Flashcards
What is the DNA structure of most all of the DNA viruses?
What are the exceptions
Most are double stranded and linear
exceptions include: Parvovirus B19 is ssDNA Papillomavirus (circular DNA) Polyomavirus (circular DNA) Hepadnavirus (circular DNA)
What is the DNA structure of most all of the DNA viruses?
What are the exceptions
Most are double stranded and linear
exceptions include: Parvovirus B19 is ssDNA Papillomavirus (circular DNA) Polyomavirus (circular DNA) Hepadnavirus (circular DNA)
Examples of live atteuated vaccines?
MMR Sabine polio vaccine (oral) varicella zoster vaccine yellow fever vaccine smallpox vaccine intranasal influenza vaccine
What live virus vaccines should be considered for HIV positive patients?
Rotavirus recommended for all infants with HIV
MMR and varicella for CD4 counts >200
Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts
where do most get their envelope?
exception?
usually from plasma membrane but herpes virus gets its envelope from nuclear membrane
which families virus do not have an envelope
Naked (non-enveloped)
Adenovirus Calicivirus Papilloma Parvovirus Picornavirus Polyomavirus Reovirus Hepevirus
signet ring cells
gastric adenocarcinoma
nutmeg liver
right sided heart failure and budd chiari syndrome
maternal elev of AFP
anencephaly, spina bifida, omphalocele, gastroschisis
RBC cast in urine
acute glomerulonephritis
Currant-Jelly sputum
klebsiella
Dog or cat bite
pasteurella multocida
Examples of live atteuated vaccines?
MMR Sabine polio vaccine (oral) varicella zoster vaccine yellow fever vaccine smallpox vaccine intranasal influenza vaccine
What live virus vaccines should be considered for HIV positive patients?
Rotavirus recommended for all infants with HIV
MMR and varicella for CD4 counts >200
Live virus influenza vaccine and herpes zoster vaccine are not recommended even in higher CD4 counts
EBV associated malignancies
Hodgkin lymphoma Burkitt lymphoma Nasopharyngeal carcinoma Diffuse large cell lymphoma Oral hairy leukoplakia Lymphoproliferative disorders
which families virus do not have an envelope
Naked (non-enveloped)
Adenovirus Calicivirus Papilloma Parvovirus Picornavirus Polyomavirus Reovirus Hepevirus
signet ring cells
gastric adenocarcinoma
nutmeg liver
right sided heart failure and budd chiari syndrome
benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark
Alkaptonuria
RBC cast in urine
acute glomerulonephritis
Currant-Jelly sputum
klebsiella
Dog or cat bite
pasteurella multocida
Retrovirus family members
HIV
Human T cell leukemia (HTLV)
MC cause of fatal infantile gastroenteritis
rotavirus
HSV-1 causes what
Oral herpes labialis (cold sores) Gingivostomatitis Keratoconjunctivitis Temporal lobe encephalitis Genital herpes
Monospot test
Detects heterophile antibodies
Antigens found in horse, sheep, and beef RBCs
High sensitivity and specificity
(for Epstein Barr Virus)
fever, jaundice, black vomit
yellow fever
EBV associated malignancies
Hodgkin lymphoma Burkitt lymphoma Nasopharyngeal carcinoma Diffuse large cell lymphoma Oral hairy leukoplakia Lymphoproliferative disorders
where is latency established
HSV-1 HSV-2 VZV CMV EBV
HSV1:trigeminal ganglia HSV2: sacral ganglia Varicella zoster: DRG or trigeminal ganglia CMV: Mononuclear cells EBV: B Cells
fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash
measles
benign disease caused by deficiency of homogentisic acid oxidase patients have dark organs and dark connective tissue urine turns dark
Alkaptonuria
nephritis, hearing loss, cataracts
alport syndrome
Retrovirus
HIV
Human T cell leukemia (HTLV)
thyroglossal duct cyst presentation
- asymptomatic mass in the midline neck
- moves with swallowing
- often in pt
painful raised lesions on finger pads and fever
osler’s nodes (infective endocarditis)
Bamboo spine on xray
ankylosing spondylitis
fever, jaundice, black vomit
yellow fever
diarrhea in children during winter months
rotavirus
small irregular blue gray spots on the buccal mucosa surrounded by a base of red
koplik spots in measles
fever, runny nose, cough, conjunctivitis, koplik spots, diffuse rash
measles
Ring enhancing lesions in the brain
Toxoplasmosis
Non-Hodgkin lymphoma (primary CNS lymphoma)
toxoplasmosis prophylaxis,
when is it given
TMP-smx
or
dapstone+pentamadine+leucovorin
when CD4 is less than 100
nephritis, hearing loss, cataracts
alport syndrome
What regulates prolactin secretion
TRH increase
Dopamine inhibits
Prolactin also inhibits by increasing dopamine
thyroglossal duct cyst presentation
- asymptomatic mass in the midline neck
- moves with swallowing
- often in pt
Protease inhibitors
Saquinavir Ritonavir Indinavir Nelfinavir Amprenavir Fosamprenavir Lopinavir Tipranavir Atazanavir Darunavir
NRTI
Zidovudine Didanosine Lamivudine Abacavir Emtricitabine Tenofovir
NNRTIs
Nevirapine Delavirdine Efavirenz Etravirine Rilpivirine
Protease inhibitor SE
GI intolerance
Hyperlipidemia/hypertriglyceridemia
Lipodystrophy
Ritonavir SE
protease inhibitor
Inhibits cytochrome P450
Pancreatitis
Nephrolithiasis side effect from what drugs
Idinavir
Atazanavir
(protease inhibitors)
Increased bilirubin SE from what drug
Atazanavir
Protease inhibitor
Bone marrow suppression from what drugs for HIV
Zidovudine
NRTI
Pancreatitis and peripheral neuropathy from what drugs for HIV
Didanosine,
Zalcitabine
Stavudine
(NRTIs)
Hepatic steatosis from what drugs for HIV
Didanosine
Stavudine
(NRTIs)
Hypersensitivity from what drugs for HIV
Abacavir (NRTI)
Side effect of NNRTIs
Rash
SE of efavirenz (NNRTI)
Neuropsychiatric
False positive cannabinoid drug test
Teratogenic
Enfuvurtide
Mech
SE
Fusion inhibitor by binding gp41, inhibiting viral entry
se:
injection site reaction
increased risk of bacterial pneumoniae
Raltegravir Mech
SE
Integrase inhibitor
SE:
nausea
rash
myopathy
Maraviroc mech
who can use it?
CCR5 antagonist, inhibiting gp120 conformational change so virus cannot bind host cell effectively.
only patients with all R5 virus
Cancers assoc with asbestos
mesothelioma
bronchogenic carcinoma
owl’s eye inclusions
cmv
owl’s eye nucleus
reed sterberg cells (hodgkin lymphoma)
owl’s eye protozoan
Giardia lamblia
Howell-Jolly bodies
DNA remnants (asplena)
Treatment for PCP
TMP-SMX (bactrim)
or if sulfa allergy:
Pentamidine
or
unofficially Clindamycin and primaquine
Treat rhizopus/mucormycosis
Surgery and amphotericin B
most common opportunistic infection in HIV patients
PCP
treatment for systemic candidasis
Fluconazole for immunocompetent
Amphotericin B or caspofungin for immunocompromised
animal urine you should think of
leptospira
hantavirus for rodent urine
what hormones arise from anterior pituitary
FSH LH TSH PROLACTIN GH ACTH MSH or melanotropin
what effect does adipocyte generated leptin have on the hypothalamus
INHIBITS LATERAL THALAMUS TO STOP HUNGER
STIMULATES VENTROMEDIAL THALAMUS FOR SATIETY
treatment for sporothrix schenckii
itraconazole
or
KOH
councilman bodies
apoptotic liver cells (viral hepatitis, yellow fever)
Anti-dsDNA antibodies
lupus nephritis
Dementia and eosinophilic inclusions in neurons
Lewy body dementia
Side effects of orlistat
steatorrhea
GI disturbances
Decreased absorption of fat soluble vitamins
Enzyme converting glucose to sorbitol
Aldose reductase
Amphotericin B Mechanism
Use
SE
How to avoid some SE
Binds ergosterol in cell membrane of fungi, forms pores in membrane, loss of electrolytes and small molecules, fungal death
Can be used intrathecally for fungal meningitis
SE: Fever/chills hypotension nephrotioxicity Arrhythmias Anemia IV phlebitis
Avoid nephrotoxicity by increased hydration
Avoid toxicity by liposomal amphotericin (but expensive)
Nystatin Mechanism
Clinical uses
same as amphotericin B. But topical form b/c too toxic for systemic use.
Swish and swallow for oral candidiasis (thrush), topical for diaper rash or vaginal candidiasis
Azole mechanism
inhibits fungal sterol (ergosterol) synthesis by inhibiting cytochrome P450 that converts lanosterol to ergosterol
Clinical use for Itraconazole
First line therapy
- Blastomyces
- Coccidoides
- Paracoccidoides
- Histoplasma
- Sporothrix
Clinical use for Ketoconazole
NOT FIRST LINE
- Blastomyces
- Coccidoides
- Histoplasma
- Candida
Clinical use for Fluconazole
- Cryptococcal meningitis (can cross BBB)
- Candidal infections
Clinical use for Posaconazole
Active against many fungi refractory to other treatments
-Mucor
Clinical use for Clotrimazole and microconazole
Used for topical fungal infections
Clinical use for Voriconazole
Aspergillus
SE of azoles
- Decrease production of cortisol and testosterone
- Gynecomastia
- Impotence
- Drug Drug interactions
- Increased hepatic enzymes
Flucytosine mechanism
Clinical use
SE
converted into 5-FU by cytosine deaminase
Inhibitng DNA and RNA biosynthesis
Use:Used in combo with amphotericin B to treat systemic candidal and cryptococcal infections
SE: BM toxicity and GI symptoms
caspofungin mechanism
Use
SE:
inhibits cell wall synthesis by inhibiting synthesis of Beta-1,3-D Glucan leading to cell lysis and death
Use: Invasive aspergillosis, candida infection
SE: GI upset and flushing
Terbinafine (lamisil) mechanism
Use
SE
Inhibits fungal enzyme squalene epoxidase leading to decreased ergosterol synthesis
Use: TOPICAL -Tinea pedis -Tinea corporis ORAL -Onychomycosis -Tinea capiti
SE:
GI symptoms
Hepatotoxicity
Griseofulvin mechanism
Use
Targets microtubule function inhibiting mitosis
Deposits in keratin-containing tissues
Use:
- Tinea corporis
- Tinea capitis
- Onychomycosis
SE: -Teratogenic -Headache -GI symptoms Confusion -Cytochrome P450 inducer
Strawberry tongue
Scarlet fever/
Kawasaki disease/
Toxic shocks syndrome
Rash on palms and soles
2ndary syphilis
Rocky mountain spotted fever
Coxsackie A virus
Name for thyroid hormone secreting teratoma
struma ovarii
medx to shrink prolactinomas
Dopamine agonists
- Bromocriptine
- Cabergoline
Treatment for Entamoeba histolytica
Kill Trophozoites with
-Metronidazole
or
-Tinidazole
Kill asymptomatic cyst passers with
-Iodoquinol
or
-Paromomycin
Uses for metronidazole
GET GAP on the Metro
Giardia Entamoeba Trichomonas Gardnerella vaginalis Anaerobic bacteria Pylor (H. pylori)
Treatment for Toxoplasma gondii
Sulfadiazine+ Pyrimethamine+Folinic acid
treatment for Trypanosoma brucei
Suramin for blood borne disease
Melarsoprol for CNS penetration
Treat P. vivax and P. ovale
Primaquine
Treat of malaria
Chloroquine
+primaquine if Pvivax or Povale
Treatment of Chloroquine resistant malari
Quinine + Doxycycline
Atovaquone-proguanil
Artemether-Lumefantrine
Mefloquine
Treatment of Babesiosis
Quinine+clindamycin
most common protozoal infection in the US
Trichomonas vaginalis
Diarrhea with liver abcess?
Not Giardia but Entamoeba histolytica
Names for the stages in the malaria life cycle
Sporozoites injected
In liver early schizonts, late schizonts,
Merozoites rupture
Trophozoites resemble diamond ring, in RBC
Early schizont, late schizont in RBC
Merozoites released with lysis
Gametocytes (falicparum is banana shaped)
Taken up by mosquito
Smudge cell
CLL
Port-wine stain in ophthalmic division of trigeminal ganglion
Sturge-Weber syndrome
S3 heart sound
Dilated cardiomyopathy Post MI Left ventricular failure Mitral regurgitation Left to right shunt (VSD/ASD/PDA)
Subepithelial humps on EM
poststreptococcal glomerulonephritis
Spike and dome on EM
Membranous glomerulonephritis
Adv. rxn from mixing succinylcholine and inhaled anesthetics
Malignant hyperthermia
tx with dantrolene
Currant jelly stool
Intussusception
Ketoconazole inhibits what enzyme of the adrenal steroid synthesis pathway
Desmolase (Cholesterol–>Pregnenolone)
Treatment for Pinworm/Enterobius Vermicularis
Ascaris Lumbricoides
Albendazole
Mebendazole
Pyrantel Pamoate
(same for both)
Treatment of Trichinella spiralis
Benzimidazoles
Treatment of Strongyloides stercoralis
Ivermectin
Mebendazole
What are the hookworms
tx?
Necator Americanus
Ancyclostoma duodenale
tx
Albendazole
Mebendazole
Pyrantel Pamoate
Tx of taena solium
Praziquantel
Albendazole +
dexamethasone (neurocysticercosis)
Treatment of Echinococus granulosus
injection of scolicidal agent (ethanol, hypertonic saline)
followed by surgical removal
-Albendazole in conjuction w the procedure
Most common helminthic infection in US
2nd most common helminthis infxn in the US
Enterobius vermicularis is most common in the US
Ascaris lumbricoides is the 2nd most common helminthic infxn in the US
1/4 of world infected with it
Ascaris lumbricoides
Snail host swimmers itch
Schistosoma species
Most common predisposing factor for bladder cancer in 3rd world countries
Schistosoma haematobium
Giant roundworm
Ascaris lumbricoides
responsible for lymphatic filariasis
Wuchereria bancrofti
Adult pt from Mexico with new onset seizures and brain calcifications
Taena solium (neurocystercosis)
hematuria in patient form developing country
Schistosoma haematobium
Treat giardia, entamoeba, trichomonas
Metronidazole
Treat most all flukes and tapeworms
Praziquantel
Treat hookworm, pinworm, roundworm
Benzimidazoles (Mebendazole)
Pyrantel Pamoate
Treat chagas disease
Benznidazole
Nifurtimox
Best guess for roundworms
Benzimidazoles
Treat Leishmaniasis
Cutaneous-Sodium stibogluconate
Visceral-Liposomal amphotericin B
Contracted by eating undercooked fish and causes an inflammation of the biliary tract
Clonorchis
Which 2 agents are usually used in the treatment of peduculosis capitis and pediculosis pubis
Pyrethrin
Permethrin
Why is lindane not the preferred agent in the treatment of lice
Neurotoxicity and Resistance
Incidences of cancer in men
mortality in men
INCIDENCE
Prostate
Lung
Colon
MORTALITY Lung Prostate Colon Pancreas
Incidences of cancer in women
mortality in women
INCIDENCE Breast Lung Colon Uterus
MORTALITY Lung Breast Colon Pancreas
DPC mutation also known as
what does DPC mean?
SMAD4
Deleted in pancreatic cancer
DCC mutation means
Deleted in colon cancer
K-RAS
H-RAS
N-RAS
K-RAS: Colon, lung, pancreatic tumors
H-RAS: Bladder and kidney tumors (Hematuria)
N-RAS: Melanomas and hematologic malignancies
Follicular thyroid carcinoma is associated with what mutations?
RAS mutations
BCR-ABL
t9;22
philadelpha chromosome
CML
Tyrosine kinase constitutively on
ret mechanism
associations
tyrosine kinase always on
MEN2A and 2B
-Pheochromocytoma
-Medullary thyroid cancer
Papillary carcinoma of the thyroid
HER2/new (c-erbB2) associations
tx
Breast cancer
Ovarian cancer
Gastric cancer
Tx with trastuzumab
L-myc association
lung tumors
N-myc association
Neuroblastoma (sounds like a brain tumor but really is one of the adrenal medulla)
Most common causes of hypocalcemia
vitamin d deficiency chronic renal disease parathyroidectomy autoimmune destruction of parathyroid glands digeorge syndrome pseudohypoparathyroidism acute pancreatitis
cancer assoc with hashimoto thyroiditis
Marginal cell lymphoma
What is iron bound to in human cells
myoglobin and ferritin
What is iron bound to in blood
hemoglobin and transferrin
arsenic risks for cancer
Squamous cell skin cancer
Angiosarcoma of the liver
Lung cancer
vinyl chloride risk for cancer
angiosarcoma
Naphthalene (moth balls) risk for cancer
Transitional cell bladder cancer
smoking increases risk for same cancer type that naphthalene does
Transitional cell bladder cancer
Asbestos increases risk for
Bronchogenic carcinoma (MOST COMMON!!_ Malignant mesothelioma
In asbestosis what is the most common cancer
BRONCHOGENIC CARCINOMA not malignant mesothelioma
Most common cancers assoc with ionizing radiation
Myeloid leukemias
- AML
- CML
Thyroid cancer (all types, papillary is just the most common in general)
What cancers are assoc with UV radiation exposure?
Which type of UV is most problematic?
Squamous cell carcinoma
Basal cell carcinoma
Melanoma
UVC is the shortest wavelength and filtered out by ozone layer
UVB causes pyrimidine dimers in DNA. MOST PROBLEMATIC
UVA is the longest wave length, inducing generation of free radicals. contributes only slightly to skin cancer risk.
Actinic keratosis is due to what?
Precursor to what?
Tx with what?
Due to sun exposure
Precursors to squamous cell skin cancer
Tx: 5-FU
Dysplastic nevi progress to
Melanoma
Adenomatous colon polyps progress to
colon cancer
Barretts esophagus progresses to
Esophageal adenocarcinoma
Tuberous sclerosis presentation
neoplasms?
Facial angiofibromas -Adenoma sebaceum Seziures Intellectual disability Ash Leaf Spots
Neoplasms include:
- Cardiac rhabdomyoma
- Renal angiomyolipoma
- Astrocytoma
HBV and HCV increase risk for
Hepatocellular carcinoma (HBV can without cirrhosis)
HCV increases risk for
Papillary thyroid carcinoma
HTLV increases risk for
T-cell lymphoma
EBV increases risk for
Hodgkin lymphoma
Burkitt lymphoma
Nasopharyngeal carcinoma
Schistosoma haematobium increases risk for
SCC of bladder (not transitional as in smoking)
Clonorchis sinensis increases risk for
Biliary cancer
Down syndrome associated with what neoplasm
ALL
AML
Ataxia-telangiectasia assoc with what neoplasm
Leukemia
Lymphoma
Paget disease of bone assoc with what neoplasm
Osteosarcoma
Nitrosamines assoc with what neoplasm
Esophageal cancer
Gastric cancer
Colon cancer
HPV cancer risk
Vulvar cancer Vaginal cancer Cervical cancer Anal cancer Penile cancer (16 and 18)
Most common side effect is hypoglycemia in this oral type 2 diabetes drug
Sulfonylureas
Primarily effects postprandial hyperglycemia (oral diabetes type II drug)
alpha-glucosidases
MOA: closes K+ channels on beta cells
sulfonylureas
MOA: inhibits alpha-glucosidase at intestinal brush border
alpha-glucosidase inhibitors
MOA: agonist at PPARgamma receptor
TZD
features of anaplasia
High nucleus:cytoplasm ratio
Prominent nucleoli
Clumping of nuclear chromatin
Many mitotic figures
Malignant tumor from epithelium
Stain?
adenocarcinoma
papillary carcinoma
stain with cytokeratin
Epithelial tumors spread by:
Mesenchymal tumors spread:
Lymphatics for epithelial tumors
Hematogenously for mesenchymal tumors
CEA
Colon cancer
Pancreatic cancer
CA 19-9
Pancreatic cancer
alpha-fetoprotein
Hepatocellular carcinoma and testicular tumors
CA-125
Ovarian cancer (but also elevated with anything irritating peritoneum…)
S-100
Melanoma
Schwannoma
Alkaline phosphatase
Metastasis to bone
Biliary disease
Paget disease of bone
Psammoma bodies
Papillary thyroid cancer
Serous papillary cystadenocarcinoma of the ovary
Meningioma
Malignant mesothelioma
what hormones use steroid receptors
Estrogens Progesterone Testosterone Aldosterone Vitamin D Thyroid hormones Glucocorticoids
What hormones use tyrosine kinase receptors
insulin insulin like growth factor fibroblast growth factor platelet derived growth factor prolactin growth hormone
RLS in purine synthesis
glutamine PRPP amidotransferase
RLS in pyrimidine synthesis
CPS2
What are two cofactors involved in the ability to induce angiogenesis in tumors
Basic fibroblast growth factor (bFGF)
Vascular endothelial growth factor (VEGF)
Most common liver metastatic cancers
Cancer Sometimes Penetrates Benign Liver
Colon Stomach Pancreas Breast Lung
most common brain metastatic cancers
Lots of Bad Stuff Kills Glia
Lung Breast Skin (melanoma) Kidney (renal cell carcinoma) GI tract (colon cancer)
most common bone metastatic cancers
Permanently Relocated Tumors Like Bones
Prostate Renal cell carcinoma Testes/Thyroid Lung Breast
What is Cachexia and why does it happen?
Profound wt loss
Loss of fat and lean muscle, b/c tumor produces cytokines that raise the BMR
Paraneoplastic effects of tumors
Small cell lung cancer (ACTH–>Cushing syndrome)
(ADH–>SIADH)
(Lambert-Eaton syndrome)
Squamous cell lung cancer
(Humoral hypercalcemia of malignancy: PTHrp)
Lambert-Eaton syndrome is associated with what?
Mechanism?
Clinical presentation?
Assoc with small cell lung cancer
Antibodies against presynaptic ca2+ channels at the NMJ
Weakness improves with use (c/f with myasthenia gravis)
What can release PTHrp
Squamous cell lung cancer
Squamous cell cancers of head and neck
Breast cancer
Renal cell carcinoma
How does multiple myeloma cause hypercalcemia?
Secretes local osteolytic factors causing lytic bone lesions and hypercalcemia
EPO secreting conditions?
Potentially Really High Hematocrit
Pheochromocytoma
Renal cell carcinoma
Hepatocellular carcinoma
Hemangioblastoma
also Uterine fibroids (leiomyoma)
most common cause of hypercalcemia
Primary hyperparathyroidism
What malignancies cause hypercalcemi
Squamous cell lung cancer squamous of head and neck breast cancer renal cell carcinoma multiple myeloma hodgkin lymphoma lytic bone metastases
RLS for urea cycle
CPS I (carbamoyl phosphate synthetase I)
RLS fo fatty acid synth
Acetyl-CoA carboxylase
RLS for beta-oxidation of fatty acids
CAT 1 (Carnitine acyltransferase I)
RLS for bile acid synthesis
7-alpha hydroxylase
RLS for heme synthesis
Amino levulinate synthase
5 most important lifestyle factors that impact cancer risk
Smoking Obesity Poor diet Inactivity Sun exposure
Smoking increases risk for what types of cancers
Lung cancer Laryngeal cancer Oral cancer Esophageal cancer Pancreatic cancer Renal Cell carcinoma Bladder cancer
What cancers are increased with obesity
in both women and men
In women
In men
Men and women: Esophageal adenocarcinoma Renal cell carcinoma Women: Endometrial cancer Gallbladder cancer Men: Thyroid cancer Colon cancer
Screening recommendations for the following cancers according to USPSTF
Breast cancer Cervical cancer Prostate cancer Colon cancer Ovarian cancer Smoking
Breast: mammogram every 2 years 50-75
Cervical: pap smear every 3 years, 21-65
Prostate: no recommendation 75 do not
Colon: Colonoscopy every 10 years, 50-75. but if family hx then 40 or 10 yrs before that of dx for family member
Ovarian: no recommendation
Smoking:
annual chest CT for age 55-80 with 30 pack year smoking history or current smoker or quit within last 15 years
What immune cells are involved in killing cancer cells
CD8+ Cytotoxic T lymphocytes MOST IMPORTANT!
NK cells
Macrophages
treatment for homocystinuria?
Decrease methionine
Increase cysteine
Increase B6 and B12
Add folate
what irrev enzymes are involved in gluconeogenesis
Pyruvate carboxylase
PEP carboxykinase
Fructose 1,6 bisphosphatase
Glucose 6 phosphatase
Rescue agent for 5-FU toxicity
Uridine
SE of Methotrexate
SE of 5-FU
Fibrosis of lung for methotrexate
Photosensitivity for 5-FU
6-MP can become toxic when given with
allopurinol
How to get around the CI of allopurinol with 6mp?
give 6-Thioguanine, b/c not metabolized by xanthine oxidase
Cytarabine is what
what does it do
Pyrimidine analog
Inhibiting DNA polymerase
Cyclophosphamide mechanism
Use
SE
Any special characteristics?
Alkylates guanine residues on DNA, crosslinking it
Use: Cancer Immunosuppresion for -Lupus nephritis -Polyarteritis nodosa
SE:
-Hemorrhagic cystitis because metabolite acrolein is toxic
Give mesna to prevent
-Increases risk of TCC of bladder
REQUIRES BIOACTIVATION IN LIVER
Ifosfamide
same as cyclophosphamide except used for testicular cancer and not as immunosuppressant
Nitrosureas
use
SE
put nitro in your MUSTANG (-MUSTINE)
alkylating agent that crosses BBB, so use for brain tumors
SE: CNS toxicity
Busulfan mech
Use
SE
Cross links DNA
Use:
CML, also ablate BM before transplant
SE:
- severe myelosuppression
- pulmonary fibrosis
- hyperpigmentation
Doxorubicin and Daunorubicin Mech
Use
SE
Anthracyclines that generate free radicals, intercalate DNA,
Use:
Solid tumors
Leukemias
Lymphomas
SE:
-Cardiotoxic (dilated cardiomyopathy, b/c heart is susceptible to free radical damage due to deficiency in superoxide dismutase)
PREVENT THIS WITH DEXRAZOXANE
Dexrazoxane
Prevent cardiotoxicity with Daunorubicin and doxorubicin
Dactinomycin mechanism
Use
Intercalates DNA
Use:
Wilms tumor
Ewing Sarcoma
Rhabdomyosarcoma
Bleomycin
Use:
Mech
SE
Use: with etoposide and cisplatin, treats testicular cancer
Mechanism: Generates free radicals
SE: Pulmonary fibrosis
What oncology drugs cause pulmonary fibrosis and what are their mechanisms?
Bleomycin (generates free radicals)
Busulfan (cross links DNA)
Methotrexate (inhibits dihydrofolate reductase))
Uses for methotrexate
Leukemias
Lymphomas
Choriocarcinomas
Sarcomas
Abortion Ectopic pregnancy RA Psoriasis IBD
6-MP uses
prevent organ rejection
RA
Leukemia
IBD
5-FU uses
Colon cancer
Pancreatic cancer
Basal cell skin cancer
Actinic keratosis
Azathioprine use
SLE
folic acid analog
methotrexate
pyrimidine analog
5-FU
3 most common types of thyroid cancer
Papillary carcinoma
Follicular carcinoma
Medullary carcinoma
what cancers are assoc with RET gene mutation
MEN 2A and 2B
Medullary thyroid carcinoma
Papillary thyroid carcinoma
Cisplatin, Carboplatin, Oxaliplatin
Uses
SE
Mech: Cross link DNA
Uses:
- Testicular cancer
- Ovarian cancer
- Bladder cancer
SE:
-Nephrotoxicity (prevent with amifostine and chloride diuresis)
-Acoustic nerve damage
What drugs are nephrotoxic/ototoxic
Vancomycin
Aminoglycosides
Loop diuretics
Cisplatin and carboplatin
Etoposide, Teniposide
Mech:
Use:
Mech: Inhibit Topoisomerase 2–> DNA degradation
Use:
- Small cell lung cancer
- Prostate cancer
- Testicular cancer
regimen for treating testicular cancer
Eradicate Ball Cancer
Etoposide+Bleomycin+Cisplatin
or
Etoposide+Ifosfamide+Cisplatin
Irinotecan, Topotecan
Mech
Use
Mech: Inhibit topoisomerase I
Use
Irinotecan: Metastatic colon cancer
Topotecan: Small cell lung cancer/Ovarian cancer/Cervical cancer
Vincristine
mech
uses
and what are drugs that also treat these same conditions
SE
mech: blocks polymerization of microtubules
use: -Hodgkin lymphoma -Wilms tumor -Ewing sarcoma (Dactinomycin can also work for these childhood cancers)
-Choriocarcinoma (methotrexate works also)
se:
- Neurotoxicity
- Peripheral neuritis
Vinblastine
Mech
se:
Mech: blocks microtubule polymerization
SE: Myelosuppression (vinblastine BLASTS BONE MARROW)
Paclitaxel mech
use
SE
mech: stabilizes microtubules
Use:
-Ovarian and breast carcinomas
SE: myelosuppression and hypersensitivity
Microtubule drugs
Vincristine Vinblastine Paclitaxel Mebendazole Albendazole Griseofulvin Colchicine
Hydroxyurea Mech
use
Mech: Inhibits ribonucleotide reductase, inhibiting DNA synthesis)
use:
- Melanoma
- CML
- increases HbF in sickle cell patients
Prednisone mech
Use
SE
Mech: triggers apoptosis
use:
lymphoid tumors
-CLL
-hodgkin lymphoma
SE: BAM CUSHINGOID -Buffalo hump -Amenorrhea -Moon facies -Crazy (psychosis/agitation) -Ulcers -Skin changes -HTN -Infection -Necrosis of femoral head -Glaucoma and cataracts -Osteoporosis -Immunosuppression -Diabetes
glucocorticoid SE
BAM CUSHINGOID
- Buffalo hump
- Amenorrhea
- Moon facies
- Crazy (psychosis/agitation)
- Ulcers
- Skin changes
- HTN
- Infection
- Necrosis of femoral head
- Glaucoma and cataracts
- Osteoporosis
- Immunosuppression
- Diabetes
Tamoxifen mech
Use
SE
Tamoxifen ER antagonist -Breast ER agonist -Bone ER partial agonist -Endometrium
Use:
- ER + Breast cancer
- Prevention in pt with BRCA mutation
- Endometrial cancer (b/c partial agonist)
SE:
-Increase risk of endometrial carcinoma (b/c partial agonist)
SERMs
Tamoxifen, Raloxifene
Raloxifene mech
USe
ER antagonist -Breast -Endometrium ER agonist -Bone
Use:
Treat osteoporosis
Trastuzumab mech
Use
SE
HER-2 monoclonal antibody
Use: Treat breast cancer that overexpress HER-2
SE:
Cardiotoxic (HERts THE HEART
Rituximab
mech
Use
Antibody against CD20
Uses:
- Lymphomas and leukemias
- RA
- Vasculitis
- Pemphigus vulgaris
- ITP
Imatinib mech
Use
Enzyme inhibitor targets mutant BCR-ABL tyrosine kinase produced by philadelphia chromosome t(9;22)
Use:
- CML
- ALL
- AML
