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Therapeutics P3 Semester 1 > Exam 1 - Oncology (Endocrine) > Flashcards

Exam 1 - Oncology (Endocrine) Flashcards

1
Q

enzymes review:
cholesterol to pregnenolone

A

cholesterol side chain cleavage enzyme

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2
Q

enzymes review:
pregnenolone to 17a-hydroxypregnenolone

A

17a-hydroxylase

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3
Q

enzymes review:
17a-hydroxypregnenolone to dehydroepiandosterone

A

17,20-lyase

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4
Q

enzymes review:
testosterone to estradiol

A

aromatase

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5
Q

enzymes review:
testosterone to DHT

A

5a-reductase

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6
Q

enzymes review:
androstenedione to estrone

A

aromatase (CYP19)

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7
Q

Aromatase = CYP__

A

19

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8
Q

2 major strategies to endocrine therapy

A
  1. stop steroid receptor fxn
  2. decrease production of steroids
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9
Q

2 major classes used for endocrine therapy

A

aromatase inhibitors
SERMs?

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10
Q

poorly differentiated tumors are generally ______, _____ and ______

A

ER-, more sensitive to cytotoxic agents, spread/grow faster than well differentiated ones

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11
Q

Which hormone is produced in pituitary gland?

A

LH

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12
Q

more ER = _____ (better or worse) outcomes with endocrine therapy

A

better

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13
Q

triple negative tumors (ER-, PR-, HER2-) respond best to what type of therapies?

A

chemo

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14
Q

Luminal A (ER+/PR+) respond best to what type of therapies?

A

endocrine therapy (antiestrogen or aromatase inhibitor)

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15
Q

HER2+ responds best to what type of therapy?

A

trastuzumab

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16
Q

tamoxifen(Nolvadex) is:
-_____
-_____
-_____

A

-oldest, most used in ER+ breast cancer
-prodrug
-effective in post and premenopausal women

17
Q

T/F: Tamoxifen can be used in high risk pts who don’t actually have cancer yet

A

T

18
Q

CYP enzyme responsible for interaction w/ Tamoxifen

A

CYP2D6

19
Q

agonist or antagonist?
-AIs
-SERMs
-SERDs

A

-agonist
-both
-antagonist

20
Q

SERMs AE

A

hot flashes (antagonist effect)
increased coag/clots/VTE risk (agonist effect)
uterine endometrial hyperplasia (agoinst)

21
Q

SERMs beneficial effects

A

prevents breast cancer (antagonist)
blocks bone resorption (agonist)

22
Q

Fulvestrant

A

IM dosing
full SERD antagonist
postmenopausal women only

23
Q

Elacestrant

A

-PO dosing
-partial agonist at low doses and full antagonist at high doses in terms of SERD activity
-postmenopausal women only

24
Q

aromatase inhibitors primary target

A

peripheral adipose tissue (not ovary)

25
Q

T/F: AIs are used in pre and post menopausal women

A

F (just post)

26
Q

non-steroidal AIs AE

A

increased bone density loss (more fractures than tamoxifen)

27
Q

Exemestane (Aromasin)

A

-inhibitor that binds irreversibly at active site and inactivates enzyme
-post menopausal only (2nd line)

28
Q

Exemestane (Aromasin) AE

A

hot flashes
peripheral edema and weight gain
increased cholesterol levels

29
Q

is slow release or fast preferred for GnRH analogs

A

slow, as fast would cause an increase in all steroid hormones (agonist)

30
Q

GnRH analog AE

A

initial transient worsening of Sx
long term: hot flashes, sexual dysfxn

31
Q

GnRH for pre or post

A

pre

32
Q

for postmenopausal women w/ER+ we use:

A

tamoxifen
non-s AI (anastrazole, letrozole)
s AI (exemestane)
fulvestrant

33
Q

for premenopausal we use:

A

GnRH agonists (goserelin and leuprolide)
surgical oophorectomy
tamoxifen

33
Q

GnRH analogs in men for prostate cancer cause

A

initial transient increase in testosterone
long term: gynecomastia, sexual dysfxn

34
Q

flare or no flare
-degarelix
-leuprolide
-relugolix
-goselerin
-triptorelin

A

-no flare
-flare
-no flare
-flare
-flare

35
Q

Abiraterone (Zytiga) MOA

A

inhibits fxn of 17 a-hydroxylase and 17,20 lyase
-this causes more DHEA and androstenedione

36
Q

common SE of abiraterone

A

increased cholesterol

37
Q

enzalutamide, apalutamide, darolutamide uses

A

for metastatic and non-metastatic prostate cancer

38
Q

mechanisms of resistance in endocrine therapy

A

mutations in AR that prevent binding of AR antagonists
-this is preferred over CRPC (castration resistant prostate cancer) because it is more dangerous, resistant and aggressive

Therapeutics P3 Semester 1 (16 decks)

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