FINAL Chemo Tx Flashcards
1
Q
MOA of cyclophosphamide
A
Attach akyl groups to DNA
•Either breaks or cross-link DNA strands so that the cell cannot read the DNA’s gene correctly, miscoding of base pairing
•Cytotoxic
•Cell cycle NON-specific: Effective at any phase but cells most susceptible late G1 and S phase.
2
Q
cyclophosphamide is used for what CA
A
ovarian
breast
non-H lymphoma
3
Q
d. Hormonal therapy is indented for
A
breast and testicular CA management
4
Q
h. Neoadjuvant therapy
A
tx given BEFORE the primary tx to enhance efficacy of primary tx
Example is chemo or radiation prior to surgery for tumor removal
5
Q
partial response to CA tx is defined as what
A
- at least 30% decrease in target lesions
6
Q
Progressive disease (PD) is defined as
A
at least 20% increase in the target lesions or appearance of one or more new lesion
7
Q
- neither sufficient shrinkage to qualify PR or PD
A
d. Stable disease (SD)
8
Q
Duration of overall response
A
- progression free survival (PFS):
but
i. Could be progression free and die form the tx
9
Q
chemo scheduling is based on
A
. Scheduling: 21-28 day cycles, based on pt’s body surface area ( calculated in m 2) and the amt of time it takes the bone marrow to recover ( around 28 days)
10
Q
Synthesis of cell components needed for DNA
A
G1
11
Q
DNA replicated
A
S phase
12
Q
-RESTING AND NOT DIVIDING
A
G0
13
Q
synthesis of cellular components required for mitosis
A
o G2
14
Q
this drug is known for it’s ASE on the bladder caused by acrolein
A
Cyclophosphamide
hematuria, freq, irritation, fibrosis, massive hemorrhage, bladder CA
Hemorrhagic or nonhemorrhagic cystitis
15
Q
can administer this drug to avoid toxic SE of cyclophosphamide or ifosfamide (alkyklating nonsepcific)
A
admin MercaptoEthane Sulfonate Na (MESNA) IV
binds to acrolein
16
Q
MOA PLATINUM COMPOUNDS
A
” Similar to alkylating agents -bind DNA inter-strand crosslinks w/ platinum and inhibition
“ MOA: disrupts DNA synthesis
17
Q
platin CA
A
LUNG
breast, ovarian, bladder, head/neck, esophageal, gastric, testicular
18
Q
major ASE of cisplatin
A
RENAL TOX & electrolyte disturbances
“ N/V: severe and often intractable í give an antiemetic to offset
“ Ototoxicity: tinnitus & high pitched hearing
“ Peripheral neuropathy:
19
Q
Probably one of the worst platin for emesis
A
cisplatin
20
Q
Carboplatin (Paraplatin®, CBDCA®) used in what CA
A
” Ovarian
“ Lung
21
Q
Oxaliplatin (Eloxatin®) is used specifically for this CA
A
” Colon/rectum stage 3 and usually used for stage 4
22
Q
carboplatin ADE
A
less ADE than cisplatin
Thrombocytopenia limit 28 days
23
Q
this chemo drug for
A
Neurotoxic dose limiting effects Assoc w/ both resp & neuropathy rxn –> Sensitivity to cold ❄️ ❄️ ❄️
24
Q
ANTITUMOR ANTIBIOTICS
A
RUBY’S and bleo
25
doxorubicin can be used for what CA
Leukemia
Lymphoma
Breast cancer
26
Daunorubicin for what CA
Leukemia (AML) - limited to solid tumor efficacy
Cumulative dose
Watch out in pts with preexisting heart issues
27
Bleomycin for what CA
" Testicular
" Lymphomas
" Head/neck carcinomas
28
main ASE of antibiotic CA tx
" Causes red color in urine
" Have to worry about cyclophosphamide and hemorrhagic cystitis
" N/V - mod to severe ( in the higher group)
" Mucositis
" Extravastation- tissue damage
" Severe alopecia
" Hand-foot syndrome w/ liposomal í palmar-plantar erythrodysesthesia = redness, pain, swelling palms & soles
" Irreversible, dose-dependent cardiotoxicity ❤️ ❤️
" Chronic dose-dep dilated cardiomyopathy & heart failureí Initial EKG changes, arrhythmias
29
which drugs can be used to reduce the dose related cardiomiopathy effect of antibiotic CA txs like doxorubicin
dexrazoxane
raised off the deck
30
ADE specific to bleomyocin
" Fatal pulmonary toxicity -pulmonary coral. Look for pneumonitis, cough and crackles
" Hypertrophic skin changes and hyperpigmentation
31
Methotrexate is what kind of drug
what phase is it active in of the cell cycle
folic acid anatgonist
S phase
Inhibits dihydrofolate reductase --> inhibits tetrahydrofolate synthesis no DTMP
32
RX used to reduced form of folic acid to negate toxic effects of MTX in nl tissue (can't give after the fact!!!)
Leucovorin rescue - folinic acid
lucky cat
33
ADE w/ methotrexate
Renal toxicity w/ high dose
Myelosuppression & mucositis (skin & GI mucosa)
DO NOT TAKE AT THE SAME TIME AS NSAIDS
Long term use--->hepatotoxic, pul infiltrates & fibrosis
34
Pemetrexed (folic acid anatgonist) can be used for
Non-Small Cell Lung Cancer (NSCLC)
| In combination with platinum tx for lung cancer
35
what can be used to reduce toxicity w/ pemetrexed
Vitamin B 12 and folic acid can reduce toxicity similar to methotrexate
36
PYRIMIDINE ANALOGS
5-Fluorouracil (5-FU)
(Adrucil®)
Capecitabine (Xeloda®)
37
Epirubicin used for what CA
" Breast
" Gastroesophageal
ASE: flushing
38
how do the antitumor antibodies work?
* Inhibits topoisomerase II
| * Cell cycle specific: G2-M phase
39
When do we typically see mucositis with drugs like methotrexate ?
how do we manage this
Mucositis occurs 5-7d post chemo and resolves 1-3wks. Treat severe pain with opioids. Can also use magic mouth wash (lido + diphenhydramine + Al/Mg antacid) OR sucralfate liquid
40
" 5-FU prodrugí
| " Converted to 5-FU in liver
Capecitabine (Xeloda®)
41
ADE with Capecitabine (Xeloda®)
" D & hand-foot syndrome
| " Less myelosuprresion, N/V & mucositis than 5-FU
42
Gemcitabine (Gemzar)
Antimetabolite - pyrimidine analog/antimetabolite/antagonist
also works in S phase
43
Antimicrotubule agent: VINCA alkaloid
vinblast
vincristine
vinorelbine
44
which Antimicrotubule agent: VINCA alkaloid is used for Breast, Hodgkins, Non-H lymph, testicular
vinblastin
45
vincristine is used for what CA
Acute leukemias,
Hodgkins and non-H lymph,
Wilm's tumor
46
Antimicrotubule agent: VINCA alkaloid work at what phase of cell cycle
"•Inhibit tubulin: Active in M phase
•Derived from Periwinkle plants
•Cell cycle specific: M phase"
47
this antimictorbulue is known as the worst for myelosuppression
Myelosuppression: Blasts out bone marrow!
•N/v
•Alopecia
•Vesicant: can cause tissue damage if extravasated"
48
Taxanes like docetacel and cabzitaxel act in what phase
M
"•Enhance tubulin polymerization -> inhibit mitosis
•From WESTERN EURO YEW tree
•Cell cycle specfic: M phase"
49
ADE associated with docetaxel
"•+++ Myelosuppression: dose limiting!
•High incidence peripheral neuropathy
•Allergic rxn: pre-treat with antihistamine or corticosteroid: May be caused by Cremopor vehicle used in formulation"
50
hematuria is associated with which taxel
cabazitaxel
51
Antimicrotubule agent - NON-TAXANE microtubule dyanamics inhibitor
Eribulin
52
Eribulin is used for what CA
Refractory breast CA, lung CA
53
ADE of eirbulin
"•+++Myelosuppression - neutropenia
•+++Peripheral neuropathy
•QT prolongation
•Used if failed other drugs"
54
•DIARRHEA - dose limiting in this topoisomerase inhibitor for colon CA
irinotecan
55
irinotecan acts at which cell cycle
"Disrupt protein production in cancer cells (inhibit topoisom I which is enzyme that regulates ""packaging"" DNA within the cell nucleus
•Cell cycle specific: G2-M"
56
what don't you want to use irinotecan with
Don't use Irinotecan and 5-FU together for colon cancer - +++ DIARRHEA
57
Etoposide VP-16 (VePesid) is used for what cancers
lung and testicular
58
Prednisone can be used for what CA
Lymphocytic leukemia, non-H Lymphoma
LA LA land
59
ADE of predisone
Depends on dose and duration: fluid retention, immune system suppression, increased appetite, insomnia
60
SERM - selective estrogen receptor modulator that an be used in breast cancer for pts with estrogen receptor
tamoxifen
61
tamoxifen how does it work
selective receptor modulator
partial agonist (blocks estrogen receptors in SOME tissues but not others)
62
ADE for tamoxifen
"•ADEs vary from minor (altered menstrual period) to major (thromboembolic events)
•Hypercalcemia, hot flashes, menstrual disorders, BONE PAIN, nausea"
63
this hormonal drug " can prevent androgen from being converted to estrogen
Anastrozole
(Arimidex®)
aromatase inhibitor
64
Anastrozole
(Arimidex®)
ADE
" Prevent androgen from being converted to estrogen " Asthenia,
" N/V/D
" Hot flashes
" Pain, dizziness
65
Leuprolide acetate
| Eligard®
GRH
Palliative therapy for prostate CA
Yeah it's an agonist but given continuously it actually blocks the production of testosterone
66
ADE of
Leuprolide acetate (Eligard®)
Goserelin acetate (Zoladex®)
```
" Hot flashes b/c block testosterone í vascular stability
" Edema
" Pain
" GI upset
" Resp & urinary d/o
```
67
this hormonal agent used for prostate cancer has been known to cause LIVER FAILURE, gynecomastia, hot flashes, loss of libido, impotence, n/v
Flutamide
Bicalutamide
(Casodex®)
Nilutamide
(Nilandron®)
68
older Androgen receptor blocker (antiandrogen)
"•Flutamide
•Bicaludamide (Casodex)"
prostate cancer
69
New oral antiandrogen $
| New oral antiandrogen $
Abiraterone (Zytiga)
Enzalutamide (Xtandi)
70
Abiraterone (Zytiga)
Enzalutamide (Xtandi)
are reserved for
" Castrate resistant mets prostatic CA
| " $$$$
71
Enzalutamide (Xtandi) ADE
" Peripheral edema
" Hot flashes
" Fatigue" D
72
Abiraterone
(Zytiga®)
can be administered with
Administer w/ prednisone - prevents compensatory in ↑ ACTH & aldosterone synthesis
73
this drug Down regulating T cell activation and has been associated with immune activated ADE
" Block pathway = activated tumor-specific Tcells to kill tumor cells & secrete cytokines to restore antitumor immune response
nivolumab
74
this drug targets VEGF and targets agiogenic growth
bevacizumab
beaver scissos mob
```
CG-CORN
colorectal cancer
glioblastoma
cervical
ovarian
renal cell carcinoma
non small cell
```
75
bevacizumab SE
wound healing complications
76
trastuzumanb
used for HER2 positive breast cancer
77
trastuzumab
Monoclonal antibody against HER2
78
ADE of trastuzumab
```
" Rash
" Edema
" Arthralgia
" Renal impairment
" GI sx
```
cardiotoxcity
79
ERLOTINIB is used for
elmo eating dibs
NSCL & Pancreatic Cancer
going to get a rash eating all those nibs out of the trash
small little lungs
and pancrease
80
imatinib
eye mat used against the CaMaL
bcr-abl TARGETED
81
delayed emesis is deifned as
vomiting more than 24 hours after
82
SEROTONIN (5-HT3) " 1st line
SEROTONIN (5-HT3) "
```
o Dolasetron (Anzemet®)
o Granisetron (Kytril®)
o Ondansetron (Zofran®)
o Palonesetron (Aloxi®) - 1/wk MAX
```
83
main SE with SEROTONIN (5-HT3) for emesis
" HA, sedation, diarrhea
84
how to take SEROTONIN (5-HT3)
" Take 30 mins before level 3- chemo, give w/ corticosteroid
85
corticosteroids for emesis are
what type of emesis would you use them for?
CORTICOSTEROIDS
o Dexamethasone- better/ more studied
o Methylprednisolone
" Delayed emesis
" Used acutely d/t high dosing
" Combine w/ 5-HT3 antagonist
86
CORTICOSTEROIDS- ADE
o Dexamethasone- better/ more studied
o Methylprednisolone
Transient & intense perineal, vaginal, anal burning - too rapid IV administration
87
NEUROKININ-1 (NK-1) ANTAGONIST
o Aprepitant (PO) / Fosaprepitant (IV) (Emend®)
preppy ants
88
Metoclopramide (Reglan®)
would be given for what type of emesis
Delayed N & in combo w/ lesser emetogenic agents
89
" Delayed emesis
" break thru N/V - prn
" low minimal risk emesis
" think phenothiazine like mental health rxs
what are the ADE of this drug
PHENOTHIAZINE DERIVATIVES
Prochlorperazine (Compazine®)
pro color pear is minimal risk and break through
Drowsiness, akathesia, dystonia but less than metoclopramide
90
antipsychotic medications that can be used if prochlorperazine fails
```
BUTYROPHENONES
o Haloperidol (Haldol®)
o Droperidol
```
91
```
BENZODIAZEPINE
o Lorazepam (Ativan®)
```
ADE
" Amnesia x 8 hrs, sedation, hypoTN, perceptual disturbances
92
ESA: Erythropoetin (EPO) & Darbepoietn
" Must have a consent form signed off
| " Initiate therapy if Hgb <10
93
MC drugs that cause anemia
```
IL-2
proleukin
MTT- ibritumomab
tositumomab
carbitaxel
```
94
ESA and their SE
ESA: Darbepoetin (Aranesp) and Epoetin (Epogen). Had REMS but was discontinued. Inc risk CV events, death, thromboembolic events, stroke, tumor progression/recurrence
95
Do not tranfuse w/ PRBC until ...
Do not tranfuse w/ PRBC until pt becomes symptomatic from anemia: SOB, weakness, fatigue, orthostasis.
96
WBC nadir
when do counts recover
WBC nadir: 10-14 day after chemo. Counts recover 3-4 weeks post chemo (EXCEPT Mitomycin C and nitrosoureas nadir is 4-6wk post tx)
97
To admin chemo pt should have: WBC >
| or ANC >1500
To admin chemo pt should have: WBC > 3000/mm3 OR ANC > 1500/mm3
AND Platelets ≥ 100,000/mm3
98
neutropenia is considered
Neutropenia: ANC < 500, or a count of < 1000 with predicted decrease to < 500 over next 48hrs
febrile nuetropenia is considered ANC<500 with temp >101
99
when would we used CSF for neutropneia
CSFs - colony stimulating factors: can reduce risk febrile neutropenia by 50%.
Use them if risk of neutropenia is > 20%, and consider if risk is 10-20%
100
drugs with neutropenic risk
Antitumor antibodies: Doxorubicin, bleomycin, epirubicin
Cyclophosphamide (give Amifostine which may reduce neutropenia) Also give G-CSF????
oxliplatin
antimetabolites : MTX 5FU. gemcitabine capecitabine
vinblastin
taxanes
eribulin (non taxin)
101
drugs iwth thrombocytopenia risk
carbo
oxa
cabazitaxel
interleukin
