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Pharm II > FINAL Chemo Tx > Flashcards

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.

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2
Q

cyclophosphamide is used for what CA

A

ovarian
breast
non-H lymphoma

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3
Q

d. Hormonal therapy is indented for

A

breast and testicular CA management

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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

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5
Q

partial response to CA tx is defined as what

A
  • at least 30% decrease in target lesions
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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

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7
Q
  • neither sufficient shrinkage to qualify PR or PD
A

d. Stable disease (SD)

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8
Q

Duration of overall response

A
  • progression free survival (PFS):

but
i. Could be progression free and die form the tx

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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)

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10
Q

Synthesis of cell components needed for DNA

A

G1

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11
Q

DNA replicated

A

S phase

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12
Q

-RESTING AND NOT DIVIDING

A

G0

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13
Q

synthesis of cellular components required for mitosis

A

o G2

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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

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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

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16
Q

MOA PLATINUM COMPOUNDS

A

” Similar to alkylating agents -bind DNA inter-strand crosslinks w/ platinum and inhibition
“ MOA: disrupts DNA synthesis

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17
Q

platin CA

A

LUNG

breast, ovarian, bladder, head/neck, esophageal, gastric, testicular

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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:

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19
Q

Probably one of the worst platin for emesis

A

cisplatin

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20
Q

Carboplatin (Paraplatin®, CBDCA®) used in what CA

A

” Ovarian

“ Lung

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21
Q

Oxaliplatin (Eloxatin®) is used specifically for this CA

A

” Colon/rectum stage 3 and usually used for stage 4

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22
Q

carboplatin ADE

A

less ADE than cisplatin

Thrombocytopenia limit 28 days

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23
Q

this chemo drug for

A

Neurotoxic dose limiting effects Assoc w/ both resp & neuropathy rxn –> Sensitivity to cold ❄️ ❄️ ❄️

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24
Q

ANTITUMOR ANTIBIOTICS

A

RUBY’S and bleo

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25
Q

doxorubicin can be used for what CA

A

Leukemia
Lymphoma
Breast cancer

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26
Q

Daunorubicin for what CA

A

Leukemia (AML) - limited to solid tumor efficacy

Cumulative dose
Watch out in pts with preexisting heart issues

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27
Q

Bleomycin for what CA

A

” Testicular
“ Lymphomas
“ Head/neck carcinomas

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28
Q

main ASE of antibiotic CA tx

A

” 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

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29
Q

which drugs can be used to reduce the dose related cardiomiopathy effect of antibiotic CA txs like doxorubicin

A

dexrazoxane

raised off the deck

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30
Q

ADE specific to bleomyocin

A

” Fatal pulmonary toxicity -pulmonary coral. Look for pneumonitis, cough and crackles
“ Hypertrophic skin changes and hyperpigmentation

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31
Q

Methotrexate is what kind of drug

what phase is it active in of the cell cycle

A

folic acid anatgonist
S phase

Inhibits dihydrofolate reductase –> inhibits tetrahydrofolate synthesis no DTMP

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32
Q

RX used to reduced form of folic acid to negate toxic effects of MTX in nl tissue (can’t give after the fact!!!)

A

Leucovorin rescue - folinic acid

lucky cat

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33
Q

ADE w/ methotrexate

A

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

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34
Q

Pemetrexed (folic acid anatgonist) can be used for

A

Non-Small Cell Lung Cancer (NSCLC)

In combination with platinum tx for lung cancer

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35
Q

what can be used to reduce toxicity w/ pemetrexed

A

Vitamin B 12 and folic acid can reduce toxicity similar to methotrexate

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36
Q

PYRIMIDINE ANALOGS

A

5-Fluorouracil (5-FU)
(Adrucil®)

Capecitabine (Xeloda®)

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37
Q

Epirubicin used for what CA

A

” Breast
“ Gastroesophageal

ASE: flushing

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38
Q

how do the antitumor antibodies work?

A
  • Inhibits topoisomerase II

* Cell cycle specific: G2-M phase

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39
Q

When do we typically see mucositis with drugs like methotrexate ?

how do we manage this

A

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

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40
Q

” 5-FU prodrugí

“ Converted to 5-FU in liver

A

Capecitabine (Xeloda®)

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41
Q

ADE with Capecitabine (Xeloda®)

A

” D & hand-foot syndrome

“ Less myelosuprresion, N/V & mucositis than 5-FU

42
Q

Gemcitabine (Gemzar)

A

Antimetabolite - pyrimidine analog/antimetabolite/antagonist

also works in S phase

43
Q

Antimicrotubule agent: VINCA alkaloid

A

vinblast
vincristine
vinorelbine

44
Q

which Antimicrotubule agent: VINCA alkaloid is used for Breast, Hodgkins, Non-H lymph, testicular

A

vinblastin

45
Q

vincristine is used for what CA

A

Acute leukemias,
Hodgkins and non-H lymph,
Wilm’s tumor

46
Q

Antimicrotubule agent: VINCA alkaloid work at what phase of cell cycle

A

“•Inhibit tubulin: Active in M phase
•Derived from Periwinkle plants
•Cell cycle specific: M phase”

47
Q

this antimictorbulue is known as the worst for myelosuppression

A

Myelosuppression: Blasts out bone marrow!
•N/v
•Alopecia
•Vesicant: can cause tissue damage if extravasated”

48
Q

Taxanes like docetacel and cabzitaxel act in what phase

A

M

“•Enhance tubulin polymerization -> inhibit mitosis
•From WESTERN EURO YEW tree
•Cell cycle specfic: M phase”

49
Q

ADE associated with docetaxel

A

“•+++ 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
Q

hematuria is associated with which taxel

A

cabazitaxel

51
Q

Antimicrotubule agent - NON-TAXANE microtubule dyanamics inhibitor

A

Eribulin

52
Q

Eribulin is used for what CA

A

Refractory breast CA, lung CA

53
Q

ADE of eirbulin

A

“•+++Myelosuppression - neutropenia
•+++Peripheral neuropathy
•QT prolongation
•Used if failed other drugs”

54
Q

•DIARRHEA - dose limiting in this topoisomerase inhibitor for colon CA

A

irinotecan

55
Q

irinotecan acts at which cell cycle

A

“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
Q

what don’t you want to use irinotecan with

A

Don’t use Irinotecan and 5-FU together for colon cancer - +++ DIARRHEA

57
Q

Etoposide VP-16 (VePesid) is used for what cancers

A

lung and testicular

58
Q

Prednisone can be used for what CA

A

Lymphocytic leukemia, non-H Lymphoma

LA LA land

59
Q

ADE of predisone

A

Depends on dose and duration: fluid retention, immune system suppression, increased appetite, insomnia

60
Q

SERM - selective estrogen receptor modulator that an be used in breast cancer for pts with estrogen receptor

A

tamoxifen

61
Q

tamoxifen how does it work

A

selective receptor modulator

partial agonist (blocks estrogen receptors in SOME tissues but not others)

62
Q

ADE for tamoxifen

A

“•ADEs vary from minor (altered menstrual period) to major (thromboembolic events)
•Hypercalcemia, hot flashes, menstrual disorders, BONE PAIN, nausea”

63
Q

this hormonal drug “ can prevent androgen from being converted to estrogen

A

Anastrozole
(Arimidex®)

aromatase inhibitor

64
Q

Anastrozole
(Arimidex®)

ADE

A

” Prevent androgen from being converted to estrogen “ Asthenia,
“ N/V/D
“ Hot flashes
“ Pain, dizziness

65
Q

Leuprolide acetate

Eligard®

A

GRH

Palliative therapy for prostate CA

Yeah it’s an agonist but given continuously it actually blocks the production of testosterone

66
Q

ADE of

Leuprolide acetate (Eligard®)

Goserelin acetate (Zoladex®)

A 
"	Hot flashes b/c block testosterone í vascular stability
"	Edema
"	Pain
"	GI upset
"	Resp & urinary d/o
67
Q

this hormonal agent used for prostate cancer has been known to cause LIVER FAILURE, gynecomastia, hot flashes, loss of libido, impotence, n/v

A

Flutamide

Bicalutamide
(Casodex®)

Nilutamide
(Nilandron®)

68
Q

older Androgen receptor blocker (antiandrogen)

A

“•Flutamide
•Bicaludamide (Casodex)”

prostate cancer

69
Q

New oral antiandrogen $

New oral antiandrogen $

A

Abiraterone (Zytiga)

Enzalutamide (Xtandi)

70
Q

Abiraterone (Zytiga)

Enzalutamide (Xtandi)

are reserved for

A

” Castrate resistant mets prostatic CA

“ $$$$

71
Q

Enzalutamide (Xtandi) ADE

A

” Peripheral edema
“ Hot flashes
“ Fatigue” D

72
Q

Abiraterone
(Zytiga®)

can be administered with

A

Administer w/ prednisone - prevents compensatory in ↑ ACTH & aldosterone synthesis

73
Q

this drug Down regulating T cell activation and has been associated with immune activated ADE

A

” Block pathway = activated tumor-specific Tcells to kill tumor cells & secrete cytokines to restore antitumor immune response

nivolumab

74
Q

this drug targets VEGF and targets agiogenic growth

A

bevacizumab

beaver scissos mob

CG-CORN
colorectal cancer 
glioblastoma
cervical 
ovarian 
renal cell carcinoma
non small cell
75
Q

bevacizumab SE

A

wound healing complications

76
Q

trastuzumanb

A

used for HER2 positive breast cancer

77
Q

trastuzumab

A

Monoclonal antibody against HER2

78
Q

ADE of trastuzumab

A 
"	Rash
"	Edema
"	Arthralgia
"	Renal impairment
"	GI sx

cardiotoxcity

79
Q

ERLOTINIB is used for

A

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
Q

imatinib

A

eye mat used against the CaMaL

bcr-abl TARGETED

81
Q

delayed emesis is deifned as

A

vomiting more than 24 hours after

82
Q

SEROTONIN (5-HT3) “ 1st line

A

SEROTONIN (5-HT3) “

o	Dolasetron (Anzemet®)
o	Granisetron (Kytril®)
o	Ondansetron (Zofran®)
o	Palonesetron (Aloxi®) - 1/wk MAX
83
Q

main SE with SEROTONIN (5-HT3) for emesis

A

” HA, sedation, diarrhea

84
Q

how to take SEROTONIN (5-HT3)

A

” Take 30 mins before level 3- chemo, give w/ corticosteroid

85
Q

corticosteroids for emesis are

what type of emesis would you use them for?

A

CORTICOSTEROIDS
o Dexamethasone- better/ more studied
o Methylprednisolone

” Delayed emesis

” Used acutely d/t high dosing
“ Combine w/ 5-HT3 antagonist

86
Q

CORTICOSTEROIDS- ADE
o Dexamethasone- better/ more studied
o Methylprednisolone

A

Transient & intense perineal, vaginal, anal burning - too rapid IV administration

87
Q

NEUROKININ-1 (NK-1) ANTAGONIST

A

o Aprepitant (PO) / Fosaprepitant (IV) (Emend®)

preppy ants

88
Q

Metoclopramide (Reglan®)

would be given for what type of emesis

A

Delayed N & in combo w/ lesser emetogenic agents

89
Q

” Delayed emesis
“ break thru N/V - prn
“ low minimal risk emesis
“ think phenothiazine like mental health rxs

what are the ADE of this drug

A

PHENOTHIAZINE DERIVATIVES

Prochlorperazine (Compazine®)

pro color pear is minimal risk and break through

Drowsiness, akathesia, dystonia but less than metoclopramide

90
Q

antipsychotic medications that can be used if prochlorperazine fails

A 
BUTYROPHENONES
o	Haloperidol (Haldol®)
o	Droperidol
91
Q 
BENZODIAZEPINE
o	Lorazepam (Ativan®)

ADE

A

” Amnesia x 8 hrs, sedation, hypoTN, perceptual disturbances

92
Q

ESA: Erythropoetin (EPO) & Darbepoietn

A

” Must have a consent form signed off

“ Initiate therapy if Hgb <10

93
Q

MC drugs that cause anemia

A 
IL-2
proleukin
MTT- ibritumomab
tositumomab 
carbitaxel
94
Q

ESA and their SE

A

ESA: Darbepoetin (Aranesp) and Epoetin (Epogen). Had REMS but was discontinued. Inc risk CV events, death, thromboembolic events, stroke, tumor progression/recurrence

95
Q

Do not tranfuse w/ PRBC until …

A

Do not tranfuse w/ PRBC until pt becomes symptomatic from anemia: SOB, weakness, fatigue, orthostasis.

96
Q

WBC nadir

when do counts recover

A

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
Q

To admin chemo pt should have: WBC >

or ANC >1500

A

To admin chemo pt should have: WBC > 3000/mm3 OR ANC > 1500/mm3
AND Platelets ≥ 100,000/mm3

98
Q

neutropenia is considered

A

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
Q

when would we used CSF for neutropneia

A

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
Q

drugs with neutropenic risk

A

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
Q

drugs iwth thrombocytopenia risk

A

carbo
oxa
cabazitaxel
interleukin

Pharm II (16 decks)

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