Final Exam study Flashcards
What origin is a carcinoma?
malignant neoplasm of squamous epithelial cell origin
What origin is a adenocarcinoma?
malignant neoplasm of gland tissue
What origin is a sarcoma?
malignant neoplasm derived from glandular tissue such as bone, muscle, fat
What type of classification is BRCA 1/2?
-tumor suppressors
-mutation increases risk for cancer
-are susceptible to PARP inhibitors due to synthetic lethality
ex. Olaparib
What are the parts of the cell cycle?
G0/G1 - accumulates building blocks for division
S- cell replicates its DNA
G2 - cell assembles machinery for the chromosomes to seperate/ cell double checks chromosomes
M- mitosis
What type of chemotherapies work in the G1 phase?
kinase inhibitors, hormone inhibitors, CDK4/6 inhibitors
What type of Chemotherapies work in the S phase?
anti-metabolites, anti-folates, topo I inhibitors
What type of chemotherapies work in the G2 phase?
Topo II inhibitors
What type of chemotherapies work in the M phase?
microtubule inhibitors
What chemotherapies are non-cell cycle specific?
alkylators, intercalaters
What are two well-known tumor suppressors?
TP53, p16
What are two well-known oncogenes?
KRAS, P13K
What are the mechanisms of drug resistance?
-increased transport of drugs out of the cell through efflux pumps (often via PgP or MRP) *most common reason to resistance for multiple chemotherapies at once
-reduced transport into the cell
-decreased activation of prodrug
-increased detoxification of drug molecule (increased metabolism of drug)
-changes in drug target or function
-physiological changes such as cancer cells refuging into the blood brain barrier, massive stromalization (area becomes fibrous), cell cycle slowing
-increased anti-apoptopic proteins in cancer cells or increased repair of dna damage due to chemotherapies
What enzyme converts androstenedione to estrone?
CYP19 (Aromatase)
What endocrine therapies can be used for pre-menopausal women?
tamoxifen
leuprolide, goserelin
What endocrine therapies can be used for post-menopausal women?
tamoxifen
fulvestrant
anastrozole, letrozole, exemestane
What medications can be used in hormonal therapy for prostate cancer?
leuprolide, goselerin, triptorelin (GnRH analogs)
degarelix, relugolix (GnRH antagonists)
Abiraterone (CYP17 antagonist)
Enzalutamide, apalutamide, darolutamide (AR antagonists)
What is a diagnostic molecular pathway?
genomic DNA gets tested for mutation and if positive then will go on therapy for that
What are the different types of kinase inhibitors?
Type I-binds to active site of kinase
type II- binds to inactive site of kinase
type III- allosterically bind to kinase
What are some examples of Type I tyrosine kinase inhibitors?
EGFR inhibitors (afatinib, neratinib, gefitinib, erlotinib)
What medication is given when a patient acquires a T790M mutation to gefitinib?
Osimertinib
What kinase inhibitors are indicated with a BCR-Abl translocation?
Imatinib, Ponatinib (indicated after T315I mutation)
What is a prognostic molecular pathology?
helps to predict recurrence and can prevent overtreatment but does not drive indications for specific therapy
What are the anti-metabolite chemotherapies?
5-Fluorouracil (+ leucovorate for increasing efficacy)
cytarabine (+ tetrahydrouridine)
6-Mercaptopurine
Methotrexate
What rescues from a 5-FU overdose?
Thymidine
What are alkylating agents?
generate reactive electrophilic intermediates that react with nucleophilic groups on DNA/protein
-create cross-linkages that are inter- and intra- strand linkages
What side effects are of note in patients treated with alkylating agents?
increased risk of second malignancies
What chemotherapies are considered alkylating agents?
cyclophosphamide, Mitomycin C, chlorambucil
What chemotherapies are considered platinum therapies?
Cisplatin, carboplatin, oxaliplatin
What is the difference between alkylating and platinum agents?
alkylating agents - have alkyl groups; form intra- and inter- strand crosslinks
platinum agents- cause intra strand crosslinks
What side effects are of note with cisplatin?
-nephrotoxicity
-not myelosuppressive
What cell phase do Topo I inhibitors work in?
S phase specific
What are some examples of chemotherapies that are Topo I inhibitors?
Topotecan, Irinotecan
What are some examples of chemotherapies that are Topo II inhibitors?
Doxorubicin (also an intercalator), Etoposide (G2/M specific)
Bleomycin
What medication mediates Doxorubicin toxicity?
Dexrazoxane
What are the microtubule inhibitors?
Vincristine, paclitaxel
Are Taxanes microtubule stabilizers or destabilizers?
microtubule stabilizers
-prevents microtubule breakdown
Are vinca alkaloids microtubule stabilizers or destabilizers?
microtubule destabilizers
-prevents microtubule assembly
What are the major side effects of vincristine?
peripheral neuropathy, neurotoxicty
What are the major side effects of paclitaxel?
myelosuppression
What immunotherapies bind to the EGF receptor?
Cetuximab, panitumumab
What is the nomenclature with monoclonal antibodies?
chimeric =-xi
mouse= -o
humanized = -zu
fully human = -u
What medications are VEGF inhibitors?
Bevacizumab
What are some examples of BiTE therapies?
Blinatumomab -binds CD3 and CD19
What T cell therapy targets CTLA-4?
ipilimumab
What medications are DNA methylating agents?
Azacitibine
What medications are proteasome inhibitors?
borteZOMIB
What is the MOA of venetoclax?
inhibits BCL-2 (an anti-apoptotic protein)
-1st FDA approved small molecule that inhibits a protein-protein interation
What medications are indicated for anticipatory N/V?
Lorazepam 0.5-1 mg po
What medications are indicated for delayed N/V?
dexamethasone, NK-1 antagonist, olanzapine
What is included in a moderately emetogenic regimen?
steroid, 5-HT3 antagonist +/- either olanzapine or aprepitant
-can be 2 or 3 drugs
What is included in a highly emetogenic regimen?
NK-1 antagonist, Steroid (Dexamethasone) , 5-HT3 antagonist, Olanzapine
What is the most emetogenic chemotherapy agent?
Cisplatin
What adverse effects are there for 5-HT3 antagonists?
headache, constipation
What NK-1 antagonist side effects are there?
hiccups
What side effects are there with olanzapine?
sedation
What medication do you use for neutropenic fever?
colony stimulating factors
-filgrastim or pegfilgrastim
What is the corrected calcium equation?
serum calcium + 0.8(4- serum albumin)
What is first line therapy for hypercalcemia?
mild HCM - hydration, zolendronic acid or pamidronate
moderate HCM- zolendronic acid
severe HCM- hydration, zolendronic acid, calcitonin if refractory
What are the treatment options for treatment refractory HCM?
denosumab
What clinical pearl is related to dosing for SRE?
renal adjustment dosing is needed for pamidronate, zolendronic acid
