final exam week 7 (2) Flashcards
chemo
goal =
#1 kill every ______ and produce a _______
#2 if they cant _____ – control _________ and offer _______
chemo
goal =
#1 kill every cancer cell and produce a cure
#2 if they cant cure – control growth and offer palliation
____– rest
____– cell growth
____– DNA synthesis
____ – prepare to divide
____ – mitosis
GO – rest
G1 – cell growth
S – DNA synthesis
G2 – prepare to divide
M – mitosis
_________= the ration of proliferating cells to resting cells
Chemo works best with higher or lower growth fraction?
Growth fraction
higher - (so cancer cells are proliferatiing more than they are resting)
Young Malignant tumors vs old
_________
- initially grow very fast
- (high growth fraction)
____________
- as tumor size increases = rate of proliferation decreases
- (low growth fraction)
- necrotic core
- decreased nutrient supply at core
- more cells in resting phase (G0)
- more difficult to treat
Young Malignant tumors
- initially grow very fast (high growth fraction)
old malignant tumors
- as tumor size increases = rate of proliferation decreases (low growth fraction)
- necrotic core
- decreased nutrient supply at core
- more cells in resting phase (G0)
- more difficult to treat
chemo barriers to success
1. cure = 100% of cancer cells die
must use _____ dose throughout treatment for 100% kill = same dose therapy
this is hard for patient to tolerate
same
chemo barriers to success
2. late detection = _____ response
- metastasis
- ____ tumor less responsive
- patient more debilitated by disease
- late detection = poor response
- metastasis
- old tumor less responsive
- patient more debilitated by disease
chemo barriers to success
- solid tumors respond ______
- ___ growth fraction (chemo works best on high growth fraction tumors)
- ______ blood supply – hard to get treatment to them
- solid tumors responds poorly
- low growth fraction (chemo works best on high growth fraction tumors)
- limited blood supply – hard to get treatment to them
chemo barriers to success
4. drug _______
cancer cells _______ constantly
drug resistant mutations will flourish (natural selection)
- drug resistance
cancer cells mutate constantly
drug resistant mutations will flourish (natural selection)
chemo barriers to success
5. cell_________
ongoing mutation
cells differ greatly – different responses to drugs
older tumor = ___creased heterogeneity
- cell heterogeneity
ongoing mutation
cells differ greatly – different responses to drugs
older tumor = increased heterogeneity
chemo strategies for success
1. intermittent chemo
goal = 100% cancer cell death with limited normal cell injury
we want to give enough time between chemo doses to let the normal cells _______, but not too long
- intermittent chemo
goal = 100% cancer cell death with limited normal cell injury
we want to give enough time between chemo doses to let the normal cells recover, but not too long
chemo strategies for success
2. combination therapy
better than just one drug
adv
- reduces drug _______
- reduced ______ cell injury
- increases cancer cell____
disadv
- toxicities/interactions
*pay attention to drug toxicities so your not doubling up on toxicities to certain organs
Ex: nephrotoxic drugs
- combination therapy
better than just one drug
adv
- reduces drug resistance
- reduced normal cell injury
- increases cancer cell kill
disadv
- toxicities/interactions
*pay attention to drug toxicities so your not doubling up on toxicities to certain organs
Ex: nephrotoxic drugs
chemo strategies for success
3. optimal dosing
dosing schedule
- ____ results
- cell cycle _______ agents
- keeps active drug present in body
- optimal dosing
dosing schedule
- max results
- cell cycle specific agents
- keeps active drug present in body
chemo strategies for success
4. regional therapy
not systemic
- access to tumors
- _____ drug concentrations
- __crease systemic toxicity
- regional therapy
not systemic
- access to tumors
- high drug concentrations
- decrease systemic toxicity
magic mouth wash
Rx cocktail for ______
Treats oral symptoms or curative?
- lidocaine
- Mylanta
- Diphenhydramine
- Nystatin
- Prednisolone
- Distilled water
Swish, gargle, spit
Q 6 hours
May be swallowed if esophageal involvement
magic mouth wash
Rx cocktail for stomatitis
Treats oral symptoms, not curative
- lidocaine
- Mylanta
- Diphenhydramine
- Nystatin
- Prednisolone
- Distilled water
Swish, gargle, spit
Q 6 hours
May be swallowed if esophageal involvement
chemo Other toxicities
Reproductive
- Developing fetus
- Testes sterility
Women –
Men –
Other toxicities
Reproductive
- Developing fetus
- Testes sterility
Women – do not become pregnant
Men – consider sperm banking
Anti cancer agents
1. ________– cause cell death
2. _________ – antiestrogen drugs, block effects of hormones on tumor
3. ________ – alters body’s response to cancer by stimulating immune sysem
4. _______ – target cancer cells directly
Cytotoxic agents
Biologicals
Targeted drugs
Hormonal agents
Anti cancer agents
1. Cytotoxic agents – cause cell death
2. Hormonal agents – antiestrogen drugs, block effects of hormones on tumor
3. Biologicals – alters body’s response to cancer by stimulating immune sysem
4. Targeted drugs – target cancer cells directly
Drug regiman often includes drugs that are phase specific and non-phase specific = increases cancer cell kill
Non specific drug vs specific
- Doxorubicin
- methotrexate
- Cyclophosphasmide
- vincristine
- N
- S - S phase
- N
- S - M phase
- Ondasetron
- Promethazine
- Dexamethasone
- Magic mouthwash
Drugs that treat toxicities
Cell cycle specific drugs vs Cell cycle non-specific drugs?
1. Work only at a specific phase,
2. Implications = often used with cell specific drugs
3. Problem = cant interrupt cells in G phase resting phase, b/c they are out of cell cycle
4. Works at all cell cycle phases,
5. Problem = not as effective to our proliferating cells
6. Implications = must stay in body for a long time to be effective so all cells make it through to the phase
7. doesn’t work in G phase
8. works in G phase
- S
- NS
- S
- NS
- NS
- S
- S
- NS
cancer pharm
Cytotoxic drugs:
MOA?
Cyclophosphamide
Doxorubicin
Methotrexate
Vincristine
MOA - Disrupt DNA synthesis
Disrupt mitosis
- Cytotoxic drugs: Alkylating agents - Cyclophosphamide
- Cytotoxic drugs: Antitumor abx - Doxorubicin
- Cytotoxic drugs: Antimetabolites - Methotrexate
- Cytotoxic drugs: Mitotic inhibitors: vinca alkaloids - Vincristine
cancer pharm
cancer pharm
2
Cell cycle non-specific
2
Cell cycle specific
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
NON
1. Cyclophosphamide
- Doxorubicin
SPECIFIC
3. Methotrexate
4 .Vincristine
- Cell cycle specific - S phase
- Cell cycle specific – M phase
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
- Methotrexate
- Vincristine
cancer pharm
s/e
Bone marrow suppression
n/v
hairloss
+
Viscant
Hemorrhagic cystitis
Sterility
Discoloration of skin and nails
Bladder injury
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
Cyclophosphamide
cancer pharm
s/e
Bone marrow suppression
n/v
hairloss
+
Cardiotoxicity
Acute and delayed reaction
Red color urine and sweat
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
Doxorubicin
cancer pharm
s/e
Bone marrow suppression
n/v
hairloss
+
Nephrotoxicity
Hepatoxicity
Fetal death and abnormalities
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
Methotrexate
used for RA and lupus too
cancer pharm
s/e
s/e
(NO Bone marrow suppression)
n/v
hairloss
+
Peripheral neuropathy
Vesicant
Vincristine
Doxorubicin
Methotrexate
Cyclophosphamide
Vincristine
- Blocks serotonin receptors on vagal nerve and in the chemoreceptor trigger zone
- Blocks dopamine recpetors in the chemoreceptor trigger zone
Promethazine
Ondansetron
- Ondansetron
- Promethazine
cancer pharm
indications
1.Chemo, radiation, post-op n/v
2.Chemo, radiation, post-op, general n/v
Promethazine
Ondansetron
- Ondansetron
- Promethazine
cancer pharm
s/e
1.h/a
diarrhea
dizzy
2.respiratory depression
drowsy/sedation
Promethazine
Ondansetron
- Ondansetron
- Promethazine
cancer pharm
implications:
- works better with steroid
- BLACK BOX WARNING
Resp depression <2 y/o
Gangrenous extravasation
Promethazine
Ondansetron
- Ondansetron
- Promethazine
- Immune checkpoint inhibtors – all immune cells to response more strongly to cancer
- T cell transfer theraoy – boost natural T cell ability to fight cancer
Biologics (immunotherapy)
- Monoclonal antibodies – mark cencer cells so theyre better seen by the body’s immune system
- Treatment vaccines – boosting immune systems response to cancer
Biologics (immunotherapy)
- Immune system modulators – enhance the body’s immune response against cancer – prevents or slows tumor growth and spread of cancer
Biologics (immunotherapy)
MOA
Uses body;s immune system to kill cencer cells
Revs up immune system
Biologics (immunotherapy)
s/e
pain
swelling
soreness
flu like s/e
weight gain
diarrhea
risk for infection
Biologics (immunotherapy)
