Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharm III > Flood Chapter 42 > Flashcards

Flood Chapter 42 Flashcards

1
Q

A broad range of chemicals (drugs) aimed at treating cancer by eradicating malignant cells anywhere in the body are referred to as

A

Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Effectiveness of chemotherapy requires that there be complete destruction (total cell kill) of all cancer cells because?

A

a single surviving cell with the ability to divide can give rise to sufficient progeny to ultimately kill the host.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Harnessing our intrinsic immune surveillance system has become more and more a part of contemporary investigations of cancer and its treatment because?

A

The role of the immune system in identifying and eliminating foreign tumor cells has gained increasing recognition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The use of several chemotherapeutic drugs (also called antineoplastic drugs) concurrently or in a planned sequence is commonly done in efforts to?

A

eradicate even small residual tumor cell populations that have survived treatment with a single or previous agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the characteristics of drugs used in combination chemotherapy regimens

A

Use the largest tolerated doses of each chemotherapeutic drug

Drugs that work via different mechanisms

Drugs that do not share similar toxic effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the advantage of using combination chemo agents with different MOA

A

Using a combination of agents that have different mechanisms decreases the chances that drug-resistant tumor cell populations will emerge.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Chemotherapeutic drugs used in combination are usually administered over short periods at specific treatment intervals rather than as continuous therapy. This is because?

A

Empiric observation that normal cells usually recover more rapidly from a pulse of maximal chemotherapy than do malignant cells.

Immunosuppression is less profound with intermittent administration of chemotherapy.

Even if all cells in a tumor are sensitive to a drug, a single dose of the drug is not usually sufficient to kill the typically hundreds of millions of cells that are present in patients with cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

With rare exceptions, the optimal dose of chemotherapeutic drugs requires repetitive dosing because?

A

Even if all cells in a tumor are sensitive to a drug, a single dose of the drug is not usually sufficient to kill the typically hundreds of millions of cells that are present in patients with cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Malignant cells are often characterized by?

A

rapid division and synthesis of DNA.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Most conventional chemotherapeutic drugs exert their antineoplastic effects on cells that are?

A

actively undergoing division (mitosis) or DNA synthesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What affects how drugs are scheduled and combined for maximal effect.

A

The biology of the cancer under treatment

Cell cycle specificity of agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which cancers are slow-growing malignant cells with a slow rate of division, and often unresponsive or at best partially responsive to conventional chemotherapy.

A

carcinoma of the lung and colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What cells are more vulnerable to the toxic effects of chemotherapeutic drugs.

A

Rapidly dividing normal cells like the cells found in the;

bone marrow
gastrointestinal mucosa
skin, and hair follicles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Clinical manifestations of toxicity caused by chemotherapeutic drugs represent activity at normal rapidly dividing cells and often include?

A 
myelosuppression (leukopenia, thrombocytopenia, or anemia), 
nausea
vomiting
diarrhea
mucosal ulceration 
dermatitis and 
alopecia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

The most common toxicity that leads to temporary or permanent withdrawal of chemotherapy is?

A

Myelosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The dose-limiting factor for many chemotherapeutic drugs is?

A

Myelosuppression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Drug-induced myelosuppression is usually irreversible. True/False?

A

is usually reversible with discontinuation of the chemotherapeutic agent.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Resistance to chemotherapeutic drugs often occurs and has many causes, these include?

A

Induction of drug-metabolizing enzymes in the liver, other tissues, or tumor cells, accelerating drug conversion to nontoxic metabolites.

Many solid tumors grow so rapidly that portions of the tumor are poorly vascularized, preventing therapeutic concentrations from reaching many target cells.

In poorly perfused areas of some tumors, cells remain resistant to chemotherapeutic drugs because of relative hypoxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hypoxia causes resistance to both _______ and ___________

A

radiation

most chemotherapeutic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What cancer is or susceptible to resistance due to hypoxia

A

malignancies susceptible to treatment with the mitomycins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Side effects of cyclophosphamide ?

A

Hypersensitivity
Fibrosis Pneumonitis
Pericarditis, pericardial effusion =possible tamponade
N/V
Hemorrhagic Cystitis ( so if you see dysuria and hematuria d/c the drug)
Inappropriate secretion of arginine vasopressin (possible water intoxication)
Extravasation DOES NOT produce thrombophlebitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Are patients with history of of chemo-induced nausea and vomiting prone to PONV ?

A

Not necessarily.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What antiemetics regimen have facilitated tolerance of emetogenic chemotherapeutic drugs ?

A

Serotonin antagonists (5HT3 antagonists ) as effective antiemetic

In addition to combination antiemetic has facilitated tolerance of emetogenic chemo drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

The most commonly used Nitrogen Mustards are ? MMCC*

A

Mechlorethemine
Melphalan
Cyclophosphamide
Chlorambucil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Mechlotheramine, what are the characteristics of this drugs ?

A

Rapid acting
Given IV to minimize local tissue irritation
Intensely powerful vesicant
Gloves must be worn
Can localize effect of this drug by injecting it in the arteries that supply the target tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Total Dose of Mechlotermine ? Think Etomidate

A

0.4 mg/kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

why are tumors in poorly perfused area resistant to chemo?

A

Because of relative hypoxia,

Hypoxia = resistance time chemo and radiation ; except malignancies susceptible syndrome to treatment with mitomycins.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are Toiposomerases?

A

Enzymes that regulate over winding or underlining of DNA during replication and are the targets for many chemotherapeutic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does resistance to alkylating drugs occur ?

A

Her expression of drug neutralizing substances and metabolizing proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How are chemotherapeutic drugs classified?

A

According to their mechanism of action

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Dorriety appropriate lab test in the preop for patients receiving chemotherapy?

A

Hemoglobin, platelet count, white blood cell count, coagulation profile, arterial blood gases, blood glucose, plus my electrolytes, liver and renal function test, EKG, and chest x-ray.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does the presence of mucositis affect care of the patient?

A

It makes placement of pharyngeal airway, laryngeal mask airway, and esophageal catheters questionable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Can you expect in a patient with a history of severe vomiting or diarrhea?

A

Electrolyte disturbances and decrease intravascular fluid volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How can chemotherapeutic drugs affect succinylcholine?

A

If the chemo drug decreases plasma cholinesterase activity it may prolong the effect of succinylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the definition of therapeutic index?

A

Did those that causes toxicity divided by the minimum effective dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Is the standard definition of therapeutic index useful in the use of chemotherapeutic drugs?

A

No it is not useful, as these agents all produce significant, even life-threatening toxicity I dosage which may not reach levels that are high enough to eradicate cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Do chemotherapeutic drugs possess a narrow therapeutic index?

A

Because they typically target proteins or nucleus acid which are common to both malignant and non -malignant cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is the dosage go for chemotherapeutic drugs?

A

Maximum tolerated doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Patients who have a history of chemotherapy induced nausea and vomiting are not necessarily prone to postoperative nausea and vomiting. True or false?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Patients who have a history of tolerating him out to Jen and chemotherapy regimen’s are likely to develop postoperative nausea and vomiting. True or false?

A

False. If they are usually able to tolerate him out to Jenny chemotherapy regimen’s they are unlikely to develop post op Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What class of anti-emetic has been developed to facilitate the tolerance of chemotherapeutic drugs.

A

Serotonin antagonist as effective anti-medics in addition to combination anti-medic regimens has facilitated the tolerance of ematogenic chemotherapeutic drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are the chemotherapeutic drugs that damage DNA and what are they associated with?

A

Alkylating drugs, topoisemerases, and they are associated with secondary malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What type of tissues are more susceptible to the side to toxic effects of certain chemotherapy drugs and why?

A

Hi leave for the fruit of tissues they undergo rapid Mitosis. Mucositis, diarrhea, myelosuppression,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the alkylating agents?

A

Nitrogen mustard
Alkyl sulfonates
nitrosoureas
triazines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

How do alkylating agents out there DNA?

A

1) They form covalent I’ll kill bonds with nucleic acid bases = Result in enter strand DNA cross links
2) DNA cross links are toxic to cells undergoing division
3) By altering the structure of DNA, the drugs inhibit DNA replication and transcription.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Why are alkylating chemotherapeutic drugs more likely to kill malignant cells and non-malignant cells?

A

Because the DNA damage they produce is more likely To affect the cells with the greater proliferation rate and cancer cells have rates of proliferation greater than non-cancerous cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the most important those limiting factor in the clinical use of alkylating drugs?

A

Bone marrow suppression also called Mayla suppression is the most important those limiting factor in the clinical use of alkylating drugs especially busulfan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which calculating drugs produces the most bone marrow suppression?

A

Busulfan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Alkylating agents stop mitosis in how long?

A

6 to 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Alkylating drugs cause lymphocytopenia in how long

A

In 24 hours

51
Q

Depression of platelet and erythrocyte count , hemolytic anemia is predictably present with alkylating drugs . True or False?

A

True

52
Q

Treatment with alkylating drugs is off in associated with gonadal dysfunction including

A

Oligospermia and Amenorrhea

53
Q

Why do alkylating drugs cause hemorrhagic cystitis ?

A

Because of irritation caused by the acrolein metabolite of cyclophosphamide or ifosfamide

54
Q

My thought is a rest, cellular hypertrophy, and desquamation of the epithelium are manifestations of

A

The effects of alkylating drugs on the gastrointestinal Mucosa

55
Q

All alkylating drugs are powerful central nervous system stimulants manifesting most often as…

A

Nausea and vomiting

Skeletal muscle weakness and seizures maybe present

56
Q

A common side effect of alkylating drugs is…

A

Alopecia due to damage to hair follicles

57
Q

A frequent side effect of alkylating drugs is…

A

Increased skin pigmentation

58
Q

Potential adverse effects of alkylating drugs is…

A

Nidus and Pulmonary fibrosis. Symptomatic patients may demonstrate a Decreased Pulmonary Diffusing Capacity

59
Q

Describe the relationship between prolongation of succinylcholine and alkylating drugs

A

Alkylating drugs in Hibbett plasma cholinesterase Activity for as long as 2 to 3 weeks after administration and can lead to prolong skeletal muscle paralysis after administration of succinylcholine

60
Q

How do I alkylating drug produce uric acid induce nephropathy?

A

Alkylating drugs rapidly destroy malignant cells in produce increase purine and pyrimidine breakdown leading to uric acid induced nephropathy.

61
Q

What are the three methods to minimize the likelihood of uric acid induced nephropathy in patients receiving alkylating drugs?

A

1) Adequate fluid intake
2) Alkalinization of the urine.
3) Allepurinol before drug treatment

62
Q

What are the most commonly used Nitrogen Mustards?

A

1) Mechlorethamine
2) Cyclophosphamide
3) Melphalan
4) Chlorambucil

63
Q

Why is Mechorethamine administered IV?

A

To minimize local tissue irritation

64
Q

What are the characteristics of Mechorethamine ?

A

1) Rapidly acting nitrogen mustard
2) Must be freshly prepared before each administration
3) Intensely powerful vesicant requiring the gloves be worn
4) Undergoes chemical transformation that is so rapid that the active drug is no longer present after a few minutes

65
Q

What is the total dose of Mechlorethamine?

A

0.4 mg/kg

66
Q

That’s an advantage of the rapid chemical transformation of Mechlorethamine ?

A

It’s possible to prevent tissue toxicity from the drunk by isolating the blood supply to get tissue

67
Q

Possible to localize the action of Mechlorethamine?

A

Theoretically , yes .

By injecting to drug into the arterial blood supply of the specific tissue being targeted

68
Q

What diseases is Mechorethamine used for?

A

Hodgkin’s disease and other lymphomas

69
Q

What is MOPP regimen?

A

Combination chemotherapy drug Mechlorethamine + Vincristine + procarbazene , and prednisone.
MOPP regimen

70
Q

Are the major side effects of Mechorethamine?

A

Nausea, vomiting, and Myelosuppression.

71
Q

What are those limiting factors of mechlorethamine ?

A

Leukopenia

Thrombocytopenia

72
Q

Is the skin lesion frequently associated with Nitrogen Mustards therapy

A

Herpes zoster.

Nathan viral infections maybe unmasked by treatment with mechlorethemine

73
Q

Is a potential complication of Mechloretamine ?

A

Trumbo phlebitis, extravasation resulting in severe local tissue reactions with brawny and tender induration that may persist for long periods

74
Q

Describe the conversion of cyclophosphamide to acrolein

A

Cyclophosphamide to aldophosphamide in the liver.
Target cells convert aldophosphamide to highly cytotoxic metabolites : Phosphoramide and acrolein
Phosphoramide and acrolein then alkylate DNA.

Cyclo> Aldo> Phosphoramide & Acrolein = alkylate DNA

75
Q

Cyclophosphamide is effective in the treatment of what type of diseases.

A

Wide range of cancers and inflammatory diseases.

76
Q

Favorable responses have been shown with cyclophosphamide in what diseases

A

Hodgkin’s disease
lymphosarcoma
Burkett lymphoma
acute lymphoblastic leukemia of childhood

77
Q

Cyclophosphamide is frequently used in combination with—— and ———- As a juvenile therapy after surgery for breast cancer when there is involvement of the axillary nodes

A

Methotrexate and Fluorouracil

78
Q

What properties of cyclophosphamide leads to its use in nonneoplastic disorders

A

potent immunosuppressive properties

Therefore used in nonneoplastic plastic disorders associated with altered immune reactivity . Ex: Wegener granulomatosis and rheumatoid arthritis

79
Q

What has been noted in patients receiving cyclophosphamide with an incidence less than 1%? How long to these effects for?

A

Hypersensitivity reaction and fibrosis Pneumonitis .

Incidence is less 1%

Symptoms develop months to years after initiation of the drug

80
Q

Large doses of cyclophosphamide are associated with

A

with incidence of pericarditis and pericardial effusion and even cardiac tamponade .

81
Q

2 weeks after last dose of cyclophosphamide, smaller number of patients may develop …

A

Hemorrhagic myocarditis with symptoms of CHF

82
Q

How does Cyclophosphamide differ from other Nitrogen Mustards ?

A

Significant degrees of thrombocytopenia less common in cyclophosphamide

But Alopecia is more common .

83
Q

How are side effects of Cyclophosphamide and other Nitrogen Mustards similar ?

A

Nausea and Vomiting occur with equal frequency

84
Q

What are 3 POSSIBLE side effects of Cyclophosphamide?

A

Mucosal Ulcerations
Increased Skin pigmentation
Hepatotoxicity

85
Q

5% to 10 % of patients on cyclophosphamide experience _____reflecting chemical irritation produced by its reactive metabolites .

A

Sterile Hemorrhagic cystitis .

86
Q

What are the indications to discontinue cyclophosphamide?

A

Dysuria and Hematuria

87
Q

What happens with dosages > 50 mg/kg of cyclophosphamide ?

A

Inappropriate secretion of arginine vasopressin hormone .

Lots of antidiuretic hormone , water intoxication can happen especially that these patients are usually kept hydrated to prevent hemorrhagic cystitis .

88
Q

A first sign of toxicity concern for a patient taking Bleomycin

A

Cough

89
Q

Rescue technique for patients taking methotrexate

A

Thymidine and Folate

90
Q

Alarming side effect in Doxorubicin

A

Red urine

91
Q

Least Vinca to cause myelosupression

A

Vincristine

92
Q

2% cardiomyopathy , fatal approx 3 weeks after onset of symptoms in 60%

A

Topisomerase Inhibotors

93
Q

What drugs don’t cause Nausea

A

Look it up

94
Q

What is the first line drug for panic disorder and OCD ?

A

SSRIs

95
Q

What is Venlafaxine ?

A

Dual serotonin and Norepinepherine Resp take blockade

96
Q

What is Mirtazapine ?

A

Alpha and ….

97
Q

Compare TCA to SSRI

A

SSRI = no anticholinergic
No Postural hypotension
No major effects on seizure threshold
No cardiac impulses elongation

  • relatively low complications when overdose except : Venlafaxine
98
Q

Which SSRI has the least safety profile in overdose ?

A

Venlafaxine bc it is similar to to TCA when it comes to overdose associated risk of proconvulsant and cardiac side effects .

99
Q

What are the effects of abrupt discontinuation if SSRI with short elimination half times? What what are those meds?

A

Paroxetine, Venlafaxine

Dizziness, paresthesias , myalgia, irritability , insomnia , visual disturbances .

100
Q

What is the black box warning with newer antidepressants , primarily SSRIs?

A

Suicidal tendencies in children and adolescents

101
Q

Do SSRIs have antiplatelet activity ?

A

Yes .

102
Q

What is serotonin syndrome ?

A

Anxiety
Chills
Ataxia
Insomnia

103
Q

What drugs does Fluoxetine potentiates what drug ?

A

Beta Blockers bc it is the most potent inhibitor if the same P450 enzyme that metabolizes Beta Blockers

104
Q

Most important advantage of of SSRIs compared with TCA?

A

Relatively safe when taken in overdose .

105
Q

Side effects of TCA occur most commonly manifesting as

A

Anticholinergic effects
CV effects
CNS effects

106
Q

Imipramine normal plasma level is

A

225ng/mL or less

107
Q

Desipramine normal plasma level

A

225ng/mL

108
Q

Nortiptyline normal plasma level

A

50 to 150 ng/mL

109
Q

Mechanism of action of SSRIs

A

They don’t know but they are guessing that it Prevents reuptake of serotonin

110
Q

What is the TCA mechanism of action

A

Act at several transporters and receptors, but antidepressant effects is likely produced by blocking reuptake of serotonin and/or norepinephrine at the PRESYNAPATIC terminal

111
Q

Onset of TCA is

A

2- 3 weeks

112
Q

What is the therapeutic window of TCA

A

100 to 300 ng/mL

113
Q

TCA plasma level > 500 ng/mL

A

.

114
Q

Metabolism of TCA is by what method

A

Both Oxidation and Conjugation

115
Q

What is the metabolism of Doxepin ?

A

Demethylation into an active metabolite nordoxepin

116
Q

Atropine is a useful treatment in TCA with slow AV or intraventricular conduction cardiac impulses

A

True.

117
Q

Amitryptiline and doxepin produce the greatest

A

Degree of sedation

118
Q

Imipramine metabolism is by what ?

A

.

119
Q

What Is chronic TCA therapy length .

A

> 6 weeks

120
Q

Most common and most serious S/E of MAOIs ?

A

Orthostatic hypotension

121
Q

MAOI A is found where ?

A

Platelets and human Brain

122
Q

MAOI B is found where ?

A

Placenta

123
Q

MAOIs Anesthesia Management

A

.

Pharm III (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions