Jose Chemo Drugs Flashcards
What are the categories of Alkylating Agents?
MEAT - NP…P
Nitrogen Mustards Ethyleneimines Alkyl Sulfonates Triazenes Nitrosureas (-mustine's) Methylhydrazine
Platinums are similiar
What is the MOA of Alkylating Agents?
Covalent DNA binding
Crosslinking Guanine Bases
DNA unable to uncoil, separate and replicate
What is the cell cycle specificity of Alkylating Agents?
CCNS
What are the Nitrogen Mustard drugs?
C-MIC likes Mustard
Cyclophosphamide
Ifosfamide
Melphalan
Chlorambucil
What disease processes is Cyclophosphamide/Ifosfamide used to treat?
ALL ALL CANCERS CLL HAVE Hodgkins NO Non-Hodgkins MERCY Multi-My NO NBT WINNING Wilms STORIES STS
What are the major toxicities related to Cyclophosphamide?
Cardiotoxicity,
Most common toxicity: hemorrhagic cystitis (can be prevented with hydration)
” the dirty C’s”
What are the major toxicities related to Ifosfamide?
Severe urinary tract and neuro toxicity (sz, coma AMS, cerebral ataxia)
What is the cell cycle specificity of Cyclophosphamide?
CCNS
What is the cell cycle specificity of Ifosfamide?
CCNS
What is the cell cycle specificity of Melphalan?
CCNS
What disease is Melphalan used to treat?
Multi-My
Mel-Mul-My
What is the cell cycle specificity of Chlorambucil?
CCNS
What diseases is Chlorambucil used to treat?
CLL, macroglobulinemia (a form of Non-Hodgkins)
“CLL is in the name…ChLorambuciL”
chloRAMBUcil…Rambo is Macro
What are the Ethyleneimine drugs?
Thiotepa
EThyleneimine = thioTEpa
What is the cell cycle specificity of Thiotepa?
CCNS
What are the major toxicities of Thiotepa?
CNS
“C Thio makes me NervouS”
What are the Alkyl Sulfonate Drugs?
Busulfan
Anti-lock Breaking System
What is the cell cycle specificity of Busulfan?
CCNS
What diseases is Busulfan used to treat?
CML (chronic myelogenous leukemia), Transplantation (bone marrow)
“use the BUS for TRANSporTATION if you Cant Move Legs”
What are the major toxicities related to Busulfan?
Skin pigmentation, pulmonary fibrosis, and adrenal insuffficiency
“sing SAPpy songs on the BUS”
What are the Nitrosurea drugs?
Streptozocin
Carmustine
Lomustine
“mustines”
“CARSMUST LOve nitroS”
What is the cell cycle specificity of Carmustine?
CCNS
What is the cell cycle specificity of Lomustine?
CCNS
What disease is Carmustine used to treat?
Hodgkins, Non-Hodgkins, Glioblastoma
the CAR-MUST BLAST-hOMe
What are the major toxicities related to Carmustine?
Pulmonary fibrosis, renal failure and secondary leukemia
“People Require Speed”
What diseases is Streptozocin used to treat?
ONLY for malignant pancreatic insulinoma, malignant carcinoid
I got STREPT throat from CARCIN’s PANCakes
What are the Triazene drugs?
Dacarbazine
Temozolomide
“Tri Taking Drugs”
What is the cell cycle specificity of Dacarbazine?
CCNS
What diseases is Dacarbazine used to treat?
Mal-Mel, Hodgkins, STS,
“DA CARBz Make My Hip Swell”
What is the MOA of Dacarbazine?
Methylates DNA, inhibits synthesis…requires activation by the liver.
“DA METH INHIBITS the LIVER”
What are the major toxicities related to Dacarbazine?
CNS toxicity with neuropathy and lethargy
Flu-like symptoms
“DA CARBz (think of diabetes-hypo/hyper glycemia) make my nerves toxic, arms numb, tired, feels like the flu
What are the Platinum drugs?
-PLATIN’s
Cisplatin, Carboplatin, Oxaliplatin
What diseases is Cisplatin used to treat?
CHOLANGIOCARCINOMA
NSCLC, SCLC, testicular, bladder, ovarian, esophageal, lung, head and neck, colon, breast Ca.
“Latins love the genitals, breast and colon”
What is the MOA of Cisplatin?
Forms intra- and inter-strand DNA cross-links; binding to nuclear and cytoplasmic proteins
What are the major toxicities of Cisplatin?
PN, Nephrotoxicity (hydration and diuresis is important), ototoxicity
” PLATINs Never Pay OTO”
Which drugs can cross the BBB?
Nitrosureas (Carmustine, Lomustine and Streptozocin)
Triazene: Temozolodmide
Can be used to treat brain tumors
Major Toxicities of Alkylating Agents?
Leukemogeneneic (causes leukemia; less common with Cyclophosphamide)
Mucosal Toxicity
Infertility
Neurotoxicity
Myelosuppression: Nadir of granulocytes 6-10 days and recovery taking 14-21 days.
What is the toxic effect of Streptozocin?
Renal Failure
STReptozocin = “Stops The Renals”
What diseases are treated with Temozolomide?
Malignant glioma and astrocytoma
“Try and grab my GAT”
What cell cycle specificity is Temozolomide?
CCNS
What is unique about Temozolomide?
Crosses BBB
Oral administration allows 100% bioavailability
What are the major toxicities related to Temozolomide?
Same as Dacarbazine…CNS toxicity with neuropathy and lethargy
Flu-like symptoms
What is the MOA of Procarbazine
It is an orally active methylhydrazine (differs from Dacarbazine b/c does not require activation by the liver)…Methylates DNA and inhibits DNA synthesis and function.
Cell cycle is unknown!
What diseases are treated with Procarbazine?
Hodgkins and Non-Hodgkins, and brain tumors
“proCARbazINE same as CARmustINE…CAR-MUST BLAST-OMA”
What are the toxicities related to Procarbazine?
CNS depression
May provoke HTN b/c blocks metabolism of catecholamines and sympathomimetics
Avoid alcohol due to disulfiram like reactions
Risk of Leukemia
Infertility
DO NOT GIVE WITH OTHER CNS DEPRESSANTS
What secondary effects of Platinum drugs are important to monitor for?
Platinum drugs are mutagenic, teratogenic and carcinogenic…Ovarian cancer patients treated with platinum drugs have 4x greater risk of developing leukemia.
What is the cell cycle specificity of Antimetabolites?
CCS - S phase
Antimetabolites end in S
What are the categories of Antimetabolites?
Folic Acid Analogues
Pyrimidine Analogues
Purine Analogues
Cytidine Analogues
ANTI-ANAL
What drugs are Folic Acid Analogues
Methotrexate (MTX)
Pemetrexed
ACID METH & Pot
What drugs are Pyrimidine Analogues?
Fluorouracil (5-FU)
What is the cell cycle specificity of 5-FU?
CCS - S phase
What is the cell cycle specificity of Gemcitabine?
CCS - S phase
Cytidine Analog
What diseases are treated with 5-FU?
Metastatic Colon Ca, gastroesophageal (UGI), breast, HEPATOCELLULAR cancer.
What is the MOA of 5-FU?
Inhibits TS; incorporation of FUTP into RNA resulting in alteration in RNA processing; incorporation of FdUTP into DNA resulting in inhibition of DNA synthesis and function.
What diseases are treated with MTX?
ALL; CHORIOCARCINOMA, OSTEOGENIC SARCOMA
breast, head, neck and lung cancers, primary CNS lymphoma, non-Hodgkin’s, bladder cancer.
What is the MOA of MTX?
Inhibits DHFR; inhibits TS; inhibits de novo purine nucleotide synthesis
What toxicities are associated with MTX?
SPONTANEOUS HEMORRHAGE: platelet dysfunction. SEVERE INFECTION
TERATOGENESIS: congenital malformation. MTX is a folate inhibitor and lack of folic acid causes neural tube defects in fetus.
NEUROTOXICITY: encephalopathy
What toxicities are associated with 5-FU?
Neurotoxicity: remember the picture
SEVERE GI TOXICITIES: INCLUDING SHOCK AND DEATH
Anorexia, Stomatitis and GI ulcers: makes sense b/c 5FU treats gastroesophageal Ca…some people stop taking because GI effects are too harsh.