L17 Pharmacology: Anti-Cancer Drugs

Question 1

Which anticancer drug class is the most cardiotoxic?

Answer 1

Anthracyclines

Question 2

alkylating agents

Answer 2

same MOA: but differ greatly in PK, lipid solubility, chemical reactivity and properties of membrane transport

• nitrogen mustards: cyclophosphamide, ifosfamide
• platinum analogues: carboplatin, cisplatin

Question 3

does the different alkylating agent classes show cross-resistance?

Answer 3

no!

Question 4

platinum analogues with hypersensitivity toxicities

Answer 4

carboplatin, oxaliplatin

Question 5

platinium analogue with most nephrotoxicity

Answer 5

cisplatin

Question 6

less cardiotoxic anthracycline/analogue

Answer 6

mitoxantrone, liposomal doxorubicin

Question 7

cardiac protectant

Answer 7

dexrazoxane

Question 8

oxaliplatin is only stable in

Answer 8

D5W, not NS

Question 9

How to premedicate cholinergic syndorme induced by irinotecan?

Answer 9

IV/SC atropine 0.25-1mg

Question 10

riskfactors for anthracycline-induced cardiotoxicity

Answer 10

1. cumulative dose, 2. adm schedule (high peaks), 3. age (v young/old), 4. mediastinal radiation, 5. known cardiac disease

Question 11

max dose of vincristine

Answer 11

2mg weekly, else may cause peripheral neuropathy

Question 12

which anticancer drug result in constipatioN?

Answer 12

vincristine: ileus

Question 13

premedication for paclitaxel

Answer 13

prevention of hypersensitivity

- H1/2-blocker, corticosteroids

Question 14

exception for paclitaxel, does not require pre med

Answer 14

albumin stabilised nanoparticle version (Abraxane)

Question 15

premedication for docetaxel

Answer 15

prevention of edema, caused by incr capillary permeability
- dexamethasone starting on the day before chemo, min 3 doses (continuing for 2 additional days) to recuce incidence and severity of fluid retention

Question 16

tamoxifen is indicated for

Answer 16

treatment of estrogen-pos breast cancer

Question 17

tamoxifen MOA

Answer 17

inhibit nuclear binding of estrogen receptor, block estrogen stimulating breast cancer cells

Question 18

are delayed anticancer drug toxicities reversible?

Answer 18

occurs months to years after treatment, may be irreversible

Question 19

prevention/mgmt of neurotoxicity caused by ifosfamide

Answer 19

• avoid use in elderly/renal dysfunction
• prolong infusion time
• avoid concomittant use with cns active drugs
• discont or decrease dose at onset of sx
• methylene blue (inhibit MAO metabolism to chloroactealdeyhde)

Question 20

is topoisomerase I inhibitor MOA irreversible?

Answer 20

no, reversible - substrate of cleavable complexes

Question 21

is topoisomerase II inhibitor MOA irreversible?

Answer 21

yes, covalent complexes formed