Meds Flashcards
Selective estrogen receptor modulators
Tamoxifen & raloxifene
What does metformin do to decrease breast cancer?
Inhibits tumor cell growth and proliferation through adenosine mono phosphate (AMP) kinase activation
How does finasteride lower the incidence of prostate cancer?
It lowers PSA levels and shrinks normal prostate tissue
(But this leads to higher incidence of high grade prostate cancer)
COX-2 inhibitors
Inhibit cyclooxygenase enzymes that are involved in the synthesis of proinflammatory prostaglandins
(May prevent colon and breast cancer)
Which chemos especially can damage sperm and germ cells and affect the ovaries?
Alkylating agents
What can decrease the production of sperm?
Hormone therapy
XELOX
Capecitabine + 5-FU
What do Biphosphonates do?
Reduce bone fractures in patients with metastatic disease to bone
Bind to crystals in the bone and inhibit the resorption of it, as well as induce osteoclastic apoptosis
Ex: Risedronate
Alendronate
Ibandronate
Zoledronic Acid
Pamidronate
Etidronate
What cell cycle phase do taxanes work in?
M phase to inhibit microtubules necessary for division
What cancers are taxanes used for?
Breast, lung, myelomas, lymphomas, leukemias
What dose limiting side effect can taxanes have?
Peripheral nerve damage
What cell cycle phase do vinca alkaloids work in?
Predominantly M phase, they are cytotoxic to microtubules and cell cycle arrest in metaphase
What side effects occur from vinca alkaloids?
Myelosuppression, peripheral neuropathy, N/V
What cell cycle phase do epipodophyllotoxins work in?
Late S and G2 phases, they form a complex with topoisomerase and DNA resulting in the inhibition and function of the topoisomerase enzyme that is require for DNA synthesis
Which drugs are epipodophyllotoxins?
Etoposide, teniposide, camptothecan, topotecan
What side effects occur from epipodophyllotoxins?
Diarrhea and neutropenia
What is Sipuleucel-T vaccine use to treat?
Metastatic prostate cancer (need to be asymptomatic, have node or bone Mets, and testosterone level <50)
What does cytokine immunotherapy do?
Stimulate the growth of T cells to enhance the immune response
What are side effects of interferons?
Flu-like symptoms, fatigue, anorexia, neuropsychiatric symptoms, electrolyte disturbance
-omab
Murine : mouse
-ximab
Chimeric : human and mouse
-zumab
Humanized - predominantly human
-umab
Human only
Trastuzumab target and side effects?
Antigen targeted HER2
Damage the heart —> chest pain, cough, dyspnea, fluid retention, dizziness, fainting
Rituximab targets?
Antigen targeted CD20, which is found on B cells
Bevacizumab targets?
Antigen targeted VEGF, which affects angiogenesis
Proteasome inhibitors
Bortezomib and carfilzomib
Stop the proteasome from breaking down the proteins that normally would cause the cell to die
Apoptosis inducers
Angiogenesis inhibitors examples
Bevacizumab (binds to VEGF)
Sorafenib and sunitinib bind to receptors in the surface of endothelial cells or to other proteins in the downstream signaling pathway
-tinib
Tyrosine kinase inhibitors that target EGRF & VEGF
What is erlotinib used for?
Advanced NSCLC and advanced pancreatic cancer
What is sunitinib used for?
Advanced renal cell carcinoma and GIST tumors
What is ponatinib used for?
CML
What is imatinib used for?
Philadelphia chromosome positive CML
What is dasatinib used for?
Philadelphia chromosome positive CML
What is ibrutinib used for?
Mantle cell lymphoma, CML, Waldenstrom’s macroglobulinemia
-nib
Kinase inhibitors target RAF/RAS/MET pathway
Sorafenib, dabrafenib, trametinib, vemurafenib
-lisib
P13K inhibitors
The P13K pathway reviles cell survival and proliferation
-gib
Hedgehog pathway - embryonic development (brain and spinal cord development)
E.g. sonidegib for locally advanced basal cell carcinoma
Which meds in particular have skin reactions?
EGFR inhibitors
Skin Toxicity Evaluation Protocol with Panitumumab trial in 2010 highlighted importance of preemptive therapy with EGFR inhibitors
What are the side effect of anti-angiogenesis agents?
Hypertension, bleeding and bruising, clotting dysfunction manifested as thrombotic events
What cancers are hormone therapy approved for?
Breast and prostate
What are tamoxifen and fulvestrant?
Antiestrogens
What are anastrazole and exemestane?
Aromatase inhibitors
What are biclutamide and flutamide?
Antiandrogens
What are goserelin and leuprolide?
Luteinizing hormone releasing hormone (LHRH) agonist
What cancers are alkylating agents used for?
Leukemia, lymphoma, Hodgkin’s, multiple myeloma, sarcoma, lung, breast, ovary
What do alkylating agents do?
Interfere with DNA replication, RNA transcription, nucleic acid function
What long term damage can alkylating agents cause?
Damage to bone marrow leading to acute leukemia 5-10yrs after treatment
Fertility risk
What drugs are alkylating agents?
Non-platins:
nitrogen mustards: mexhlorethanine, chlorambucil, cyclophosphamide, ifosfamide, melohalan
Nitrosoureas: streptozocin, carmustin (BCNU), lomustine
Alkyl sulfonates: busulfan
Triazines: dacarbazine and temozolomide
Ethylenimines: thioptepa, altretamine,
Platinum analogs: carboplatin, cisplatin, oxaliplatin
What do antimetabolites do?
Inhibit protein synthesis, substitute erroneous substances needed for DNA/RNA replication, and inhibit DNA synthesis
Damage cells during the S phase
What type of drugs are 5-FU, 6-MP, capecitabine, cladribine, clofarabine, cytarabine, fluxuridine, fludarabine, gemcitabine, hydroxyurea, MTX, pemetrexed, pentostatin, thioguanine?
Antimetabolites
What do anti tumor antibiotics (AKA anthracyclines) do?
Interfere with enzymes involved in DNA synthesis
What is a lifetime dose limiting effect of anthracyclines?
Permanent cardiac damage
What type of drug are daunorubicin, doxorubicin, epirubicin, idarubicin, valrubicin?
Anthracyclines
What are the 3 subtypes of plant alkaloids?
Vinca alkaloids, epipodophyllotoxins, taxanes
What do glucocorticoids do?
Modify transcription and protein synthesis, reversal of capillary permeability and inhibit glucose transport and phosphorylation to induce cell death
What can glucocorticoids be used for?
To kill cancer cells
To treat N/V, hypersensitivity reactions, SVC syndrome, SCC
What are interferons mechanism of action?
They are a type of cytokine
They enhance cytotoxicity, enhance phagocytic activity and inhibit viral replication. I.e. they directly target cancer cells by slowing growth and encouraging normal cell behavior
What does Melphalan have a high incidence of causing?
Mucositis
What drug(s) are linked to hemorrhagic cystitis?
Cyclophosphamide and ifosfamide
What is the mechanism of action of tyrosine kinase inhibitors?
They bind to tyrosine kinase in EGFR inhibiting EGFR activation
Erythropoietin, darbopoetin MOA and side effects
moa: stimulate stems cells to develop into RBCs
Side effects: HTN, increased risk of VTE (particularly in MM), diarrhea, fluid retention
Weeks for results
Black box warning: chemo induced anemia only
What are the most common chemo agents to cause mucositis?
Busulfan, capecitabine, cyclophosphamide, doxil, 5-FU, mechlorethamine
What side effect is most frequent with cisplatin?
Acute N/V
What meds have a high (>90%) ematogenic potential?
Cisplatin, combo of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >= 1500mg/m^2, dacarbazine, procarbazine
What meds have a medium (30-90%) emetogenic potential?
Arsenic trioxide, carboplatin, PO cyclophosphamide, cyclophosphamide<1500mg/m^2, cytarabine >1g/m^2, daunorubicin, doxorubicin, epirubicin, PO etoposide, idarubicin, ifosfamide, irinotecan, oxaliplatin, temozolamide
What drugs should be used for breakthrough emesis?
Corticosteroids, haloperidol, metoclopramide, scopolamine
What drugs should be used for acute emesis?
Antihistamines (promethazine, diphenhydramine, hydroxyzine), steroids (prednisone, dex), 5-HT3 antagonists (ondansetron, gransetron PO only, sancusco patch, palonsetron)
What drugs should be used for delayed emesis?
Neuroleptics (prochlorperazine, chlorpromazine), Motility agents (metoclopramide), Substance P antagonist (aprepitant)
What drugs should be used for anticipatory emesis?
Benzodiazepines (diazepam, lorazepam)
Which drugs cause constipation?
Vinca alkaloids, biological response modifiers (thalidomide, lethalidomide), small molecule inhibitors (bortezomib), opioids, Antinausea meds (5-HT3 antag, benzodiazepines)
What meds should be given for chemo-induced diarrhea?
Loperamide
High dose loperamide if irinotecan
Somatostatin of refractory to loperamide
LIKELY to work: octreotide
What meds should be given for radiation-induced diarrhea?
Oral opiates (loperamide and diphenoxylate)
LIKELY to work: probiotics, psyllium fiber, octreotide if grade 2 or 3
What drugs are most often associated with Hand-Foot syndrome?
Taxanes, antiangogenic, topoisomerase inhibitors
What is the management of Acneiform rash?
Topical or oral steroids, topical or oral antibacterial, alcohol free moisturizers BID
What drugs are given to manage pruritis?
Topical mod to potent steroids or topical antipruritics with menthol and PO antipruritics
PO antipruritics and PO corticosteroids, PO gabapentin pregabalin with or without phototherapy
Which drugs are most often associated with peripheral neuropathy?
Platinums (Cisplatin and oxaliplatin)
Taxanes
Vinca alkaloids
Proteasome inhibitors
What are the symptoms of peripheral neuropathy in cisplatin?
Lhermitte’s sign (lightning-like sensation) in neck, down the legs and back with flexion of the neck, recovery up to 2 years
What are the symptoms of peripheral neuropathy in oxaliplatin?
Pharyngo-laryngitis-dysthesia that is aggravated by cold, dysthesias if hands and feet, feeling of jaw tightening, feeling of loss of breath
80% will experience, 40% recover in 6-8months
What is an uncommon adverse event in patient receiving biphosphonates?
Osteonecrosis of the jaw
What is denosumab used for?
Prevention of skeletal-related events in patients with bone mets from solid tumors
What meds can stimulate appetite?
Megesterol, steroids, dronabinol
Which chemos have a high (>90%) emetogenic potential?
Cisplatin, combination of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >=1500mg/m^2, dacarbazine, procarbazine
