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Meds Flashcards

1
Q

Selective estrogen receptor modulators

A

Tamoxifen & raloxifene

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2
Q

What does metformin do to decrease breast cancer?

A

Inhibits tumor cell growth and proliferation through adenosine mono phosphate (AMP) kinase activation

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3
Q

How does finasteride lower the incidence of prostate cancer?

A

It lowers PSA levels and shrinks normal prostate tissue

(But this leads to higher incidence of high grade prostate cancer)

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4
Q

COX-2 inhibitors

A

Inhibit cyclooxygenase enzymes that are involved in the synthesis of proinflammatory prostaglandins

(May prevent colon and breast cancer)

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5
Q

Which chemos especially can damage sperm and germ cells and affect the ovaries?

A

Alkylating agents

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6
Q

What can decrease the production of sperm?

A

Hormone therapy

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7
Q

XELOX

A

Capecitabine + 5-FU

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8
Q

What do Biphosphonates do?

A

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

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9
Q

What cell cycle phase do taxanes work in?

A

M phase to inhibit microtubules necessary for division

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10
Q

What cancers are taxanes used for?

A

Breast, lung, myelomas, lymphomas, leukemias

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11
Q

What dose limiting side effect can taxanes have?

A

Peripheral nerve damage

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12
Q

What cell cycle phase do vinca alkaloids work in?

A

Predominantly M phase, they are cytotoxic to microtubules and cell cycle arrest in metaphase

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13
Q

What side effects occur from vinca alkaloids?

A

Myelosuppression, peripheral neuropathy, N/V

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14
Q

What cell cycle phase do epipodophyllotoxins work in?

A

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

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15
Q

Which drugs are epipodophyllotoxins?

A

Etoposide, teniposide, camptothecan, topotecan

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16
Q

What side effects occur from epipodophyllotoxins?

A

Diarrhea and neutropenia

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17
Q

What is Sipuleucel-T vaccine use to treat?

A

Metastatic prostate cancer (need to be asymptomatic, have node or bone Mets, and testosterone level <50)

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18
Q

What does cytokine immunotherapy do?

A

Stimulate the growth of T cells to enhance the immune response

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19
Q

What are side effects of interferons?

A

Flu-like symptoms, fatigue, anorexia, neuropsychiatric symptoms, electrolyte disturbance

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20
Q

-omab

A

Murine : mouse

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21
Q

-ximab

A

Chimeric : human and mouse

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22
Q

-zumab

A

Humanized - predominantly human

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23
Q

-umab

A

Human only

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24
Q

Trastuzumab target and side effects?

A

Antigen targeted HER2

Damage the heart —> chest pain, cough, dyspnea, fluid retention, dizziness, fainting

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25
Rituximab targets?
Antigen targeted CD20, which is found on B cells
26
Bevacizumab targets?
Antigen targeted VEGF, which affects angiogenesis
27
Proteasome inhibitors
Bortezomib and carfilzomib Stop the proteasome from breaking down the proteins that normally would cause the cell to die Apoptosis inducers
28
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
29
-tinib
Tyrosine kinase inhibitors that target EGRF & VEGF
30
What is erlotinib used for?
Advanced NSCLC and advanced pancreatic cancer
31
What is sunitinib used for?
Advanced renal cell carcinoma and GIST tumors
32
What is ponatinib used for?
CML
33
What is imatinib used for?
Philadelphia chromosome positive CML
34
What is dasatinib used for?
Philadelphia chromosome positive CML
35
What is ibrutinib used for?
Mantle cell lymphoma, CML, Waldenstrom’s macroglobulinemia
36
-nib
Kinase inhibitors target RAF/RAS/MET pathway Sorafenib, dabrafenib, trametinib, vemurafenib
37
-lisib
P13K inhibitors The P13K pathway reviles cell survival and proliferation
38
-gib
Hedgehog pathway - embryonic development (brain and spinal cord development) E.g. sonidegib for locally advanced basal cell carcinoma
39
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
40
What are the side effect of anti-angiogenesis agents?
Hypertension, bleeding and bruising, clotting dysfunction manifested as thrombotic events
41
What cancers are hormone therapy approved for?
Breast and prostate
42
What are tamoxifen and fulvestrant?
Antiestrogens
43
What are anastrazole and exemestane?
Aromatase inhibitors
44
What are biclutamide and flutamide?
Antiandrogens
45
What are goserelin and leuprolide?
Luteinizing hormone releasing hormone (LHRH) agonist
46
What cancers are alkylating agents used for?
Leukemia, lymphoma, Hodgkin’s, multiple myeloma, sarcoma, lung, breast, ovary
47
What do alkylating agents do?
Interfere with DNA replication, RNA transcription, nucleic acid function
48
What long term damage can alkylating agents cause?
Damage to bone marrow leading to acute leukemia 5-10yrs after treatment Fertility risk
49
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
50
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
51
What type of drugs are 5-FU, 6-MP, capecitabine, cladribine, clofarabine, cytarabine, fluxuridine, fludarabine, gemcitabine, hydroxyurea, MTX, pemetrexed, pentostatin, thioguanine?
Antimetabolites
52
What do anti tumor antibiotics (AKA anthracyclines) do?
Interfere with enzymes involved in DNA synthesis
53
What is a lifetime dose limiting effect of anthracyclines?
Permanent cardiac damage
54
What type of drug are daunorubicin, doxorubicin, epirubicin, idarubicin, valrubicin?
Anthracyclines
55
What are the 3 subtypes of plant alkaloids?
Vinca alkaloids, epipodophyllotoxins, taxanes
56
What do glucocorticoids do?
Modify transcription and protein synthesis, reversal of capillary permeability and inhibit glucose transport and phosphorylation to induce cell death
57
What can glucocorticoids be used for?
To kill cancer cells To treat N/V, hypersensitivity reactions, SVC syndrome, SCC
58
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
59
What does Melphalan have a high incidence of causing?
Mucositis
60
What drug(s) are linked to hemorrhagic cystitis?
Cyclophosphamide and ifosfamide
61
What is the mechanism of action of tyrosine kinase inhibitors?
They bind to tyrosine kinase in EGFR inhibiting EGFR activation
62
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
63
What are the most common chemo agents to cause mucositis?
Busulfan, capecitabine, cyclophosphamide, doxil, 5-FU, mechlorethamine
64
What side effect is most frequent with cisplatin?
Acute N/V
65
What meds have a high (>90%) ematogenic potential?
Cisplatin, combo of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >\= 1500mg/m^2, dacarbazine, procarbazine
66
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
67
What drugs should be used for breakthrough emesis?
Corticosteroids, haloperidol, metoclopramide, scopolamine
68
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)
69
What drugs should be used for delayed emesis?
Neuroleptics (prochlorperazine, chlorpromazine), Motility agents (metoclopramide), Substance P antagonist (aprepitant)
70
What drugs should be used for anticipatory emesis?
Benzodiazepines (diazepam, lorazepam)
71
Which drugs cause constipation?
Vinca alkaloids, biological response modifiers (thalidomide, lethalidomide), small molecule inhibitors (bortezomib), opioids, Antinausea meds (5-HT3 antag, benzodiazepines)
72
What meds should be given for chemo-induced diarrhea?
Loperamide High dose loperamide if irinotecan Somatostatin of refractory to loperamide LIKELY to work: octreotide
73
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
74
What drugs are most often associated with Hand-Foot syndrome?
Taxanes, antiangogenic, topoisomerase inhibitors
75
What is the management of Acneiform rash?
Topical or oral steroids, topical or oral antibacterial, alcohol free moisturizers BID
76
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
77
Which drugs are most often associated with peripheral neuropathy?
Platinums (Cisplatin and oxaliplatin) Taxanes Vinca alkaloids Proteasome inhibitors
78
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
79
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
80
What is an uncommon adverse event in patient receiving biphosphonates?
Osteonecrosis of the jaw
81
What is denosumab used for?
Prevention of skeletal-related events in patients with bone mets from solid tumors
82
What meds can stimulate appetite?
Megesterol, steroids, dronabinol
83
Which chemos have a high (>90%) emetogenic potential?
Cisplatin, combination of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >\=1500mg/m^2, dacarbazine, procarbazine

OCN Review (8 decks)

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