Millikan 25 drugs

Question 1

Cisplatin

Answer 1

non-classical alkylator (N7 of guanosine), germ cell tumor, bladder cancer; CN VIII nerve, long sensory nerves

Question 2

Carboplatin

Answer 2

Non-classical alkylator (N7 guanosine), epithelial malignancies, second-line of lymphoma

Question 3

Cyclophosphamide

Answer 3

Alkylator (nitrogen mustard), Breast cancer, lymphomas, immunosuppression, stem cell mobilization, very cytotoxic. ACROLEIN causing bladder hemorrhage, 5q-. MESNa

Question 4

Doxorubicin

Answer 4

Topoisomerase II inhibitor, Breast cancer, lymphoma- CARDIAC TOXICITY, mitigated by prolonged infusion schedules and iron chelators; DLT: stomatitis and myelosuppression

Question 5

5-FU

Answer 5

anti-metabolite pyrimidine analog (suicide inhibitor of thymidine synthase), GI cancers, AE: hand foot syndrome, actinic recall, Reversal: URIDINE TRIACETATE for reversal

Question 6

Ibrutinib

Answer 6

TKI (Bruton’s Tyrosine Kinase) covalently modifying ATP binding site, CLL. Inhibited by C481S (SH–> OH)

Question 7

Imatinib

Answer 7

TKI; CML, GIST, Ph+ ALL; AE: muscle cramps, asthenia, edema, fragile skin. Resistance: CYP3A4, Loss of p53, transport, overexpression of BCR-ABL1, T315I mutation

Question 8

Leuprolide

Answer 8

Receptor super-agonist (LHRH/GnRH analogs), prostate, breast cancer; AE: iatrogenic osteoporosis, worsening resistance and affective disorders

Question 9

Nivolumab

Answer 9

Immune checkpoint inhibitor (Blocks PD-1), Melanoma, Lung cancer, Renal cell carcinoma. AE: colitis, rash, thyroid

Question 10

Paclitaxel

Answer 10

Anti-tubulin (stabilizes conformation), Epithelial malignancies (breast and ovarian), NEUROPATHY

Question 11

Rituximab

Answer 11

Immune therapy, Anti-CD20, B-cell malignancies; Induces ADCC and Complement-dependent cytotoxicity

Question 12

Tamoxifen

Answer 12

Receptor antagonist (Selective estrogen receptor modulator), Breast cancer; Will stimulate ER of bone/uterus

Question 13

Trastuzumab

Answer 13

Receptor antagonist, Her-2 over-expressing breast and upper GI cancers. Built from an antibody conjugated with highly toxic anti-tubule drug

Question 14

Anastrozole

Answer 14

Ligand reduction (Aromatase inhibitor), Breast cancer; AE= arthralgia and myalgia

Question 15

Bendamustine

Answer 15

Nitrogen mustard, lymphomas, AE: prolonged neutropenia

Question 16

Bortezomib

Answer 16

Proteasome inhibitor (26S, a threonine protease), multiple myeloma, mantle cell lymphoma, Waldenström’s; DLT: fatigue, neuropathy, myelosuppression

Question 17

Crizotinib

Answer 17

TKI, lung cancers with ALK or ROS1 activation, C-Met overexpression

Question 18

Cytarabine arabinoside

Answer 18

Purine analog antimetabolite, AML, second-line lymphoma, Intrathecal, rapidly cleared to Ara-U

Question 19

Enzalutamide

Answer 19

Androgen Receptor antagonist, Prostate

Question 20

Etoposide

Answer 20

Topo II inhibitor, germ cell tumors, lymphoma; AE: acute leukemia that is rapidly fatal 2-3 yr latency

Question 21

Gemcitabine

Answer 21

antimetabolite, pyrimidine analog, pancrease cancer, bladder cancer, second-line setting; Rarely causes alopecia

Question 22

Methotrexate

Answer 22

Antimetabolite (anti-folate), many cancers, DO NOT GIVE IN PLEURAL EFFUSION OR ASCITES, leuvocorin, DLT= mucositis. Can be given in RA and psoriasis

Question 23

Panitumumab

Answer 23

Receptor antagonist (EGFR), EGFR driven cancers of aerodigestive tract; fewer infusion reactions than cetuximab. Only works with WT Ras/Raf

Question 24

Pazopanib

Answer 24

TKI, renal cell carcinoma

Question 25

Temazolamide

Answer 25

non-classical alkylator, Brain cancers, CHECK MGMT FIRST, MMR+, MGMT-

Question 26

Cladribine

Answer 26

Purine analog; Harry Cell leukemia

Question 27

Irinotecan

Answer 27

Topoisomerase I inhibitor; Pro-drug (SN38 is active, which can be inhibited by gut flora); DLT: diarrhea