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Pharm Exam 3 > Neoplasm 1 > Flashcards

Neoplasm 1 Flashcards

1
Q

Carcinoma

A

begins in the skin or in tissues that line or cover internal organs.

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2
Q

Sarcoma

A

begins in bone, cartilage, fat, muscle, blood vessels, or other connective/supportive tissue.

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3
Q

Leukemia

A

starts in blood-forming tissue (bone marrow); causes large numbers of abnormal blood cells to be produced and enter the blood.

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4
Q

Lymphoma and multiple myeloma

A

begin in the cells of the immune system.

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5
Q

What is the MC type of CA in the US?

A

Skin

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6
Q

What is the MC CA to cause death in the US?

A

Lungs

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7
Q

Lung CA can be classified into?

A

small cell lung cancer or non-small cell lung cancer

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8
Q

What causes colorectal CA to arise?

A

Adenomatous polyps

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9
Q

Where do malignancies occur in breast CA?

A

Arises from malignant transformation of the epithelial cells lining the ducts and lobules of the breast

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10
Q

Problems that arise w/ use of chemotherapeutic drugs?

A

Emergence of resistant organisms and cells
Adverse effects they can cause to the host

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11
Q

Which areas of the body are susceptible to SE caused by chemotherapeutic drugs?

A

common side effects in hematological, GI, integumentary systems

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12
Q

How are cytotoxic meds prescribed?

A

Protocols:
Dosing by body surface area
Dosing in cycles
Grouping similar cytotoxic agents together in categories
Understanding of the cell kill theory to determine treatment length

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13
Q

What is used to calculate dosing of cytotoxic drugs and why?

A

BSA - its less affected by adipose mass than weight; therefore a better indicator of the patient’s metabolic mass

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14
Q

What are cytotoxic cycles?

A

Ways to administer cytotoxic meds in cycles. Some are given over a short period of time, others over several hrs. Cycles are given every 1, 2, 3, or 4 wks.

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15
Q

What is cell kill theory?

A

Proposes that a set percentage of cells are killed with each dose of chemotherapy
When only a few cancer cells remain, it is hoped that the body’s immune response system will take over and kill the final few cells

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16
Q

What are the phases of the cell cycle?

A

Phase I: Resting Phase (G-O)
Phase II: Post-mitotic Phase (G-1)
Phase III: Synthesis (S)
Phase IV: Premitotic Phase (G-2)
Phase V: Mitosis (M)

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17
Q

Why does CA occur in cells?

A

Cancer cells enter the cell cycle independently of the body’s feedback system
Deregulation of cell-cycle control proteins plays a key role in the development of cancer

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18
Q

Cell cycle time

A

the amount of time required for a cell to move from one mitotic phase or cell division to another

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19
Q

Growth fraction

A

refers to the percentage of cells actively dividing at a given point in time

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20
Q

Tumors with a greater fraction of cells in G-0 are more sensitive to which type of agents?

A

cycle-nonspecific agents

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21
Q

A higher growth fraction causes what?

A

more cancer cells to be killed when they are exposed to cell cycle-specific drugs

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22
Q

Tumor burden

A

the number of cancer cells present in the tumor

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23
Q

Cancers to small tumor burden are more sensitive to what?

A

cytotoxic therapy because they have a high number of cells reproducing

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24
Q

Cell cycle–specific (CCS) drugs

A

agents that exert their cytotoxic activity during a particular phase of cell division cycle

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25
Q

Cell cycle non-specific (CCNS) drugs

A

agents that have cytotoxic activity unrelated to the cell cycle

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26
Q

Examples of cell cycle specific drugs?

A

DNA synthesis inhibitors and mitotic inhibitors

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27
Q

Examples of cell cycle non-specific drugs

A

Alkylating agents and DNA intercalating agents

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28
Q

In which cases will cell cycle-specific drugs NOT work?

A

Cell cycle–specific agents are not active against cells in the resting state (G-0)

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29
Q

Alkylating Agents MOA

A

Interfere with DNA replication to prevent cells from reproducing

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30
Q

What is the most severe SE that Alkylating Agents can cause?

A

acute bone marrow suppression and they are leukemogenic (causing leukemia)

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31
Q

Are Alkylating Agents specific or not?

A

Non-specific

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32
Q

Alkylating Agents use

A

Chronic leukemia
Non-Hodgkin’s lymphoma
Hodgkin’s lymphoma
Multiple myeloma
Some cancers of the lung, breast, and ovary

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33
Q

Which chemo agent helps empty bone marrow prior to bone marrow transplant to allow new cells to engraft?

A

Alkylating Agents - cyclophosphamide

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34
Q

What is the MC Alkylating Agents used?

A

clophosphamide

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35
Q

What kind of agent is Cyclophosphamide & Ifosafamide?

A

Alkylating Agents

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36
Q

Cyclophosphamide & Ifosafamide SE

A

Hemorrhagic cystitis
Bone marrow depression

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37
Q

What can lower the chance of hemorrhagic cystitis d/t Cyclophosphamide & Ifosafamide?

A

IV injection of Mesna (sodium 2-mercaptothane sulfonate) inactivates the toxic compounds and can minimize hemorrhagic cystitis

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38
Q

How can Cyclophosphamide & Ifosafamide be taken?

A

Orally

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39
Q

What kind of agent is Busulfan?

A

Alkylating Agents

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40
Q

Busulfan SE

A

Dose limiting myelosuppression
Pulmonary fibrosis

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41
Q

When using Busulfan, what should be monitored?

A

Baseline, and routine pulmonary function tests (PFTs) are required

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42
Q

What type of drugs are Platinum compounds (cisplatin, carboplatin and oxaliplatin)?

A

Alkylating Agents

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43
Q

Platinum compounds (cisplatin, carboplatin and oxaliplatin) SE

A

Severe, persistent vomiting
Nephrotoxicity

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44
Q

How long can emesis last after cisplatin administration?

A

Occurs 1 hour after administration of cisplatin and may continue for as long as 5 days (pretreat w/ Zofran)

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45
Q

Antimetabolites MOA

A

Interfere with DNA and RNA formation - inhibit the normal use of a metabolite by cells

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46
Q

What are antimetabolites used to tx?

A

Used to treat leukemias as well as tumors of the breast, ovary, and the GI tract

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47
Q

Which phase do antimetabolites work in?

A

Cell cycle specific; act in the S phase of the cell cycle

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48
Q

What drug class is Folate analogue (methotrexate) part of?

A

Antimetabolites

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49
Q

Folate analogue (methotrexate) MOA

A

Acts as an antagonist of folate by inhibiting dihydrofolate reductase and reduces DNA, RNA, and protein synthesis

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50
Q

Folate analogue (methotrexate) use

A

Acute leukemia’s
Non-Hodgkins
Rheumatoid arthritis

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51
Q

Folate antagonists (methotrexate) SE

A

Bone marrow toxicities
Mucositis
Hepatotoxicity

52
Q

What can be administered to prevent Folate antagonists (methotrexate) SE?

A

leucovorin - usually started 24 hrs after MTX to let the drug do its work

53
Q

Which drugs decrease the elimination of MTX?

A

Cisplatin, probenecid and NSAIDs decrease elimination leading to toxicity

54
Q

Which drug class is 6-Mercaptopurine (6-MP) in?

A

Antimetabolite

55
Q

When is 6-Mercaptopurine (6-MP) given?

A

Given with methotrexate to maintain remission of acute lymphoblastic leukemia (ALL)

56
Q

6-Mercaptopurine (6-MP) SE

A

Myelosuppression
Hepatotoxicity
Increased rate of other cancers

57
Q

What drug class is Cytarabine in?

A

Antimetabolites

58
Q

When is Cytarabine used?

A

Used in leukemias

59
Q

Cytarabine SE

A

Allergic conjuntivitis

60
Q

Cytarabine SE

A

Allergic conjunctivitis

61
Q

Allergic conjunctivitis caused by Cytarabine can be tx with?

A

Dexamethasone eye drops are required

62
Q

What drug is closely related to cytarabine and is used as a 1st line to tx pancreatic CA?

A

Gemcitabine

63
Q

What class is 5-Fluorouracil (5-FU) in?

A

Antimetabolites

64
Q

What is 5-Fluorouracil (5-FU) used for?

A

BCC + Slow growing solid tumors (colorectal, breast, ovarian, pancreatic, gastric carcinomas)

65
Q

5-Fluorouracil (5-FU) SE

A

Severe ulceration of the oral and GI mucosa

66
Q

Which drug can minimize 5-FU toxicity?

A

Leucovorin can be given to minimize toxicity

67
Q

Antitumor Antibiotics MOA

A

Interfere with DNA by stopping enzymes needed for cell division or by altering the membranes that surround cells

68
Q

Antitumor Abx are cycle nonspecific, what is the one exeption?

A

Bleomycin

69
Q

Antitumor Antibiotics toxicities

A

cardiovascular systems, pulmonary

70
Q

Anthracycline abx can cause what type of toxicity?

A

The anthracycline antibiotics are toxic to the heart, leading to cardiomyopathy

71
Q

What class are Doxorubicin, Daunorubicin, and Idarubicin in?

A

Antitumor abx

72
Q

When are Doxorubicin, Daunorubicin, and Idarubicin used?

A

Used in the ABVD regimen for Hodgkins disease

73
Q

Doxorubicin, Daunorubicin, and Idarubicin SE

A

Irreversible, dose dependent cardiotoxicity

74
Q

What can be given w/ Doxorubicin, Daunorubicin, and Idarubicin to prevent cardiotoxicity?

A

Dexrazoxane was developed to protect the heart

75
Q

Doxorubicin black box

A

Cardiomyopathy, secondary malignancy, etc.

76
Q

Bleomycin drug class?

A

Antitumor abx

77
Q

When is Bleomycin used?

A

Testicular cancer and a part of ABVD regimen for Hodgkins lymphomas

78
Q

Bleomycin SE

A

Pulmonary toxicity

79
Q

Bleomycin black box warning

A

Pulm fibrosis from toxicity

80
Q

Vinca Alkaloids MOA

A

Inhibit tubulin

81
Q

Which phase of the cell cycle do Vinca Alkaloids act in?

A

M phase

82
Q

Vinblastine, Vincristine, and Vinorelbine drug class

A

Vinca Alkaloids

83
Q

Vinblastine, Vincristine, and Vinorelbine SE

A

Dose limiting neurotoxicity – foot drop syndrome
Vinorelbine causes pain at the sight of the tumor

84
Q

Vinca Alkaloids use

A

Vinblastine is administered with bleomycin and cisplatin for the treatment of metastatic testicular cancer
(leukemia and lymphoma)

85
Q

Paclitaxel and Docetaxel drug class

A

Taxane

86
Q

Paclitaxel and Docetaxel MOA

A

Stop the microtubules from breaking down - Cancer cells become so clogged with microtubules that they cannot grow and divide

87
Q

Paclitaxel and Docetaxel SE

A

Serious hypersensitivity
Dose limiting neutropenia

88
Q

Paclitaxel and Docetaxel use

A

Advanced ovarian cancer, breast cancer
Also used for other cancers (AIDS-related Kaposi’s sarcoma and lung cancer)

89
Q

Paclitaxel black box

A

Anaphylaxis can occur

90
Q

Biological Response Modifiers MOA

A

Stimulate the patient’s immune system to protect the body from foreign substances such as tumor cells

91
Q

Tumor necrosis factor (TNF):

A

natural substance produced by many cells in response to the presence of tumor cells and infectious agents

92
Q

Monoclonal antibodies

A

agents that are able to target specific antigens

93
Q

Rituximab is in what drug class?

A

Monoclonal antibodies

94
Q

Rituximab black box

A

Fatal infusion rxn

95
Q

Bevacizumab is in what drug class?

A

Monoclonal antibody

96
Q

Bevacizumab MOA

A

Antibody to vascular endothelial growth factor (VEGF) which cuts off blood supply to the tumor (angiogenesis inhibitor)

97
Q

When is Bevacizumab used?

A

First line for colorectal cancer, non-small cell lung cancer, breast cancer

98
Q

Bevacizumab black box

A

Can cause hemorrhage - GI perforations, surgery healing issues, etc.

99
Q

Cytokines

A

naturally occurring substances secreted by immune system cells

100
Q

Interferons

A

proteins produced by the body in response to biological agents such as viruses and tumor cells

101
Q

Interleukins

A

regulatory substances produced by lymphocytes and monocytes

102
Q

Colony-stimulating factors (CSF):

A

naturally occurring proteins that regulate the growth and development of blood cells

103
Q

What does G-CSF (granulocyte colony-stimulating factor) do?

A

G-CSF (granulocyte colony-stimulating factor) increases the number of granulocytes or neutrophils, WBCs that are vital to fighting infection

104
Q

Erythropoietin

A

naturally produced by the kidneys in response to decreased RBC production or hypoxia

105
Q

Vaccine therapy

A

based on the idea that tumor-associated antigens are on the cell surface of tumors not found on normal cells

106
Q

Gene therapy

A

technique in which new genetic material is inserted into a patient’s cell to correct an inborn genetic error or to introduce a new biological function to the cell

107
Q

What drug class is Tamoxifen in?

A

Selective estrogen receptor modulator

108
Q

When is Tamoxifen used?

A

prevention of breast cancer in high-risk patients and breast CA

109
Q

Tamoxifen SE

A

Hot flashes, fluid retention, vaginal bleeding and discharge, thromboembolism
Can cause endometrial cancer

110
Q

Raloxifene is better than Tamoxifen because?

A

lower risk of uterine cancer and thromboembolism

111
Q

Raloxifene drug class

A

SERM

112
Q

Fulvestrant drug class

A

Pure estrogen-receptor antagonist

113
Q

Advantages of Fulvestrant?

A

No endometrial cancer risk and low thromboembolism risk

114
Q

Anastrazole and Letrozole drug class

A

Aromatase inhibitors

115
Q

Anastrazole and Letrozole use

A

breast CA in postmenopause

116
Q

Anastrazole and Letrozole SE

A

Increased risk of fx

117
Q

Do Anastrazole and Letrozole have any increased risk of endometrial CA or thromboembolism?

A

No

118
Q

Flutamide, Bicalutamide and Nilutamide drug class

A

Androgen receptor blockers

119
Q

Flutamide, Bicalutamide and Nilutamide use

A

prostate CA

120
Q

Flutamide, Bicalutamide and Nilutamide SE

A

gynecomastia and liver injury (black box)

121
Q

Luteinizing hormone–releasing hormone agonists

A

Cause stimulation of the LHRH receptor that results in decreased output of luteinizing hormone (LH) by the anterior pituitary

122
Q

leuprolide and Goserelin drug class

A

Luteinizing hormone–releasing hormone agonists

123
Q

How do steroids work in CA therapy?

A

Glucocorticoids (prednisone, dexamethasone): suppress mitosis in lymphocytes

124
Q

Progestins use

A

used in breast and endometrial cancer
Also used to stimulate appetite in cachectic patients

125
Q

Dexrazoxane and Amifostine are used for what?

A

Chemoprotective agents

Pharm Exam 3 (7 decks)

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