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Oncology Flashcards

1
Q

What are the phases of the cell cycle?

A

Interphase - G0, G1, S, G2
M phase - mitosis and cytokinesis (w/in mitosis phase)

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2
Q

What happens in the G1 phase of the cell cycle

A

preparation for DNA replication- cell growth and protein synthesis

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3
Q

What happens in the S phase of the cell cycle?

A

DNA replication

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4
Q

What happens in the G2 phase of the cell cycle?

A

Condensation of genetic material

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5
Q

What are the four stages of mitosis?

A

Prophase
Metaphase
Anaphase
Telophase (and cytokinesis)

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6
Q

What are the three checkpoints in the cell cycle?

A

G1/S checkpoint
G2 checkpoint
M checkpoint

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7
Q

What happens at the G1/S checkpoint?

A

Decision point on whether to divide or enter G0

Checks for size, nutrients, molecular signals, DNA integrity

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8
Q

What happens at the G2 checkpoint?

A

Decision point on whether to pause in G2 and repair, or undergo apoptosis

Checks for DNA integrity and that DNA replication is complete

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9
Q

What happens at the M checkpoint?

A

Also known as spindle checkpoint

Makes sure all chromosomes are lined up in spindle and none are floating off in the cell

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10
Q

What checkpoints does p53 regulate?

A

G1 and G2

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11
Q

What activates p53 in normal cells?

A

DNA damage

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12
Q

Where in the cell cycle do antimetabolites work?

A

S phase

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13
Q

Where in the cell cycle do alkylating agents work?

A

Overall non-specific but do work in S phase

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14
Q

Where in the cell cycle do platinum agents work?

A

S phase

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15
Q

Where in the cell cycle do antitumor antibiotics work?

A

S and G2 phase

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16
Q

Where in the cell cycle do vinca alkaloids work?

A

M phase

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17
Q

Where in the cell cycle do taxanes work?

A

M phase

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18
Q

What is the MOA of antimetabolites?

A

Mimic normal purines and pyrimidines

This makes sense why they work in S phase (DNA replication)

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19
Q

What is the MOA of alkylating agents?

A

Cross-link DNA strands

This makes sense why they work in S phase (DNA replication)

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20
Q

What is the MOA of platinum agents?

A

Platinum compounds cross-link DNA strands –> Inhibits DNA synthesis

This makes sense why they work in S phase (DNA replication)

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21
Q

What is the MOA of antitumor antibiotics?

A

Inhibition of topoisomerase II –> obstruction of DNA and RNA synthesis

Multiple MOAs exist

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22
Q

What is the MOA of vinca alkaloids?

A

Mitotic spindle poisons; inhibit microtubule assembly

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23
Q

What is the MOA of taxanes?

A

Interfere with microtubule reorganization and disassembly

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24
Q

What are some examples of antimetabolite chemo drugs?

A

Methotrexante
5-FU
Azathioprine
Cytosine arabinoside (Cytosar)
Hydroxyurea

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25
What are some exaples of alylators?
Cytoxan Chlorambucil Melphalan Lomustine
26
What are examples of platinum agents?
Cisplatin Carboplatin
27
What are examples of antitumor antibiotics?
Doxorubicn Mitoxantrone Bleomycin
28
What are examples of vinca alkaloids?
Vincristine Vinblastine Vinorelbine
29
What are examples of taxanes?
Paclitaxel Docetaxel
30
What does the Gompertzian growth curve show?
Initial exponential phase of tumor growth occurs largely before tumor is clinically detectable AKA growth has slowed by the time we detect most tumors, which makes them less responsive to chemotherapy
31
Why are neutrophils most sensitive to chemotherapy?
They have shortest circulating lifespan of about 10 hours
32
What drug has a delayed double nadir?
Carboplatin First nadir at 10-14d Second nadir at 21d
33
What breeds of dogs are predisposed to alopecia with chemotherapy?
Anything with a continuously growing hair coat - poodles, Maltese, terriers, old English sheepdogs
34
What drugs cause indirect GI signs (nausea) via stimulation of the chemoreceptor trigger zone (CRTZ)?
Cisplatin Streptozotocin
35
What is a unique side effect of vincristine?
Peripheral neuropathy (ileus, neuropathy)
36
What is the MOA of Cerenia (maropitant)?
Substance P inhibitor/Neurokinin-1 inhibitor (NK-1 is where substance P acts) Central and peripherally acting
37
What is the MOA of Reglan/metoclopramide?
Centrally: dopamine (D2) antagonist, serotonin (5-HT3) antagonist in CRTZ Peripherally: dopamine (D2) antagonist, serotonin (5-HT4) agonist
38
What is the MOA of Zofran/ondansetron?
Central and peripheral serotonin (5-HT3) antagonist
39
Is Flagyl/metronidazole bacteriostatic or bacteriocidal?
Bacteriocidal
40
What classes of chemotherapy drugs should you use with caution in MDR-1 mutants?
Vinca alkaloids Antitumor antibiotics Taxanes
41
What chemotherapy are the main vesicants?
Doxorubicin Vincristine
42
How do you treat doxorubicin extravasation?
Stop infusion Draw back to remove as much drug as possible Ice pack the leg Dexrazoxane/Zenecard
43
Do you heat pack or ice pack with vincristine?
Heat pack
44
Where are vinca alkaloids metabolized?
Liver - dose reduce based on tbili
45
What is a unique side effect of taxanes?
Hypersensitivity
46
What chemotherapy drugs have cumulative myelosuppression?
CCNU Melphalan Chlorambucil
47
What is the unique side effect of cytoxan?
Sterile hemorrhagic cystitis Also nephrotoxicity
48
What metabolite is responsible for sterile hemorrhagic cystitis?
Acrolein
49
Fanconi syndrome was recently associated with what chemotherapy drug?
Chlorambucil Reinert NC, Feldman DG. Acquired Fanconi syndrome in four cats treated with chlorambucil. J Feline Med Surg. 2016 Dec;18(12):1034-1040. doi: 10.1177/1098612X15593108. Epub 2015 Jul 13. PMID: 26170278.
50
What are the unique side effects of CCNU?
Hepatotoxicity Pulmonary fibrosis (cumulative; rare in animals)
51
What drug must you ABSOLUTELY have a chemo hood for?
Mechlorethamine (Mustargen)
52
What tumor is streptozoticin sometimes used for?
Insulinoma
53
Where does streptozoticin concentrate and what might result from that?
Pancreatic Beta cells --> diabetes mellitus
54
What unique side effect is seen with cisplatin in cats?
FATAL pulmonary edema Cisplatin splats cats
55
How is carboplatin excreted?
Renal excretion
56
Cisplatin has what unique side effect?
Nephrotoxicity Also emetogenic
57
What unique side effect do we see with doxorubicin in dogs vs. cats?
Dogs - cumulative cardiotoxicity Cats - cumulative nephrotoxicity
58
What tumor type should use avoid or take caution with using doxorubicin?
MCT - causes degranulation
59
Where is doxorubicin metabolized?
Liver - reduce if tbili is elevated
60
What is the MOA of Palladia?
Tyrosine kinase inhibitor --> blocks c-kit Also works on VEGFR
61
What are potential side effects of Palladia?
Protein losing nephropathy Systemic hypertension Lameness/muscle cramping GI side effects
62
What is the MOA of Tanovea (Rabacfosadine)?
It is a prodrug (GS-9219) of the nucleotide analog 9-(2-phosphonylmethoxyethyl) guanine (PMEG) --> phosphorylated to PMEGpp which causes cytotoxicity due to inhibition of nuclear DNA polymerases
63
What are potential side effects of Palladia?
Dermatopathy Pulmonary fibrosis GI BM suppression Renal Hepatic
64
What is the MOA of L-asparaginase?
Breaks down asparagine to starve cancerous lymphocytes
65
What is the major side effect of Elspar?
Allergic reaction Rarely also pancreatitis
66
After how many doses does resistance to Elspar typically develop?
3-5 doses
67
What is Oncept and how does it work?
Bacterial plasmid melanoma vaccine Contains human DNA encoding for tyrosinase inserted into a bacterial plasmid --> tyrosinase is the rate limiting enzyme in melanin production
68
What is the MOA of bisphosphonates?
Osteclast inhibition
69
What is potential toxicity of bisphosphonates?
Renal toxicity Oral forms (aledronate): possible esophageal irritation/strictures +/- absorption issues
70
Which chemotherapy drugs can cross the BBB?
Antimetabolites - cytarabine, hydroxyurea Alkylating agents - Lomustine, carmustine, procarbazine
71
What major CD markers are on B vs. T cells in flow cytometry?
B cells - CD21, MHC class II, CD79 T cells - CD3, CD4, CD8
72
What CD marker is found on all leukocytes?
CD45
73
Is PARR or flow more sensitive for minimal residual disease?
PARR (need as little as 1 lymphocyte in 100,000)
74
What is technically the gold standard for immunophenotyping in lymphoma?
IHC
75
What immunoglobulin is most commonly produced in multiple myeloma in dogs vs. cats?
Dogs: IgG or IgA Cats: IgG
76
What are possible causes of renal disease in patients with multiple myeloma?
Bence Jones Proteinuria Tumor infiltration into renal tissue Hypercalcemia Amyloidosis Diminished perfusion secondary to HVS
77
Diagnosis of MM requires how many of the 4 criteria and what are they?
2 of 4 Monoclonal gammopathy Lytic bone lesions >20% plasma cells in bone marrow Bence Jones proteinuria (25-40% of dogs have this)
78
Why can't you determine Bence Jones proteinuria on a urine dipstick?
It's the light chains of the Ig that are found in urine
79
What is the sensitivity and specificity of BRAF?
Sensitivity 85% Specificity 99%
80
Myasthenia gravis is associated with what tumor type?
Thymoma (think myasthenia --> megaE)
81
Hypertrophic osteopathy can occur secondary to what?
Think respiratory things Pneumonia Lung tumors Pulmonary mets Also - Abdominal tumors
82
Ectopic ACTH secretion can occur (rarely) secondary to what?
Pulmonary lung tumors Uncommon
83
Dermatologic paraneoplastic syndromes are associated with what tumor types?
Feline pancreatic carcinoma Bile duct and HCC Feline lymphoma Renal caricnoma Uterine leiomyoma Thymomas
84
What proportion of hypercalcemic dogs have cancer?
2/3
85
What proportion of hypercalcemic cats have cancer?
1/3
86
What is the mechanism through which LSA/AGASACA/MM cause hypercalcemia?
Lymphoma and AGASACA - PTHrp Multiple myeloma - lysis from bony lesions
87
What is the fluid of choice when rehydrating/diuresing a patient with hypercalcemia?
0.9% NaCl b/c it doesn't contain calcium and is sodium heavy which forces renal tubules to flush out calcium
88
Are neoplastic or non-neoplastic causes more common in hypoglycemia?
Non-neoplastic
89
What tumor types are associated with paraneoplastic hypoglycemia?
Insulinoma GI leiomyoma/sarcoma HCC Less common: Renal adenocarcinoma Lymphoma Mammary carcinoma
90
What tumor types are associated with hyperviscosity syndrome?
Think in terms of mechanism: Globulins: Multiple myeloma Erythrocytes: Polycythemia vera WBCs: CLL --> secondary due to monoclonal gammopathy

ACVIM Generals (16 decks)

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