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MRCP Master > Pharm cytotoxic > Flashcards

Pharm cytotoxic Flashcards

1
Q

Examples of Alkylating agents
1.Nitrogen mustards(3)
2. nitrosoureas (2)include
3.(1)

A
  • Cross bridges : cyclophosphamide, mechlorethamine,
    2. carmustine and lomustin
    3. Busulfan
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2
Q

MAO Alkylating agents (2)

A
  • can affect ALL phases of the cell cycle.
    2 methods:
    1. Disrupt the structure of DNA by adding an alkyl group to the guanine base= DNA fragmentation; when repairing base pairs & matched wrong = cell death
    2. Forming of cross bridges prevents DNA separation = cell death
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3
Q

Indications for Alkylating agents
Nitrogen mustards
(cyclophosphamide, mechlorethamine, and ifosfamide)

A

leukemias, solid tumours (ovarian & Breast),

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4
Q

Indications of cyclophosphamide (5)

A

causes cross linking
1. Rx Ca- leukemias, solid tumours(ovarian& Breast)

  1. Rx vasculitis-GPA, microscopic polyangiitis &polyangiitis nodosa
  2. MS

4 severe RA

  1. Refractory cases of SLE
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5
Q

SE: All Alkylating agents

A

SIADH
Development of leukaemia
hair loss,
GI disturbances,
Infertility
teratogen

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6
Q

SE: cyclophosphamide

A

Haemorrhagic cystitis- to prevent Rx: Mensa
Myelosuppression,
Transitional cell carcinoma
Bladder ca
All Alkylating agents
SIADH
Development of leukaemia
hair loss,
GI disturbances,
Infertility
teratogen

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7
Q

Indications for Busulfan
(Alkylating agents) (2)

A

RX CML

Before bone marrow transplant as a part of myeloablative conditioning (kills all cells )

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8
Q

SE Busulfan (Alkylating agents)

A

suppression of the bone marrow
pulmonary fibrosis
hyperpigmentation
CNS toxicity

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9
Q

(Alkylating agents) Nitrosoureas
include:
rx

A

carmustine and lomustin
glioblastoma multiforme crosses BBB

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10
Q

Cytotoxics: Antimetabolites
- -Effect Phase
- -Mimic

A

-Effect S Phase
-Mimic Nucleobases or folic acid = Stop DNA

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11
Q

Cytotoxics: Antimetabolites 3 subclasses

A
  • mimic purine: azathioprine and cladribine (rx harie cell leuk)
  • mimic pyrimidine: cytarabine and 5-fluorouracil.
  • Folic acid analogues -methotrexate
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12
Q

Indication azathioprine
CA 2
IBD 2
Autoimmune 3
Neuro 2

A

Inhibit purine syn
Ca: ALL & CML
IBD: UC (maintaining remission after severe replase),
Crohn’s –(add-on medication to induce remission)
Autoimmune:
Autoimmune hepatitis
SLE (3rd ln),
Polymyositis (2nd ln)

Neuro :Lambert-Eaton syndrome & Myasthenia gravis (to immunosuppress)

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13
Q

SE azathioprine
In pregnancy

A

-Bone marrow depression & Megaloblastic anemia
- Nausea/vomiting
- Pancreatitis
- Increased risk of non-melanoma skin cancer

considered safe to use in pregnancy

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14
Q

MAO Fluorouracil (5-FU)

A

Pyrimidine analogue- blocks thymidylate synthase (works during S phase)

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15
Q

SE Fluorouracil (5-FU)

A

Myelosuppression, mucositis,
dermatitis
photosensitivity
mucositis,
alopecia,
GI disturbances
CNS toxicity,
hand-foot syndrome.

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16
Q

Fluorouracil (5-FU) indications

A

Solid tumours:
- Colorectal
- pancreatic
- head & neck cancer,
- breast,
- ovarian
- bladder
- hepatocellular cancer.
- basal cell carinoma

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17
Q

Indications Methotrexate

A

leukemias, (ALL), lymphomas (NHL),
solid tumors: breast & bladder cancer
choriocarcinoma, (germ cell tumor)

unruptured ectopic pregnancy,

inflammatory conditions :RA, psoriasis, IBD, SLE , and dermatomyositis

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18
Q

SE Methotrexate:
Whic abx should not be used with

A

Myelosuppression, mucositis, liver fibrosis, lung fibrosis

The concurrent trimethoprim = bone marrow suppression and severe or fatal pancytopaenia

19
Q

MOA of methotrexate

A

Inhibits dihydrofolate reductase and thymidylate synthesis
decrease in production of DNA, RNA & proteins

20
Q

Name the 2 cytotoxic drug classes that act on microtubules- (Alkaloids)
- Drugs in the each category (2x2)
-How do their MAO’s differ

A

Vinca alkaloids
- block polymerization into protofilaments = unstable mitotic spindles (stop at metaphase)
Example vinblastine & vincristine

Taxanes alkaloids
- enhance tubulin polymerization into protofilaments and microtubules
= overstablizes the microtubules
Examples: paclitaxel and docetaxel

21
Q

Indications for Taxanes alkaloids (overstablise mt)

A

solid tumors including breast, ovarian, lung, gastroesophageal, prostate, bladder, and head & neck cancers

22
Q

Indications for Vinca alkaloids

A

Indications:
- breast ca;
- pediatric tumors (rhabdomyosarcoma, nephroblastoma, Wilms tumor)
- leukemias.
- both lymphoma.

23
Q

cytotoxic SE: microtubules- (Alkaloids)

A

alopecia, GI upset myelosuppression; vincristine is more neurotoxic
Taxanes may cause a hypersensitivity rnx

24
Q

Monoclonal antibodies
suffix “-umab” refers to

A

Only made of only human components
Least likely to induce hypersensitivity rnx

25
Q

Monoclonal antibodies
suffix “-ximab” refers to

A

both human and non-human components

26
Q

Monoclonal antibodies
suffix “-zumab” refers to

A

Humanized antibodies

27
Q

MOA cetuximab
Uses (2)

A

-epidermal growth factor receptor antagonist EGFR

used in metastatic colorectal cancer
head and neck cancer

28
Q

MAO trastuzumab/ herceptin.
Uses

A

HER2/neu receptor antagonist
used in metastatic breast cancer
gastric, ovarian, and lung ca

29
Q

SE: Trastuzumab/ herceptin

A

cardiotoxicity
GI sx fever, chills, and headache.

30
Q

MAO bevacizumab
Indications

A

which binds to VEGF, or vascular endothelial growth factors.
solid tumors in metastatic phase
Rx macular degeneration, w

31
Q

SE: bevacizumab

A

inhibition of angiogenesis in normal tissues and leads to impaired wound healing.
Bleeding (hemorrhage )

32
Q

MAO Rituximab

A

binds to CD20, an antigen found on B cell membranes = cell death through multiple mechanisms.

33
Q

Indications Rituximab

A

non-Hodgkin B cell lymphomas
CLL
RA

34
Q

SE Rituximab

A

hypersensitivity reactions

suppression of the immune system & reactivation of viruses such as JC virus= progressive multifocal leukoencephalopathy, or PML

35
Q

MAO alemtuzumab
Indication

A

binds to CD52, which is found on the membrane of all lymphocytes including B cells, T cells, and natural killer cells, as well as monocytes and dendritic cells.

CLL

36
Q

MAO Abciximab
& indication

A

-glycoprotein IIb/IIIa receptor antagonist):
- prevention of ischaemic events in patients undergoing PCI

37
Q

MAO OKT3
Indication

A

(anti-CD3): used to prevent organ rejection

38
Q

MAO Cytotoxic antibiotic Bleomycin

A

Oxidizes DNA bases = fragmented DNA
Effective in the G2 phase

39
Q

Cytotoxic antibiotic Bleomycin
SE:

A

pneumonitis–> pulmonary fibrosis.

Skin toxicity (rash, exfoliation, & hyperpigmentation

stomatitis and mucositis in the mouth,
alopecia

only causes minimal myelosuppression, which is unusual for an anticancer medication.

40
Q

Cytotoxic antibiotic Bleomycin indications

A

Hodgkin’s lymphoma
testicular cancer squamous cell carcinoma of the skin

41
Q

Cytotoxic antibiotic: Anthracyclines ”RUBICIN”
Examples MAO (3)

A

doxorubicin, daunorubicin, idarubicin, and epirubicin.
1. intercalate w/ DNA inserting themselves between base pairs = inhibiting RNA and DNA synthesis
2. inhibit topoisomerase II = DNA will overwind during replication until it tears itself apart.
3. free oxygen radicals that damage the DNA strand,

42
Q

mao Antitumor antibiotics
Examples

A

interferes with cell growth by disabling DNA replication, thus leading to cellular death
mitomycin, anthracyclines which include drugs like doxorubicin, actinomycin D, and bleomycin

43
Q

Therapeutic drug monitoring post dose

A

Digoxin- at least 6 hrs post-dose
Lithium- take 12 hrs post-dose

44
Q

Therapeutic drug monitoring pre dose

A

Phenytoin levels do not need to be monitored routinely but trough levels, immediately before dose

Ciclosporin -trough levels immediately before dose

Vancomycin Monitor PRE-DOSE (trough) levels at 36 to 48 h

Gentamicin is re-started, re- check levels before the next dose

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