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Derm > Pharm: Drugs for skin cancer > Flashcards

Pharm: Drugs for skin cancer Flashcards

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Dermatology Board Prep flashcards
1
Q

Which conventional chemo drugs are used for basal cell carinoma?

A

Cisplatin, cyclophosphamide (others not on focus list)

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2
Q

Which targeted drugs are used for BCC?

A

Imiquimod, vismodegib

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3
Q

Which drugs are used for squamous cell carcinoma?

A

Cisplatin

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4
Q

Which conventional chemo drugs are used for melanoma?

A

Carmustine, dacarbazine, dactinomycin (others not on focus list)

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5
Q

Which non-conventional chemo drugs are used for melanoma?

A

Immunotherapy: aldesleukin, interferon, ipilimumab
Targeted: sorafenib, trametinib, vemurafenib

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6
Q

Which drugs are used for actinic keratosis?

A

Conventional: fluorouracil (not on focus list)

Non-conventional: imiquimod, trichloroacetic acid (and diclofenac, but not on focus list)

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7
Q

Which drugs can be applied topically for BCC?

A

Imiquimod, (fluorouracil not on focus list)

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8
Q

Which pathway is involved with BCC?

A

Hedgehog pathway (HH, PTCH, SMO, GLI)

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9
Q

Imiquimod pregnancy category?

A

Cat. C

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10
Q

Vismodegib pregnancy category?

A

Cat. D

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11
Q

Imiquimod MOA

A

Big picture: activates immune response.

Activates TLR 7 and 8, blocks adenosine receptor, activates NF-κB (upregulates TNF, ILs)

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12
Q

Imiquimod adverse effects

A

Local irriation (to inactive ingredients: paraben, benzyl alcohol), photosensitivity (avoid direct sunlight), may compromise birth control (condom, diaphragm) when used to treat HPV

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13
Q

Imiquimod indications

A

BCC, actinic keratosis, HPV

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14
Q

Imiquimod administration

A

Topical

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15
Q

Vismodegib MOA

A

Directly inhibits SMO

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16
Q

Vismodegib administration

A

Oral

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17
Q

Vismodegib distribution

A

Includes semen (hence male mediated teratogenicity)

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18
Q

Vismodegib metabolism, excretion

A

Hepatic: extensive metabolism (it’s a lipophilic molecule)

Excreted in bile

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19
Q

Vismodegib adverse effects

A

Due to blocking SMO:
Severe birth defects
Male-mediated teratogenicity
Intrauterine fetal death

Other:
Alopecia (most common AE)
GI: N/V/D
Wt loss
Fatigue
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20
Q

What must a woman taking vismodegib do?

A

Be on the most effective birth control possible, and continue for at least 7 months after drug therapy has stopped

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21
Q

What must you tell a man taking vismodegib?

A

Inform him about male-mediated teratogenicity

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22
Q

What is the primary treatment for SCC?

A

Surgery (with or without radiation)

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23
Q

What drugs can be used for SCC?

A

No standard regimen, but cisplatin appears to be most effective

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24
Q

What are the advantages/disadvantages of using conventional chemo drugs for melanoma?

A

Poor response rate, better side-effect profile

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25
Q

What are the advantages/disadvantages of using immunotherapy drugs for melanoma?

A

Better response rate, bad side effect profile

26
Q

What are the immunotherapy drugs that can be used for melanoma?

A

Aldesleukin, interferon, ipilimumab

27
Q

Aldesleukin MOA

A

Binds to IL-2 receptor: prolif. and differentiation of macrophages, monocytes, T & B cells, NK cells

28
Q

Aldesleukin adverse effects

A

Capillary leak syndrome (due to activation of NK cells)
CV: vasodilation, hypotension, sinus tachycardia, supraventricular arrhythmias
CNS: Diminished mental status, speech difficulties, limb/gait ataxia, cortical blindness, hallucinations, agitation
Pulmonary: cough, dyspnea, rales, rhonchi
Renal: renal failure due to capillary leak syndrome
Liver: hepatic failure (due to cap. leak syndrome)

29
Q

Aldesleukin contraindications:

A

CNS, cardiac, pulm, renal, hepatic disease.

Organ transplant recipient (will cause rejection)

30
Q

Who can recieve aldesleukin therapy?

A

Only stable patients: very bad side effect profile.

31
Q

What should you monitor with aldesleukin therapy?

A

Baseline organ function tests, daily CXR

32
Q

Interferon MOA

A

Acts like endogenous interferon: binds to IFNAR, signals through JAK/STAT pathway, leads to transcription of >300 genes

33
Q

Interferon Administration

A

IV or SC

34
Q

Aldesleukin administration

A

IV or SC

35
Q

Interferon adverse effects

A

Most common: flu, flu-like illness
Worsening of preexisting infection, blood toxicity, alopecia, elevated LFTs. Pulmonary: cough/dyspnea, pulm. infiltrates, pneumonitis, pneumonia

36
Q

Interfereon BBW

A

Autoimmune disease, cardiac disease, depression

37
Q

What do you have to monitor with interferon?

A

CBC, CXR, LFTs, EKG

38
Q

Ipilimumab MOA

A

Big picture: leads to cytotoxic T cell activation.

Anti-CTLA4 mAb: binds to CTLA4, prevents it from interacting with B7 (aka CD80/86); so, it inhibits an inhibitor of T cell activation.

39
Q

Ipilimumab Admin

A

IV

40
Q

Ipilimumab adverse effects

A

Most common: fatigue, diarrhea, itching, dermatitis (range from mild to toxic epidermal necrolysis

41
Q

Ipilimumab BBWs

A

Very many

42
Q

Sorafenib MOA

A

Multi-TKI (inhibits VEGF-R, PDGFR, KIT, Raf kinase)

43
Q

Sorafenib administration

A

Oral

44
Q

Sorafenib metabolism

A

Hepatic (causes LFTs)

45
Q

Sorafenib Adverse effects

A

Most common: rash/desquamation (can be severe), anemia, hand/foot syndrome.
Other: Hepatic dysfunction (due to hepatic metabolism)
Rare: hemorrhage (inhibition of VEGF-R) in GI, respiratory and CNS reported

46
Q

How effective is sorafenib in the treatment of melanoma?

A

Combined with dacarbazine, it increases progression-free survival, but not overall survival

47
Q

Sorafenib pregnancy category?

A

Cat. D

48
Q

What is the recommended regimen for sorafenib?

A

Dacarbazine IV on day 1

Daily sorafenib PO x 21 days

49
Q

Trametinib MOA

A

Reversible MEK inhibitor (requires genetic testing of tumor)

50
Q

Who can’t use trametinib?

A

People with previous anti-BRAF treatment

51
Q

Trametinib admin

A

oral

52
Q

Trametinib adverse effects

A

Most common: elevated LFTs, dermatitis, erythema, hand/foot syndrome, diarrhea.
Other: GI: stomatitis, anemia, decreased LVEF, HTN, hemorrhage.
Rare: cardiomyopathy, interstitial lung disease, retinal pigment epithelial detachment

53
Q

What do you have to monitor with trametinib therapy?

A

Ejection fraction, CBC, LFTs

54
Q

Vemurafenib MOA

A

Inhibits BRAF (must do genetic testing to confirm V600E mutation)

55
Q

Vemurafenib resistance mechanisms

A

Alternative signaling pathway

56
Q

Vemurafenib admin

A

oral

57
Q

Vemurafenib metabolism

A

Hepatic: P-gp and CYP interactions possible

58
Q

Vemurafenib adverse effects

A

Common: arthralgia, fatigue, rash, photosensitivity, alopecia, N/D.
Serious: renal dysfunction, liver toxicity, QT prolong/TdP, cutaneous SCC (in 25% of patients), Stevens-Johnson syndrome, eyes: uveitis, iritis, retinal vein occlusion

59
Q

What do you have to monitor with vemurafenib?

A

LFTs, EKG, electrolytes, do a regular derm exam

60
Q

What drugs can be used to treat actinic keratosis?

A

Topical fluorouracil, imiquimod, diclofenac, trichloroacetic acid

Derm (9 decks)

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