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PULM > PHARM LUNG CANCER > Flashcards

PHARM LUNG CANCER Flashcards

1
Q

MOA carboplatin

A

platinum drugs that form DNA intra-strand cross links

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2
Q

MOA cisplatin

A

platinum drug that forms DNA intra-strand crosslinks

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3
Q

MOA of ifosfamide

A

forms intra and interstrand cross links

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4
Q

MOA of cyclophosphamide

A

pro drug alkylating agent that forms DNA cross-links, resulting in inhibition of DNA synthesis and function

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5
Q

MOA of doxorubicin

A

intercalator, free radicals bind to DNA causing strand breakage; inhibits topoisomerase II

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6
Q

Etoposide MOA

A

inhibits topoisomerase II, resulting in DNA damage

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7
Q

irinotecan/topotecan MOA

A

inhibits topoisomerase I, resulting in DNA damage

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8
Q

Gemcitabine MOA

A

DNA polymerase inhibitor

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9
Q

MOA of pemetrexed

A

Dihydrofolate reductase inhibitor

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10
Q

Paclitaxel MOA

A

prevent microtubule disassembly into tubulin monomers

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11
Q

Vincristine/Vinorelbine MOA

A

prevent assembly of tublin dimers into microtubules

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12
Q

Erlotinib MOA

A

EGFR TK reversible inhibitor

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13
Q

Crizotinib MOA

A

reversible multiple TK inhibitor

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14
Q

Bevacizumab MOA

A

antibody to VEGF resulting in inhibition of tumor vascularization

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15
Q

who gets screened w/ CT for lung cancer?

A

pts 55-80 w/ 30 pack-yr hx of smoking who quit 15 yrs prior

radiation exposure risk is greater than benefit of finding tumors early

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16
Q

which mutations in lung cancers do you want to test for?

A

look for EGFR and EML4-ALK mutations in adenocarcinomas

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17
Q

what is the indication for erlotinib?

A

only used in adenocarcinomas w/ EGFR overexpression

18
Q

what is the indication for crizotinib?

A

used in adenocarcinomas with EML4-ALK mutations

19
Q

what is the indication for bevacizumab?

A

used in adenocarcinomas

20
Q

what is a very common adverse effect of erlotinib?

A

Rash

21
Q

How would you treat a severe rash caused by TKIs?

A

reduce dose of chemo agent

  1. protective sun lotion
  2. steroid creams
  3. consider tetra cycline as pre-emptive therapy
22
Q

what are 5 general ways that explain the resistance to conventional chemotherapy agents

A
  1. mutations in target
  2. decreased metabolic activation
  3. decreased metabolic degradation
  4. increased repair
  5. MDR efflux pump
23
Q

Name some drugs that have the MDR efflux pump

A

doxorubicin
vinca alkaloids
taxanes
etoposide

24
Q

which tumor genotype are you looking for in adenocarcinoma which may increase sensitivity to the drug?

A

exon 19 or L858R in ATP binding site of EGFR

25
Q

which tumor genotype are you looking for in an adenocarcinoma which may decrease sensitivity to erlotinib?

A

T790M in ATP binding site of EGFR

26
Q

what are some strategies that will mitigate overdiagnosis?

A
  1. screen only pts w/ appropriate risk
  2. change threshold for positive test
  3. change terminology (use of the word cancer)
  4. reduce freq. of screening
  5. reduce low-yield diagnostics
  6. improve safety and efficacy of screening tools
27
Q

which 3 cancer chemotherapy drugs have a dose limiting toxicity other than myelosuppression?

A

Cisplatin–>renal tubular damage, failure, MLS
Vincristine–>neurotoxicity, ANS dysfunction, GI status (impaction)
etoposide–>myelosuppression, hematologic toxicity

28
Q

which mutations are more common in smokers?

A

KRAS mutations

29
Q

which mutations are more common in never smokers?

A

EGFR mutations

30
Q

what are the potential downsides to blocking formation of new blood vessels in tumors?

A
  1. prevent chemodrugs from getting to their target

2. induce more aggressive cells that have increased capacity to spread

31
Q

how do we test for EGFR mutations?

A

DNA sequencing

32
Q

how do we test for ALK gene rearrangement testing?

A

FISH

33
Q

what is the standard treatment for SCLC?

A

Etoposide + Cisplatin or Carboplatin

34
Q

what is the standard treatment for NSCLC?

A

Cisplatin AND one of the following: paclitaxel, gemcitabine, docetaxel, vinorelbine, irinotecan or pemetrexed

35
Q

intrathecal administration of what class of drugs is fatal?

A

vinca alkaloids

36
Q

which chemo agent has this side-effect profile: interstitial lung disease, stomach or intestinal perforation, corneal perforation/ulceration and rash?

A

erlotinib

37
Q

how do you want to take erlotinib?

A

on an empty stomach because it has variable bioavailability with food

38
Q

which chemo drug has this side-effect profile?

  • Visual disorders
  • Edema
  • GI toxicity (N/V/D/C)
A

crizotinib

39
Q

which chemo drug has this side-effect profile?
LIFE-THREATENING BLEEDING (post-surgical)
Hemorrhage (gastric perforation)
HTN (arterial thromboembolism)
Alopecia
Asthenia, Dizziness, Headache
fistulas

A

Bevacizumab

40
Q

which chemo drug do you absolutely avoid using on squamous cell carcinoma of the lung?

A

Bevacizumab

PULM (14 decks)

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