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pharm-skin cancer Flashcards

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1
Q

MOA carmustine

A

both alkylation and carbamoylation of amino acids

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2
Q

MOA aldesleukin

A

IL-2 agonist

-induces prolif. and differentiation of lymphocytes, monocytes, mphages, CTLs, including NK cells

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3
Q

MOA cisplatin

A

forms DNA intrastrand crosslinks and adducts

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4
Q

MOA cyclophosphamide

A

prodrug alkylating agent

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5
Q

MOA dacarbazine

A

pro drug active alkylating moiety

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6
Q

MOA imiquimod

A

immunostimulant (small molecule tumor-directed immune response initiator)

  • directly activates TLR7 and TLR8
  • blocks adenosine receptors
  • activation of NFkappaB (upreg. of cytokines like TNF-alpha, & interleukins)
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7
Q

MOA interferon

A

immunostimulant
-indiscriminate stimulation of immune response which has effects on: antiviral, antiproliferative, immunomod., cell differentiation, MHC expression, cytokine induction

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8
Q

MOA ipilimumab

A

cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) recombinant antibody
-bolsters antitumor response of immune system via CD8 t-cells

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9
Q

MOA methotrexate

A

DHFR inhibitor

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10
Q

MOA sorafenib

A

oral multi-kinase inhibitor (VEGF, PDGFR, KIT, Raf kinase)

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11
Q

MOA trametinib

A

oral reversible MEK inhibitor

-for pts w/ BRAFV600E or V600K mutations

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12
Q

MOA Trichloroacetic acid

A

chemical peel, rapidly penetrates and cauterizes skin keratin or other tissue

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13
Q

MOA Vemurafenib

A

oral inhibitor of mutated BRAF, including BRAFV600E

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14
Q

MOA Vismodegib

A

oral SMO inhibitor that targets the hedgehog pathway for basal cell carcinoma

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15
Q

what is the dose limiting adverse effect of cisplatin?

A

renal tubular damage and failure (also myelosuppression)

-monitor with renal function tests

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16
Q

what are the 2 main targeted drugs used to treat basal cell carcinoma?

A

Imiquimod

Vismodegib

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17
Q

what are the 3 main targeted drugs used to treat actinic keratosis?

A
  1. diclofenac (NSAID)
  2. Imiquimod (immunostimulant)
  3. Trichloroacetic acid (chemical peel)
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18
Q

what are the majority of the targeted therapies indicated for?

A

melanoma

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19
Q

what is the prognosis of skin cancers if they are found and treated early?

A

most are cured

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20
Q

what is the most effective nontargeted drug for basal cell carcinoma?

A

cisplatin

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21
Q

is imiquimod indicated for local or advanced basal cell carcinoma?

A

local

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22
Q

is vismodegib indicated for local or advanced basal cell carcinoma?

A

advanced or metastatic

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23
Q

what is the advantage to using topical agents in basal cell carcinoma?

A

keeps the pt from developing systemic toxicity

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24
Q

what is the disadvantage to using topical agents in basal cell carcinoma?

A

you might miss deeply seated malignant cells

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25
what is capillary leak syndrome? (aldesleukin)
``` increased vasc. perm. hypotension pulmonary edema hepatocyte damage renal failure ```
26
what are some of the important adverse effects of imiquimod?
mild localize skin rxns increased photosensitivity contact can compromise condom integrity
27
what are the major adverse effects of vismodegib?
intrauterine fetal death male-mediated teratogenicity (via semen) pregnancy (women need to be on BC for 7 months after their last dose) -alopecia
28
what is the most common adverse effect of vismodegib?
alopecia
29
which drug is most effective in metastatic/advanced squamous cell carcinoma?
cisplatin
30
what are 3 categories of drug types that are indicated for melanoma?
1. immunotherapy 2. signal transduction inhibitors 3. chemotherapy (most effective)
31
how is aldesleukin administered?
IV or SC
32
what are the major contraindications for aldesleukin?
contraindicated in pts with: CNS, cardiac, and pulmonary, renal, hepatic or organ transplant
33
how does aldesleukin cause renal failure in pts with melanoma?
capillary leak syndrome A. stim. of CD122hiNK cells (make proinflamm. cytokines like TNF and vasoactive mediators) OR B. direct binding of IL-2 to CD25 endothelial cells
34
what are the 3 must know contraindications for interferon?
1. autoimmune disease 2. cardiac disease 3. depression (risk of suicidal ideation)
35
what is the most common adverse effect of interferon?
flu-like symptoms
36
what are the adverse effects of interferon and how would you monitor them?
1. neutropenia, leukopenia, anemia, alopecia (CBCs) 2. elevated LFTs 3. pulm. infiltrates, pneumonitis, pneumonia (CXR) 4. Cough and dyspnea
37
what are the severe and fatal immune-mediated adverse rxns with ipilimumab and what are they caused by?
dermatitis including toxic epidermal necrolysis | -caused by T-cell activation and proliferation
38
what are some of the important BBW for ipilimumab?
``` adrenal insufficiency diarrhea Guillain-Barre syndrome hepatitis hyperthyroidism hypopituitarism hypothyroidism myasthenia gravis peripheral neuropathy pregnancy serious rash ```
39
what are the most common adverse effects of ipilimumab?
fatigue, diarrhea, itching and rash
40
what are the adverse effects of sorafenib?
hepatitis (elevated LFTs b/c hepatic metabolism) hand and foot syndrome, rash, anemia (hematologic toxicity) BM suppression and neutropenia (CBCs) increased incidence of bleeding
41
what are the most common adverse effects of sorafenib?
hand and foot syndrome rash anemia
42
which 2 drugs for skin cancer require genotyping before you prescribe them?
Trametinib | Vemurafenib
43
trametinib works on melanomas with which mutations?
BRAF V600E or V600K
44
what are some of the adverse effects of trametinib?
LIVER-decreased LVEF (need to recheck ejection fraction) HEART-cardiomyopathy (rare) EYE-retinal pigment epithelial detachment (rare) rapid onset of skin toxicity GI toxicity HTN, hemorrhage ILD (rare)
45
what are some of the rare but important adverse effects of trametinib?
retinal pigment epithelial detachment cardiomyopathy ILD
46
where is vemurafenib metabolized?
in liver (have to recheck LFTs)
47
what are the 4 major categories of serious adverse reactions to vemurafenib?
Liver (check LFTs) Heart (QT prolongation, Check ECG) Skin-severe dermatologic rxn, cutaneous squamous cell carcinoma -->do derm. exam Eye-serious opthalmologic issues
48
how can resistance to vemurafenib develop?
parallel proliferative signaling
49
what are some of the common and non-lifethreatening adverse effects of vemurafenib?
``` arthralgia fatigue rash photosensitivity alopecia N/D ```
50
what 5 skin cancer drugs all have rash as a common toxicity?
``` Imiquimod Ipilimumab Sorafenib Trametinib Vemurafenib (I'm Ill So Try Veronica) ```
51
both Trametinib and vemurafenib have what 3 categories of adverse effects in common?
1. liver 2. heart 3. eye
52
what are the 2 topical agents for actinic keratosis?
fluorouracil | imiquimod
53
what are some adverse rxns to trichloroacetic acid?
burning | inflammation and localized tenderness
54
what is the major environmental risk factor for non-melanoma skin cancer?
exposure to UV radiation
55
what are the effects of UV light on skin?
``` immediate (redness) long term (photo-aging, immunosuppression, carcinogenicity) ```
56
a typical customer of a tanning salon in the course of 20 sessions is exposed to up to _________- times the avg normal annual exposure from sunlight
1.2
57
The body's pigmentary responses to a sunlamps UV-A (immediate and persistent skin darkening) do not protect it from what?
sunburn cancer-inducing DNA damage immunosuppression photoaging
58
what is SPF?
Sun protecting factor amount of UV radiation required to produce a sunburn on protected skin relative to that of unprotected skin (based on redness)
59
SPF mainly measures UV-A or UV-B?
UV-B (main cause of sunburn)
60
UV radiation dosage depends on what 2 things?
duration of exposure and the intensity of the UV radiation
61
what is the value that tells you about the sunscreen's ability to block UV-A radiation?
critical wavelength
62
what is broad spectrum UV-A protection?
critical wavelength greater than 370 nm
63
what is the complete assessment of UV protection?
using the critical wavelength and SPF to see how much UV protection you are getting
64
what is substantivity?
sunscreens ability to remain effective under adverse conditions such as exposure to water and sweat
65
what is stability?
long-lasting protection to prevent photodegradation (using multiple filters to achieve high SPF level)
66
products that are broadspectrum SPF >15 can now include this statement:
if used as directed with other sun protection measures, decreases the risk of skin cancer and early skin aging caused by the sun
67
if the sunscreen has SPF less than 15 what does the FDA require on the bottle
spending time in the sun increases your risk of skin cancer and early skin aging this product has been shown only to prevent sunburn, not skin cancer or early skin aging
68
what has changed with the terms sunblock etc?
can't use the words sunblock, waterproof, or sweatproof, can only say water resistant (40 mins or 80 mins) - cant claim instant protection - cant claim efficacy for more than 2 hours
69
what is the new labeling limit of SPF by FDA?
50+
70
what is UV-A1?
340-400 nm
71
what is UV-A2?
320-340 nm
72
What is UV-B?
290-320 nm
73
which drugs used to treat skin cancer are category C?
Aldesleukin Imiquimod Interferon Ipilmumab
74
which drugs used to treat skin cancer are category D?
sorafenib trametinib vemurafenib vismodegib
75
which skin cancer drug has a major risk of secondary tumors?
vemurafenib
76
which 2 skin cancer drugs both have eye problems?
trametinib vemurafenib (EYE TRy VEronica)
77
which 2 skin cancer drugs cause photosensitivity?
imiquimod vemurafenib (Photo In Venice)
78
which skin cancer drug has endocrinopathies as its side effect?
ipilimumab
79
which 3 skin cancer drugs cause blood dyscrasias?
``` interferon trametinib sorafenib BITS (so you have to check CBCs) ```
80
which skin cancer drug has a major risk of bleeding?
sorafenib
81
which skin cancer drug can cause HTN?
sorafenib

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