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DERM > pharm-skin cancer > Flashcards

pharm-skin cancer Flashcards

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Dermatology Board Prep flashcards
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
Q

what is capillary leak syndrome? (aldesleukin)

A 
increased vasc. perm.
hypotension
pulmonary edema
hepatocyte damage
renal failure
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26
Q

what are some of the important adverse effects of imiquimod?

A

mild localize skin rxns
increased photosensitivity
contact can compromise condom integrity

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27
Q

what are the major adverse effects of vismodegib?

A

intrauterine fetal death
male-mediated teratogenicity (via semen)
pregnancy (women need to be on BC for 7 months after their last dose)
-alopecia

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28
Q

what is the most common adverse effect of vismodegib?

A

alopecia

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29
Q

which drug is most effective in metastatic/advanced squamous cell carcinoma?

A

cisplatin

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30
Q

what are 3 categories of drug types that are indicated for melanoma?

A
  1. immunotherapy
  2. signal transduction inhibitors
  3. chemotherapy (most effective)
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31
Q

how is aldesleukin administered?

A

IV or SC

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32
Q

what are the major contraindications for aldesleukin?

A

contraindicated in pts with: CNS, cardiac, and pulmonary, renal, hepatic or organ transplant

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33
Q

how does aldesleukin cause renal failure in pts with melanoma?

A

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
Q

what are the 3 must know contraindications for interferon?

A
  1. autoimmune disease
  2. cardiac disease
  3. depression (risk of suicidal ideation)
35
Q

what is the most common adverse effect of interferon?

A

flu-like symptoms

36
Q

what are the adverse effects of interferon and how would you monitor them?

A
  1. neutropenia, leukopenia, anemia, alopecia (CBCs)
  2. elevated LFTs
  3. pulm. infiltrates, pneumonitis, pneumonia (CXR)
  4. Cough and dyspnea
37
Q

what are the severe and fatal immune-mediated adverse rxns with ipilimumab and what are they caused by?

A

dermatitis including toxic epidermal necrolysis

-caused by T-cell activation and proliferation

38
Q

what are some of the important BBW for ipilimumab?

A 
adrenal insufficiency
diarrhea
Guillain-Barre syndrome
hepatitis
hyperthyroidism
hypopituitarism
hypothyroidism
myasthenia gravis
peripheral neuropathy
pregnancy
serious rash
39
Q

what are the most common adverse effects of ipilimumab?

A

fatigue, diarrhea, itching and rash

40
Q

what are the adverse effects of sorafenib?

A

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
Q

what are the most common adverse effects of sorafenib?

A

hand and foot syndrome
rash
anemia

42
Q

which 2 drugs for skin cancer require genotyping before you prescribe them?

A

Trametinib

Vemurafenib

43
Q

trametinib works on melanomas with which mutations?

A

BRAF V600E or V600K

44
Q

what are some of the adverse effects of trametinib?

A

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
Q

what are some of the rare but important adverse effects of trametinib?

A

retinal pigment epithelial detachment
cardiomyopathy
ILD

46
Q

where is vemurafenib metabolized?

A

in liver (have to recheck LFTs)

47
Q

what are the 4 major categories of serious adverse reactions to vemurafenib?

A

Liver (check LFTs)
Heart (QT prolongation, Check ECG)
Skin-severe dermatologic rxn, cutaneous squamous cell carcinoma –>do derm. exam
Eye-serious opthalmologic issues

48
Q

how can resistance to vemurafenib develop?

A

parallel proliferative signaling

49
Q

what are some of the common and non-lifethreatening adverse effects of vemurafenib?

A 
arthralgia
fatigue
rash
photosensitivity
alopecia
N/D
50
Q

what 5 skin cancer drugs all have rash as a common toxicity?

A 
Imiquimod
Ipilimumab
Sorafenib
Trametinib
Vemurafenib
(I'm Ill So Try Veronica)
51
Q

both Trametinib and vemurafenib have what 3 categories of adverse effects in common?

A
  1. liver
  2. heart
  3. eye
52
Q

what are the 2 topical agents for actinic keratosis?

A

fluorouracil

imiquimod

53
Q

what are some adverse rxns to trichloroacetic acid?

A

burning

inflammation and localized tenderness

54
Q

what is the major environmental risk factor for non-melanoma skin cancer?

A

exposure to UV radiation

55
Q

what are the effects of UV light on skin?

A 
immediate (redness)
long term (photo-aging, immunosuppression, carcinogenicity)
56
Q

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

A

1.2

57
Q

The body’s pigmentary responses to a sunlamps UV-A (immediate and persistent skin darkening) do not protect it from what?

A

sunburn
cancer-inducing DNA damage
immunosuppression
photoaging

58
Q

what is SPF?

A

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
Q

SPF mainly measures UV-A or UV-B?

A

UV-B (main cause of sunburn)

60
Q

UV radiation dosage depends on what 2 things?

A

duration of exposure and the intensity of the UV radiation

61
Q

what is the value that tells you about the sunscreen’s ability to block UV-A radiation?

A

critical wavelength

62
Q

what is broad spectrum UV-A protection?

A

critical wavelength greater than 370 nm

63
Q

what is the complete assessment of UV protection?

A

using the critical wavelength and SPF to see how much UV protection you are getting

64
Q

what is substantivity?

A

sunscreens ability to remain effective under adverse conditions such as exposure to water and sweat

65
Q

what is stability?

A

long-lasting protection to prevent photodegradation (using multiple filters to achieve high SPF level)

66
Q

products that are broadspectrum SPF >15 can now include this statement:

A

if used as directed with other sun protection measures, decreases the risk of skin cancer and early skin aging caused by the sun

67
Q

if the sunscreen has SPF less than 15 what does the FDA require on the bottle

A

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
Q

what has changed with the terms sunblock etc?

A

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
Q

what is the new labeling limit of SPF by FDA?

A

50+

70
Q

what is UV-A1?

A

340-400 nm

71
Q

what is UV-A2?

A

320-340 nm

72
Q

What is UV-B?

A

290-320 nm

73
Q

which drugs used to treat skin cancer are category C?

A

Aldesleukin
Imiquimod
Interferon
Ipilmumab

74
Q

which drugs used to treat skin cancer are category D?

A

sorafenib
trametinib
vemurafenib
vismodegib

75
Q

which skin cancer drug has a major risk of secondary tumors?

A

vemurafenib

76
Q

which 2 skin cancer drugs both have eye problems?

A

trametinib
vemurafenib
(EYE TRy VEronica)

77
Q

which 2 skin cancer drugs cause photosensitivity?

A

imiquimod
vemurafenib
(Photo In Venice)

78
Q

which skin cancer drug has endocrinopathies as its side effect?

A

ipilimumab

79
Q

which 3 skin cancer drugs cause blood dyscrasias?

A 
interferon
trametinib
sorafenib
BITS
(so you have to check CBCs)
80
Q

which skin cancer drug has a major risk of bleeding?

A

sorafenib

81
Q

which skin cancer drug can cause HTN?

A

sorafenib

DERM (11 decks)

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