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Year 4 Oncology > Therapeutics > Flashcards

Therapeutics Flashcards

1
Q

Risk factors of N&V secondary to chemotherapy?

A
  • anxiety
  • age less than 50 years old
  • concurrent use of opioids
  • the type of chemotherapy used
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2
Q

Which anti-emetics may be used to treat N&V in chemotherapy?

A

For patients at low-risk of symptoms then drugs such as metoclopramide may be used first-line.

For high-risk patients then 5HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone

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3
Q

What is cyclophosphamide and how does it work?

A

An alkylating agent used in the management of cancer and autoimmune conditions.

It works by causing cross-linking of DNA

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4
Q

Cyclophosphamide adverse affects

A

haemorrhagic cystitis

myelosuppression

transitional cell carcinoma

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5
Q

How can the incidence of haemorrhagic cystitis in cyclophosphamide use be reduced?

A

Use of hydration and mesna

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6
Q

What is mesna and why is it used?

A

2-mercaptoethane sulfonate Na

a metabolite of cyclophosphamide called acrolein is toxic to urothelium
- mesna binds to and inactivates acrolein helping to prevent haemorrhagic cystitis

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7
Q

Cytotoxic agents: antibiotic examples?

A

Bleomycin

Anthracyclines (e.g doxorubicin)

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8
Q

What is the action of bleomycin?

A

Degrades preformed DNA

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9
Q

What is the action of anthracyclines e.g. doxorubicin?

A

Stabilizes DNA-topoisomerase II complex inhibits DNA & RNA synthesis

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10
Q

Cytotoxic agents: major adverse affect of bleomycin?

A

Lung fibrosis

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11
Q

Cytotoxic agents: major adverse affect of anthracyclines e.g. doxorubicin?

A

Cardiomyopathy

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12
Q

Cytotoxic agents: antimetabolite examples

A

Methotrexate

Fluorouracil (5-FU)

6-mercaptopurine

Cytarabine

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13
Q

Methotrexate mechanism of action?

A

Inhibits dihydrofolate reductase and thymidylate synthesis

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14
Q

Fluorouracil (5-FU) mechanism of action?

A

Pyrimidine analogue inducing cell cycle arrest and apoptosis by blocking thymidylate synthase (works during S phase)

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15
Q

6-mercaptopurine mechanism of action?

A

Purine analogue that is activated by HGPRTase, decreasing purine synthesis

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16
Q

Cytarabine mechanism of action?

A

Pyrimidine antagonist. Interferes with DNA synthesis specifically at the S-phase of the cell cycle and inhibits DNA polymerase

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17
Q

Cytarabine major adverse affects?

A

Myelosuppression

Ataxia

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18
Q

6-mercaptopurine major adverse affect?

A

Myelosuppression

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19
Q

Fluorouracil (5-FU) major adverse affects?

A

Myelosuppression, mucositis, dermatitis

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20
Q

Methotrexate major adverse affects?

A

Myelosuppression, mucositis, liver fibrosis, lung fibrosis

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21
Q

Examples of cytotoxic agents that act on microtubules

A

Vincristine, vinblastine

Docetaxel

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22
Q

Docetaxel major adverse affect?

A

Neutropenia

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23
Q

Docetaxel mechanism of action?

A

Prevents microtubule depolymerisation & disassembly, decreasing free tubulin

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24
Q

Vincristine, vinblastine mechanism of action?

A

Inhibits formation of microtubules

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25
Vincristine major adverse affects?
Peripheral neuropathy (reversible) , paralytic ileus
26
Vinblastine major adverse affect?
Myelosupression
27
Example of cytotoxic agent which inhibits topoisomerase?
Irinotecan
28
Irinotecan mechanism of action?
Inhibits topoisomerase I which prevents relaxation of supercoiled DNA
29
Major adverse affect of irinotecan?
Myelosupression
30
Cisplatin - mechanism of action
Causes cross-linking in DNA
31
Hydroxyurea (hydroxycarbamide) mechanism of action?
Inhibits ribonucleotide reductase, decreasing DNA synthesis
32
Major adverse affects of cisplatin?
Ototoxicity Peripheral neuropathy Hypomagnesaemia
33
Hydroxyurea (hydroxycarbamide)
Myelosuppression
34
Hydroxyurea (hydroxycarbamide) and cisplatin are examples of what?
Cytotoxic drugs
35
What are immune checkpoint inhibitors?
Immunotherapy (alternative to cytotoxic chemotherapy) . In contrast to therapies such as chemotherapy and tumour-targeted drugs that directly affect the growth and proliferation of tumour cells, these targeted treatments harness the body’s natural anti-cancer immune response. They boost its ability to attack and destroy the cancer cells. Some cancer cells make high levels of proteins that turn T-cells off, reducing their desrtuction. Checkpoint inhibitors block this process and reactivate and increase the body’s own T-cell population, enhancing the immune systems own ability to recognise and fight cancer cells.
36
Where are the proteins CTLA-4 and PD-1 are found?
T-cells
37
Where are the PD-L1 proteins found?
On cancer cells
38
Types of checkpoint inhibitors?
Blockade of CTLA-4 (cytotoxic T lymphocyte-associated protein 4): Ipilimumab Blockade of PD-1 (programmed cell death protein 1): Nivolumab (Opdivo) and pembrolizumab (Keytruda) Blockade of PD-L1: Atezolizumab, Avelumab, Durvalumab
39
What is pilimumab (Yervoy) and what is it used to treat?
A checkpoint inhibitor that blocks CTLA-4 (cytotoxic T lymphocyte-associated protein 4) Advanced melanoma
40
What are Nivolumab (Opdivo) and pembrolizumab (Keytruda) and what do they treat?
Checkpoint inhbitors that block PD-1 (programmed cell death protein 1) These are treatments for melanoma, Hodgkin's lymphoma, non-small cell lung cancer and urological cancers.
41
What are Atezolizumab, Avelumab and Durvalumab and what do they treat?
Checkpoint inhibitors that block PD-L1 and is used to treat lung cancer and urothelial cancer. I
42
Administration of checkpoint inhibitors?
All CTLA-4 inhibitors and PD-1/PD-L1 inhibitors currently available are monoclonal antibodies (laboratory-produced molecules engineered to serve as substitute antibodies that each bind to a specific protein). They are all administered by injection/intravenous infusion. Mostly, they are given as a single-agent treatment but sometimes, they can be combined with chemotherapy or each other. For example, ipilimumab and nivolumab can be used in combination.
43
What side effects might checkpoint inhibitors cause and why?
This mechanism of action of these drugs can result in side effects termed 'Immune-related adverse events' that are inflammatory and autoimmune in nature. This is because all immune cells are boosted by these drugs, not just the ones that target cancer. The over-active T-cells can produce side effects such as: - Dry, itchy skin and rashes (most commonly) - Nausea and vomiting - Decreased appetite - Diarrhoea - Tiredness and fatigue - Shortness of breath and a dry cough.
44
Checkpoint inhibitors: management and monitoring
Management of such side effects reflects the inflammatory nature, often involving corticosteroids. It is important to monitor liver, kidney and thyroid function as these drugs can affect these organs.
45
Radiotherapy is an important form of therapy for cancer and accounts for 50% of all treatment regimens. There are many side effects of radiotherapy and they are best characterised into early and late onset side effects. EXAMPLES OF EARLY SIDE EFFECTS
Tiredness/Fatigue Skin erythema Alopecia Mucositis (diarrhoea, dysuria)
46
Radiotherapy is an important form of therapy for cancer and accounts for 50% of all treatment regimens. There are many side effects of radiotherapy and they are best characterised into early and late onset side effects. EXAMPLES OF LATE SIDE EFFECTS
Skin pigmentation changes Pulmonary fibrosis Infertility
47
What type of chemotherapy agent are doxorubicin and daunorubicin examples of?
Anthracyclines
48
Examples of anthracyclines
doxorubicin daunorubicin
49
Important classical side effect of Anthracyclines (doxorubicin, daunorubicin)?
Cardiomyopathy
50
Important classical side effect of anti-HER-2 monoclonal antibodies (e.g. Herceptin) cause cardiomyopathy?
Cardiomyopathy
51
What is Herceptin and example of?
anti-HER-2 monoclonal antibody
52
Examples of platinum agents?
Cisplatin Carboplatin
53
What are cisplatin and carboplatin examples of?
Platinum agents
54
Important classical side effects of platinum agents (cisplatin, carboplatin)?
cause peripheral neuropathy and sensorineural hearing loss +Cisplatin has a risk of ototoxicity and nephrotoxicity
55
Important classical urinary system side effects of cyclophosphamides?
Haemorrhagic cystitis TCC of the bladder
56
What does gynaecological side effect is related to tamoxifen use?
Endometrial cancer
57
Important resp side effect of belomycin
Lung fibrosis
58
Important neurological side effect of cytarabine?
Ataxia
59
What is Cetuximab and what is it used for?
Cetuximab is an example of a monoclonal antibody Used in treating squamous cell carcinomas of the head and neck and to treat bowel cancer. It targets epidermal growth factor receptor, blocking the activation of this receptor and inhibiting the growth and metastasis of the tumour.
60
What is adjuvant chemotherapy?
Adjuvant chemotherapy refers to chemotherapy that people receive after another cancer treatment, such as surgery
61
What is neoadjuvant therapy?
Neoadjuvant therapy includes treatmentsTrusted Source that doctors use as an initial step to shrink tumors and kill any cancer cells that have spread. After that, they will start the primary treatment.
62
What type of cancer is cyclophosphamide commonly used to treat?
Glialblastoma
63
Classes of chemotherapy
Alkylating agents Taxanes Vinka alkaloids Platinum complexes Platinum complexes Antimetabolites Anthracyclines Antitumour antibiotics Topoisomerase inhibitors
64
Neutropenic sepsis: questions to ask
Date of last chemo Which agent Any lines? Drug and allergies

Year 4 Oncology (15 decks)

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