Topoisomerase inhibitors and Microtubule Inhibitors + more Flashcards
Topoisomerase I cuts one or two strands?
One
Topoisomerase II cuts one or two strands?
Two
Topoisomerase inhibitors are not cell-cycle specific. True or False?
False. They are cell-cycle specific (S-phase)
Which of the following are Topoisomerase I inhibitors? Select all that apply
A) Camptothecins
B) Anthracyclines
C) Podophyllotoxins
A) Camptothecins
Which of the following are Topoisomerase II inhibitors? Select all that apply
A) Camptothecins
B) Anthracyclines
C) Podophyllotoxins
B) Anthracyclines
C) Podophyllotoxins
Topoisomerase inhibitors cause cell death by:
A) Block DHFR and preventing the formation of purines
B) Block DNA polymerase and incorporating itself into DNA
C) Block the enzyme necessary for relaxing DNA supercoils during replication and transcription
D) Crosslinking and methylating DNA
C) Block the enzyme necessary for relaxing DNA supercoils during replication and transcription
The following all describe the physiology of topoisomerase (TOP) EXCEPT:
A) Resolve topological problems during DNA replication and transcription
B) Form covalent and reversible breaks in the DNA backbone
C) Allow rearrangements and maneuvering of DNA strands and re-ligation of DNA
D) Type I enzymes remove supercoiling in unwound DNA via single-stranded cuts while Type II enzymes separate & unknot DNA via double-stranded breaks
E) All of the above are true
E) All of the above are true
Choose the Camptothecins in the Topoisomeraise I inhibitors: A) Etoposide B) Irinotecan C) Idarubicin D) Topotecan
B) Irinotecan
D) Topotecan
The mechanism of action of Irinotecan and Topotecan is best described as:
A) Intercalate into the DNA at the topoisomerase-DNA interface to prevent the reversal of the topoisomerase cleavage complex
B) Inhibits topoisomerase II and intercalates into DNA to prevent replication
C) Inhibits topoisomerase II to prevent the re-ligation of DNA strand breaks, leading to cell death
D) Inhibits topoisomerase I causing overwinding of DNA helix during replication
A) Intercalate into the DNA at the topoisomerase-DNA interface to prevent the reversal of the topoisomerase cleavage complex
What are the class toxicities for Camptothecins? (Match drug and toxicity) Select all that apply:
A) Irinotecan; myelosuppression
B) Doxorubicin; myelosuppression
C) Teniposide; Cardiotoxicity
D) Topotecan; GI toxicities (diarrhea, abdominal cramping)
A) Irinotecan; myelosuppression
D) Topotecan; GI toxicities (diarrhea, abdominal cramping)
Irinotecan has a specific pathophysiology to explain its notable toxicity of early/late forms of diarrhea. Select the most accurate explanation:
A) Its non-liposomal form is more difficult to metabolize
B) The short half-life of the drug makes it more potent depending on the patient
C) This drug is a prodrug metabolized into an active metabolite, SN-38
D) The drug name sounds like “I RUN TO THE CAN” so seems legit
C) This drug is a prodrug metabolized into an active metabolite, SN-38
Does Irinotecan require supportive care? Select all the apply
A) Yes; to acute anticholinergic symptoms with IV/SQ atropine or pre-medicate
B) No; it is a generally well tolerated drug with no notable toxicites
C) Yes; to manage delayed diarrhea with antidiarrheals
D) No; the symptoms are generally self-limiting or can be reversed by holding the agent
A) Yes; to acute anticholinergic symptoms with IV/SQ atropine or pre-medicate
C) Yes; to manage delayed diarrhea with antidiarrheals
Which of the following are true about Irinotecan? Select all the apply
A) It is interchangeable with its liposomal formulation
B) The name of the liposomal formulation is Onivyde
C) It requires hepatic adjustment
D) BBW: Bone marrow suppression, early/late forms of diarrhea
B) The name of the liposomal formulation (Onivyde)
C) It requires hepatic adjustment
D) BBW: Bone marrow suppression, early/late forms of diarrhea
What are the proposed mechanisms for free intestinal luminal SN38 responsible for irinotecan-induced diarrhea?
A) Direct mucosal damage via water/electrolyte malabsorption and mucous hypersecretion
B) Altered luminal environment leading to proliferation of bacterial beta-glucuronidase to convert SN38-G to SN-38
C) Severe colonic damage via increased cell apoptosis, crypt hypoplasia and dilation, and villous atrophy
D) All of the above
D) All of the above
Why would classical chemotherapeutic agents be re-formulated with advanced delivery systems (i.e. liposomes, protein-bound)?
i) Lower cost
ii) Provide targeted drug delivery
iii) Reduce toxic effects of drugs
iv) Usually interchangeable
v) Improve therapeutic index and efficacy of drug
A) i, ii, v
B) ii, iii, iv
C) ii, iii, v
D) ii, iii, iv, v
ii) Provide targeted drug delivery
iii) Reduce toxic effects of drugs
v) Improve therapeutic index and efficacy of drug
C) ii, iii, v
Topotecan is only PO formulation and is a prodrug like Irinotecan. True or false?
False. Topotecan is IV and PO, and it is NOT a prodrug = no active metabolite
Topotecan requires renal or hepatic adjustment?
Renal
How does Topotecan’s notable toxicites compare to Irinotecan’s notable toxicities?
A) They are exactly the same and require the same supportive care measures
B) Irinotecan has a BBW for only early/late forms of diarrhea while Topotecan has a BBW for bone marrow suppression
C) Irinotecan has a BBW for only early/late forms of diarrhea and bone marrow suppression while Topotecan has a BBW for bone marrow suppression
D) Topotecan is generally well tolerated overall since it is not a prodrug and does not have an active metabolite
C) Irinotecan has a BBW for only early/late forms of diarrhea and bone marrow suppression while Topotecan has a BBW for bone marrow suppression (diarrhea - mild)
Doxorubicin, Daunorubicin, Epirubicin, and Mitoxantrone are all from which class?
A) Anthracyclines; Topoisomerase I inhibitors
B) Anthracyclines; Topoisomeraise II inhibitors
C) Campothecins; Topoisomerase I inhibitors
D) Podophyllotoxins; Topoisomerase II inhibitors
B) Anthracyclines; Topoisomeraise II inhibitors
Choose the best description for anthracyclines:
A) Antitumor antibiotic that intercalates into DNA, inhibits topoisomerase II, and generate free oxygen radicals
B) Semisynthetic analog that inhibits microtubule assembly during M phase of the cell cycle
C) Natural derivative that inhibits microtubule disassembly during G2/M phase of the cell cycle
D) Antitumor antibiotic generates free oxygen radicals to induce single and double strand breaks
A) Antitumor antibiotic that intercalates into DNA, inhibits topoisomerase II, and generate free oxygen radicals
Describe the main class toxicities for Doxorubicin and Mitoxantrone: Select all that apply A) Cardiotoxicity B) Hematopoietic cell suppression C) Extravasation risk D) Diarrhea
A) Cardiotoxicity
C) Extravasation risk
“Early” cardiotoxicity means
A) Occurs as soon as after 1st one with elevated troponins and pre-clinical myocardial cell damage
B) May occur years later and become symptomatic because LVEF is very low
C) Potentially asymptomatic with LVEF reduction that may occur months later
C) Potentially asymptomatic with LVEF reduction that may occur months later
“Late cardiotoxicity means:
A) Occurs as soon as after 1st one with elevated troponins and pre-clinical myocardial cell damage
B) May occur years later and become symptomatic because LVEF is very low
C) Potentially asymptomatic with LVEF reduction that may occur months later
B) May occur years later and become symptomatic because LVEF is very low
“Acute” cardiotoxicity means
A) Occurs as soon as after 1st one with elevated troponins and pre-clinical myocardial cell damage
B) May occur years later and become symptomatic because LVEF is very low
C) Potentially asymptomatic with LVEF reduction that may occur months later
A) Occurs as soon as after 1st one with elevated troponins and pre-clinical myocardial cell damage
Match the correct chemotherapy-related cardiotoxicity with its characteristic:
A) Cardiomyocyte death via necrosis/apoptosis; irreversible; anthracyclines
B) Cardiomyocyte dysfunction; reversible; Anti-HER2 agents
C) Cardiomyocyte death via necrosis/apoptosis; reversible; anthracyclines
D) Cardiomyocyte dysfunction; irreversible; Anti-HER2 agents
A) Cardiomyocyte death via necrosis/apoptosis; irreversible; anthracyclines
Since anthracyclines have dose-related cardiotoxicity, it is best to limit total lifetime dose and use the liposomal agent when possible. Additionally, symptoms are managed similarly to HF. True or False?
True
The pathophysiology behind the cardiotoxicity of anthracyclines involves:
A) Generation of ROS from Doxorubicin interaction with iron
B) High density of mitochondria in cardiomyocytes increases sensitivity to oxidative stress
C) ROS induces cardiomyocyte apoptosis via release of pro-inflammatory cytokines
D) All of the above
A) Generation of ROS from Doxorubicin interaction with iron
B) High density of mitochondria in cardiomyocytes increases sensitivity to oxidative stress
C) ROS induces cardiomyocyte apoptosis via release of pro-inflammatory cytokines
D) All of the above
Which cardioprotective agent can be used for anthracyclines? A) Dextrazoxane (Zinecard/Totect) B) Glucarpidase C) Loperamide D) None of the above
A) Dextrazoxane (Zinecard/Totect)
How does Dexrazoxane help with cardioprotection?
A) Reduces incidence of CHF and decrease in LVEF
B) Can be used to anthracycline extravasation
C) Prevents myelosuppression
D) A & B
A) Reduces incidence of CHF and decrease in LVEF
B) Can be used to anthracycline extravasation
D) A & B
Which anthracycline drug is considered the "Red Devil" because of its color and strcuture? A) Doxorubicin B) Daunorubicin C) Epirubicin D) Idarubicin
A) Doxorubicin
What are the BBW for Doxorubicin? Select all the apply A) Bone marrow suppression B) Irreversible cardiotoxicity C) Extravasation D) Secondary malignancies
A) Bone marrow suppression
B) Irreversible cardiotoxicity
C) Extravasation
D) Secondary malignancies
What are the unique characteristics of Doxorubicin?
A) Requires hepatic adjustment
B) Keep cumulative dose of <300-500 mg/m2 due to risk of bone marrow suppression
C) Red discoloration of bodily fluids
D) Diarrhea risk
A) Requires hepatic adjustment
Correction for other choices
B) Keep cumulative dose of <300-500 mg/m2 due to risk of cardiotoxicity
C) Red discoloration of bodily fluids (not unique bc Daunorubicin, Epirubicin, and Idarubicin have this)
D) Dose dependent emetic risk
Dexrazoxane can be used for Doxorubicin as an antidote for anthracycline extravasation and cardioprotection for anthracycline-induced cardiotoxicity. True or false?
True
Daunorubicin and Idarubicin has the same BBW as Doxorubicin EXCEPT: A) Bone marrow suppression B) Irreversible cardiotoxicity C) Extravasation D) Use in hepatic/renal impairment
D) Use in hepatic/renal impairment
Which of the following is unique to Daunorubicin, Idarubicin, and Epirubicin?
A) Requires renal AND hepatic adjustment
B) Keep cumulative dose due to risk of bone marrow suppression
C) Blue discoloration of bodily fluids
D) Diarrhea risk
A) Requires renal AND hepatic adjustment
Correction
B) Keep cumulative dose of <400-550 mg/m2 (Dauno) and <900 (Epirub) due to risk of cardiotoxicity & NO cumulative dose for Ida
C) Red discoloration of bodily fluids
D) Moderate emetic risk (Dauno)
Which anthracycline needs supportive care, and in combination with other chemotherapeutic agent? A) Doxorubicin + Fludarabine B) Daunorubicin + Ifofasmide C) Idarubicin + Cyclophosphamide D) Epirubicin + Cyclophosphamide
D) Epirubicin + Cyclophosphamide
Which anthracycline has a lesser cardiac risk since it is not given in cycles, so it does NOT have a cumulative dose limit? A) Epirubicin B) Idarubicin C) Doxorubicin D) Daunorubicin
B) Idarubicin
Mitoxantrone causes red discoloration like the rest of the anthracycline class? True or False
False. BLUE
What are the BBW for Mitoxantrone? Select all the apply A) Bone marrow suppression B) Irreversible Cardiotoxicity C) Secondary leukemia D) Appropriate administration (IV only) E) Extravasation
A) Bone marrow suppression
B) Irreversible Cardiotoxicity
C) Secondary leukemia
D) Appropriate administration (IV only)
E) Extravasation is a notable tox but not BBW
Mitoxantrone requires ___ adjustment and ___ has a cumulative dose due to risk of cardiotoxicity.
A) Hepatic, Does have a cumulative dose
B) Renal; Does have a cumulative dose
D) Hepatic, Does not have a cumulative dose
D) Renal, Does not have a cumulative dose
A) Hepatic, Does have a cumulative dose
The least cardiotoxic anthracyclines are Idarubicin and Mitoxantrone; however, all of these will have additive of effects over a lifetime cumulative dose and risk of cardiotoxicity if you interchange between agents. True or False?
True
Podophyllotoxins are part of which class and which drugs fall under this category? A) Topoisomerase II; Etoposide B) Topoisomerase II: Irinotecan C) Topoisomerase I: Teniposide D) Topoisomerase I: Mitoxantrone
A) Topoisomerase II; Etoposide + Teniposide
Podophyllotoxins inhibit topoisomerase I to prevent the re-ligation of DNA strand breaks, leading to cell death. The class toxicity is myelosuppression. True or False?
False. Inhibits Topoisomerase II. As a class, it does cause myelosuppression
Etoposide (VP-16) is available in IV only. True or False?
False. It is available IV and PO
Which of the following characteristics describe Etoposide?
A) Requires renal and hepatic adjustment
B) Hypersensitivity due to Polysorbate 80 in IV formulations
C) Has BBW for bone marrow suppression
D) Thrombocytopenia (mild) and mucositis (high doses) with low emetic risk
E) All of the above
A) Requires renal and hepatic adjustment
B) Hypersensitivity due to Polysorbate 80 in IV formulations
C) Has BBW for bone marrow suppression
D) Thrombocytopenia (mild) and mucositis (high doses) with low emetic risk
E) All of the above
Teniposide (VM-26) is the same as Etoposide in notable toxicities and renal & hepatic adjustment. True or false?
False. Additional BBW of hypersensitivity reaction and it requires no renal or hepatic adjustment.
Anthracyclines are cell-cycle specific for the M phase while Microtubule inhibitors are cell-cycle specific for the S phase. True or False?
False. Anthracyclines are cell-cycle specific for the S phase while Microtubule inhibitors are cell-cycle specific for the M phase.
How do microtubule inhibitors stop cell division?
A) Inhibiting microtubule assembly during S phase arresting the cell cycle and preventing cell division
B) Inhibiting microtubule assembly during M phase arresting the cell cycle and preventing cell division
C) Block enzyme necessary for relaxing DNA supercoils during replication and transcription
D) Generates free oxygen radicals to induce single and double strand breaks and inhibit DNA synthesis
B) Inhibiting microtubule assembly during M phase arresting the cell cycle and preventing cell division
What are the 2 types of microtubule inhibitors? A) Topoisomerase I and II B) Vincas and Bleomycin C) Taxanes and Vincas D) Bleomycin and Taxanes
C) Taxanes and Vincas
Antimicrotubles induce cytotoxicity via binding to specific sites and
A) Inhibiting microtubule polymerization
B) Deploymerization
C) Blocking cell cycle checkpoints
D) A & B
A) Inhibiting microtubule polymerization
B) Deploymerization
D) A & B
Vinca alkaloids include which of the following (Select all the apply): A) Paclitaxel B) Vinorelbine C) Vinblastine D) Vincristine
B) Vinorelbine
C) Vinblastine
D) Vincristine
Main class toxicities for Vinca Alkaloids are: A) GI abnormalities B) Extravasation C) Peripheral Neuropathy D) B & C
B) Extravasation
C) Peripheral Neuropathy
D) B & C
Which drug much be compounded and dispense in IVPB? A) Vinblastine B) Vincristine C) Vinorelbine D) Bleomycin
B) Vincristine because BBW for IV use only (fatal if given IT so it cannot be given in a syringe)
** same for all Vinca alkaloids [technically ABC]
Select all of the drugs that have liposomal formulations A) Vincristine B) Irinotecan C) Doxorubicin D) Daunorubicin
A) Vincristine
B) Irinotecan
C) Doxorubicin
D) Daunorubicin
Vincristine has which BBW that requires a WARM compress and hyaluronidase injections vs a cold compress: A) IV use only B) Peripheral/autonomic neuropathies C) Constipation D) Extravasation
D) Extravasation
for all Vinca Alkaloids
Vinorelbine has an almost identical toxicity profile as Vinblastine, which includes myelosuppression (mainly neutropenia) + peripheral neuropathy (mild) + constipation + Vinca alkaloid BBWs: peripheral neuropathy + extravasation. True or False?
True
Vinblastine and Vincristine require hepatic adjustment while Vinorelbine requires renal adjustment. True or false?
False. Vinorelbine requires hepatic adjustment and renal adjustment with dialysis
Which drug may need prophylactic bowel regimens due to notable toxicities? A) Paclitaxel B) Bleomycin C) Etoposide D) Vincristine
D) Vincristine
Taxanes are under which class of chemotherapeutic agents? A) Topoisomerase inhibitors B) Microtubule inhibitors C) Antitumor antibiotics D) None of the above
B) Microtubule inhibitors
Taxanes inhibits microtubule assembly during G2/M phase of the cell cycle, preventing cell replication. True or False?
False. Disassembly
Paclitaxel, Docetaxel, and Cabazitaxel have class toxicities of which of the following: A) Myelosuppression B) HFS C) Peripheral Neuropathy D) Hypersensitivity reactions
A) Myelosuppression
C) Peripheral Neuropathy
D) Hypersensitivity reactions
If Paclitaxel was administered, which of the following would you monitor for?
A) LFTs
B) Serum Creatinine
C) CBC with Differential, esp WBCs and ANC
D) Hypersensitivity symptoms
E) Paresthesias and numbness in extremities
A) LFTs (requires hepatic adjustment)
C) CBC with Differential, esp WBCs and ANC (BBW bone marrow suppression)
D) Hypersensitivity symptoms (BBW. Due to vehicle in formulation. Cremohpor or polysorbate 80)
E) Paresthesias and numbness in extremities (peripheral neuropathy most common on Paclitaxel)
What is required before the administration of Paclitaxel?
A) Premeds of corticosteroids
B) Premeds of corticosteroids, H1RA, and H2RA
C) No premeds needed
B) Premeds of corticosteroids, H1RA, and H2RA
What are the unique BBW with Docetaxel? Select all that apply
A) Neutropenia
B) Fluid retention
C) Use in hepatic impairment/Increased mortality risk
D) Extravasation
A) Neutropenia
B) Fluid retention
C) Use in hepatic impairment/Increased mortality risk
+ Hypersensitivity due to vehicle (Polysorbate 80)
What would you monitor when administering Docetaxel? A) Serum Creatinine B) LFTs C) I&Os D) CBC with differential E) Hypersensitivity symptoms
B) LFTs (BBW use in hepatic impairment/increased mortality risk)
C) I&Os (BBW fluid retention)
D) CBC with differential (peripheral neuropathy, BBW fluid retention)
E) Hypersensitivity symptoms (BBW)
+ Paresthesias and numbness in extremities (peripheral neuropathy)
Docetaxel requires pre-medication with corticosteroid for 3 days, starting 1 day prior to docetaxel, to reduce hypersensitivity and fluid retention. True or False?
True
Cabazitaxel has which characteristics?
A) BBW for neutropenia and hypersensitivity
B) Requires hepatic adjustment
C) Requires premeds with corticosteroids, H1RA, and H2RA
D) BBW for peripheral neuropathy
A) BBW for neutropenia and hypersensitivity (Polysorbate 80)
B) Requires hepatic adjustment
C) Requires premeds with corticosteroids, H1RA, and H2RA
How do microtubule inhibitors cause chemo-induced peripheral neuropathy?
A) Impairment of axonal transport of synaptic vesicles
B) Loss of neuronal fibers and demyelination of nerve sheaths
C) Changes in peripheral nerve stability due to electrolyte imbalances
D) Mitochondrial damage leading to ROS and oxidative stress, which increases production of pro-inflammatory cytokines
E) All of the above
A) Impairment of axonal transport of synaptic vesicles
B) Loss of neuronal fibers and demyelination of nerve sheaths
C) Changes in peripheral nerve stability due to electrolyte imbalances
D) Mitochondrial damage leading to ROS and oxidative stress, which increases production of pro-inflammatory cytokines
E) All of the above
Taxanes are more sensory dominant neuropathy (paresthesias, dysesthesias, numbness) vs. Vinca alkaloids have sensorimotor and autonomic neuropathies (muscle weakness, cramping, constipation). True or false?
True
Which of the following is an antitumor antibiotic that works most effectively on the G2 phase of the cell cycle? A) Doxorubicin B) Mitoxantrone C) Bleomycin D) Vincristine
C) Bleomycin
Describe the MOA of Bleomycin
A) Intercalates into the DNA at the topoisomerase-DNA interface to prevent reversal of the topoisomerease cleavage complex
B) Inhibits microtubule assembly during M phase of the cell cycle
C) Generates free oxygen radicals to induce single and double strand breaks and inhibits DNA synthesis
D) None of the above
C) Generates free oxygen radicals to induce single and double strand breaks and inhibits DNA synthesis
What are class toxicities for bleomycin?
A) Pulmonary toxicities
B) Hypersensitivity reactions
C) Rash (hyperpigmentation, flagellate erythema)
E) Neutropenia
A) Pulmonary toxicities (BBW)
B) Hypersensitivity reactions
C) Rash (hyperpigmentation, flagellate erythema)
+ Photosensitivity, idiosyncratic reaction (BBW)
Which of the following statements about bleomycin is false?
A) Requires hepatic adjustment due to increased risk of mortality when given in hepatic impairment
B) Avoid supplemental O2 because it increase risk fo pulmonary toxicity
C) Usually, patients are given 2-unit test dose prior to the first 2 doses to assess for anaphylactic reaction
D) Pulmonary toxicity associated with lifetime cumulative dose >400 units and age >70 yrs
A) Requires hepatic adjustment due to increased risk of mortality when given in hepatic impairment
Requires renal adjustment
Choose the characteristics that describe Bleomycin’s pulmonary toxicity
A) Nonspecific and usually a diagnosis of exclusion
B) Symptoms develop over days-weeks and usually occurs within 6 months of bleomycin treatment
C) It is progressive, and considered irreversible
D) Bleomycin should be permanently discontinued if PFTs suspect pulmonary toxicity
E) All of the above
A) Nonspecific and usually a diagnosis of exclusion
B) Symptoms develop over days-weeks and usually occurs within 6 months of bleomycin treatment
C) It is progressive, and considered irreversible
D) Bleomycin should be permanently discontinued if PFTs suspect pulmonary toxicity
E) All of the above
The management of Bleomycin pulmonary toxicity includes
A) Permanently discontinue bleomycin
B) Prolonged course of systemic glucocorticoids
C) Sparing use of supplemental O2 and IV fluids
D) Holding bleomycin until symptoms resolve
A) Permanently discontinue bleomycin
B) Prolonged course of systemic glucocorticoids
C) Sparing use of supplemental O2 and IV fluids
