Tubulin-Binding Drugs Flashcards
Tubulin-binding drugs such as vinca alkaloids and taxanes MOA
Antimitotic chemotherapeutic drugs that disrupt normal function of micro tubules
Specifically how does vinca alkaloids work
By binding to depolymerized microtubules and inhibiting microtubule formation
Specifically how do taxanes work
By binding to POLYMERIZED microtubules and inhibiting their breakdown
What is the result of tubular-binding drugs
Failure of the cell to undergo mitosis leading to cell death
Vincristine is highly effective against what diseases
Hodgkin disease, non Hodgkin lymphoma, and pediatric solid tumor
Vinorelbine is used for
Breast and lung ca
Vinblastine is used for
Testicular cancer and non hodgkin lymphoma
What is the most prominent side effects of vinca alkaloids appearing 7-10 days after initiation of treatment
Myelosuppression manifesting as leukopenia, thrombocytopenia and anemia.
Between vincristine, vinblastine and vinorelbine- who is less likely to cause bone marrow suppression
Vincristine
What is the dose limiting side effect of vincristine-what is the first sign
Symmetric peripheral sensory motor neuropathy- loss of Achilles’ tendon reflex being first sign
Are CNS side effects common with vincristine-why
No- doesn’t cross the bbb
What does ssep show about vincristine
Demyelination
Is the peripheral neuropathy reversible with vincristine
Yes, although some say it may take months or be incomplete.
What are the anesthetic considerations for vincristine
Significant risk of worsening neuropathy- LA should be reduced, epinephrine should be avoided. Nerve localization technique that minimizes risk of intraneuronal injection.
What electrolyte imbalance has been associated with vincristine…why
Hyponatremia- high urinary sodium with inappropriate secretion of arginine vasopressin.
What are the autonomic nervous system effects seen with vincristine therapy
Paralytic ileus Abdominal pain Urinary retention Dry mouth Tachycardia Parotid gland tenderness
Vinblastine side effect on the second or third day of treatment
Mental depression
Vinorelbine used to treat breast and lung cancer side effects
Chest pain
Bronchospasm
Dyspnea
Pulmonary infiltration
How does estramustine work
Inhibits microtubule assembly and depolymerization
Estramustine is a useful drug to use as a combination drug for what cancer
Hormone refractory prostate cancer
Paclitaxel is useful for what four cancers
Breast
Lung
Ovarian
Bladder
How are taxanes cleared from plasma
Rapidly despite being largely protein bound
What side effects are taxanes associated with
Myelosuppression
Peripheral neuropathy -glove and stocking distribution
Alopecia
With taxanes what musculoskeletal side effects are experienced
Arthaligia and myalgia
What cardiac side effects are seen with taxanes
Dysrhythmias
Mi
Bradycardia
Docetaxal side effects
Peripheral edema
Pleural effusions
Ascites
Fluid retention of docetaxal may be pretreated with
Dexmethasone
What skin issues is associated with docetaxal
Erythematous maculopapular rash on forearms and hands
What occurs in 25-30% of patients treated with taxanes
Hypersensitivity reaction from release of histamine or other chemical mediators
