Week 14: Oncology Meds Flashcards
Chemotherapy is best for those cancers with a high growth factor. What does this mean?
there ar emore proliferating cells than dying cells
Since chemo is effective on cells with high growth fractions (like cancer), what else can be effected?
High growth fraction normal cells:
Bone Marrow
Hair Follicles
Sperm Forming Cells
GI Epithelium
Solid tumors respond ___ to anti-cancer drugs
poorly (need debulking)
If solid tumors respond poorly to chemo, what does chemo help against?
metastasis or spreading cancer
What kinds of cancers respond best to drug therapy
disseminated cancers (high growth fraction) like leukemia and lymphoma
Why are CNS tumors hard to treat
the BBB prevents drugs from getting where the cancer is
What is the most effective way of tackling cancer via chemo
using multiple agents and attacking at different cell cycle stages
What are some commonly seen effects from anticancer drugs
Bone Marrow Depression (Neutropenia, Thrombocytopenia, Anemia)
Gi Issues
Hair Loss (Alopecia)
Sperm Forming Cell Issues (Sterility)
NV
Hyperuricemia
Vessel Injury from extravasation
Most traditional chemotherapeutic drugs interfere …
either with the synthesis of DNA, RNA, or proteins OR with the appropriate functioning molecules
How do cells die when someone has a chemo agent given
a proportion dies - thats why multiple doses are needed
Cell Cycle Specific Drugs
toxic to the cell at a particular phase and cause no significant harm during other phases
Cell Cycle Non Specific Drugs
kills cells regardless of their phase in the cell cycle - and are considered more toxic but stronger
Targeted Cancer Therapy
Newest chemo drugs that block the growth and spread of cancer by “Harnessing” bodys own immune system
Blocks signals that tell cancer cells to grow and divide uncontrollably
Advantage of Targeted Cancer Therapies
may be more effective and less harmful to normal cells
Prototype Cancer Chemotherapy/Oncology Drugs
9:
Cyclophosphamide (Cytoxan)
Methotrexate (Rheumatrex, MTX)
Mercaptopurine (Purinethol)
Fluorouracil (Adrucil)
Doxorubicin (Adriamycin)
Vincristine (Oncovin)
Cisplatin (Cisplatinum)
Paclitaxel (Taxol)
Tamoxifen (Nolvadex)
Cyclophosphamide (Cytoxin) Classification
ALKYLATING Chemotherapeutic Agent
Action of cyclophosphamide
Inactivation of DNA (via alkylation)
Binds to DNA to form cross links and prevent DNA, RNA, and protein synthesis
DNA Breakage will occur from alkylation
Is cyclophosphamide cell cycle phase specific or non specific
cell cycle phase non specific
What sort of cancers is cyclophosphamide used in
hematologic cancers and solid tumors
What happens when cyclophosphamide is metabolized by the liver
it turns into the cytotoxic agent against cancer cells (alkylation)
ADRs of Cyclophosphamide
- LEUKOPENIA (major one)
- Thrombocytopenia
- Hemorrhagic Cystitis (High Dose Therapy)
Other - Bone marrow depression, alopecia, amenorrhea, azoospermia, teratogenesis,hyperuricemia, NV
What is the lowest point of bone marrow depression with cyclophosphamide
nadir of WBC is between 9-14 days - most sensitive to infection but neupogen can help counteract this
What is hemorrhagic cystitis and how do we prevent it form occurring when taking cyclophosphamide?
It is bleeding inflamed bladder form high doses
we prevent by giving IV fluids and liberal amounts of fluid intake
What is length of cyclophosphamide therapy guided by?
It is guided by keeping leukocyte count between 3000-4000 mm^3
What other disease does cyclophosphamide help treat
rheumatoid arthritis (lower immune system to help)
Route of cyclophosphamide
IV or oral
Mesnex (Mesna)
a drug to help protect the bladder from high doses of cyclophosphamide
What is the issue with long term cyclophosphamide therapy
secondary cancers can occur like with other chemo drugs
Methotrexate (Rheumatrex, MTX) Classification
Antimetabolite Chemotherapeutic Agent ; Folate Antagonist
Action of Methotrexate
inhibits folic acid reduction, thereby interfering with synthesis of the coenzyme needed for DNA synthesis
S phase specific
Is methotrexate cell cycle phase specific or non specific
specific (S Phase)
Route of Methotrexate
Oral - for routine doses
IM - large doses
ADRs of Methotrexate
- STOMATITIS
- PULMONARY INFILTRATES AND FIBROSIS (In Lungs) (can permanently effect resp fxn)
Other: Leukopenia, Thrombocytopenia, Hepatotoxicity, NV, Alopecia, Tubular Necrosis (In Kidneys), HA, Gingivitis, Alopecia
What other disease can methotrexate be used on and why
Rheumatoid Arthritis - strong immunosuppressive effects inhibiting T Lymphocytes
Can also be used in Chrohns Disease soemtimes
Methotraxate is an anti-metbolite. What does this mean
it looks like folic acid to the body but is not
it will antagonize the receptors to stop cell DNA synthesis
Leucovorin
“Rescue” Folinic Acid
It is an antidote for methotrexate that can save normal body cells
Mercaptopurine (6-MP, Purinethol) Classification
Antimetabolite, Chemotherapeutic Agent, Purine Analog
Action of 6-MP / Mercaptopurine
Inhibits DNA synthesis by preventing purine incorporation into the DNA (antagonist)
S Phase Specific