Whites Lectures Flashcards by Cole Connelley

what drug is the gold standard for leukemia?

Gleveec/Imatinib

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when is chemo most affective?

during the GROWTH phase of a tumor

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chemo kills via what kinetics?

1st order

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major thing that allows for cancer drug resistance

drug efflux

- multi drug resistance protein (MDR) -> MDR1, MDRP1, BCRP -> eliminate hydrophobic compounds by pumping out drugs

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cyclophosphamide side effects

BLADDER toxicity

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Doxorubicin side effects

CARDIOTOXICITY

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Bleomycin side effects

PULMONARY fibrosis

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know the 3 charts/diagrams

1st powerpoint

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ABVD

A - doxorubicin
B - bleomycin
V - vinblastine
D - dacarbazine

for HODGKINS lymphoma

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CHOP

C - cyclophosphamide
H - hydroxydaunorubicin
O - vincristine
P - prednisone

for NON-HODGKINS lymphoma

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FOLFOX

FO - fluorouracil
L - leucovorin
OX - oxiplatin

for COLORECTAL cancer

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TIP

T - paclitaxel
I - ifosfamide
P - platinum agent cisplatin

for TESTICULAR cancer

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MOA of the alkylating agents and platinum compounds

nucleophilic attack of the unstable AZIRIDINE ring by electron donor -> directly damage DNA
nitrogen mustard moiety covalently binds

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cyclophosphamide (alkylating agent)

requires activation of CYP450 enzyme

- can have HEMORRHAGIC CYSTS & BLADDER TOXICITY/CANCER

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platinum compounds indications

-non small cell lung cancer (NSLC) and small cell lung cancer

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platinum compound that is 1st line treatment in COLORECTAL CANCER?

Oxaliplatin + 5FU & Leucovorin

-be careful with peripheral neuropathy

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what platinum compound is for testicular cancer?

-Cisplatin + TIP

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anthracycline antibiotics that cause CARDIOTOXICITY

Daunorubicin and Doxorubicin

-chronic -> dilated cardiomyopathy

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antibiotic that can cause PULMONARY TOXICITY

Bleomycin

-treat both Hodgkins and SCC of skin/cervix/uvula

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antibiotic used to treat rhabdomyosarcoma & Wilms tumor & Ewing sarcoma in children

Dacitnomycin (Actinomycin D)

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folate analogue (“-trexate”) PK

if given NSAIDs in RENAL failure -> delay drug excretion -> SEVERE myelosuppression

-prolonged myelosuppression w/ compromised renal function

methotrexate MOA

inhibit DIHYDROFOLATE REDUCTASE in 2 spots -> prevent conversion of DHF to THF

-LEUCOVORIN RESCUE to prevent side effects

what does methotrexate treat?

ALL

-also 1st line treatment in RA

pyrimidine analogues side effects

HAND-FOOT syndrome from Capecitabine use

chest pain w/ ischemia from CA vasospasm w/ 5-FU use

cytarabine (cytidine/pyrimidine analogue)

treat AML side effect -> chemical CONJUNCTIVITIS

6MP & 6TG (purine analogues)

- treat human leukemias -> ALL - 6MP + azathioprine predispose to opportunistic infections - 6MP -> cause AML w/ long term use for Chrohn's disease

Vinca alkaloid side effects

-NEUROTOXIC -> peripheral neuropathy

Vinblastine (vinca alkaloid)

treat TESTICULAR cancer -also Hodgkins lymphoma

Vincristine

treat peds w/ leukemia, lymphoma, WILMS tumor, neuroblastoma, RHABDOMYOSARCOM -inject into CSF -> FATAL COMA & SEIZURES

major side effects of Taxanes

HYPERSENSITIVITY w/ paclitaxel infusion FLUID RETENTION w/ docetaxel infusion

Topotecan side effects

NEUTROPENIA w/ or w/o thrombocytopenia

Irinotecan side effects

DELAYED DIARRHEA w/ or w/o neutropenia -give Loperamide to prevent this

main side effects of corticosteroids

glucose intolerance, immunosuppression, osteoporosis, psychosis

aromatase enzyme

converts androgens into estrogen hormones

estrogen receptors

- SERMs -> Tomoxifen | - SERDs -> FULVESTRANT** -> degrades the estrogen receptor on ER+/PR+ breast cancer

side effects of aromatase inhibitors

estrogen depletion -> hot flashes, vaginal bleeding/discharge, increase risk of fracture

Anti-androgens ("-tamides")

treat PROSTATE cancer

EGFR drugs that treat NSCLC with EGFR mutations

Erlotinib and Afatinib -acneiform RASH with Erlotinib**

Cetuximab

- bind to EGFR/ERBB1 receptors - treat COLON cancer and HNSCC - acneiform rash like Erlotinib

Trastuzamab

- bind to HER2/ERBB2 - treat HER2+ BREAST/gastric cancer - worry about HEART FAILURE (cardiotoxicity)

Vismodegib

- blocks Hedgehog signaling path | - treat Basal cell carcinoma (BCC)

Vemurafenib

- BRAF inhibitor (V600E) | - treat metastatic MELANOMA

2 drugs that are BTK inhibitors & treat MCL, WM, CLL, SLL

Ibrutinib and Acalabrutinib

Gleevec (imatinib)

BCR-ABL inhibitor (philadelphia chromosome t9;22) treat CML** & mucosal melanoma may have fluid retention

Crizotinib

- ALK inhibitor - treat NSCLC w/ ALK or ROS1 gene rearrangements - worry about QT prolongation & BRADYCARDIA**

Rapamycin

- mTORC1 inhibitor | - treat RENAL cancer

Bortezomib

- PROTEASOME inhibitor - 1st line treatment of Multiple Myeloma (MM)** & relapsed mantle cell lymphoma (MCL) worry about peripheral neuropathy

most common NSCLC

Adenocarcinoma

most common actionable mutation in lung cancer

EGFR mutations

Pembrolizumab

- inhibits PD-1 receptor on T cells | - treat MELANOMA and NSCLC

Ipilimumab

- inhibits CTLA-4 | - treat MELANOMA and RENAL CELL carcinoma (in combo w/ Nivolumab)