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Pharm block IV > Chemo Drugs > Flashcards

Chemo Drugs Flashcards

1
Q

Cyclophosphamide

A

CCNS - Alkylates DNA
Hematuria (rare)
Myelosuppression

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2
Q

Ifosfamide

A

CCNS - Alkylates DNA
Hematuria

Coadminister with MESNA

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3
Q

Temozolomide

A 
CCNS - Alkylates DNA
Brain tumors (gliobastoma multiforme)

Myelosuppression
Pneumocystis pneumonia

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4
Q

Cisplatin

Cis-diaminedichloroplatinum (II) (cis-DDP)

A

CCNS - Alkylates DNA
Nephrotoxic
Administer with hydration and mannitol diuresis
Dose reduction for renal insufficiency - do NOT in RF

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5
Q

Carboplatin

A

CCNS - Alkylates DNA
Excreted by kidneys and NOT nephrotoxic
(give to pts with RF)

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6
Q

Oxaliplatin

A

CCNS - Alkylates DNA
Myelosuppresion is dose limited

GI (COLORECTAL, gastric and pancreas)

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7
Q

Vincristine

and Vinorelbin

A

CCS (M phase) - plant alkaloid
prevents polymerization - INHIBIT mitotic spindle formation
Dose reduction in presence of JAUNDICE (excretion via the BILE)

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8
Q

Vinblastine (and vinorelbin)

A

CCS (M phase) - plant alkaloid
prevents polymerization - INHIBIT mitotic spindle formation

Dose reduction for JAUNDICE (hepatic dysfunction)

Myelosuppression
Vesicant (skin irritation)

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9
Q

Paclitaxel

A

CCS (M phase) - plant alkaloid
Prevents tubular disassembly - INHIBIT mitotic spindle breakdown

Dose reduce for HEPATIC dysfunction
Peripheral Sensory neuropathy (myalgias and arthralgias; loss of ankle leg reflex)
Myelosuppression
Infusion reactions due to reaction to solvent. Premedicate with steroids
Vesicant

Docetaxel (prostate cancer)
Albumin bound paclitaxel (no allergic reactions and less myelosuppression and less neuropathy)
Cabazitaxel (prostate cancer)

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10
Q

Etoposide

A

CCS (G1-S phase)
Topoisomerase II inhibitor and produces double stranded breaks in DNA

Dose reduce for HEPATIC or RENAL dysfunction
Myelosuppression
leukemogenic

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11
Q

Doxorubicin

red drug

A

CCNS
Topoisomerase II inhibitor inhibitor and produces double stranded breaks in the DNA

Schedule dependent cumulative CARDIAC TOXICITY (pretx: dexrazoxane) - dec toxicity with longer infusion times

Dose reduction for JAUNDICE
excreted as a thiol adduct into the bile

Breast cancer
leukemia
sarcoma
Hodgkin’s and non-Hodgkin’s lymphoma

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12
Q

Irinotecan

A

CCNS
acute cholinergic diarrhea (frist 24 hrs; tx - atropine)
late secretory diarrhea(7-10 days tx: imodium and hydration)

Dose reduction for JAUNDICE

UGT1A1*28 genetic testing

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13
Q

Bleomycin

A

Pulmonary toxicity cumulative
do DLCO pulmonary testing

skin hyper pigmentation

avoid high-inspired [O2] –> ARDS
If O2 needed, give lowest FiO2 to maintain O sat >90%

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14
Q

Tamoxifen

A

selective ER modulator
(antagonist in cancer. agonist in endometrium)

ER+ Breast cancer tx and prevention

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15
Q

anastrozole

letrozole
exemestane

A

aromatase inhibitor
(rapid dec of estrogen level)

arthralgia
bone pain
bone loss

ER +breast cancer

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16
Q

Flutamide

A

can prevent “flare reaction” - give before leuprolide acetate

inhibits testosterone - Prostate cancer

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17
Q

Methotrexate

A

enter via folate carrier –> Binds and inhibits dihydrofolate reductase (DHFR) –> Dec tetrahydrofolate

INTRATHECAL

High-dose methotrexate (HDMTX) + LEUCOVORIN (THF) rescue
can rescue cells with less polyglutamation (cancer cells are more polyglutamate) –> preserves non-cancer cells

Factors:

1) Hydration (saline and bicarbonate IV) and alkalinization of urine.
2) Check urine pH each void (>= 7 to start, if less give additiona sodium bicarbonate)
3) Administer methotrexate
4) Begin intravenous or oral leucovorin rescue.
5) Monitor methotrexate levels
6) Stop rescue

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18
Q

Pemetrexed

A

inhibit thymidylate synthase

Lung cancer, mesothelioma

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19
Q

Cytarabine

A

CCS - S Phase
Converted to triphosphate inhibits DNA polymerase
incorporation into DNA and inhibits chain elongation (anti-pyrimidine)

Schedule dependent cytotoxicity - S phase specific and T1/2 short
3+7 regimen (3 days of doxorubicin/daunorubicin and 7 days of continuous infusion of Cytarabine)

INTRATHECAL

high dose strategy (cerebellar toxicity)
conjunctivitis
hepatic toxicity
myelopsuppresion

20
Q

5-Fluorouracil (5-FU)

A 
CCS - S Phase
incorporation into DNA and RNA
Thymineless death (conversion to 5-DUMP and binding to thymidylate synthetase) - dec thymine nucleotide

coadminister with LEUCOVORIN - enhances cytotoxicity but INC AE

stomatitis/diarrhea
hyper pigmentation
coronary artery vasospasm
cerebellar toxicity
excess lacrimation
Hand-Foot syndrome

liver (dihydropyridimidine DPD dehydrogenase) metabolism - deficiency = INC toxicity

GI
breast cancer
head and neck cancer

radiation sensitizer

21
Q

Capecitabine

A

oral prodrug of 5-FU

22
Q

6-MerCaptoPurine

A

CCS - S Phase
metabolized by xanthine oxidase to inactive 6-thioric acid
ALLOPURINOL inhibits XA –> INC toxicity

*acute lymphoblastic/cystic leukemia - Childhood

23
Q

6-thioguanine

A

can be used in pts taking ALLOPURINOL

24
Q

Asparaginase

A

inhibits protein synthesis - hydrolyzes existing L-asparaginase
(tumor - NO asparaginase synthetase)

*acute lymphoblastic/cystic leukemia

25
Q

Hydroxyurea

A

inhibits protein synthesis (inhibits ribonucleotide reductase)

EMERGENCY to decrease high WBC in acute myeloid leukemia

26
Q

all trans retinoid acid

tretinoin

A

induces terminal differentiation of cell

*Acute ProMyelocytic Leukemia (APL, M3)

27
Q

Arsenic trioxide

A

allows myeloid differentiation to continue and apoptosis to occur
QT prolongation

acute promyelocytic leukemia

28
Q

Imatinib mesylate

A

Tyrosine Kinase inhibitor - inhibits pathways that are always active in tumor cells

  • chronic myelogenous leukemia (BCR-AML)
  • GI stromal tumor (c-KIT)
29
Q

Cetuximab

monoclonal antibody

A

inhibits EGFR –> NO cancer growth

hypersensitivity
rash
hypomagenesaemia
Trichomegaly (long eyelash)

Lung cancer
Metastatic wildtype K-RAS and N-RAS colorectal cancer
*(NOT given to pts with mutated RAS)

30
Q

Erlotinib

A

TX of choice for tumor with “activating mutation” of EFGR - metastatic adenocarcinoma of lung, head and neck

31
Q

Trastuzumab

A

binds to HER-2-neu receptor

Cardiac toxicity - reversible (INC risk with ANTHRACYCLINE)
asymptomatic, DEC in EF

*HER-2 breast cancer and GI

32
Q

bEVacizumab

A

binds to VEGF LIGAND –> impair vascular formation –> Dec tumor growth, mets

HTN
proteinuria
infusion run
arterial clots
colon perforation
Posterior reversible encephalopathy syndrome (HA, mental status and vision change) - reversible
  • lung cancer
  • metastatic colorectal cancer
33
Q

Crizotinib

A

binds to anapestic lymphoma kinase (ALK)

metastatic adenocarcinoma of lung

34
Q

vemuRAFeniB

A

inhibits mutated BRAF
oral

melanoma

35
Q

SorafeNIB
PazopaNIB
SuniatiNIB

A

inhibits VEGF receptor tyrosine kinase
Hand-foot syndrome, CHF
oral

renal cell cancer
endo and GI cancer
hepatocellular

36
Q

Skipper Hypothesis

A

ability of chemotherapy to cure is inversely proportional to tumor burden

37
Q

Goldie-Coldman Hypothesis

A

Tumor cells mutate to a resistant phenotype at a rate dependent on their intrinsic genetic instability.
Probability of cancer developing drug resistant clones depends on mutation rate and size of tumor

38
Q

shorten duration of Neutropenia

A

G-CSF or Fligrastim

39
Q

Nausea/vomit tx

A 
Prochlorperazine
Compazine
5-HT3 receptor antagonist
Lorazepam
Aprepitant
Dexamethasone
40
Q

Mesna

A

co-administer with alkylating agents (Ifosfamide)

- prevent/ameliorate heme cystisis/hematuria

41
Q

MTX and Cytarabine

A

Intrathecal

42
Q

Leucovorin (THF)

A

+MTX - rescues non cancer cell

+5-FU - INC cytotoxicity

43
Q

Adjuvant Chemo

A

POST-surgery

pt at risk for micrometastatic disease

44
Q

Neo-adjuvant Chemo

A

BEFORE surgery

achieve cytoreduction

45
Q

Performance Status

A 
0 - pt fully active
1 - restricted strenuous activity
2 - ambulatory/self care
3 - limited self care
4 - disable completely 
5 - death
46
Q

Aklkylating Agents

A

Cell-Cycle non-specific.

Covalently bind to DNA by alkylating N-7 of Guanine –> DNA-Drug intrastrand and interstrand crosslinks

47
Q

Leuprolide Acetate

A

GnRH receptor agonist

Flare reaction - tumor worse and inc bone pain

Prostate cancer
ER+ breast cancer

Pharm block IV (5 decks)

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