Anticancer Drugs Flashcards
(137 cards)
1
Q
Adjuvant chemo is used for what stage of cancer
Cancer where neoadjuvant is not given
A
Stage 1 and above
Thyroid cancer
2
Q
Neoadjuvants are done for : (6)
A
- Breast cancer
- Bladder cancer
- CRC
- Esophageal cancer
- NSCLC
- Gastric Adenocarcinoma
3
Q
Define langerhans histiocytosis
Rx.
A
Infiltration and accumulation of monocytes,macrophages, dendritic cells in affected tissues.
Can spontaneously regress.
Rx: corticosteroid + arabinoside-cytarabine + vincristine
4
Q
Rx for osteosarcoma (5)
A
Rx of choice : surgery
Drugs :
1. High dose MTX
2. Cyclophosphamide
3. Cisplatin
4. Etoposide
5. Doxorubicin
5
Q
Bone marrow sparing anticancer drugs (3)
A
- Vincristine
- Bleomycin
- Fludarabine
6
Q
Rx for prostate cancer (3)
A
Leuprolide
Goserelin
GNRH antagonist : Degarelix
7
Q
S/e of mechlorethane. S/e can be reversed by …….
A
BMS
GM-CSF
8
Q
Classification of alkylating agents (5)
A
- Classic nitrogen mustards
- Nitrosureas
- Platinum compounds
- Triazines
- Others
9
Q
Egs of nitrogen mustards (3)
A
Mechlorethamine- mustard HCL
Cyclophosphamide
Ifosamide (analogue of cyclophosphamide)
10
Q
PK of nitrosureas (2)
Eg of nitroureas.
A
Excellent CNS penetrators. Used for Rx Glioblastoma multiformae
-mustine.
11
Q
Nitrosurea causing renal damage
S/e of estramustine (2)
A
Semustine.
Gynecomastia, Thromboembolism
12
Q
Egs of platinum drugs
Eg of triazines (3)
A
-platins
-Dacarbazine
-procarbazine
-temozolomide
13
Q
Busulfan, chlorambucil are ……drugs
MOA of alkylating agents (3)
A
Alkylating drugs
Produce carbonium ions.
Results in DNA cross linking
abnormal base pairing
breakage of DNA strand.
14
Q
First nitrogen mustard
Can be given as only ….
What happens if given topical
A
Mechlorethamine
Iv-local severe vesicant
If topical-cutaneous T cell lymphoma
15
Q
Prodrug in nitrogen mustard
S/e of cyclophosphamide is due to ….
A
Cyclophosphamide —> phosphor amide mustard+ acrolein.
Haemorrhagic cystitis is due to Acrolein; protected by mesna.
16
Q
Very high doses of cyclophosphamide causes ……(3)
A
Acute myocardial necrosis
Alopecia
SIADH
17
Q
Ifosfamide S/e
A
Also a prodrug.
Ifosfamide—>
chloracetaldehyde + acrolein.
Chloracetaldehyde causes Nephro toxicity
Acrolein—> hge cystitis
More harmful than cyclophosphamide.
Increased neurotoxicity,nephrotoxicity,hge cystitis, platelet suppression.
18
Q
Nitrogen mustards are called ….
Nephrotoxicity of cisplatin seen with in …..part of kidney.
S/e of cisplatin (3)
A
Radiomimetics - action ~ ionising radiation
PCT,DCT
Nephro toxicity
Ototoxicity- high frequency hearing loss
Neurotoxicity- sensory neuropathy
19
Q
S/e of carboplatin-
S/e of oxaliplatin (2)
A
similar to cisplatin but milder, more myelosuppression.
Acute and chronic neurotoxicity
Reversible laryngopharyngeal spasm
20
Q
Primary action of dacarbazine is on …..
Procarbazine acts mainly on…. S/e
A
RNA and protein synthesis
MAOI
Disulfiram like reaction with alcohol.
21
Q
Action of temozolomide.
S/e (2)
A
Cross BBB - useful for GBM
They have increased bioavailability
Headache, constipation
22
Q
Busulfan is specific for ….
Adrenal insufficiency can be seen with …..
Other s/e (4)
A
Myeloid tissue- granulocyte precursors
Busulfan
Hyperpigmentation
Hyperuricemia
Sterility
Pulmonary fibrosis
23
Q
Busulfan active on ……. Tissue
Chlorambucil active on …….tissue
A
Myeloid
Lymphoid
24
Q
Radiosensitizer for head and neck cancer is ….
Role of amifostine
A
Cisplatin
To decrease cisplatin induced nephrotoxicity
25
S/e of cytarabine
How does amifostine protect in head and neck cancer
Cerebellar ataxia
Protects against parotid gland atrophy due to radiation of H&N
26
Amifostine protects against
Gemcitabine is effective against …
Salivary glands
Skin
GIT
not CNS
Pancreatic cancer
27
Cisplatin induced N&V drug….
Palosetron
28
How is MTX DOC for choriocarcinoma?
Another drug added for rx of chorizo carcinoma is …..
Reduced folate carrier - transport MTX into cells. In choriocarcinoma; there is increased expression of RFC.
Actinomycin D
29
Uses of methotrexate
1. Increased dose
a. Osteosarcoma
b. ALL
c. Burkitts lymphoma
d. CNS lymphoma ,choriocarcinoma.
2. Low- moderate dose:
Rheumatoid arthritis
Psoriasis
Ankylosing spondylitis
30
Low to moderate dose of MTX is …
MTX inhibits …..enzymes and thus decrease …..
Folinic acid is aka……
7.5-25 mg/week
DHFR
DNA & protein synthesis
Leucovorin
Citrovorum factor
31
When to give folinic acid ? (7)
Doses >100mg/m2
BMS
Mucositis
Acute renal failure
Idiosyncratic pneumonitis
Hepatotoxic
Rash
32
Hepatotoxic histopathology seen with MTX
MTX toxicity increase when….present
Macrovesicular fatty change
Effusion- pleural effusion, ascites present.
33
………is seen in extreme MTX toxicity
MTX use in Rheumatoid arthritis. How?
Reversible transient Oligospermia
Increase in extra cellular adenosine by MTX
34
MTX cleaving enzyme
Resistance to MTX is by ….(2)
Glucarpidase.
Increase in DHFR - gene amplification
Increase in P-gp - throws away any drug that comes into the cell. Responsible for MDR.
35
Verapamil can be used in anti cancer rx for property of …..
MTX toxicities include: (5)
Inhibit Pgp and increase anti cancer drug action.
1. Myelosuppression
2. Nephro, hepatotoxic
3. Neuro- intrathecal and high dose
4. Phototoxicity
5. Pulmonary toxicity.
36
Drugs which increase toxicity of MTX (5)
Aspirin
Penicillin
NSAID
Omeprazole
TMP-SMZ
37
Methotrexate toxicity Rx. (3)
1. Urine alkalisation -increase elimination of acidic drugs
2. When MTX- with renal failure: glucarpidase
3. Leucovirin may be used.
38
Drugs that are poor substrates of Pgp. (3)
Cabazitaxel
Eribulin
Ixabepilone
Good substrate for pgp.
Paclitaxel
39
MOA of pemetrexed.
S/e
…….is used
Thymidylate synthase
Hand foot syndrome
Folic acid/vit b12.
40
Eggs of folate antagonists
1. Methotrexate
2. Pemetrexed
41
Egs of purine antagonists (6)
1. 6 MP
2. Thioguanine- 6TG
3. Azathioprine
4. Fludarabine
5. Cladribine
6. Pentostatin
42
MOA of pentostatin.
Rx.
Irreversible inhibitor of ADA.
Hairy cell leukaemia
43
MOA of cladribine
Use: ….
Inhibits DNA polymerase and DNA replication
DOC for hairy cell leukaemia
44
Fludarabine is ……
MOA
Antiviral-vidarabine
Incorporated into DNA—> inhibit DNA synthesis
45
Precursor of 6MP
Toxic to ….
Toxic effects increase by ….
Azathioprine
Proliferating lymphocytes
Allopurinol
46
Drugs that block de novo purine synthesis (2)
Require activation by ……
Mercaptopurine
Thioguanine
HGPRT
47
S/e of 6MP
Toxicity of 6MP happens when given with ….
Reversible cholestatic jaundice
Allopurinol.
48
S/e of azathioprine
MOA & S/e of MMF
BMS
Inhibit IMPDH—> decrease purine syn.
S/e: N,V,D
49
Use of MMF
For prevention of graft rejection.
Triple therapy :
Calcineurin inhibitor + MMF+ steroid
50
S/e of vincristine (4)
S/e of bleomycin (2)
Peripheral neuropathy
SIADH
Alopecia
Areflexia
Pulmonary fibrosis
Flagellate pigmentation
51
Difference between vinca alkaloids and taxanes
Vinca: inhibit polymerisation
Taxanes: enhance polymerisation
52
Vincristine blocks polymerisation in ……phase. It’s called….
Metaphase
Spindle poisons
53
Taxanes are aka….
Block microtubules in ……phase
Taxols
Anaphase
Prevent disassembly
54
Glove and stocking pattern peripheral neuropathy seen with …..
What are the epothilones? Use: s/e
Taxanes
Ixabepilone
Use: breast cancer resistance to tax Ames and anthrocyclines
BMS, peripheral neuropathy
55
Pk of thalidomide
Thalidomide acts via inhibiting …..
S/e of thalidomide (3)
Spontaneous dissociation in blood. No renal or liver metabolism.
Angiogenesis
Sedation
Constipation
P. Neuropathy
56
S enantiomer of thalidomide is …. It is ….
Lenalidomide. It is more potent, non teratogenic
57
Uses of thalidomide (6)
1. Multiple myeloma
2. Kaposi sarcoma
3. HIV ass ulcer
4. Behcet syndrome
5. ENL
6. GVHD
58
Vinca alkaloid derived from ….plant
Topotecan,iridothecan derieved from….
S/e
Periwinkle plant-catharantha alkaloids
Camptotheca acuminata
Cholinergic s/e
59
Paclitaxel obtained from ….
Indication of paclitaxel (6)
Bark of western yew tree
1. Ovarian cancer
2. Breast cancer
3. H&N cancer
4. Small cell lung cancer
5. Esophageal cancer
6. Prostrate cancer
60
Histopathology of DCMP in doxorubicin
MOA of anthracyclines
Vacuolated degeneration of myofibrils
Free radicals -interfere with dna intercalation( breaks in DNA to decrease replication)
61
S/e…..prevented by ……
Anthracyclines are not preferred in radiotherapy. Why?
Cardio toxicity
Dexrazoxane
Radiation recall.-dose reduction to prevent radiation toxicity.
62
Actinomycin D is aka…..
Bleomycin is a …..drug
Mitoxantrone is ……
Dactinomycin
Antitumor antibiotic drug.
Analogue of doxorubicin
63
Antitumor antibiotic that causes DNA unwinding
Bleomycin. Moa (5)
Dactinomycin
Chelates copper and iron
Produce superoxide ion, free radical.
Intercalates between DNA strands
Causes chain scissors
Inhibit DNA repair
64
Bleomycin damages ……pneumocytes
Test for bleomycin toxicity.
Bleonycin toxicity is enhanced by ……
Type 1.
Causes hyperplasia of type 2 pneumocytes.
Decreased DLCO.
Oxygen.
65
Flagellate hyperpigmentation is also known as …..
Uses of daunorubicin and doxorubicin
Topical rx for psoriasis
Scratch dermatitis
Daunorubicin: haematological malignancy
Acute leukemia
Doxorubicin: solid tumor,
soft tissue sarcoma
Tazarotene.
66
What is levamisole?
MOA.
Immumodulator antihelminthic
Low dose: immunostimulant
High dose: immunosuppressant
Depolarization by stimulating nicotine receptors
67
Use of levamisole
Mitomycin C is active at sites of …..
MOA
S/e of mitomycinC
CRC with 5FU
Low oxygen tension
DNA cross links
HUS
68
Uses of mitomycin C (3)
1. SCC of anal canal
2. Topical uses: laryngeal stenosis
3. Intravitreal bladder cancer
69
MOA of procarbazine
Drug acts via hypomethylation of DNA
Class of trizene
Acts via methylation of DNA—> dna damage
Decitabine
70
Drugs that inhibit dna methyl transferase (2)
Use.
Decitabine
Azacytidine
Use: myelodysplastic syndrome
71
L-asparaginase is obtained from ……
Use.
Moa of hydroxyurea
E coli
ALL
Inhibit ribonucleotide reductase
Decrease dna synthesis
72
When to stop tamoxifen when conceiving?
SERMS do not inhibit….
3 months before
Vasomotor symptoms of menopause : hot flashes.
73
Imatinib is ……
DOC for ….
S/e of imatinib (3)
Tk inhibitor . Given oral
CML( BCR-ABL) , GIST (c-kit)
S/e:
1. N/v/d
2 Edema- periorbital, pleural effusion
3. Myalgia
74
How does resistance to imatinib occur?
Drugs to be given at that time?
Mutation to bcr-abl kinase
Dasatinib> bosutinib>nilotinib
75
Main c-kit inhibitor
Others (2)
Imatinib
Sunitinib
Regorafenib
76
EGFR TK inhibitors
ALK Inhibitors (2) use.
BRAF kinase inhibitor
Erlotinib, gefetinib
Crizotinib
Ceritinib.
NSCLC
Vemurafenib
77
Diseases with EGFR mutation? (4)
1. CRC
2. NSCLC
3. Pancreatic cancer
4. H&N cancer
78
Drugs against EGFR (2)
Cetuximab
Panitumumab
79
Difference between sunitinib and sorafenib
Sunitinib:
MultiTK inhibitor.
Against : VEGF-RCC
C-kit and PDGFR- GIST
Sorafenib:
VEGFR kit
RAF kinase
Use: RCC.
Other uses of sunitinib:
GIST, pancreatic cancer (SuGiPa)
Other uses of sorafenib:
HCC
Thyroid cancer
80
Tk given for medullary thyroid cancer (2)
Cabzantinib
Vandetanib
81
Drug given for myelofibrosis
TK Drugs given for NSCLC (4)
Ruxolitinib
Erlotinib
Gefetinib
Crizotinib
Afatinib
82
Drugs blocking Her2neu (3)
Ab against her2neu: trastuzumab
Prevent dimerization: pertuzumab
Inhibit intracellular TK: lapatinib, neratinib
83
Use of bevacizumab(3)
DR
CRC
NSCLC
84
MAB for CRC
Anti-VEGF (1)
Anti-EGFR (2)
Anti-VEGF: bevacizumab
Anti-EGFR: cetuximab, panituzumab
85
What are the anti-VEGF drugs ?
Ramu ki Bibi Rani
Ramucirumab: stomach, AdenoCA, NSCLC
Bevazicumab: CRC,NSCLC.
Ranibizumab: decrease bv proliferation in retina
Age related macular edema-wet AMD
Dm macular edema.
86
Drugs for CA breast (3)
Doxorubicin —s/e CMP
Trastuzumab —s/e CMP
Pertuzumab
Paclitaxel —s/e peripheral neuropathy
87
Drug for her2neu positive breast cancer refractory to trastuzumab
Lapatinib + capecitabine
88
Anti CD antagonists (6)
Ritu Is T O O Much
Rituximab
Ibrintumumab
Tositumumab
Ofatimumab
Obintuzumab
MS- Ocrelizumab
89
Uses of rituximab (6)
NHL
CLL
RA
MS
SLE
TTP
90
Drug for PNH
Mab for refractory AML in patients >60years
Eculizumab : C5 convertase
Gemtuzumab +ozagamicin - CD33 ab
91
Differentiation syndrome
Rx
Those Rx for. aml m3 with retinoic acid- fever, pleural and pericardial effusion, chest pain.
Dexamethasone ASAP.
92
Retinoid to rx mycosis fungoides
Another drug causing differentiation syndrome
Bexarotene- activating RXR.
Isocitrate DH
93
AML Rx for different subtype
Cytarabine not given in M3. Why?
M0-M7: cytarabine +_daunorubicin
M3: ATRA+_ arsenic trioxide
Can cause DIC
94
HDAC inhibitor for mycosis fungoides
(Histone deacetylase inhibitor)
Vorinostat
Romidepsin
95
Mtor inhibitor for Rx advanced Tcell cancer
Use of everolimus
Temsirolimus
RCC
Breast cancer
96
what is denileukin difitox?
Use:
Aa+ diphtheria toxin
Mycosis fungoides
97
S/e of denileukin difitox
Immediate : hypersensitivity
Delayed:
vascular leak syndrome -pulmonary and peripheral edema
98
MOA and use of aldesleukin
Toxicity of aldesleukin
MOA: IL-2 recombinant
Use: malignant melanoma
Metastatic renal cell cancer
Capillary leak syndrome
99
Egs of serine threonine kinase inhibitor. Use.
Vemurafenib, dabrafenib- BRAF
Trametinib- MET
Use: malignant melanoma
100
MOA of bortezomib
Use.
S/e
Proteosome inhibitor -prevent NF kB from preventing apoptosis
Multiple myeloma
Neuropathy
101
Purified antigen presenting cells used in hormone dependent prostate cancer
Drug inhibiting hedgehog pathway
Use.
Sipuleucel-T
Vismodegib
Metastatic Basal cell cancer
102
S/e of bevacizumab (4)
Thromboembolism
Gi perforation
Wound dehiscence
Tracheoesophageal fistula
103
Drugs against M phase
Drugs against G2 phase
METV
Estramustine
Taxanes
Vinca
BED
Bleomycin
Etoposide
Daunorubicin
104
Drug inhibiting G1 phase
Vinblastine
105
Action of mesna is …..
Amifostine
Preventing ifosamide bladder toxicity
Against radiation toxicity
106
MOA of palifermin
Drug given to decrease dry mouth from radiation.
Keratinocyte growth factor inhibitor
Pilocarpine
107
Use of strontium
L-asparaginase is bone marrow …..
Reduce bone pain from bone mets
Sparing
108
Drugs for neutropenia
Drug for TCP
Filgistim- G-CSF
Sargramostim- GMCSF
IL-11: Oprelvekin
109
Drug for ifosamide induced neurotoxicity
Drug for paclitaxel induced hyperuricemia.
Methylene blue
Replace with protein bound paclitaxel
110
Mc drugs causing mucositis (3)
Cytarabine
5FU
Methotrexate
111
Prevention of oral mucositis
Diarrhoea is associated with …..
Palifermin
5FU
Capecitabine
Irinotecan
Tk inhibitors :
saorafenib, Sunitinib, imatinib, dasatinib.
EGFR:
Cetuximab, panitumumab, erlotinib.
112
Drugs causing hyperpigmentation (3)
Busulfan
Hydroxyurea
Liposomal doxorubicin
113
Hand foot syndrome mx ass with ….(5)
5FU
Capecitabine
Liposomal doxorubicin
Sunitinib, sorafenib
Pemetrexed
114
Define hand foot syndrome
Tingling , burning of palms and soles
Progress to
severe pain, tenderness,edema and plaque formation
Spread to dorsum of hands and feet
115
Rx had and foot syndrome by
Cessation of offending agent- pyridoxine
116
Uses of TNF alpha inhibitors (3)
RA
IBD
Psoriatic arthritis
117
DOC for SLE
Belimumab-B-lymphocyte stimulator
118
C/F of TNF alpha inhibitor (3)
1. TB: active,
latent: INH for 1mo.
2. HBV+
3. Grade 3,4 CHF
119
Use of IL-2 receptor blockers
Basiliximab: prevent graft rejection
Docolizumab: M.S
120
S/e of calcineurin inhibitors (4)
Nephrotoxicity +
1. Hirsuitism
2. Hyperplasia of gums
3. HTN
4. Hyperuricemia
121
S/e of tacrolimus
Nephrotoxic
D- DM
N- Neurotoxic
D: diarrhea
A: alopecia
122
Drug which inhibit both EGFR and her2neu
Brentuzumab used for …..
works on …..
Lapatinib
CD30
Hogkins ,anaplastic large cell lymphoma
123
Daratumumab is against …..
Use:
Alemtuzumab against
Use
CD38
MM
CD 52
CLL
124
Iblizumab is against …… use
CD6
Psoriasis
125
MAB against asthma (3)
1. Omalizumab -against IgE
2. IL-5: mepolizumab, benralizumab
reslizumab-iv
3. Dupilumab- IL-4,IL-13
126
Mab used in IBD (3)
Moderate to severe UC &CD
1. Ustekinumab- only CD
2. TNF alpha inhibitors -UC&CD
3. Anti-integrins :
Natalizumab- alpha 4 integrin
Vedolizumab- a4B7
Block B cell migration
127
Biologicals for psoriasis (3)
1. Ustekinumab: IL-12/23
2. Guselkinumab: IL-23
3. IL-17 inhibitors : SBI
Secukinumab
Brodalumab
Ixekizumab
128
Biologicals in MS (5)
1. Natalizumab
2. Alemtuzumab
3. Daclizumab
4. Basiliximab
5. Ocrelizumab- CD20.
129
What are integrins?
Ab against integrins (2)
Proteins present on T lymphocytes, on adhesion with VCAM, lymphocytes come out I.e, egress lymphocytes from bv.
Natalizumab: a4B1
Vedolizumab: a4B7
130
Anti IL-1 antibodies
CAR
Canikinumab: CAPS
Anakinra: RA,CAPS
Rilonacept : fusion protein against IL-1
Acute gout: NSAID, colchicine,steroid resistant
131
IL-6 antibodies
Siltuximab use.
Tocilizumab
Sarilumab
Castle man’s disease
132
Drugs acting on IL-2 (4)
1. Aldesleukin
2. Denileukin difitox
3. Basilizimab
4. Daclizumab
133
World’s costliest medicine use
Onasemnogene abeparvovec
Spinal muscular dystrophy <2yrs age with SMN1 mutation
134
What is epigenomics?
Alteration in histone, chromatin, and methylation of DNA sequences
135
Proteomics
Microbiomics
Study of proteins
Study of bacterial flora of a person
136
Metagenomics
Study of environmental species which can influence human biology directly or indirectly.
137
Metabolomics
Study of range of metabolites in cells or organs and ways they are altered in disease states.
