Antineoplastic Agents Flashcards
(51 cards)
1
Q
What is cancer staging?
A
- classifying patients according to the extent of their disease with high numbers indicating more extensive, serious disease and a poorer prognosis
2
Q
What are the 2 staging systems used in cancer?
A
-AJC and TNM
3
Q
What does cancer survival depend on?
A
- tumour type, extent of disease, the treatment used and the constitution or performance status of the patient
4
Q
What is cancer surgery useful for?
A
- for reducing the tumour mass and in theory, would be curative if all the cancer cells were removed
- can also be used as palliative tx to relieve conditions like spinal cord compression
5
Q
What is radiation therapy useful for?
A
- use of ionizing radiation to kill cancer cells and reduce tumour mass
- the goal is to harm as many cancer cells as possible while limiting damage to the surrounding healthy tissues
6
Q
What does the amount of radiation used depend on?
A
- type of cancer, proximity of sensitive tissues or organs and the constitution of the patient
7
Q
What is the action of chemotherapy?
A
- involves tx with drugs which can destroy cancerous cells - affects rapidly dividing cells in general, so chemo will also harm healthy tissues (esp those with high turnover rate)
8
Q
What is the only thing that brings some specificity into chemotherapy?
A
- normal cells are able to repair DNA damage, while cancer cells cannot
9
Q
Why are multiple drugs used in a chemotherapy regimen?
A
- for synergy- it decreases the possibility of resistance developing and also reduced dose-related AE
10
Q
What drug class cannot be administered via the intrathecal route?
A
vinca alkaloids
11
Q
How do alkylating agents work?
A
- earliest chemotherapy agents- inhibit DNA replication by causing cross linking and abnormal base pairing between DNA strands
12
Q
What class of drugs contain a bifunctional nitrogen mustard moiety?
A
alkylating agents
13
Q
Why are alkylating agents quite toxic?
A
- immonium ions are able to react with any cell component containing neutrophilic functional groups such as hydroxyl, sulfhydryl, amino or carbonyl
14
Q
What is the MOA in which cancer cells are resistant to alkylating agents?
A
- increased ability to repair DNA lesions, decreased permeability to the agents or increased production of glutathione with agents with the alkylating agents
15
Q
What are the AE associated with alkylating agents?
A
- myelosuppression with granulocytopenia, thrombocytopenia and anemia, N/V, and reversible hair loss
16
Q
What are the specific alkylating agents?
A
- N mustards
- alkyl sulfonates
- nitrosoureas, triazenes
17
Q
What are antimetabolites?
A
- structural analogies of naturally occurring substrates for biochemical reactions occurring in the body
- several of them act as false substitutions in the production of NA and interrupt and stop the replication process
18
Q
What are the antimetabolites?
A
- folic acid analogs
- purine analogs
- pyrimidine analogs
19
Q
Most of the antitumour antibiotics are obtained from what?
A
streptomyces sp.
20
Q
How do antibiotics work in cancer?
A
- intercalation or by sliding between DNA base pairs and inhibiting DNA synthesis
21
Q
What is the main class of drugs that are considered anti-tumour antibiotics?
A
- anthracyclines
22
Q
What is the MOA of plant alkaloids?
A
- prevent formation of the mitotic spindle and stop cell division- the podophyllotoxins inhibit topoisomerase(enzyme that is necessary for RNA transcription) and the taxanes stabilize microtubules, thereby promoting cell division
23
Q
What cells are the most sensitive to antineoplastic agents?
A
- cells with high turnover rate, i.e. bone marrow, mucous membranes, and hair follicles (generally most sensitive)
(myelosuppression, mucositis and alopecia)
24
Q
What organ systems are affected by cumulative toxicities
A
- pulmonary
- cardiovascular
- urinary
- neurological
25
The extent of myelosuppression is_________
dose limiting
26
What 3 effects does myelosuppression lead to?
- neutropenia (WBC reduction)
- thrombocytopenia (platelet reduction)
- anemia
27
How long does recovery of cell counts usually take?
-2-3 weeks
28
What agents can be used to increase the rate at which neutrophil counts recover?
- filgrastim (G-CSF)
29
What can filgrastim prevent?
- febrile neutropenia (usually indicates an infection, and may allow chemo to continue at full doses without delays in the tx schedule)
30
What is the action of erythropoietin?
- promotes the production of RBCs and may prevent or correct anemia
31
Describe acute emesis
- symptoms begin 1-2 hours after administration of an emetogenic chemotherapy drug
- peaks: after 4-6 hours
- begins to subside after 12-24 hours
32
What is the cause of acute emesis?
- stimulation of the chemoreceptor trigger zone through serotonin release (this is why serotonin antagonists are useful here)
33
What is anticipatory nausea?
- n/v triggered by stimuli with the therapy such as the smell or sight of the hospital
- conditioned response
(managed by relaxation techniques)
34
What is delayed nausea?
- n/v that begins at least 24 hours after chemotherapy administration- may persist for 2-5 days and the mechanism is not understood
- usually seen with highly emetogenic drugs such as cisplatin
35
Why do most chemotherapy agents cause diarrhea?
- these drugs cause damage to the bowel lining (mucous membranes)
- 5-FU is an example of this
36
Mucositis can be used specifically by what?
- 5-FU, methotrexate and doxorubicin
(usually starts with burning of the lips and mouth, and then proceeds to ulcerations of the buccal mucosa, lips, floor of mouth and tongue)
37
What is extravasation?
- when a drug being given IV is adverted and infused into the tissue (number of antineoplastic drugs are vesicants and will do severe damage to tissues)
38
What are the vesicant antineoplstic drugs?
- dactinomycin
- doxorubicin
- mechlorethamine
- paclitaxol
- vinblastine
- vincristine
39
What are the drugs that often cause alopecia?
- cyclophosphamide
- 5-FU
- doxorubicin
- vincristine
- epirubicin
- bleomycin
- paclitaxol
40
How long after these drugs are given does hair loss happen?
- 7-10 days after tx (begins)
- peaks after 1-2 months
- begins to regrow around a month after being stopped
41
_______ and _______ can cause severe skin dryness and itch, as well as sensitivity to light
vincristine and 5FU
42
What is the main drug that causes pulmonary toxicity?
- bleomycin (causes a direct cytotoxic effect on pulmonary epithelium)
43
What drugs are associated with cardiotoxicity?
anthracycline antibiotics (doxorubicin, epirubicin, mitoxantrone and danarubicin)
44
Cardiotoxicity increases with _________
increased cululative dose
45
What is the MOA behind cardiotoxicity
generation of free radicals with the simultaneous suppression of these enzymes which protect cells from free radical damage
46
______ is a cardioprotective drug which may be useful to protect from cardiotoxicity
dexrazoxane
47
What drugs have a high rate of neurotoxic effects
- vinca alkaloids
- vincristine, vindesine, anad vinblastine
- - also platinum compounds
48
What are the main s/s associated with neurotoxicity
- numbness of hands and feet, gait disturbances, and in severe cases, severe motor weakness
- if drug stopped early enough, these effects are reversible
49
What is the MOA of neurotoxicity associated with platinum compounds?
- demyelination and typically manifests as sensory disturbance in the hands
50
Nephrotoxicity is associated with what drugs?
- cisplatin, ifosfamide and methotrexate
51
Infertility is a SE of what drugs
cyclophosphamide, chlorambucil, mechlorethamine, melphan
