Cancer Drugs

Question 1

Inhibits DHF reductase of pyrimidine synthesis

Answer 1

Methotrexate

Question 2

Three uses for MTX

Answer 2

1) Anti-cancer: leukemias (ALL), lymphomas, sarcomas
2) Uterine pathology: Hydatidiform mole, choriocarcinoma
3) Immunosuppression: RA and psoriasis

Question 3

What rescues MTX and from what?

Answer 3

Leucovorin allows for the myelosuppresion of MTX to be reversible
Derivative of THF which bypasses the inhibited DHF reductase

Question 4

Bone marrow suppression
Pulmonary toxicity
Tetratogenic

Answer 4

MTX

Question 5

Inhibits thymidylate synthase

Answer 5

5-Fluorouracil

Question 6

Used for colon cancer, pancreatic cancer, basal cell carcinoma and actinic keratosis

Answer 6

5-Fluorouracil

Question 7

What rescues 5-FU and from what?

Answer 7

Uridine rescues F-FU from bone marrow suppression

Question 8

Photosensitivity

Answer 8

5-FU

Question 9

What other drugs act at the same spot as MTX?

Answer 9

TMP

Question 10

Inhibits DNA polymerase as a pyrimidine analog

Answer 10

Cytarabine

Question 11

Inhibits PRPP amidotransferase portion of purine synthesis

Answer 11

6-Mercaptopurine
6-Thioguanine
Azathioprine

Question 12

This will increase 6-Mercaptopurine toxicity

Name the drug, the enzyme and the toxicity

Answer 12

6-MP is metabolized by xanthine oxidase

Allopurinol (gout drug) inhibits xanthine oxidase and will increase myelosuppression

Question 13

What drug is metabolized by xanthine oxidase and what drug in the same class isn’t?

Answer 13

6-MP metabolized by xanthine oxidase

6-thioguanine is not! (can be coadmistered with allopurinol)

Question 14

Induces free radical formation causing breaks in DNA strands

Answer 14

Bleomycin

Question 15

Pulmonary fibrosis

Answer 15

MTX (pulm tox)
Bleomycin
Busulfan

Question 16

Dactinomycin MOA

Answer 16

Intercalates DNA

Question 17

Used to tx rhabdomyosarcoma, Wilm’s tumor and Ewing sarcoma

Answer 17

Dactinomycin

“kids ACT out give them dACTinomycin”

Question 18

Generate free radicals

Intercalate into DNA

Answer 18

Doxorubicin
Daunorubicin
(Anthracyclines)

Question 19

Cardiotoxicity

Answer 19

Anthracyclines (Doxorubicin Daunorubicin)

Question 20

What saves Anthracyclines and from what

Answer 20

Using Dexrazoxane with doxorubicin/daunarubicin acts to decrease free radical formation and thus cardiotoxicity

Question 21

Why is the mechanism of cardiotoxicity?

Answer 21

doxorubicin/daunarubicin create oxygen free radical sad the heart is suspceptible to free radical damage due to decreased superoxide dismutase

Question 22

Alkylating agents (4)

Answer 22

Busulfan
Cyclophosphamide
Nitrosureas (Carmustine)
Cisplatin

Question 23

What drug requires liver bioactivation?

Answer 23

Cyclophosphamide

Question 24

What cancer drug is also used in immunosuppression in lupus nephritis and polyarteritis nodosa?

Answer 24

Cyclophosphamide

Question 25

Increased risk of transitional cell cancer of bladder

Answer 25

Cyclophosphamide

Question 26

What rescues cyclophosphamide and from what

Answer 26

MESNA recues cyclophosphamide from hemorrhagic cystitis due to acrolein (metabolite accumulation)

Question 27

What causes hemorrhagic cystitis and in what drug is this seen?

Answer 27

Acrolein | Cyclophosphamide

Question 28

What is sodium 2-mercaptoethan sulfonate

Answer 28

Mesna which rescues cyclophosphamide from producing hemorrhagic cystitis

Question 29

Used to tx brain tumors

Answer 29

Nitrosureas Carmustine Lomustine Semustine

Question 30

Crosses BBB causing CNS toxicity

Answer 30

Nitrosoureas Carmustine Lomustine Semustine

Question 31

General side effects of cancer drugs

Answer 31

Alopecia GI upset Myelosuppresion (All rapidly dividing cells)

Question 32

Causes hypersensitivity reactions

Answer 32

Paclitaxel

Question 33

Hyperstabalizes microtubules

Answer 33

Paclitaxel

Question 34

Tx ovarian and breast cancer

Answer 34

Paclitaxel

Question 35

Tx ALL NH lymphomas, Hodgkin lymphomas, Wilms tumors Ewing sarcoma and Choriocarcinoma

Answer 35

Vincristine/Vinblastine

Question 36

SE peripheral neuropathy neurotoxicity and bone marrow suppressions

Answer 36

Vincristine/Vinblastine

Question 37

Tx GU tumors (testicular, ovarian, bladder)

Answer 37

Cisplatin

Question 38

Causes ototoxicity/nephrotoxicity

Answer 38

Cisplatin

Question 39

Inhibits topoisomerase 2

Answer 39

Etoposide | Teniposide

Question 40

Tx small cell lung cancer and testicular cancer

Answer 40

Etoposide

Question 41

Inhibits topoisomerase 1

Answer 41

Irinotecan | Topotecan

Question 42

Inhibits ribonucleotide reductase

Answer 42

Hydroxyurea

Question 43

Also tx sickle cell disease

Answer 43

Hydroxyurea

Question 44

Testicular Cancer Tx

Answer 44

"Eradicate Ball Cancer" Etoposide Bleomycin (Ifosfamide) Cisplatin

Question 45

Triggers apoptosis of lymphoid cells

Answer 45

Prednisone

Question 46

SE Cushingoid Sx

Answer 46

Prednisone

Question 47

Monoclonal Ab against VEGF

Answer 47

Bevacizumab | "Bev bleeds monthly"

Question 48

SE hemorrhage and impaired wound healing

Answer 48

Bevacizumab | "Bev bleeds monthly"

Question 49

Tyrosine kinase inhibitor of BRC-ABL

Answer 49

Imatinib

Question 50

Tx CML

Answer 50

Imatinib | inhibitor of BRC-ABL

Question 51

Monoclonab Ab to CD20

Answer 51

Rituximab

Question 52

Increased risk of endometrial cancer

Answer 52

Tamoxifen

Question 53

Used to tx osteoporosis

Answer 53

Raloxifene

Question 54

Doesn't increase risk of endometrial cancer

Answer 54

Ralofxifene

Question 55

Estrogen receptor antagonist used to tx breast cancer

Answer 55

Tamoxifen

Question 56

SE Cardiotoxicity

Answer 56

Doxorubicin Trastuzumab "Herceptin hurts the heart"

Question 57

Monoclonal Ab against HER-2

Answer 57

Trastuzumab | Herceptin

Question 58

Myelosuppresion

Answer 58

5-FU 6-MP MTX