Chemo Drugs

Question 1

What are examples of alkylating agents?

Answer 1

Cyclophosphamide, chlorambucil, busulfan

Question 2

What are examples of antimetabolites?

Answer 2

5-fluorouracil, methotrexate, fludarabine

Question 3

What are examples of cytotoxic antibiotics?

Answer 3

Doxorubicin, bleomycin

Question 4

What are examples of vinca alkaloids?

Answer 4

Vincristine, vinblastine

Question 5

What are examples of taxanes?

Answer 5

Paclitaxel

Question 6

What are examples of tyrosine kinase inhibitors?

Answer 6

Imatinib, nilotinib

Question 7

What are examples of immunomodulators?

Answer 7

Thalidomide

Question 8

What are some examples of endocrine modulators?

Answer 8

Tamoxifen, anastrozole, cyproterone

Question 9

What are common side effects of cyclophosphamide?

Answer 9

Haemorrhagic cystitis - incidence reduced by MESNA (an organosulphate)
BM suppression
Alopecia

Question 10

What are common side effects of doxorubicin?

Answer 10

Cardiomyopathy

BM suppression

Question 11

What are common side effects of bleomycin?

Answer 11

Pulmonary fibrosis

Question 12

What are common side effects of vincristine?

Answer 12

Peripheral neuropathy

Question 13

What are common side effects of paclitaxel?

Answer 13

Hypersensitivity

Peripheral neuropathy

Question 14

What are common side effects of 5-fluorouracil?

Answer 14

Mucositis

Question 15

How would you mx N&V in a patient on chemo?

Answer 15

Regular anti-emetics: not PRN

Especially 5-HT3 antagonists, synthetic cannabinoid and glucocorticoids

Question 16

How do 5HT3 antagonists work?

Answer 16

Block the 5HT3 area in the postrema (solitary tract nucleus and vagal afferents)
Work synergistically with other anti-emetics (steroids, NK-1)

Question 17

When would you give 5HT3 antagonists?

Answer 17

Normally before chemo

Question 18

What are common side effects of 5HT3 antagonists?

Answer 18

Constipation, headache and dizziness

Question 19

What are examples of 5HT3 receptor antagonists?

Answer 19

Ondansetron, granisetron, palonosetron

Question 20

How do neurokinin-1 antagonists work?

Answer 20

Block neurokinin-1, blocking effect of substance P.

Question 21

When would you use an NK-1 antagonist?

Answer 21

Platinum containing regimes

Question 22

How would you give NK-1 antagonists?

Answer 22

Part of a 3 day course with 5HT3 antagonists and corticosteroids.

Question 23

What are common side effects of NK-1 antagonists?

Answer 23

Hiccups, constipation, dyspepsia

ALT raise may occur

Question 24

What are some examples of NK-1 antagonists?

Answer 24

Aprepitant

Question 25

What are some examples of synthetic cannabinoids?

Answer 25

Nabilone

Question 26

How do synthetic cannabinoids work?

Answer 26

``` Mimics tetrahydrocannabinol (THC) Used in resistant chemotherapy unresponsive to other agents ```

Question 27

How do glucocorticoids work to combat N&V?

Answer 27

Unclear. Work synergistically with other agents e.g. dexamethasone Role in preventing delayed emesis (>24 hours after chemo)

Question 28

What else are glucocorticoids used for in oncology?

Answer 28

Reduce cerebral oedema, cord compression

Question 29

What is amifostine used for?

Answer 29

Reducing neutropenia and nephrotoxicity associated with cisplatin Protects against xerostomia during head and neck radiotherapy

Question 30

How does amifostine work?

Answer 30

Cytoprotective adjunct for DNA-binding chemotherapy

Question 31

What is G-CSF used for?

Answer 31

Reduction of neutropenia associated with chemo | Should not be used routinely

Question 32

What is a problem with prolonged use of G-CSF ?

Answer 32

Myeloid malignancy

Question 33

What is Rasburicase used for?

Answer 33

Prevention and treatment of tumour lysis syndrome

Question 34

How does Rasburicase work?

Answer 34

Recombinant enzyme which metabolises uric acid

Question 35

What are side effects of Rasburicase?

Answer 35

Fever | Hypersensitivity reactions

Question 36

How do you define neutropenic sepsis?

Answer 36

Neutrophil count less than 0.5x10^9 and temp >38 degrees Or, signs and symptoms consistent with sepsis

Question 37

How to ix neutropenic sepsis?

Answer 37

Urgent blood cultures

Question 38

How do you treat neutropenic sepsis?

Answer 38

One hour for treatment! Tazocin (piperacillin with tazobactam) + early oncology referral