Chemotherapy III Flashcards Preview

Pharm > Chemotherapy III > Flashcards

Flashcards in Chemotherapy III Deck (44):
1

Topoisomerase II Inhibitors: Intercalators

Daunomycin
Doxorubicin
Mitoxantrone
Dactinomycin

2

Topoisomerase II Inhibitors:
Non-intercalators

Etoposide

3

Topoisomerase I Inhibitors

Topotecan
Irinotecan

4

Which drugs are cross resistant due to MDR?

Non-intercalating topo II inhibitors
Intercalating topo II inhibitors
Tubulin Inhibitors (alkaloids)

5

What is one way to reverse MDR resistance?

Give drugs as continuous infusions > downregulate the P glycoprotein

6

What is the P glycoprotein?

Membrane bound efflux pump

7

Which drugs can block the efflux pump and reverse resistance?

Quinine
Verapamil
Cyclosporine

8

Which anticancer drugs are MDR cells resistant to?

Vinca alkaloids (Vinblastine, Vincristine)

Anthracyclines (Daunorubicin, doxorubicin, mitroxantrone)

Epipodophyllotoxins (Etoposide, Teniposide)

Mitomycin C
Actinomycin D
Taxol
Topotecan

9

Doxorubicin MOA

Cell cycle non-specific
Intercalates into DNA and inhibits topo II producing double stranded DNA breaks

10

When should you dose reduce doxorubicin?

Jaundice (excreted in bile)

11

Doxorubicin SE

Nausea, vomiting, hair loss, stomatitis

MYELOSUPPRESSION = d-l

12

What can the cumulative toxicity of doxorubicin cause? What is the max life time dose?

Cardiomyopathy
400 mg/M^2
Schedule dependent

13

What should you obtain before administering doxorubicin?

EJECTION FRACTION

14

How can you reduce the cardiac toxicity of Doxorubicin?

Give longer infusion times (96 hour)
Pretreat with an iron chelator (dexrazoxane)

15

Irinotecan MOA

Topoisomerase I inhibitor
Requires bioactivation

16

When should you dose reduce Irinotecan?

Jaundice

17

Irinotecan SE

Early diarrhea (during infusion or first 24 hours)

Late diarrhea (7-10 days after)

18

How can you treat the early and late diarrhea of Irinotecan?

Early: treat with atropine (cholinergic)

Late: treat with imodium, hydration

19

What genetic mutation/Syndrome will cause increase myelosuppression and diarrhea with Irinotecan?

UGT1A1*28
(decreases glucoronidation)
Gilbert's Syndrome

20

Irinotecan Indication

Colon cancer

21

Bleomycin MOA

Cell cycle specific
Free radical damage to DNA

22

When should you dose reduce bleomycin?

Renal insufficiency

23

Which organs can inactivate Bleomycin?

Which organs cannot?

Liver and kidney

Lungs and Skin

24

Bleomycin SE

Skin hyperpigmentation

PULMONARY TOXICITY = d-l
(cumulative toxicity)

Anaphylactoid reactions

25

What should you monitor in a patient taking Bleomycin?

Pulmonary function
(Diffusion capacity of carbon monoxide-DLCO)

Obtain baseline pulm function tests prior to administration

26

What should you avoid administering in a patient taking Bleomycin?

High oxygen concentrations

27

Bleomycin Indication

Testicular Cancer

28

Hormone dependent cancers

Breast cancer
Prostate cancer

29

Prednisone Indication

Myeloproliferative or Lymphoproliferative Disorders:

Multipl Myeloma, Hodgkin's disease, non-hodgkin's lymphoma, leukemia (some)

30

Prednisone SE

Weight gain, HTN, edema, carb intolerance, suppression of pituitary-adrenal axis, weakness, euphoria, increased appetite

31

Dexamethasone Indications

Chemotherapy related nausea and vomiting (use with 5-HT3 inhibitors)

Cerebral edema, spinal cord edema due to spinal cord compression

32

Tamoxifen

Oral selective estrogen receptor modulator (SERM)

33

Tamoxifen MOA

Agonist-antagonist with respect to estrogen receptor (antagonist in cancer cell)

34

Tamoxifen SE

Hot flashes
Thrombosis
Endometrial cancer
Decreases rate of bone loss

35

Tamoxifen Indication

Prevents breast cancer in high risk women who take for 5 years

36

Aromatase Inhibitors MOA

Rapidly decrease estrogen levels

37

Aromatase Inhibitors Indication

Estrogen receptor positive breast cancers

38

Aromatase Inhibitors SE

Arthralgias, bone pain, bone loss, osteoporosis, hot flashes

39

Aromatase Inhibitors

Anastrozole, Letrozole, Exemestane

40

Goal of Prostate Cancer treatment

decrease testosterone production > Androgen deprivation therapy

41

Flutamide/ Bicalcutamide MOA

Inhibit cancer cell uptake of testoterone

42

Leuprolide acetate MOA

Decrease levels of androgens by decreasing FSH and LH by using a gonadotropin releasing hormone agonist

43

What can you pretreat with to avoid the tumor flare of Leuprolide acetate?

Flutamide
Bicualutamide

44

Side effects of Androgen Deprivation Therapy?

Weakness
Decreased libido
Erectile dysfunction
Loss of muscle mass Gynecomastia
Change in body fat distribution