Flashcards in Chemotherapy III Deck (44):
Topoisomerase II Inhibitors: Intercalators
Topoisomerase II Inhibitors:
Topoisomerase I Inhibitors
Which drugs are cross resistant due to MDR?
Non-intercalating topo II inhibitors
Intercalating topo II inhibitors
Tubulin Inhibitors (alkaloids)
What is one way to reverse MDR resistance?
Give drugs as continuous infusions > downregulate the P glycoprotein
What is the P glycoprotein?
Membrane bound efflux pump
Which drugs can block the efflux pump and reverse resistance?
Which anticancer drugs are MDR cells resistant to?
Vinca alkaloids (Vinblastine, Vincristine)
Anthracyclines (Daunorubicin, doxorubicin, mitroxantrone)
Epipodophyllotoxins (Etoposide, Teniposide)
Cell cycle non-specific
Intercalates into DNA and inhibits topo II producing double stranded DNA breaks
When should you dose reduce doxorubicin?
Jaundice (excreted in bile)
Nausea, vomiting, hair loss, stomatitis
MYELOSUPPRESSION = d-l
What can the cumulative toxicity of doxorubicin cause? What is the max life time dose?
What should you obtain before administering doxorubicin?
How can you reduce the cardiac toxicity of Doxorubicin?
Give longer infusion times (96 hour)
Pretreat with an iron chelator (dexrazoxane)
Topoisomerase I inhibitor
When should you dose reduce Irinotecan?
Early diarrhea (during infusion or first 24 hours)
Late diarrhea (7-10 days after)
How can you treat the early and late diarrhea of Irinotecan?
Early: treat with atropine (cholinergic)
Late: treat with imodium, hydration
What genetic mutation/Syndrome will cause increase myelosuppression and diarrhea with Irinotecan?
Cell cycle specific
Free radical damage to DNA
When should you dose reduce bleomycin?
Which organs can inactivate Bleomycin?
Which organs cannot?
Liver and kidney
Lungs and Skin
PULMONARY TOXICITY = d-l
What should you monitor in a patient taking Bleomycin?
(Diffusion capacity of carbon monoxide-DLCO)
Obtain baseline pulm function tests prior to administration
What should you avoid administering in a patient taking Bleomycin?
High oxygen concentrations
Hormone dependent cancers
Myeloproliferative or Lymphoproliferative Disorders:
Multipl Myeloma, Hodgkin's disease, non-hodgkin's lymphoma, leukemia (some)
Weight gain, HTN, edema, carb intolerance, suppression of pituitary-adrenal axis, weakness, euphoria, increased appetite
Chemotherapy related nausea and vomiting (use with 5-HT3 inhibitors)
Cerebral edema, spinal cord edema due to spinal cord compression
Oral selective estrogen receptor modulator (SERM)
Agonist-antagonist with respect to estrogen receptor (antagonist in cancer cell)
Decreases rate of bone loss
Prevents breast cancer in high risk women who take for 5 years
Aromatase Inhibitors MOA
Rapidly decrease estrogen levels
Aromatase Inhibitors Indication
Estrogen receptor positive breast cancers
Aromatase Inhibitors SE
Arthralgias, bone pain, bone loss, osteoporosis, hot flashes
Anastrozole, Letrozole, Exemestane
Goal of Prostate Cancer treatment
decrease testosterone production > Androgen deprivation therapy
Flutamide/ Bicalcutamide MOA
Inhibit cancer cell uptake of testoterone
Leuprolide acetate MOA
Decrease levels of androgens by decreasing FSH and LH by using a gonadotropin releasing hormone agonist
What can you pretreat with to avoid the tumor flare of Leuprolide acetate?