DSA antineoplastic agents, Linger, Part I

Question 1

What are the alkylating agents

Answer 1

cyclophosphamide
ifosfamide
busulfan
cisplatin

Question 2

What are the antimetabolites

Answer 2

methotrexate
fluorouracil 5
mercaptopurine

Question 3

what are the vinca alkaloids

Answer 3

vinblastine and vincristine

Question 4

what are the taxanes

Answer 4

paclitaxel

Question 5

what are the epipodophyllotoxins

Answer 5

etoposide

Question 6

what are the antibiotic natural products

Answer 6

doxorubicin and danuorubicin

Question 7

what are the anthracenediones

Answer 7

belomycin

Question 8

what are the enzymes used for anit-neoplasia

Answer 8

L asparaginase

pegaspargase

Question 9

What are the “-nibs”

Answer 9

protein tyrosine kinase inhibitors

like imatinib

Question 10

what are the monoclonal Ab

Answer 10

rastuzumab

Question 11

what are the rescue agents

Answer 11

leucovorin and mesna

Question 12

what are the drugs to minimize neutropnia

Answer 12

filgrastim and pegfilgrastin

Question 13

What is the serotonin antagonist

Answer 13

ondansetron

Question 14

what cancers are curable with chemo

Answer 14

ALL, AML, Ewing Sarcoma
Gestational trophoblastic carcinoma
Hodgkin, non hodgkin, burkitt, diffuse large cell
follcular mixed cell
lymphoblastic
rhabdomyosarcoma
testicular carcinoma
Wilms tumor

Question 15

what viruses can lead to what types cancer

Answer 15

Hep B and C– hepatocellular
HIV– hodgkins and non-hodgkins
HPV– cervical and head and neck
Ebstein-barr virus – nasopharyngeal

Question 16

What is Primary Induction therapy

Answer 16

1st Tx given

Question 17

Neoadjuvant therapy

Answer 17

Tx as first step to shrink tumor beofre primary treatment is given
(type of induction therapy)

Question 18

what is adjuvant therapy

Answer 18

additional cancer Tx given after primary Tx to lower the risk that the cancer will come back

Question 19

When do you use primary induction chemotherapy

Answer 19

with advanced cancer with no other alternative Tx options

Question 20

why is chemo commonly used as an adjuvant therapy

Answer 20

to reduce incidence of both local and systemic recurrence

Question 21

What is G1 phase cell cycle

Answer 21

precedes DNA synthesis

cell makes components to make DNA

Question 22

What is S phase cell cylce

Answer 22

DNA synthesis

Question 23

What is the G2 phase

Answer 23

synthesis of components for cell division

Question 24

What is the M phase

Answer 24

cell divides into 2 daughter G1 cells

each daughter cell may re-enter cell cycle or pass into nonproliferative stage

Question 25

What controls the transitions in cell cycle

Answer 25

activity of specific cyclin dependent kinases (CDKs) which ar activated by small regulatory proteins called cyclins and can be inhibited by other proteins like p16 and p53 (tumor suppressors)

Question 26

What does cell cycle specific mean

Answer 26

agents that are cytotoxic for cells during specific phases of the cell cycle

Question 27

what does cell cycle nonspecific mean

Answer 27

agents that are cytotoxic regardless of whether the cells are cycling or resting in G0 compartment

Question 28

what drug classes are cell cycle specific

Answer 28

``` antimetabolites epipodophyllotoxins antitumor antibodies taxanes vinca alkaloids camptothecins ```

Question 29

what are the cell cycle nonspecific drug classes

Answer 29

``` alkylating agents antimetabolites (cladribine) antracyclines antitumor antibiotics platinum analogs ```

Question 30

What are the S phase metabolites

Answer 30

``` antimetabolites: capecitabine clofarabine cytarabine fludarabine 5-fluoro uracil gemcitabine 6- merccaptopurine methotrexate 6-thioguanine ```

Question 31

what drug inhibits S-G2 phase

Answer 31

etoposide

Question 32

What drug and its class inhibits G2-M phase

Answer 32

bleomycin (antibiotic)

Question 33

what are the taxanes and what phase do they inhibit

Answer 33

paclitaxel docetaxel M phase

Question 34

what are the vinca alkaloids and what phase do they inhibit

Answer 34

vinblastine vincristine vinorelbine M phase

Question 35

what are the camptothecins and what phase do they inhibit

Answer 35

S phase

Question 36

which antitumoe antibiotics are not cell cycle specific

Answer 36

dactinomycin and mitomycin

Question 37

majority of cells in center of solid tumor are in what phase and why

Answer 37

G0 because of bad vascularization and absence of nutrients | low growth fraction

Question 38

antineoplastic tumors work better on high or low growth fraction

Answer 38

high

Question 39

why is chemo effective for burkitt lymphoma

Answer 39

because have high growth fractions close to 100% so drugs work

Question 40

when is antineoplastic chemo indicated

Answer 40

disseminated neoplasms that are not ammenable via surgery

Question 41

how do antineplastic drugs kill (kinetics)

Answer 41

log | first order kinetcs that a given dose will kill a constant fraction of cells

Question 42

what are pharmacologic sanctuaries

Answer 42

regions where tumor cells are less susceptible to antineoplastic agents

Question 43

what are the main sheculdes of administration chemo drugs

Answer 43

intermittent high dose therpay and continuous infusion

Question 44

why is intermittent high dose therapy most ocmmon form of anticancer agent administration

Answer 44

allows recovery of normal tissues

Question 45

when is continuous infusion used

Answer 45

when the drugs are rapidly metabolized or excreted | cell cycle specific more useful this way

Question 46

what are common routes administration of the antineoplastic drugs

Answer 46

IV and PO

Question 47

what term describes: " each drug used in combination therapy should hace some individual therapeutic activity and should be used at maximal toelration based on individual

Answer 47

efficacy

Question 48

what is optimum scheduling in administration

Answer 48

intensitve intermittent schedules of drug treatment should allow the shortest time required for recovery of most sensitive target tissue (usually bone marrow) from the acute toxic effects of antineoplastic agents

Question 49

what is repeated exposure

Answer 49

several cycles of treatment should be given

Question 50

What are problems with chemo

Answer 50

drug resistance toxicity tolerance adverse effects

Question 51

what is primary resistance and how did that occur

Answer 51

absence of response on first expousre form resitance thought to be due to genomic instability assoc with development of most cancers

Question 52

what are mech of resistance to single agents

Answer 52

decreased drug transport into cells reduced drug affinity increased expression of enzyme that inactivates drug increased expression of DNA repair enzymes for drugs that damange DNA

Question 53

What causes an multi-drug resistant phenotype

Answer 53

increased expression MDR1 gene which encodes cell surface transporter glycoprotein (P glycoprotein) P glycoprotein pump is ATP dependent

Question 54

What drugs may inhibit the P glycoprotein transporter

Answer 54

Ca Ch blockers like verapamil

Question 55

what areas of normal cells are attacked by chemo drugs

Answer 55

high growth areas | bone marrow, GI, hair follicles, buccal mucosa, sperm forming cells

Question 56

what are common adverse effects of chemo

Answer 56

severe vomiting, nausea, stomatis, alopecia myelosuppression, predisposition to infection and impaired wound healing azoospermia sometimes developmental growth of children may be depressed

Question 57

when do blood counts reach their low post Tx? cycle timing?

Answer 57

10-14 days and recover by day 21 and normal by 28 | treatment is every 21-28 days

Question 58

how is neturopenia, thrombocytopenia and anemia Tx from Tx with chemo drugs

Answer 58

the GM CSF and G CSF drugs oprelvekin- thrombocytes erythropoeitin- RBC

Question 59

where is vomitin controlled

Answer 59

2 medullary centers | comiting center and chemoR trigger zone

Question 60

Which drugs cause severe emesis

Answer 60

cisplatin, dacarbazine, doxorubicin, mechlorethamine

Question 61

what drugs have minimal emesis

Answer 61

methotrexate and fluorouracil

Question 62

what are the main anti-emetics used to depress vomiting adverse effect

Answer 62

ondansetron, serotonin antagonist

Question 63

the chemo drugs work on what vomiting medullary center

Answer 63

the chemoR trigger zone which releases NT that act on vomiting center

Question 64

what is stomatitis

Answer 64

inflammation of oral mucosa

Question 65

what drugs cause most profound alopecia

Answer 65

cyclophosphamide, dactinomycin, doxorubicin, paclitaxel and vincristine

Question 66

what agent is used to decreased bone destrcution in metastatic diseases in the bones

Answer 66

bisphosphonates inhibit osteoclast action and bone resorption and may be used to delay time to first skeletal complication