Final Exam study

Question 1

What origin is a carcinoma?

Answer 1

malignant neoplasm of squamous epithelial cell origin

Question 2

What origin is a adenocarcinoma?

Answer 2

malignant neoplasm of gland tissue

Question 3

What origin is a sarcoma?

Answer 3

malignant neoplasm derived from glandular tissue such as bone, muscle, fat

Question 4

What type of classification is BRCA 1/2?

Answer 4

-tumor suppressors
-mutation increases risk for cancer
-are susceptible to PARP inhibitors due to synthetic lethality
ex. Olaparib

Question 5

What are the parts of the cell cycle?

Answer 5

G0/G1 - accumulates building blocks for division
S- cell replicates its DNA
G2 - cell assembles machinery for the chromosomes to seperate/ cell double checks chromosomes
M- mitosis

Question 6

What type of chemotherapies work in the G1 phase?

Answer 6

kinase inhibitors, hormone inhibitors, CDK4/6 inhibitors

Question 7

What type of Chemotherapies work in the S phase?

Answer 7

anti-metabolites, anti-folates, topo I inhibitors

Question 8

What type of chemotherapies work in the G2 phase?

Answer 8

Topo II inhibitors

Question 9

What type of chemotherapies work in the M phase?

Answer 9

microtubule inhibitors

Question 10

What chemotherapies are non-cell cycle specific?

Answer 10

alkylators, intercalaters

Question 11

What are two well-known tumor suppressors?

Answer 11

TP53, p16

Question 12

What are two well-known oncogenes?

Answer 12

KRAS, P13K

Question 13

What are the mechanisms of drug resistance?

Answer 13

-increased transport of drugs out of the cell through efflux pumps (often via PgP or MRP) *most common reason to resistance for multiple chemotherapies at once
-reduced transport into the cell
-decreased activation of prodrug
-increased detoxification of drug molecule (increased metabolism of drug)
-changes in drug target or function
-physiological changes such as cancer cells refuging into the blood brain barrier, massive stromalization (area becomes fibrous), cell cycle slowing
-increased anti-apoptopic proteins in cancer cells or increased repair of dna damage due to chemotherapies

Question 14

What enzyme converts androstenedione to estrone?

Answer 14

CYP19 (Aromatase)

Question 15

What endocrine therapies can be used for pre-menopausal women?

Answer 15

tamoxifen
leuprolide, goserelin

Question 16

What endocrine therapies can be used for post-menopausal women?

Answer 16

tamoxifen
fulvestrant
anastrozole, letrozole, exemestane

Question 17

What medications can be used in hormonal therapy for prostate cancer?

Answer 17

leuprolide, goselerin, triptorelin (GnRH analogs)
degarelix, relugolix (GnRH antagonists)
Abiraterone (CYP17 antagonist)
Enzalutamide, apalutamide, darolutamide (AR antagonists)

Question 18

What is a diagnostic molecular pathway?

Answer 18

genomic DNA gets tested for mutation and if positive then will go on therapy for that

Question 19

What are the different types of kinase inhibitors?

Answer 19

Type I-binds to active site of kinase
type II- binds to inactive site of kinase
type III- allosterically bind to kinase

Question 20

What are some examples of Type I tyrosine kinase inhibitors?

Answer 20

EGFR inhibitors (afatinib, neratinib, gefitinib, erlotinib)

Question 21

What medication is given when a patient acquires a T790M mutation to gefitinib?

Answer 21

Osimertinib

Question 22

What kinase inhibitors are indicated with a BCR-Abl translocation?

Answer 22

Imatinib, Ponatinib (indicated after T315I mutation)

Question 23

What is a prognostic molecular pathology?

Answer 23

helps to predict recurrence and can prevent overtreatment but does not drive indications for specific therapy

Question 24

What are the anti-metabolite chemotherapies?

Answer 24

5-Fluorouracil (+ leucovorate for increasing efficacy)
cytarabine (+ tetrahydrouridine)
6-Mercaptopurine
Methotrexate

Question 25

What rescues from a 5-FU overdose?

Answer 25

Thymidine

Question 26

What are alkylating agents?

Answer 26

generate reactive electrophilic intermediates that react with nucleophilic groups on DNA/protein -create cross-linkages that are inter- and intra- strand linkages

Question 27

What side effects are of note in patients treated with alkylating agents?

Answer 27

increased risk of second malignancies

Question 28

What chemotherapies are considered alkylating agents?

Answer 28

cyclophosphamide, Mitomycin C, chlorambucil

Question 29

What chemotherapies are considered platinum therapies?

Answer 29

Cisplatin, carboplatin, oxaliplatin

Question 30

What is the difference between alkylating and platinum agents?

Answer 30

alkylating agents - have alkyl groups; form intra- and inter- strand crosslinks platinum agents- cause intra strand crosslinks

Question 31

What side effects are of note with cisplatin?

Answer 31

-nephrotoxicity -not myelosuppressive

Question 32

What cell phase do Topo I inhibitors work in?

Answer 32

S phase specific

Question 33

What are some examples of chemotherapies that are Topo I inhibitors?

Answer 33

Topotecan, Irinotecan

Question 34

What are some examples of chemotherapies that are Topo II inhibitors?

Answer 34

Doxorubicin (also an intercalator), Etoposide (G2/M specific) Bleomycin

Question 35

What medication mediates Doxorubicin toxicity?

Answer 35

Dexrazoxane

Question 36

What are the microtubule inhibitors?

Answer 36

Vincristine, paclitaxel

Question 37

Are Taxanes microtubule stabilizers or destabilizers?

Answer 37

microtubule stabilizers -prevents microtubule breakdown

Question 38

Are vinca alkaloids microtubule stabilizers or destabilizers?

Answer 38

microtubule destabilizers -prevents microtubule assembly

Question 39

What are the major side effects of vincristine?

Answer 39

peripheral neuropathy, neurotoxicty

Question 40

What are the major side effects of paclitaxel?

Answer 40

myelosuppression

Question 41

What immunotherapies bind to the EGF receptor?

Answer 41

Cetuximab, panitumumab

Question 42

What is the nomenclature with monoclonal antibodies?

Answer 42

chimeric =-xi mouse= -o humanized = -zu fully human = -u

Question 43

What medications are VEGF inhibitors?

Answer 43

Bevacizumab

Question 44

What are some examples of BiTE therapies?

Answer 44

Blinatumomab -binds CD3 and CD19

Question 45

What T cell therapy targets CTLA-4?

Answer 45

ipilimumab

Question 46

What medications are DNA methylating agents?

Answer 46

Azacitibine

Question 47

What medications are proteasome inhibitors?

Answer 47

borteZOMIB

Question 48

What is the MOA of venetoclax?

Answer 48

inhibits BCL-2 (an anti-apoptotic protein) -1st FDA approved small molecule that inhibits a protein-protein interation

Question 49

What medications are indicated for anticipatory N/V?

Answer 49

Lorazepam 0.5-1 mg po

Question 50

What medications are indicated for delayed N/V?

Answer 50

dexamethasone, NK-1 antagonist, olanzapine

Question 51

What is included in a moderately emetogenic regimen?

Answer 51

steroid, 5-HT3 antagonist +/- either olanzapine or aprepitant -can be 2 or 3 drugs

Question 51

What is included in a highly emetogenic regimen?

Answer 51

NK-1 antagonist, Steroid (Dexamethasone) , 5-HT3 antagonist, Olanzapine

Question 51

What is the most emetogenic chemotherapy agent?

Answer 51

Cisplatin

Question 52

What adverse effects are there for 5-HT3 antagonists?

Answer 52

headache, constipation

Question 53

What NK-1 antagonist side effects are there?

Answer 53

hiccups

Question 54

What side effects are there with olanzapine?

Answer 54

sedation

Question 55

What medication do you use for neutropenic fever?

Answer 55

colony stimulating factors -filgrastim or pegfilgrastim

Question 56

What is the corrected calcium equation?

Answer 56

serum calcium + 0.8(4- serum albumin)

Question 57

What is first line therapy for hypercalcemia?

Answer 57

mild HCM - hydration, zolendronic acid or pamidronate moderate HCM- zolendronic acid severe HCM- hydration, zolendronic acid, calcitonin if refractory

Question 58

What are the treatment options for treatment refractory HCM?

Answer 58

denosumab

Question 59

What clinical pearl is related to dosing for SRE?

Answer 59

renal adjustment dosing is needed for pamidronate, zolendronic acid