L21, L23, L25- Chemotherapy and Neoplastic Diseases Flashcards Preview

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Flashcards in L21, L23, L25- Chemotherapy and Neoplastic Diseases Deck (116):

in general chemotherapies aim to attack (1) or (2)

-metabolic sites essential to cell replication


-(1) chemotherapy is used to attack micrometastases following surgery and radiation
-(2) chemotherapy is given prior to surgery to shrink the cancer
-(3) chemotherapy is indicated when neoplasms are disseminated (spread) and surgery is not possible

1- Adjuvant
2- Neoadjuvant
3- Primary


destruction of cancer cells by drugs follows (1) kinetics, and is this phenomenon is termed (2)

1- first order (a given dose destroys a constant fraction of cells)
2- log kill


Diagnosis of leukemia requires (1) leukemic cells present. (2) log kills by treatment eliminates 99.999% of cancer cells to induce clinical remission. However, in the case of leukemia, (3) cells would remain, therefore (4) is required. In contrast, drugs for bacterial infections only require (5) log kills, as the body readily eliminates residual bacterial cells- not the case for cancer cells.

1- 10^9
2- 5 log kills
3- 10^4 cells (0.001%)
4- additional Tx (tumor cells aren't as readily eliminated as bacterial cells)
5- 3 log kills


describe the effects of combination chemotherapy

-multiple chemotherapy drugs used, each with different mechanism of action (standard approach)
-synergism can be reached
-used to prevent/slow down development of resistance to anticancer drugs
-maximal kill, tolerated toxicity: each drug has its own log kill and can destroy tumor cells that are resistant to the other drugs
-given intermittently to allow normal tissue to recover (ex. immune system to reduce chance of serious infection)


anticancer drugs are more effective on (rapid/slow) growing neoplasms, especially those with (large/small) growth fractions

1- rapid growth
2- large growth fraction (more cells in cell cycle)


list the two types of chemotherapy drugs and their subtypes

Cell Cycle-Specific agents: antimetabolites (S), bleomycin (G2), microtubule inhibitors (M), epipodophyllotoxins (S-G2), camptothecins (S-G2)

Cell Cycle-Nonspecific agents: alkylating agents, platinum coordination complexes, antitumor antibiotics


Cell cycle-specific drugs are most effective on (1) malignancies and other tumors with (2) as they target (3).
Cell cycle-nonspecific drugs are most useful for (4) tumors, as well as other tumors with (5) as they target (6).

1- hematologic
2- large growth fraction
3- cell cycle (S to M phases)

4- solid
5- large growth fraction
6- cells in Go phase or in cell cycle


primary drug resistance is defined as....

no response to a drug upon first exposure (naturally resistant)


acquired drug resistance can be either (1) due to (2) OR (3) because (4) occurs

1- single drug resistance
2- inc expression/amplification of one or more genes
3- multi-drug resistance (MDR)
4- resistance to several drugs after exposure to single agent (very difficult to Tx)


MDR mainly occurs as a result of.....

(multi-drug resistance)
-overexpression of membrane efflux pumps
-MOST importantly P-Glycoprotein (most responsible)


(T/F) chemotherapy drugs have a narrower therapeutic window compared to other drugs

T- usually higher dose needed for min therapeutic effects and lower dose needed for min toxic effects


chemotherapy drugs that target rapidly proliferating cells will also affect the following types of normal cells, (1), causing the following adverse effects, (2)

1- buccal mucosa, GI mucosa, bone marrow, hair cells
2- severe vomiting (GI), stomatitis (buccal- mouth/lip inflammation), bone marrow suppression, alopecia (hair)


the following drugs have high myelosuppression....

-alkylating agents


the following drugs have medium myelosuppression....

-methotrexate (MTX)
-5-FU (fluorouracil)


the following drugs have low myelosuppression....



Name the drug related to the following specific adverse effect:
(1) cardiotoxicity
(2) hemorrhagic cystitis
(3) peripheral neuropathy
(4) pulmonary fibrosis

1- doxorubicin
2- cyclophosphamide
3- vincristine, paclitaxel
4- bleomycin


_______ drugs are used to manage chemotherapy induced emesis (vomiting)

-5-HT3 (serotonin) receptor blockers
-NK-1 (neurokinin) inhibitors


_______ drugs are used to prevent and treat chemotherapy induced neutropenia (from myelosuppression)



_______ drugs rescue bone marrow from MTX



(1) binds the metabolite of (2) drug- (3) - to prevent hemorrhagic cystitis

1- mesna
2- cyclophosphamide
3- acroleine


(1) drugs reduce anthracycline induced cardiotoxicity, usually from (2) drugs

1- dexrazoxane
2- doxorubicin


_______ drugs reduce renal toxicity of cisplatin



because most antineoplastic agents are (1), (2) may arise 10 or more years after curing cancer; this is the biggest problem after therapy with (3)

1- mutagenic
2- neoplasms
3- alkylating agents


Antimetabolite chemotherapy drugs mostly target (1) related pathways, they are cycle-(non-/specific) affecting the (3) phase most. The three types of antimetabolites include: (4).

1- nucleotide or nuclei acid synthesis
2- cycle-specific
3- S phase (DNA replication)
4- folate analogs, purine analogs, pyrimidine analogs


The main folate analog of the antimetabolite drugs is (1), which functions to inhibit (2). This deprives the cell of folate and therefore decreases the synthesis of (3) specifically and (4) overall.

1- MTX (methotrexate)
2- dihydrofolate reductase
3- dTMP (from dUMP) and purine synthesis
4- DNA, RNA, proteins => cell death


describe the mechanism of action of MTX in detail

-inhibits dihydrofolate reductase
-catalyzes folate --> DHF and DHF --> THF
-THF (tetrahydrofolate) is methylates to Me-THF
-Me-THF is needed for thymidylate synthase to convert dUMP --> dTMP AND for adenine/guanine synthesis
-=> incomplete and disrupted DNA(/RNA) synthesis


MTX metabolism is defined as the conversion to (1) by (2) enzyme

1- polyglutamates (MTX-PGs)
2- folylpolyglutamate synthase (FPGS)


list the adverse effects on MTX

-Common: stomatitis, mucositis, myelosuppression (medium), alopecia, nausea/vomiting
-Uncommon is renal damage if high dose is given

-hepatic fibrosis, cirrhosis
-neurological toxicities with IT administration (intrathecal, administration into CSF for brain tumors as MTX won't cross BBB)


Leucovorin is also called (1), and is an antidote to (2) drugs in order to rescue (3) as it provides normal tissue with (4).

1- N(5)-formyl-THF (replaces Me-THF)
2- folate analogs / MTX / drugs that reduce folate
3- bone marrow
4- reduced folate (bypassing DHFR inhibition by MTX)

[basically used so normal cells (bone marrow) can produce dTMP, purines (adenine/guanine) for DNA/RNA synthesis during chemotherapy, although too much would cancel the effects of MTX]


list the two main purine analogs

-6-MP (6-mercaptopurine)
-6-TG (6-thioguanine)


6-MP is an analog of (1), and is converted to (2) by (3) enzyme. (2) will inhibit (4) and block the formation of (5). Lastly, dysfunctional (6) will result from incorporated (7) analogs.

1- (thiol analog of) hypoxanthine
2- thiol-IMP
3- HGPRT (salvage pathway)
4- 1st step of de novo purine ring biosynthesis
5- AMP/GMP from IMP
7- guanylate analogs


6-MP is metabolized into (1) by (2) enzyme. 6-MP should not be given to patients taking (3) drug as it inhibits (2).

1- thiouric acid
2- xanthine oxidase
3- allopurinol (--> oxypurinol by xanthine oxidase is the effector)


list the adverse effects of 6-MP



list the cell cycle-specific agents and the associated phases they affect

-antimetabolites (S phase)
-bleomycin (G2 phase)
-MT inhibitors (M phase)
-epipodophyllotoxins (S-G2 phase)
-camptothecins (S-G2 phase)


list the cell cycle-nonspecific agents

alkylating agents, platinum coordination complexes, antitumor antibiotics (except bleomycin)


P-glycoprotein can lead to MDR to the following anticancer drugs: (1)

They cannot transfer the following cancer drugs: (2)

1- doxorubicin, daunorubicin, dactinomycin, vincristine, vinblastine, etoposide

2- alkylating agents, antimetabolites, cisplatin


what are the contraindications of using MTX

MTX is teratogenic and abortifacient -- avoid in pregnancy


6-MP is mostly used in (1) cancer.

It has resistance based on the following: (2), (3), (4)

1- acute lymphatic leukemia

2- HGPRT deficiency / Lesch-Nyhan syndrome: cannot bio-transform 6-MP
-inc dephosphorylation
-inc metabolism of drug to thiouric acid


After administration of 6-thioguanine, it is converted to (1) in order to (2) and (3). It is mainly used for (4) cancers. Its toxic adverse effects include: (5).

1- nucleotide / TGMP
2- inhibit purine synthesis / phosphorylation of GMP --> GDP
3- incorporate into DNA, RNA --> dysfunctional strands
4- acute nonlymphocytic leukemias
5- -n/v/d, myelosuppression, hepatotoxicity


6-MP and 6-TG are secondarily metabolized by....

TPMT- thiopurine methyltransferase: if it has weak activity then they cause inc risk of severe toxicities (myelosuppression)


list the pyrimidine analogs

-5-FU (5-fluorouracil)


5-FU is converted to (1) in order to inhibit (2) and therefore (3). (4) will result as a consequence. 5-FU can also be converted to (5) to disrupt (6).

1- 5-FdUMP
2- thymidylate synthase (dec dTMP)
3- DNA synthesis
4- thymineless cell death
5- 5-FUTP
6- RNA processing and function due to incorporation


5-FU is metabolized by (1) enzyme, which is deficient in (2)% of cancer patients who will suffer with (3)

1- DPD (dihydropyrimidine dehydrogenase)
2- 5% Pts
3- severe toxicity: myelosuppression, neurotoxicity, life-threatening diarrhea


traditional adverse effects of 5-FU are...

-n/v, alopecia, myelosuppression
-erythematous desquamation of hands/soles ('hand-foot' syndrome) after extended infusions


5-FU is commonly combined with (1) in (2) cancer. A (3) complex formation results, since (1) increases the levels of (4). In essence (1) potentiates the activity of 5-FU.

1- leucovorin (N5-formyl-THF)
2- colorectal cancer
3- thymidylate synthase-5F-dUMP-N5,N10-methylene-THF complex
4- N5,N10-methylene-THF


-5-FU is commonly used to treat (1) cancers
-Resistance to 5-FU results from (2)

1- breast, GI CAs + topically for keratoses/BCC
2- inability to convert 5-FU to 5-FdUMP


(1) is a oral prodrug of 5-fluorouracil and is converted to 5-FU through (2). It is used for (3) cancers.

1- capecitabine
2- series of 3 enzymatic reactions
3- metastatic breast and GI CAs
(same mechanism of action and adverse effects as 5-FU)


T/F- MTX has much higher affinity for DHF reductase than folate

T- 1000 times more affinity then folate


ARA-C, aka (1), is an analog of (2). It functions by the following mechanism: (3).

1- cytarabine
2- deoxycytidine
3- phosphorylation x3 --> triphosphate form (ara-CTP) --> incorporated into DNA --> inhibits DNA polymerase (dec DNA synthesis)


ARA-C is used for (1) cancers in combination with (2) and (3). It is administered in (4) fashion. Adverse effects include: (5).

1- acute non-lymphocytic leukemia
2- 6-TG
3- daunorubicin
4- IV or IT if necessary
5- n/v/d, severe myelosuppression, hepatic dysfunction (+ seizures/altered mental state if high dose given IT)


describe antitumor antibiotics mechanism

-binds DNA via intercalation between bases
-blocks synthesis of DNA/RNA
-causes DNA strand breakage
-interferes with cell replication


list the types/subtypes of antitumor antibiotics

-Anthracyclines: doxorubicin, daunorubicin


(1) are the most important type of antitumor antibiotics, and (2) is the most widely used, and (3) is also a popular drug

1- anthracyclines antibiotics
2- doxorubicin
3- daunorubicin


list the 4 major mechanisms of action for anthracyclines

-inhibit topoisomerase II (gyrase)
-intercalate in DNA --> blocks DNA/RNA synthesis + strand breakage
-bind cell membrane --> alter fluidity + ion transport
-generate free radicals via Fe-dep enzyme mediated process


(1) is a major toxicity of anthracyclines, caused by its (2) mechanism

1- cardiac toxicity
2- generation of free radicals


list the 4 mechanisms of resistance to anthracyclines

-inc efflux via P-glycoprotein (MDR1)
-inc glutathione peroxidase activity => inc free radical scavenging
-dec activity or mutation of topoisomerase II (gyrase)
-enhanced ability of cancer cells to repair breaks in DNA strand


list the adverse effects of anthracyclines [include an agent given to reduce its unique adverse effect]

-cardiotoxicity: via free radicals, dose dependent dilated cardiomyopathy w/ associated HF
**dexrazoxane** is an Fe-chelating agent to reduce cardiotoxicity


anthracyclines are always given by (1) administration because of (2); (3) is the main method of excretion

1/2- IV, deactivated in GIT
3- bile excretion (some renal)


doxorubicin is used for the following CAs: (1)

daunorubicin is used for the following CAs: (2)

1- lymphoblastic leukemia, acute myoblastic leukemia, Wilm's tumor, neuroblastoma, sarcomas, breast / ovarian / transitional cell bladde / thyroid / gastric / bronchogenic CA, Hodgkin's disease, malignant lymphoma

2- acute nonlymphocytic leukemia (adults), acute lymphocytic leukemia (adults + children)


bleomycin is made up of (1) and caused (2) by (3) process, resulting in cells being (4)

1- glycoprotein mixture
2- breakage of DNA
3- oxidative processes
4- arrested in G2 phase


bleomycin forms a (1) complex which is converted to (2) via oxidation; (3) released from this reaction reacts with (4) to cause (5)

1- DNA-bleomycin-Fe2+
2- DNA-bleomycin-Fe3+
3- electrons (liberated)
4- O2 --> free radicals (superoxide, hydroxyl radicals)
5- DNA strand breakage (attacks phospho-diester bond)


list the adverse effects of bleomycin

-minimal myelosuppression
-**pulmonary toxicity: pneumonitis, fibrosis (low levels of bleomycin hydroxylase)
-cutaneous rxns: hyperpigmentation, hyperkeratosis, erythema, ulceration (absent bleo. hyd. enzy.)
-hyperthermia, HA, n/v
(dose limiting)


bleomycin is given by (1) administration, metabolized by (2) enzyme, and is used for (3) CAs

1- IV, SC, IM, intracavitary
2- bleomycin hydrolase (levels differ based on tissue- low in lungs and skin)
3- testicular CA, lymphomas


alkylating agents general mechanism of action

-transfer alkyl group to various cell molecules
-DNA alkylation => cell death
-alkylation of one DNA strand OR both thru cross-linking (most are bi-functional)


-(1) is the most widely used alkylating agent
-toxicities occur in (2) tissues
-(3) are the most common adverse effects
-alkylating agents are also dangerous due to their (4) properties

1- cyclophosphamide
2- rapidly growing tissues: bone marrow, GIT, gonads
3- n/v
4- mutagenic, carcinogenic


list the alkylating agents

-nitrogen mustards
-platinum coordination complexes


list the nitrogen mustards



list the major characteristics and adverse effects of mechlorethamine

-very unstable; soln made just before administration
-powerful vesicant (causes blistering), given IV

adverse effects: severe n/v, severe myelosuppression, alopecia, immunos`uppression


Cyclophosphamide is given by (1) route of administration and is converted to (2) by (3) into an active drug. It is used for (4) cancers.

1- oral/IV (prodrug)
2- 4-OH-cyclophosphamide
3- CYP2B
4- broadly, its apart of most combination chemotherapies


list the adverse effects of cyclophosphamide

-hemorrhagic cystitis (acrolein metabolite)


(1) is the metabolite of cyclophosphamide that causes (2). (2) can be prevented by (3) and (4).

1- acrolein
2- hemorrhagic cystitis
3- adequate fluid intake
4- mesna (drug binds acrolein in bladder)


(1) is an analog of cyclophosphamide with (2) as an additional adverse effect which can be treated with (3) [if it doesn't respond spontaneously to discontinued treatment)

1- ifosfamide (same mechanism as cyclophosphamide)
2- neurotoxicity: encephalitis with ranging Sx severity (onset takes hrs-days)
3- methylene blue, thiamine


melphalan is a (1) type of chemotherapy drug; its mechanism of action is (2) and has (3) adverse effects

1- alkylating agent, nitrogen mustard
2- bi-functional DNA alkylation (cross-linking of DNA strands) => cell death
3- myelosuppression


The nitrosoureas drugs are (1). The are useful in treating (2) because of their (3) property.

(alkylating agents)
1- carmustine, lomustine
2- brain tumors
3- highly lipophilic => crosses BBB


list the other alkylating agents



busulfan is a (1) type chemotherapy drug, mainly used for (2) cancers, and has (3) as its adverse effects

1- alkylating agent (other)
2- CML (chronic myeloid leukemia)
3- myelosuppression, pulmonary fibrosis


Dacarbazine is a (1) type chemotherapy drug that is activated by (2) and has a (3) mechanism of action. It is mainly used for (4) cancers, and has (5) as its adverse effects.

1- alkylating agent (other)
2- CYP450 isoforms
3- methylating agent
4- malignant melanoma, Hodgkin's lymphoma
5- n/v, low/moderate myelosuppression
(IV administration)


Procarbazine is a (1) type chemotherapy drug that is activated by (2) and has a (3) mechanism of action. It is mainly used for (4) cancers, and has (5) as its adverse effects.

1- alkylating agent (other)
2- CYP450 isoforms
3- methylating agent of DNA, RNA, protein
4- Hodgkin's disease
5- n/v, myelosuppression, weak MAO inhibitor (=> HTN rxns w/ SNS agents, tyramine foods), disulfiram-like rxn, mutagenic, teratogenic
(oral administration)


The platinum coordination complexes include (1) and (2). They act by (3). They are used for (4) cancers and are administered by (5).

1- cisplatin
2- carboplatin
3- covalent DNA binding => cross-linking => dec DNA synthesis
4- broadly for many CAs (testicular, ovarian CA)
5- IV


list the adverse effects of cisplatin [include drug to reduce one particular effect]

-mild/moderate myelosuppression
-ototoxicity (hearing/vestibular issues)
-peripheral neuropathy
-nephrotoxicity (tx by hydration/diuresis OR Amifostine to reduce renal toxicity)


list the adverse effects of carboplatin

include the following, but less severity than cisplatin: dose-limiting myelosuppression, n/v, ototoxicity (hearing/vestibular issues), neurotoxicity, nephrotoxicity


describe the general mechanism of action of MT inhibitors

disrupts mitotic spindle essential for DNA partitioning --> arrests the cell in Metaphase of mitosis


list the MT inhibitors (include subtypes)

-Vinca alkaloids: vincristine, vinblastine
-Taxanes: paclitaxel, docetaxel


describe vinca alkaloids mechanism of action

(vincristine, vinblastine)
-binds β-tubulin --> prevents MT polymerization
-cells arrested in metaphase --> stops cell division --> apoptosis


list the adverse effects for vinca alkaloids

Vincristine: peripheral neuropathy, mild myelosuppression, alopecia

Vinblastine: dose-limiting myelosuppression, alopecia, peripheral neuropathy


describe taxanes mechanism of action

(paclitaxel, docetaxel)
-binds β-tubulin --> promotes MT polymerization
-MT stabilization arrests cell in mitosis --> apoptosis


list the adverse effects of taxanes

Paclitaxel: myelosuppression, alopecia, peripheral neuropathy, hypersensitivty (reduced with meds)

Docetaxel: dose-limiting myelosuppression, alopecia, peripheral neuropathy (less than paclitaxel), fluid retention, mucositis


taxanes can be pretreated with _____ to avoid _____

Paclitaxel: dexamethasone / diphenhydramine / H2 blocker to prevent hypersensitivity

Docetaxel: dexamethasone to prevent fluid retention


Etoposide is a (1) type chemotherapy drug. Its mechanism is to inhibit (2) resulting in (3) and causing (4). It has the following adverse effects: (5).

1- epipodophyllotoxins
2- topoisomerase II (gyrase)
3- DNA strand breakage
4- cell arrest in late S to G2
5- myelosuppression, alopecia, n/v


The main camptothecins are (1) and (2) which function to (3) to cause (4).

1/2- topotecan, irinothecan
3- inhibit topoisomerase I
4- DNA damage (breakage) in S phase => G2 arrest => cell death


list the types of hormonal chemotherapeutic agents

-estrogen inhibitors
-androgen inhibitors


The main glucocorticoid is (1) which has a (2) property in order to have (3) function. It is used to treat (4) cancers.

1- prednisone
2- lypholytic
3- suppress mitosis in lymphocytes (cell death)
4- acute leukemia, malignant lymphomas


list the types of estrogen inhibitors

-SERMs: selective estrogen receptor modulators
-SERDs: selective estrogen receptor downregulators
-AIs: aromatase inhibitors


describe the function of each SERM

(selective estrogen receptor modulator)
Tamoxifen: antagonist in breast tissue/cancer (agonist for nonbreast tissues); Tx for receptor-pos. BC (tumor growth in response to hormone) and to chemopreventive for BC (of people at risk)

Raloxifene: antiestrogen in uterus/breast (inhibits bone resorption - a proestrogen effect; Tx for osteoporosis and BC prevention


The main SERD is (1) which has the following mechanism of action: (2). It is used for (3) treatment.

1- fulvestrant
2- binds estrogen receptor --> prevents dimerization + promotes degradation (note it has NO estrogen agonist activity)
3- receptor-pos. metastatic BC


Aromatase functions to complete (1), which is vital in (2), therefore inhibitors are adjuvant treatments for (3)

1- androstenedione to estrone conversion
2- post-menopausal women, the only source of estrogens
3- receptor-pos. BC


(1) and (2) are nonsteroidal aromatase inhibitors through a (3) mechanism

(4) is steroidal, and inhibits through (5) mechanism

1/2- anastrozole, letrozole
3- reversible competitive inhibitor

4- exemestane
5- irreversible inhibitor


list the types of androgen inhibitors and indicate the preferred type

-GnRH agonists (PREFERRED- alone or in combination)
-androgen receptor blockers
(for prostate cancer)


list the GnRH agonists

leuprolide, goserelin
(for prostate cancer)


describe GnRH agonists mechanism of action [include drug often used concurrently]

-initial surge of LH/FSH
-followed by inhibition of gonadotropin release
-=> 10% of normal testosterone levels after 1 mo.
(note- for prostate cancer & GnRH usually has pulsatile excretion)

Flutamide given to counteract initial surge


The main androgen receptor blocker is (1) which is metabolized into (2) and acts as a (3) type androgen receptor blocker.

1- flutamide (nonsteroidal, synthetic)
2- hydroxylated metabolite
3- competitive antagonist (--> prevents translocation to nucleus)
(given in first mo. of prostate cancer Tx along side GnRH agonist (leuprolide/goserelin) to prevent LH/FSH surge)


Signal transduction inhibitors mainly includes ______ type of receptors since they are mutated and constituitively active in malignant cells/transformatiom

TK (tyrosine kinase)


gefitinib function

EGFR TK inhibitor (cellular side)


erlotinib function

EGFR TK inhibitor (cellular side)


lapatinib function

EGFR and ErbB2 TK inhibitor (cellular side)


imatinib function

Bcr-Abl TK inhibitor (cellular side - for CML)


trastuzumab function, include major adverse effect

-monoclonal Ab against ErbB2 TK receptor (lumen side)
-reversible cardiotoxicity


list the miscellaneous chemotherapy agents



describe mechanism of action of asparaginase

-normal tissue synthesizes their own L-asparagine for protein synthesis
-neoplastic tissues need exogenous sources (absent asparagine synthetase)
-asparaginase hydrolyzes serum asparagine, depriving necrotic tissue => dec protein synthesis and cell death


list adverse effects of asparaginase

-dec clotting factors
-liver abnormalities
-pancreatitis + seizures + coma due to ammonia (NH3) toxicity


(1) inhibits ribonucleotide reductase leading to (2) and therefore (3) and (4). It is administered (5).

1- hydroxyurea
2- depleted dNTs pools
3- dec DNA synthesis
4- cell death in S phase
5- orally


IFN-(α/β/γ) is used for (2) cancers with (3) as its mechanism and it has the following adverse effects: (4).

1- IFN-α
2- hairy cell leukemia, CML, malignant melanoma, Kaposi's sarcoma
3- stimulates NK to kill cancer + inc HLA-II production (=> inc MHC expression)
4- depression, fever/chills, leukopenia, thrombocytopenia, fatigue/malaise, anorexia/weight loss, alopecia, transient elevated liver enzymes


cisplatin and vinblastine are used in combination for _______

testicular cancer


what are the risks of Tamoxifen

-Estrogen agonist in nonbreast tissue --> endometrial hyperplasia and possible cancer
-not given to patients with risk or signs of osteoporosis in post-menopausal women

-inc risk of thrombosis, venous thromoboembolism due to weak estrogenic properties => significant procoagulant effect (raloxifene has this risk, but lower)


______ is a SERM used is postmenopausal women

Raloxifene (>> tamoxifen)