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OCN Review > Meds > Flashcards

Meds Flashcards

1
Q

Selective estrogen receptor modulators

A

Tamoxifen & raloxifene

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2
Q

What does metformin do to decrease breast cancer?

A

Inhibits tumor cell growth and proliferation through adenosine mono phosphate (AMP) kinase activation

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3
Q

How does finasteride lower the incidence of prostate cancer?

A

It lowers PSA levels and shrinks normal prostate tissue

(But this leads to higher incidence of high grade prostate cancer)

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4
Q

COX-2 inhibitors

A

Inhibit cyclooxygenase enzymes that are involved in the synthesis of proinflammatory prostaglandins

(May prevent colon and breast cancer)

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5
Q

Which chemos especially can damage sperm and germ cells and affect the ovaries?

A

Alkylating agents

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6
Q

What can decrease the production of sperm?

A

Hormone therapy

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7
Q

XELOX

A

Capecitabine + 5-FU

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8
Q

What do Biphosphonates do?

A

Reduce bone fractures in patients with metastatic disease to bone

Bind to crystals in the bone and inhibit the resorption of it, as well as induce osteoclastic apoptosis

Ex: Risedronate
Alendronate
Ibandronate
Zoledronic Acid
Pamidronate
Etidronate

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9
Q

What cell cycle phase do taxanes work in?

A

M phase to inhibit microtubules necessary for division

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10
Q

What cancers are taxanes used for?

A

Breast, lung, myelomas, lymphomas, leukemias

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11
Q

What dose limiting side effect can taxanes have?

A

Peripheral nerve damage

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12
Q

What cell cycle phase do vinca alkaloids work in?

A

Predominantly M phase, they are cytotoxic to microtubules and cell cycle arrest in metaphase

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13
Q

What side effects occur from vinca alkaloids?

A

Myelosuppression, peripheral neuropathy, N/V

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14
Q

What cell cycle phase do epipodophyllotoxins work in?

A

Late S and G2 phases, they form a complex with topoisomerase and DNA resulting in the inhibition and function of the topoisomerase enzyme that is require for DNA synthesis

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15
Q

Which drugs are epipodophyllotoxins?

A

Etoposide, teniposide, camptothecan, topotecan

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16
Q

What side effects occur from epipodophyllotoxins?

A

Diarrhea and neutropenia

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17
Q

What is Sipuleucel-T vaccine use to treat?

A

Metastatic prostate cancer (need to be asymptomatic, have node or bone Mets, and testosterone level <50)

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18
Q

What does cytokine immunotherapy do?

A

Stimulate the growth of T cells to enhance the immune response

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19
Q

What are side effects of interferons?

A

Flu-like symptoms, fatigue, anorexia, neuropsychiatric symptoms, electrolyte disturbance

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20
Q

-omab

A

Murine : mouse

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21
Q

-ximab

A

Chimeric : human and mouse

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22
Q

-zumab

A

Humanized - predominantly human

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23
Q

-umab

A

Human only

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24
Q

Trastuzumab target and side effects?

A

Antigen targeted HER2

Damage the heart —> chest pain, cough, dyspnea, fluid retention, dizziness, fainting

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25
Q

Rituximab targets?

A

Antigen targeted CD20, which is found on B cells

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26
Q

Bevacizumab targets?

A

Antigen targeted VEGF, which affects angiogenesis

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27
Q

Proteasome inhibitors

A

Bortezomib and carfilzomib

Stop the proteasome from breaking down the proteins that normally would cause the cell to die

Apoptosis inducers

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28
Q

Angiogenesis inhibitors examples

A

Bevacizumab (binds to VEGF)
Sorafenib and sunitinib bind to receptors in the surface of endothelial cells or to other proteins in the downstream signaling pathway

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29
Q

-tinib

A

Tyrosine kinase inhibitors that target EGRF & VEGF

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30
Q

What is erlotinib used for?

A

Advanced NSCLC and advanced pancreatic cancer

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31
Q

What is sunitinib used for?

A

Advanced renal cell carcinoma and GIST tumors

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32
Q

What is ponatinib used for?

A

CML

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33
Q

What is imatinib used for?

A

Philadelphia chromosome positive CML

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34
Q

What is dasatinib used for?

A

Philadelphia chromosome positive CML

35
Q

What is ibrutinib used for?

A

Mantle cell lymphoma, CML, Waldenstrom’s macroglobulinemia

36
Q

-nib

A

Kinase inhibitors target RAF/RAS/MET pathway

Sorafenib, dabrafenib, trametinib, vemurafenib

37
Q

-lisib

A

P13K inhibitors

The P13K pathway reviles cell survival and proliferation

38
Q

-gib

A

Hedgehog pathway - embryonic development (brain and spinal cord development)

E.g. sonidegib for locally advanced basal cell carcinoma

39
Q

Which meds in particular have skin reactions?

A

EGFR inhibitors

Skin Toxicity Evaluation Protocol with Panitumumab trial in 2010 highlighted importance of preemptive therapy with EGFR inhibitors

40
Q

What are the side effect of anti-angiogenesis agents?

A

Hypertension, bleeding and bruising, clotting dysfunction manifested as thrombotic events

41
Q

What cancers are hormone therapy approved for?

A

Breast and prostate

42
Q

What are tamoxifen and fulvestrant?

A

Antiestrogens

43
Q

What are anastrazole and exemestane?

A

Aromatase inhibitors

44
Q

What are biclutamide and flutamide?

A

Antiandrogens

45
Q

What are goserelin and leuprolide?

A

Luteinizing hormone releasing hormone (LHRH) agonist

46
Q

What cancers are alkylating agents used for?

A

Leukemia, lymphoma, Hodgkin’s, multiple myeloma, sarcoma, lung, breast, ovary

47
Q

What do alkylating agents do?

A

Interfere with DNA replication, RNA transcription, nucleic acid function

48
Q

What long term damage can alkylating agents cause?

A

Damage to bone marrow leading to acute leukemia 5-10yrs after treatment
Fertility risk

49
Q

What drugs are alkylating agents?

A

Non-platins:
nitrogen mustards: mexhlorethanine, chlorambucil, cyclophosphamide, ifosfamide, melohalan
Nitrosoureas: streptozocin, carmustin (BCNU), lomustine
Alkyl sulfonates: busulfan
Triazines: dacarbazine and temozolomide
Ethylenimines: thioptepa, altretamine,

Platinum analogs: carboplatin, cisplatin, oxaliplatin

50
Q

What do antimetabolites do?

A

Inhibit protein synthesis, substitute erroneous substances needed for DNA/RNA replication, and inhibit DNA synthesis

Damage cells during the S phase

51
Q

What type of drugs are 5-FU, 6-MP, capecitabine, cladribine, clofarabine, cytarabine, fluxuridine, fludarabine, gemcitabine, hydroxyurea, MTX, pemetrexed, pentostatin, thioguanine?

A

Antimetabolites

52
Q

What do anti tumor antibiotics (AKA anthracyclines) do?

A

Interfere with enzymes involved in DNA synthesis

53
Q

What is a lifetime dose limiting effect of anthracyclines?

A

Permanent cardiac damage

54
Q

What type of drug are daunorubicin, doxorubicin, epirubicin, idarubicin, valrubicin?

A

Anthracyclines

55
Q

What are the 3 subtypes of plant alkaloids?

A

Vinca alkaloids, epipodophyllotoxins, taxanes

56
Q

What do glucocorticoids do?

A

Modify transcription and protein synthesis, reversal of capillary permeability and inhibit glucose transport and phosphorylation to induce cell death

57
Q

What can glucocorticoids be used for?

A

To kill cancer cells
To treat N/V, hypersensitivity reactions, SVC syndrome, SCC

58
Q

What are interferons mechanism of action?

A

They are a type of cytokine
They enhance cytotoxicity, enhance phagocytic activity and inhibit viral replication. I.e. they directly target cancer cells by slowing growth and encouraging normal cell behavior

59
Q

What does Melphalan have a high incidence of causing?

A

Mucositis

60
Q

What drug(s) are linked to hemorrhagic cystitis?

A

Cyclophosphamide and ifosfamide

61
Q

What is the mechanism of action of tyrosine kinase inhibitors?

A

They bind to tyrosine kinase in EGFR inhibiting EGFR activation

62
Q

Erythropoietin, darbopoetin MOA and side effects

A

moa: stimulate stems cells to develop into RBCs
Side effects: HTN, increased risk of VTE (particularly in MM), diarrhea, fluid retention

Weeks for results

Black box warning: chemo induced anemia only

63
Q

What are the most common chemo agents to cause mucositis?

A

Busulfan, capecitabine, cyclophosphamide, doxil, 5-FU, mechlorethamine

64
Q

What side effect is most frequent with cisplatin?

A

Acute N/V

65
Q

What meds have a high (>90%) ematogenic potential?

A

Cisplatin, combo of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >= 1500mg/m^2, dacarbazine, procarbazine

66
Q

What meds have a medium (30-90%) emetogenic potential?

A

Arsenic trioxide, carboplatin, PO cyclophosphamide, cyclophosphamide<1500mg/m^2, cytarabine >1g/m^2, daunorubicin, doxorubicin, epirubicin, PO etoposide, idarubicin, ifosfamide, irinotecan, oxaliplatin, temozolamide

67
Q

What drugs should be used for breakthrough emesis?

A

Corticosteroids, haloperidol, metoclopramide, scopolamine

68
Q

What drugs should be used for acute emesis?

A

Antihistamines (promethazine, diphenhydramine, hydroxyzine), steroids (prednisone, dex), 5-HT3 antagonists (ondansetron, gransetron PO only, sancusco patch, palonsetron)

69
Q

What drugs should be used for delayed emesis?

A

Neuroleptics (prochlorperazine, chlorpromazine), Motility agents (metoclopramide), Substance P antagonist (aprepitant)

70
Q

What drugs should be used for anticipatory emesis?

A

Benzodiazepines (diazepam, lorazepam)

71
Q

Which drugs cause constipation?

A

Vinca alkaloids, biological response modifiers (thalidomide, lethalidomide), small molecule inhibitors (bortezomib), opioids, Antinausea meds (5-HT3 antag, benzodiazepines)

72
Q

What meds should be given for chemo-induced diarrhea?

A

Loperamide
High dose loperamide if irinotecan
Somatostatin of refractory to loperamide

LIKELY to work: octreotide

73
Q

What meds should be given for radiation-induced diarrhea?

A

Oral opiates (loperamide and diphenoxylate)

LIKELY to work: probiotics, psyllium fiber, octreotide if grade 2 or 3

74
Q

What drugs are most often associated with Hand-Foot syndrome?

A

Taxanes, antiangogenic, topoisomerase inhibitors

75
Q

What is the management of Acneiform rash?

A

Topical or oral steroids, topical or oral antibacterial, alcohol free moisturizers BID

76
Q

What drugs are given to manage pruritis?

A

Topical mod to potent steroids or topical antipruritics with menthol and PO antipruritics

PO antipruritics and PO corticosteroids, PO gabapentin pregabalin with or without phototherapy

77
Q

Which drugs are most often associated with peripheral neuropathy?

A

Platinums (Cisplatin and oxaliplatin)
Taxanes
Vinca alkaloids
Proteasome inhibitors

78
Q

What are the symptoms of peripheral neuropathy in cisplatin?

A

Lhermitte’s sign (lightning-like sensation) in neck, down the legs and back with flexion of the neck, recovery up to 2 years

79
Q

What are the symptoms of peripheral neuropathy in oxaliplatin?

A

Pharyngo-laryngitis-dysthesia that is aggravated by cold, dysthesias if hands and feet, feeling of jaw tightening, feeling of loss of breath

80% will experience, 40% recover in 6-8months

80
Q

What is an uncommon adverse event in patient receiving biphosphonates?

A

Osteonecrosis of the jaw

81
Q

What is denosumab used for?

A

Prevention of skeletal-related events in patients with bone mets from solid tumors

82
Q

What meds can stimulate appetite?

A

Megesterol, steroids, dronabinol

83
Q

Which chemos have a high (>90%) emetogenic potential?

A

Cisplatin, combination of doxorubicin or epirubicin with cyclophosphamide, cyclophosphamide >=1500mg/m^2, dacarbazine, procarbazine

OCN Review (8 decks)

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