Onc Pharm

Question 1

MOA of methotrexate?

Answer 1

Folic acid analog that inhibits dihydrofolate reductase (DHF reductase), so decreased dTMP –> decreased DNA and protein synthesis.

Question 2

Toxicity of MTX?

Answer 2

Myelosuppression, macrovesicular fatty change in liver, mucositis, teratogenic

Question 3

What to administer with methotrexate to prevent myelosuppression?

Answer 3

Leucovorin

Question 4

5-FU MOA?

Answer 4

Pyrimidine analog bioactivated to 5F-dUMP which covalently complexes folic acid. Inhibits thymidylate synthesis.

Question 5

Toxicity of 5-FU?

Answer 5

Myelosuppression and photosensitivity.

Question 6

Rescue for 5-FU?

Answer 6

Uridine

Question 7

Cytarabine MOA?

Answer 7

Pyrimidine analog - inhibits DNA polymerase

Question 8

Toxicity of cytarabine?

Answer 8

Leukopenia, thrombocytopenia, megaloblastic anemia.

CYTarabine causes panCYTopenia

Question 9

Azathioprine
6-mercaptopurine (6-MP)
6-thioguanine

Answer 9

Purine (thiol) analogs - decrease de novo purine synthesis

Question 10

Thiols toxicity?

Answer 10

Bone marrow, GI, liver

Question 11

Dactinomycin MOA?

Answer 11

Intercalates in DNA

Question 12

Dactinomycin toxicity?

Answer 12

Myelosuppression

Question 13

Doxorubicin MOA?

Answer 13

Generates free radicals, which intercalate in DNA and break DNA, resulting in decreased DNA replication

Question 14

Doxorubicin toxicity?

Answer 14

Cardiotoxicity (dilated cardiomyopathy), myelosuppression, alopecia.

Question 15

What to give to prevent doxorubicin cardiotoxicity?

Answer 15

Dexrazoxane - iron chelating agent

Question 16

Bleomycin MOA?

Answer 16

Induces free radical formation, which cause breaks in DNA strands.

Question 17

Bleomycin toxicity?

Answer 17

Pulmonary fibrosis, skin changes, mucositis.

Question 18

Cyclophosphamide, ifosfamide

Answer 18

Alkylating agents that covalently X-link DNA and require liver bioactivation.

Question 19

Cyclophosphamide toxicity?

Answer 19

Myelosuppression, hemorrhagic cystitis

Question 20

What to give to prevent hemorrhagic cystitis?

Answer 20

MESNA

Question 21

Carmustine, lomustine, semustine, streptozocin

Answer 21

Nitrosureas that do cross-linking of DNA (cross BBB)

Question 22

Nitrosureas toxicity?

Answer 22

CNS toxicity (convulsions, dizziness, ataxia)

Question 23

Busulfan MOA?

Answer 23

Cross-links DNA

Question 24

Busulfan toxicity?

Answer 24

Severe myelosuppression, pulmonary fibrosis, hyperpigmentation

Question 25

Vincristine, vinblastine

Answer 25

Inhibit MT polymerization (M-phase arrest)

Question 26

Vincristine toxicity?

Answer 26

Neurotoxicity (areflexia, peripheral neuritis), paralytic ileus

Question 27

Vinblastine toxicity?

Answer 27

BM suppression (Blastine blasts BM)

Question 28

Taxols

Answer 28

Hyperstabilizes MTs in M phase

Question 29

Taxols toxicity?

Answer 29

Myelosuppression, alopecia, hypersensitivity

Question 30

Cisplatin, carboplatin

Answer 30

Cross-link DNA

Question 31

Cisplatin, carboplatin toxicity?

Answer 31

Nephrotoxicity and acoustic nerve damage

Question 32

Etoposide, teniposide?

Answer 32

Topoisomerase II inhibitors - increase DNA degradation

Question 33

Etoposide, teniposide toxicities?

Answer 33

Myelosuppression, GI irritation, alopecia

Question 34

Irinotecan, topotecan?

Answer 34

Topoisomerase I inhibitors - prevent DNA unwinding and replication

Question 35

Irinotecan and topotecan toxicity?

Answer 35

Severe myelosuppression, diarrhea

Question 36

Hydroxyurea

Answer 36

Inhibits ribonuclease reductase (reduces DNA synthesis0

Question 37

Hydroxyurea toxicity?

Answer 37

BM suppression, GI upset

Question 38

Tamoxifen, raloxifene

Answer 38

SERMs - block inding of estrogen to ER + cells

Question 39

Tamoxifen toxicity?

Answer 39

Increased risk of endothelial cancer "hot flashes"

Question 40

Trastuzumab MOA?

Answer 40

Her2 antagonist; TK receptor antagonist

Question 41

Trastuzumab toxicity?

Answer 41

Cardiotoxicity

Question 42

Imatinib MOA?

Answer 42

TK inhibitor of bcr-abl and c-kit

Question 43

Imatinib toxicty?

Answer 43

Fluid retention

Question 44

Rituximab MOA?

Answer 44

Mab against CD20, so kills B cells

Question 45

Rituximab toxicity?

Answer 45

Increased risk of PML

Question 46

Bevacizumab MOA?

Answer 46

Mab against VEGF

Question 47

Bevacizumab toxicity?

Answer 47

Hemorrhage and impaired wound healing