Pharm 25 Drug List

Question 1

List the Alkylating Agents: Nitrogen Mustard drugs

Answer 1

Cyclophosphamide

Ifosfamide

Question 2

Cyclophosphamide and Ifosfamide unique ASEs?

Answer 2

Hemorrhagic cystitis

CNS toxicity - confusion, AMS, encephalopathy

Question 3

Why is Mesna used in conjunction with Ifosfamide?

Answer 3

Binds to acrolein to prevent hemorrhagic cystitis

Question 4

List the Alkylating Agents: Platinum Analogues drugs

Answer 4

1. Carboplatin
2. Cisplatin
3. Oxaliplatin

Question 5

ASEs of Platinum Analogue: Carboplatin?

Answer 5

Myelosuppression - thrombocytopenia

Question 6

ASEs of Platinum Analogue: Cisplatin?

Answer 6

Ototoxicity

Highly emetic: acute (18-24hrs post tx) and delayed (48-72 hrs post tx)

Nephrotoxicity

Question 7

ASEs of Platinum Analogue: Oxaliplatin?

Answer 7

Cold sensitivity - pharygolaryngeal dysethesia

Peripheral neuropathy

Question 8

List the Topoisomerase Enzyme Inhibitor drugs

Answer 8

1. Irinotecan
2. Doxorubicin
3. Etoposide

Question 9

List the Topoisomerase Enzyme Inhibitor: Camptothecins drug

Answer 9

Irinotecan

Question 10

List the Topoisomerase Enzyme Inhibitor: Anthracycline drug

Answer 10

Doxorubicin

Question 11

List the Topoisomerase Enzyme Inhibitor: Epipodophyllotoxin drug

Answer 11

Etoposide

Question 12

ASEs of Camptothecins: Irinotecan?

Answer 12

When taking Irinotecan pts with UGT1A1 allele can experience life threatening diarrhea

Hepatic impairment

Neutropenia (UGT1A1 28)

Question 13

What adjunct therapies do you use to avoid both acute and delayed diarrhea when taking Irinotecan?

Answer 13

Acute: use atropine

Delayed: use loperamide

Question 14

ASEs of Anthracycline: Doxorubicin?

Answer 14

Cardiotoxicity (dilated cardiomyopathy)

Urine discoloration

Question 15

What medication is often given with Doxorubicin to reduce cardiotoxicity?

Answer 15

Dexrazoxane

Question 16

MOA of Dexrazoxane + Doxorubicin?

Answer 16

Inhibits free radical formation —> limiting cardiotoxicity

Question 17

What potential ASE occurs with using Dexrazoxane + Doxorubicin?

Answer 17

Potential decreases the chemo drug effectiveness.

Question 18

ASEs of Epipodophyllotoxin: Etoposide?

Answer 18

Infection related rxn: HypoTN, fever/chills

Hypersensitivity rx: Anaphylaxis, tachy, bronchospasm, dyspnea

Question 19

List the Antimicrotubule drugs

Answer 19

1. Vincristine
2. Docetaxel
3. Paclitaxel

Question 20

List the Antimicrotubules: Vinca Alkaloid drug

Answer 20

Vincristine

Question 21

List the Antimicrotubules: Taxanes drugs

Answer 21

Docetaxel

Paclitaxel

Question 22

ASEs of Vinca Alkaloid: Vincristine?

Answer 22

Neurotoxicity: sensor, motor, peripheral neuropathy

Fatal if administered intrathecally - irreversible

Question 23

What is best practice to avoid causing fatality when administering Vincristine?

Answer 23

Use IV mini infusion bags not syringes

Question 24

ASES of Taxanes: Docetaxel

and Paclitaxel?

Answer 24

Cardiovascular - peripheral edema, flushing

Neurotoxic- cumulative peripheral neuropathy

Question 25

List the Antimetabolites

Answer 25

1. Capecitabine 2. Fluorouracil (5-FU) 3. Cytarabine 4. Methotrexate (MTX)

Question 26

List the Antimetabolites: Pyrimidine Analogue dugs

Answer 26

1. Capecitabine 2. Fluorouracil (5-FU) 3. Cytarabine

Question 27

ASEs of Pyrimidine Analogues: Capecitabine and Fluorouracil (5-FU)

Answer 27

Continuous infusion: - Mucosal damage - Palmar - plantar erythrodysesthia ("hand-foot syndrome") Genetic polymorphism defect (DPD)

Question 28

List the Antimetabolites: Antifolate drug

Answer 28

Methotrexate (MTX)

Question 29

ASEs of Antifolate: Methotrexate (MTX)

Answer 29

Mucosal damage Hepatotoxicity and Nephrotoxicity

Question 30

What are 2 drug interactions with Methotrexate (MTX)?

Answer 30

- NSAIDs (decreased clearance of MRX --> increased toxicity) | - PPIs (elevate and prolong serum MTX levels (high dose MTX)

Question 31

What medication is used as a chemotherapy rescue agent and a chemotherapy modulating agent?

Answer 31

Leucovorin (Folinic Acid)

Question 32

How is Leucovorin used as a chemotherapy rescue agent?

Answer 32

Used in MTX toxicity Actively competes with and displaces MTX from intracellular binding sites Restores active folate stores required for DNA/RNA synthesis.

Question 33

How is Leucovorin used as a chemotherapy modulating agent?

Answer 33

Fluorouracil efficacy Enhances FdUMO (metabolite of 5-FU) binding to thymidylate synthesis ---> inhibiting thymidylate enzyme causing DNA damage.

Question 34

List the Antitumor antibiotic drug

Answer 34

Bleomycin

Question 35

ASEs of Antitumor antibiotic: bleomycin?

Answer 35

Pulmonary fibrosis "Bleo Lung"

Question 36

List the Proteosome inhibitor drug

Answer 36

Bortezomib

Question 37

ASEs of Proteosome inhibitor: Bortezomib?

Answer 37

Peripheral neuropathy (less if given SubQ vs IV) Herpes reactivation

Question 38

List the Immunomodulator

Answer 38

Lenalidomide

Question 39

BB warning of Immunomodulator: Lenalidomide?

Answer 39

Arterial/venous thromboembolic events (w/ dexamethasone) Severe birth defects, embryo-fetal death (extensive REMS program)

Question 40

List the Monoclonal antibodies drugs

Answer 40

1. Rituximab 2. Trastuzumab 3. Cetuximab 4. Bevacizumab 5. Pembrolizumab

Question 41

General ASEs of Monoclonal antibodies drugs?

Answer 41

Infusion related---> need to titrate d/t how large the molecules are Immune-mediated ---> toxic epidermal necrolysis, enterocolitis, hepatitis, progressive multifocal leukoencephalopathy, mucocutaneous rxn.

Question 42

List the Monoclonal antibodies: Anti-CD20 drug

Answer 42

Rituximab

Question 43

ASEs of Anti-CD20: Rituximab

Answer 43

Hep B reactivation High lymphocytes count = high infusion reaction potential CCL pts- pneumocystis jiroveccii (PCP) and antiherpetic viral prophylaxis

Question 44

List the Monoclonal antibodies: Anti-HER2 drug

Answer 44

Trastuzumab

Question 45

ASEs of Anti-HER2: Trastuzumab

Answer 45

Cardiotoxicity (reversible t1/2=30 days) - HF - Arrythmia - Cardiomyopathy

Question 46

List the Monoclonal antibodies: Anti-PD drug

Answer 46

Pembrolizumab

Question 47

ASEs of Anti-PD: Pembrolizumab

Answer 47

Immune-mediated: - Colitis - Dermatitis - Hyperglycemia - Hyperthyroidism - Nephritis - Pneumonitis

Question 48

List the Monoclonal antibodies: EGFR Inhibitor

Answer 48

Cetuximab

Question 49

ASEs of EGFR Inhibitor: Cetuximab

Answer 49

Dermatological: acneiform rash, other skin rashes Electrolyte abnormality - hypomagnesemia (may be d/t high expression of EGFR in kidneys)

Question 50

List the Monoclonal antibodies: VEGF Inhibitor

Answer 50

Bevacizumab

Question 51

ASEs of VEGF inhibitor: Bevacizumab

Answer 51

Impaired wound healing GI perforation Proteinuria/nephrotic syndrome

Question 52

List the Tyrosine Kinase Inhibitor (TKI) drugs

Answer 52

1. Imatinib 2. Ibrutinib 3. Sorafenib 4. Erlotinib

Question 53

MOA of Tyrosine Kinase Inhibitor (TKI) drugs?

Answer 53

Shuts down TK activity preventing the transfer of a phosphate group from ATP to tyrosine residues in proteins. Targets extracellular and intracellular TK receptors and ligands and intracellular fusion proteins

Question 54

Advantaged of Tyrosine kinase inhibitor drugs?

Answer 54

Single compound targeting multiple kinases Efficacy in multiple tumor types Oral therapy = convenient and less complex

Question 55

Disadvantages of Tyrosine Kinase Inhibitor drugs?

Answer 55

Lots of drug-drug interactions Toxicities Pts if monitored less frequently