Tubulin-Binding Drugs

Question 1

Tubulin-binding drugs such as vinca alkaloids and taxanes MOA

Answer 1

Antimitotic chemotherapeutic drugs that disrupt normal function of micro tubules

Question 2

Specifically how does vinca alkaloids work

Answer 2

By binding to depolymerized microtubules and inhibiting microtubule formation

Question 3

Specifically how do taxanes work

Answer 3

By binding to POLYMERIZED microtubules and inhibiting their breakdown

Question 4

What is the result of tubular-binding drugs

Answer 4

Failure of the cell to undergo mitosis leading to cell death

Question 5

Vincristine is highly effective against what diseases

Answer 5

Hodgkin disease, non Hodgkin lymphoma, and pediatric solid tumor

Question 6

Vinorelbine is used for

Answer 6

Breast and lung ca

Question 7

Vinblastine is used for

Answer 7

Testicular cancer and non hodgkin lymphoma

Question 8

What is the most prominent side effects of vinca alkaloids appearing 7-10 days after initiation of treatment

Answer 8

Myelosuppression manifesting as leukopenia, thrombocytopenia and anemia.

Question 9

Between vincristine, vinblastine and vinorelbine- who is less likely to cause bone marrow suppression

Answer 9

Vincristine

Question 10

What is the dose limiting side effect of vincristine-what is the first sign

Answer 10

Symmetric peripheral sensory motor neuropathy- loss of Achilles’ tendon reflex being first sign

Question 11

Are CNS side effects common with vincristine-why

Answer 11

No- doesn’t cross the bbb

Question 12

What does ssep show about vincristine

Answer 12

Demyelination

Question 13

Is the peripheral neuropathy reversible with vincristine

Answer 13

Yes, although some say it may take months or be incomplete.

Question 14

What are the anesthetic considerations for vincristine

Answer 14

Significant risk of worsening neuropathy- LA should be reduced, epinephrine should be avoided. Nerve localization technique that minimizes risk of intraneuronal injection.

Question 15

What electrolyte imbalance has been associated with vincristine…why

Answer 15

Hyponatremia- high urinary sodium with inappropriate secretion of arginine vasopressin.

Question 16

What are the autonomic nervous system effects seen with vincristine therapy

Answer 16

Paralytic ileus
Abdominal pain
Urinary retention
Dry mouth
Tachycardia
Parotid gland tenderness

Question 17

Vinblastine side effect on the second or third day of treatment

Answer 17

Mental depression

Question 18

Vinorelbine used to treat breast and lung cancer side effects

Answer 18

Chest pain
Bronchospasm
Dyspnea
Pulmonary infiltration

Question 19

How does estramustine work

Answer 19

Inhibits microtubule assembly and depolymerization

Question 20

Estramustine is a useful drug to use as a combination drug for what cancer

Answer 20

Hormone refractory prostate cancer

Question 21

Paclitaxel is useful for what four cancers

Answer 21

Breast
Lung
Ovarian
Bladder

Question 22

How are taxanes cleared from plasma

Answer 22

Rapidly despite being largely protein bound

Question 23

What side effects are taxanes associated with

Answer 23

Myelosuppression
Peripheral neuropathy -glove and stocking distribution
Alopecia

Question 24

With taxanes what musculoskeletal side effects are experienced

Answer 24

Arthaligia and myalgia

Question 25

What cardiac side effects are seen with taxanes

Answer 25

Dysrhythmias Mi Bradycardia

Question 26

Docetaxal side effects

Answer 26

Peripheral edema Pleural effusions Ascites

Question 27

Fluid retention of docetaxal may be pretreated with

Answer 27

Dexmethasone

Question 28

What skin issues is associated with docetaxal

Answer 28

Erythematous maculopapular rash on forearms and hands

Question 29

What occurs in 25-30% of patients treated with taxanes

Answer 29

Hypersensitivity reaction from release of histamine or other chemical mediators