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66 Cards in this Set

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Describe cancer. What is it characterized by?
A neoplastic disease that is characterized by uncontrolled cell division and a conversion of normal cells to a more primitive and undifferentiated state. Excessive cell division forms tumors or neoplasms.

Once symptoms have occurred or the tumor is detectable, a complete cure becomes less likely.
How is cancer best detected?
Through screening and prior to symptoms.
List three characteristic features of malignant tumors.
1. Cells retain their ability to undergo repeated cycles of proliferation
2. Migrate to distant sites and colonize various organs (metastasis)
3. Rapidly dividing cells compete w/ normal cells for limited supplies of body's nutrients
Name two characteristics of benign tumors.
1. Well differentiated
2. Do not invade surrounding tissues (Localized, non-invasive)
What are 3 causes of malignancies?
1. Environmental agents
2. Genetic factors, such as chromosomal abnormalities and oncogenes (genes that produce abnormal cells)
3. Viruses, such as HPV
What are 6 environmental agents that cause malignancies?
1. Hydrocarbons
2. Cigarette smoke
3. Asbestos
4. Food high in saturated fat
5. Ultraviolet radiation
6. Ionizing radiation
Where do most squamous cell carcinomas of the lung arise?
Centrally in the organ
All proliferating cells pass through 5 stages. What are they?
Go phase: resting state where cell is not dividing
G1 phase: synthesis of enzymes needed for DNA synthesis
S phase: DNA is replicated
G2 phase: synthesis of cellular components required for mitosis
M phase: mitosis and cell division
How do anti-cancer drugs work?
They are either cell cycle specific or not.

Cell cycle specific isll effect cancer cells at certain phase(s).
Most anti-tumor agents are toxic to....what kind of cells? Where are these cells located?
More toxic to proliferating/rapid growing cells, which includ non-cancer fast growing cells such as those in the mucous and GI tract?
What kind of tumors are most susceptible to anti-tumor drugs?
Tumors with a high growth fraction, ratio of dividing cells to total cells
How does chemotherapy work to fight cancer?
Follows first-order kinetics in the destruction of cancer cells. A given dose destroys a constant FRACTION of cells. To produces a cure, therapy must continue until the last tumor cell is gone.
Why is cancer so difficult to fight once you have it?
Because you will not experience any symptoms until you have 1 trillion cancer cells in your body. Less than that will not produce any symptoms.
What is the difference in high-dose chemotherapy and dosoe-dense chemotherapy in regards to tumor cell kill?
High-dose gets cancer near elimination, but not quite.

Dense-dose brings cancer to an undetectable limit, but also destroys the patient.
Treatment of anticancer drugs are focused on what kind of cells?
Any fast growing, proliferating cells.
What types of "good" cells get wiped out with anti-cancer drugs? (4)
1. Bone marrow
2. Buccal mucosa
3. GI mucosa
4. Hair cells
What are 3 SE of anticancer drugs? Describe their therapeutic index.
1. Nausea/vomiting, so patient can't eat
2. Alopecia
3. Myelosuppression (bone marrow suppression)

Most antineoplastic drugs have a narrow therapeutic index.
How are antineoplastic drugs classified? (3)
They are grouped by their:
-chemical structure
-source
-mechanism of action
Name five classifications of antineoplastic drugs?
1. Alkylating agents
2. Antimetabolites
3. Microtubule inhibitors
4. Antibiotics, kills bacteria
5. Steroid hormones and their antagonists (gynocological and prostate cancers)
What are 4 alkylating chemotherapy drugs?
1. Nitrogen mustards: MUSTARGEN
2. CYTOXAN via DNA cross-linking
3. NIROSOUREAS, bind w/ DNA
4. Platinum compounds, PLATINOL, cross-linking DNA
What is the MOA for alkylating agents?
They bind irreversably to DNA and other cell constitutes. They are a short hydro-carbon chain that is readily available to attach to DNA.

Prevent DNA replication and transcription
What do alkylating agents form?
Form cross-linkage btwn strands of DNA double-helix or with a single strand of DNA.
Are alkylating agents cell cycle specific or non-specific?
Cell cycle NONspecific drugs. They kill both rapidly proliferating and non-proliferating cells. Nonspecific to cancer.
What conditions are treated with alkylating agents? (4)
1. Hodgkin's disease
2. Chronic lymphocytic leukemia (CLL)
3. Solid tumors e.g. bladder, ovaries
4. Blood disorders, e.g. anemia, leukopenia, thrombocytopenia.
What are 4 SE of alkylating agents?
1. GI nausea and vomiting
2. Myelosuppression (bone marrow)
3. Alopecia
4. Nephrotoxicity
What are the 3 major classes of antimetabolites? Give a drug example of each
1. Folic acid analogs such as methotrexate
2. Purine analogs such as mercaptopurine
3. Pyrimidine analogs such as 5-fluorouracil
How do purine analogs work?
Interfere with metabolism on the DNA level
What is the MOA of Methotrexate? (antimetabolite)
Inhibits an enzyme that converts folic acid to its active coenzyme, which is needed for DNA, RNA and protein synthesis.

The drug gets folic acid enzyme to bind to it and doesn't allow for DNA synthesis.
What is the primary cause of cell death with Methotrexate?
Depressed DNA, RNA and protein synthesis.
Is Methotrexate cell cycle specific or non-specific?
Specific to S-phase
What are 3 SE of Methotrexate?
1. Cough
2. Dyspnea, esp. in children
3. Renal damage
What are some common toxicities associated with Methotrexate? (5)
1. Myelosuppression
2. Stomatitis, loss of lining in GI tract
3. Rash, Alopecia
4. Nausea, vomiting
5. Diarrhea
What is considered the toxic dose of Methotrexate? Describe how the dose is taken.
4 grams is lethal. Taken for one day.
What are 4 uses for Methotexate? Used in combo with other chemo-drugs, it's effective against...
1. Acute Lymphocytic Leukemia (ALL)
2. Choriocarcinoma
3. Burkitt's lymphoma in kids
4. Breast, cervix and head and neck cancers
Where are the microtubule inhibitors derived from?
The periwinkle plant and the yew trees.
What are two drugs derived from the periwinkle plant?
1. Oncovin
2. Velban
What drug is derived from teh yew tree?
Etoposide (VP-16)
What is the MOA of Microtubule inhibitors?
They bind to tubulin which interferes with the assembly of spindle proteins during mitosis.
Are microtubule inhibitors cell cycle specific or non-specific?
Specific to M phase.
What are three drug names for microtubule inhibitors?
1. Vincristine
2. Vinblastine
3. Etoposide
What are the SE for Vincristine?
Neurological toxicity, peripheral neuropathy, paresthesia, loss of reflexes. Affects neurological cells, which makes this drug unique.
What are the SE for Vinblastine?
Myelosuppression (leukopenia), severe bone marrow shut down. Immune suppressent
What are the SE for Etoposide?
Myelosuppression, alopecia. Immune suppressent
What are some therapeutic uses of Vinblastine and Vincristine?
Widely used in hematolgic neoplasms (lymphomas and leukemias)
What are some therapeutic uses of Etoposide?
Small-cell lung cancer, testicular, ovarian and many other cancers.
What are Antineoplastic Antibiotics NOT used for? What are they derived from?
Not used for treating infections. Antibiotics for cancer chemotherapy are isolated/derived from the fungus, streptomyces.
What are three examples of antineoplastic antibiotics?
DDB:
D: Doxorubicin
D: Dactinomycin
B: Bleomycin
What is the MOA of antineoplastic antibiotics? Are the cell cycle specific or non-specific?
Inhibit DNA and RNA synthesis

Cell cycle non-specific
What are 5 SE of the antineoplastic antibiotic Doxorubicin?
1. Cardiotoxicity causing CHF
2. Myelosuppression (leukopenia)
3. Fever and chills
4. Alopecia, very prominent
5. Nausea and vomiting
What are 2 therapeutic uses for Doxorubicin?
1. Lymphatic leukemias such as Hodgin's disease and ALL
2. Solid tumors such as breast, ovary and testes
What does steroid hormonal therapy rely on?
The presence of receptors for endogenous hormones required for cell proliferation.
How are steroid horomones unlike any other antineoplastic drugs?
They do not cause severe toxicity.
Tumors that are sensitive to steroid hormone therapy can be either hormone _____ or hormone ______. Describe.
1. Hormone-responsive: removal of hormonal stimulus causes tumor to regress

2. Hormone-dependent: removal of hormonal stimulus causees tumor regression
What are 3 examples of drugs in this group?
TPL
1. Tamoxifen/NOVALDEX
2. Prednisone Estrogens
3. Leuprolide
What are 4 SE of Tamoxifen?
Hot flashes, vaginal bleeding, skin rash and hypercalcemia. Antagonizes estrogen effect on a person.
Tamoxifen is useful in the treatment of....
Estrogen-positive breast cancer
How does Estrogen help with prostatic cancer?
Inhibit growth of prostatic cancer by blocking the production of LH which decreases the synthesis of androgens in the testes.
What are two SE of using Estrogen for prostatic cancer?
1. Impotence
2. Gynecomastia
How are Anti-cancer Immune Modulators different from all other cancer drugs?
They kill a fixed number of cells, not a fracture of them.
What are two examples of anti-cancer immune modulator drugs?
1. Alpha Interferon
2. Interleukin-2
How does Interleukin-2 work?
Induces several components of patient's immune system which kill cancer cells.
What are two uses for Interleukin-2?
1. Malignant melanoma, which is very deadly. Have to watch for moles/skin spots that are changing.
2. Renal cancer
What are the SE of using Interleukin-2? (4)
1. Decrease platelets
2. Capillary leak syndrome (CLS)
3. Hypotension
4. Thrombosis
What are two specific uses for Alpha interferon?
1. Leukemia(s)
2. Kaposi's sarcoma, AIDS, Bone cancer
What are the SE of using Alpha Interferon? (3)
1. Decreased platelets
2. Hypotension
3. Thrombosis
What are 5 PT implications when working with cancer patients?
1. Pt's are very weak after chemotherapy
2. Have compromised immune systems
3. May exhibit a depressed effect
4. May be in protective isolation
5. May have dangerous infections