Pharm Review Chp 16 - 19

Front 1

Standard combo tx for ALL

Back 1

Prednisone and Vincristine OR
POMP
-Predinisone
-Oncovin (aka Vincristine)
-Methotrexate
-Purimethol (6-MP)

Front 2

MOA Prednisone

Back 2

steroid that causes lymphocytopenia (is the condition of having an abnormally low level of lymphocytes in the blood)

Front 3

MOA Vincristine

Back 3

Binds tubulin and blocks the from forming microtubules
(inhibits mitosis)

Front 4

SE Vincristine

Back 4

Peripheral neuropathy
Phlebitis
Alopecia
Multiple GI problems

Front 5

MOA Methotrexate

Back 5

Inhibits dihydrofolate reductase (inhibits folate usage)

Front 6

Purimethol aka

Back 6

6-MP

Front 7

SE Purimethaol (6-MP)

Back 7

Stomatitis
SEVERE BM suppression
Alopecia
N/V
Renal & hepatic damage

Front 8

Tx Wilm's tumor
(congenital kidney tumor 2-5 yo)

Back 8

Dactinomycin & Vincristine

Front 9

DOC combo for Hodgkin's disease

Back 9

MOPP
-Mechlorethamine
-Oncovin
-Prednisone
-Procarbazine

ABVD
-Adriamycin
-Bleomycin
-Vinblastine
-Dacarbazine

Front 10

MOA Bleomycin & adriamycin

Back 10

Destroy DNA via ROS

Front 11

MOA Dacarbazine

Back 11

Alkylating agent

Front 12

SE Dacarbazine

Back 12

Highly emetogenic
Extreme BM suppression

Front 13

MOA Mechlorethamine

Back 13

Alkylates guanines in DNA --> cross-linking in pairs or removal

Front 14

SE Mechlorethamine

Back 14

Severe N/V
Extreme BM suppression
Herpes Zoster (if VZV provirus present)
Potential to cause 2nd CA
Extreme blisters if on skin or mucus membranes

Front 15

MOA Procarbazine

Back 15

Inhibits DNA & RNA synthesis

Front 16

SE Procarbazine

Back 16

BM suppression
Disulfiram rxn
Neurotoxicity

Front 17

Cancer chemotherapeutics: MOA cyclophosphamide

Back 17

Alkylating agent --> destroys DNA
(Requires biotransformation via P450 for activation)

Front 18

Cancer chemotherapeutics: SE Cyclophosphamide

Back 18

Alopecia
BM suppression
Leukocytosis
Amenorrhea
Sterility
HEMORRHAGIC CYSTITIS (bladder fibrosis)

Front 19

Cancer chemotherapeutics: SE Bleomycin

Back 19

Pulmonary fibrosis

Front 20

Cancer chemotherapeutics: MOA Cisplatin

Back 20

Platinum compound
Intra- & interstrand cross-linking b/t nucleotides --> ceasing all RNA & DNA synthesis

Front 21

Cancer chemotherapeutics: Cisplatin used for

Back 21

Solid tumors
(metastatic testicular CA, ovarian CA, bladder CA)

Front 22

Cancer chemotherapeutics: SE Cisplatin

Back 22

Persistent, intractable V
Nephrotoxicity
Ototoxicity
PERIPHERAL NEUROPATHY

Front 23

Cancer chemotherapeutics: MOA L-asparaginase

Back 23

Asparagine --> aspartic acid
(some Ca require asparagine, deprives them)

Front 24

Cancer chemotherapeutics: L-asparaginase used to tx

Back 24

ALL

Front 25

Cancer chemotherapeutics: SE L-asparaginase

Back 25

HYPERSENSITIVITIES
Decreased clotting factors
Liver problems
Pancreatitis
Seizures
Coma

Front 26

6-MP DOC for

Back 26

ALL

Front 27

Bleomycin DOC for

Back 27

testicular cancer

Front 28

Vincristine DOC for

Back 28

Hodgkin's lymphoma

Front 29

Vinblastine used to tx

Back 29

Testicular CA
Lymphoma

Front 30

Mechlorethamine used to tx

Back 30

Hematologic malignancy
(leukemia & lymphoma). Has the potential to induce secondary cancers, such as leukemia.

Front 31

Cyclophosphamide used to tx

Back 31

Lymphomas & Leukemias
Ovarian & breast CA
Childhood malignancies
Multiple myeloma

Front 32

Cisplatin DOC and 2 drugs which are similar to Cisplatin

Back 32

DOC: Testicular and bladder cancer
Carboplatin - less renal tox, more BM tox
Oxaliplatin - neurtoxic when exposed to cold

Front 33

SE Chlorambucil (similar MOA Mechlorethamine)

Back 33

Extremely BM tox
Potential 2nd CA

(Others - Melphalan, lomustine, busulfan)

Front 34

Leuprolide & Flutamide used to tx

Back 34

Prostate CA

Front 35

MOA & SE Leuprolide

Back 35

synthetic analog GnRH
Hot flashes

Front 36

MOA & SE Flutamide

Back 36

Antagonizes testosterone R
Gynecomastia

Front 37

MOA Hydroxyurea

Back 37

Inhibits ribonucleotide reductase
(req. for nucleotide synthesis in WBC)

Front 38

Hydroxyurea used to tx

Back 38

Leukemia
(Sickle cell pt - reduces # crises)

Front 39

SE hydroxyurea

Back 39

BM tox (managed via titration)
Causes synthesis fetal Hgb (useful in sickle cell pt)

Front 40

MOA ATRA (all-trans-retinoic acid)

Back 40

Binds to mutated form retinoic acid R
(causes blasts to differentiate --> mature myeloid cells) This induces remission.

Front 41

ATRA used to tx

Back 41

AML subtype 3 (15:17 translocation)

Front 42

SE ATRA

Back 42

Induces disseminated intravascular coagulation.

Front 43

MOA Tamoxifen

Back 43

Inhibits Estrogen R in breast. Use in treatment and in women who are at high risk for the development of breast cancer.

Front 44

SE Tamoxifen

Back 44

Hot flashes
Increased risk DVT & PE
Increased risk endometrial CA

Front 45

Taxanes (2 drugs)

Back 45

Paclitaxel
Doxetaxel

Front 46

MOA taxanes

Back 46

Inhibit microtubule disassembly --> apoptosis

Front 47

Taxanes used to tx

Back 47

Breast, Lung, Ovarian CA

Front 48

SE Taxanes

Back 48

Dose-limiting BM suppression

Front 49

PGE2 responsible for

Back 49

Sensitizing n. endings to other pain mediators
Fever

Front 50

PGI2 responsible for

Back 50

Inhibiting gastric secretions

Front 51

PGE2 & PGF2 responsible for

Back 51

Stimulate production protective mucus in stomach & small intestine

Front 52

MOA Aspirin

Back 52

IRREVERSIBLY acetylates cyclooxygenase
(central and peripheral tissue)

Front 53

Effects of ASA

Back 53

-decrease inflammation & fever
-decreases coaguation via platelets
-analgesic

Front 54

How does ASA reduce coagulation

Back 54

Decreases thromboxane (d/t COX inhibition)
Thromboxane - enhanses platelet aggregation
(takes 2 wks for reversal of this - new platelets formed)

Front 55

Who is ASA contraindicated in

Back 55

GOUT pt
(competes w/ uric acid at renal transporters)

Front 56

Some uses of ASA

Back 56

RA
HA, arthralgia, angina, PDA
Topically - corns & calluses
Prophylactically - Hx MI, stroke, A. fib

Front 57

Overdose of ASA causes

Back 57

Uncoupling Ox-Phos

Front 58

Effect of ox-phos uncoupling resulting from OD ASA

Back 58

Increase CO2 --> hyperventilation --> resp. alkalosis
Kidney response w/ metabolic acidosis

Front 59

Immediate acid-base disturbance ASA

Back 59

Metabolic acidosis (acidic nature ASA)

Front 60

ASA toxic levels leads to

Back 60

Central resp. paralysis --> hypoventilation --> increase CO2 --> Resp. acidosis

Front 61

Other SE ASA

Back 61

Tinnitus
(mild ASA intox)

Front 62

Special about APAP

Back 62

NO peripheral anti-inflammatory action
(CNS cyclooxygenase)

Front 63

APAP used for

Back 63

-reducing fever
(good antipyretic w/o risk reye's syndrome in kids)
-reducing pain perception
-Children w/ viral infection

Front 64

Use of Indomethacin (Etodolac, Sulindac)

Back 64

Acute gouty arthritis
Ankylosing spondylitis
OA of hip
Pain control for uveitis & post-op ophthalmic
Fever in Hodgkin's disease

Front 65

SE Indomethacin

Back 65

GI distrubances (ulceration)
RARE
-Pancreatitis
-Fatal hepatitis
-Aplastic anemia

Front 66

Other non-selective NSAIDS

Back 66

Ibuprofen
Ketorolac
Tolmetin
Naproxen

Front 67

COX-2 inhibitor? Effect?

Back 67

Celecoxib
(decreasing formation PG in inflammatory or injurious conditions)

Front 68

GI SE w/ COX-2 inhibitors

Back 68

Less

Front 69

Who can you NOT use COX-2 inhibitor in?

Back 69

Allergic to sulfa drug

Front 70

SE of ALL NSAIDS (except APAP)

Back 70

Increase risk of miscarriage
Exacerbate HF & HTN
Promote GI d/o (chronic use)
Inhibit platelet fnct --> increase bleeding

Front 71

Aspirin overdose

Back 71

Causes uncoupling of oxidative phosphorylation. This results in an increase in pre-respiratory processes in an attempt to overcome the ability to make as much ATP as usual. This results in an accumulation of carbon dioxide, which causes hyperventilation by the patient. Repsiratory alkalosis is established. As the level of aspriin increases to toxic levels, a central respiratory paralysis occurs, resulting in hypoventilation. CO2 ldevels rise, creating a respiratory acidosis. Generally also a metabolic acidosis.

Front 72

Acetaminophen

Back 72

No peripheral anti-inflammatory action, but it does inhibit cox.

Front 73

Acetaminophen DOC

Back 73

Children with viral infections, as it is as effective an antipyretic as asprin but without the risk of inducing Reye's syndrome.

Front 74

Phenylbutazone

Back 74

Used in animals. Tends to cause agranulocytosis and fatal aplastic anemia.

Front 75

Indomethacin, etodolac and sulindac

Back 75

Have anti-inflammatory, analgesic, and antipyretic activity. Indomethacin is mostly reserved for certain severe instances, such as acute gouty arthritis, ankylosing spondylitis, and osteoarthritis of the hip.

Front 76

COX-2 Inhibitors

Back 76

Selectively inhibit COX2. Ex. celecoxib, cannot e used in sulfa-allergic patients.

Front 77

AE of all NSAIDS

Back 77

Increase the risk of miscarriage if used around the time of conception. They can also exacerbate heart failure and hypertension. Chronic use can promot serious GI sidorders.