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43 Cards in this Set
- Front
- Back
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what is chemotherapy dosing based on?
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body surface area - expressed in m cubed
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what are the 7 possible mechanism of chemotherapy resistance?
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1. decreased influx of drug into cell/nucleus; 2. increased efflux of drug; 3. increased detox mechanisms; 4. decreased activation of drugs; 5. amplified or altered drug target; 6. altered cell cycle kinetics; 7. increased ability to tolerate damage
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why are chemo drugs used in combo?
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to over come resistance, enhance the anti-tumor effect and to rescue normal cells from cell death (myelosuppression - occurs around day 28)
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what are the 5 criteria for combo therapy?
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1. drug should be active alone against tumor; 2. drugs should act by different mechanism; 3. drugs should have different dose limiting toxicities; 4. drugs should have different mechanisms of resistance; 5. drugs should include cell cycle specific and non-specific agents
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what is the most common dose limiting toxicity of chemotherapeutic drugs?
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myelosuppression
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what are the most common types of myelosuppression?
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neutropenia (filgrastim used to lessen problems), erythropenia and thrombocytopenia and anemia (secondary to RBC loss)
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with which drugs is alopecia common?
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cyclophophamide, doxorubicin, mechlorethamine, paclitaxel, ifosfamide
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with which drugs is extravasation necrosis common?
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mitomycin, mechlorethamine, paclitaxel, anthracyclines and vinca
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how do you treat extravasation necrosis?
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for vinca - heat and haluronidase; other agents cold and neutralizing solution
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which with drugs is light sensitivity common?
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5-FU and methotrexate
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which what drug is hypersensitivity common?
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paclitaxel due to diluenting agent used to solubilize the drug
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what adverse effect of chemotherapy drugs is most upsetting to patients?
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N&V
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with what drugs is N&V common?
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CISPLATIN! High dose cyclophosphamide, carmustine, high dose doxorubicin, temoxolomide, high dose methotrexate, dactinomycin
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what is somatitis and what drugs cause it?
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inflammation of the oral or GI mucosa that can lead to cachexia (wasting) and infection; common with 5FU and methotrexate
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with which drugs is diarrhea common?
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topotecan and irinotecan
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which drugs cause pulmonary toxicities?
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bleomycin: inactivated by an enzyme absent in the lungs; mitomycin and nitrogen mustards
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which drugs cause direct renal death?
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cisplatin and carboplatin
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which drug indireclty causes renal cell damage?
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amifostine: detoxifies free radical sthat can lead to renal cell death; given with platinum analogs to decrease toxicity
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with which drugs is neuropathy common?
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vincristine, carboplatin and oxaliplatin
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which which drugs are CV adverse effects common?
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anthracyclines; extent of damage is proportional to total CUMULATIVE DOSE!
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what is dexrazoxane?
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a chelating agent that removes iron buildup in the heart and prevents damage caused by chemotherapy agents
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with which drugs is ototoxicity/peripheral neuropathy common?
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cisplatin and paclitaxel
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with which drugs is hemorrhagic cystitis common?
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cyclophosphamide and ifosfamide due to a breakdown product called acrolein
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What is mesna?
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a drug that binds to acrolein and inactivates it to prevent hemorrhagic cystitis
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what is the M.O. of alkylating agents?
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they bind covalently to DNA and stop cell growth
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what type of cells do alkylating agents attack?
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ANY dividing cell - the faster growing the cell the more susceptible
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what are anthracyclines?
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anti-tumor antibiotics
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what is the M.O. of anthracycline?
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lead to inhibition of DNA synthesis and thus cell death
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what is the M.O. of mitomycin and mithramycin?
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they are like alkylating agents - mostly crosslinkers
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what is the M.O. of doxorubicin?
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intercalation of DNA - drug slides non-covalently between base pairs of DNA and contorts the double helix
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what is the M.O. of daunorubicin?
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intercalation of DNA - drug slides non-covalently between base pairs of DNA and contorts the double helix
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what is the M.O. of epirubicin?
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intercalation of DNA - drug slides non-covalently between base pairs of DNA and contorts the double helix
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what is the M.O. of dactinomycin?
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intercalation of DNA - drug slides non-covalently between base pairs of DNA and contorts the double helix
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what is the M.O. of mitoxantrone?
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intercalation of DNA - drug slides non-covalently between base pairs of DNA and contorts the double helix
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what is the M.O. of bleomycin?
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it forms free radicals which damage DNA
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what is the M.O. of antimetabolites?
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they block the biosynthesis or use of normal cellular metabolites which eventually inhibits DNA synthesis (S phase)
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what type of cells do antimetabolite drugs attack?
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slower growing tumor cells
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what are vincas?
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plant alkaloids that arrest cell divisoin by preventing formation of the mitotic spindle through disaggregation of microtubules
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what are camptothecins?
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plant alkaloids that inhibit topoisomerase 1 causing DNA starngs to break = cell death
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what are epipodophyllotoxins?
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plant alkaloids that inhibit topoisomerase 1 causing DNA starngs to break = cell death
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what are taxenes?
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plant alkaloids that stabilizes microtubules to inhibit mitotic spindle assembly = inhibits cell division
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what is the M.O. of asparaginase and pegasparaginase?
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they remove a vital amino acid (ASN) critical to the growth of some tumor cells
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why is pegasparaginase better retained in tumor cells?
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due to the PEG (polyethyleneglycol) molecule added to it
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