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231 Cards in this Set
- Front
- Back
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What classes of chemo drugs act on mitosis?
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Vinca alkaloids
Taxanes |
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What classes of chemo drugs act on DNA synthesis?
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Anti-metabolites
Epipodophylloxtoxins Camptothecins |
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What classes of chemo drugs are cycle nonspecific?
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Alkylating agents
Anthracyclines |
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Ifosfamide is what class of chemo drug?
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Alkylating agent
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Busulfan is what class of chemo drug?
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Alkylating agent
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DTIC is what class of chemo drug?
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Alkylating agent
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Acrolein causes what illness?
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Hemorrhagic cystitis
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What is the first step in the MOA of cyclophosphamide?
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Drug converted by hepatic microsomal enzymes to 4-HCP
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In the metabolism of cyclophosphamide, 4-HCP is converted to what?
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Acrolein
Phosphoramide mustard |
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What is the role of phosphoramide mustard?
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Alkylates DNA
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Ifosfamide is converted to what two substances in its metabolism?
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Acrolein
Ifosforamic mustard |
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Ifosfamide is most useful in treating what cancers?
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Solid tumors
Lymphomas |
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What alkylating agent treats graft-vs-host disease?
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Cyclophosphamide
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What alkylating agent treats rheumatic disorders and autoimmune nephritis?
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Cyclophosphamide
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What is the most common toxicity associated with cyclophosphamide?
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Myelosuppression
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What is the most common toxicity associated with Ifosfamide?
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Hemorrhagic cystitis
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SIADH is associated with what alkylating agent?
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Cyclophosphamide
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Acrolein binds to what in the bladder wall?
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Thiol
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How do you prevent hemorrhagic cystitis?
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Vigorous hydration (more than 2 liters/day)
MESNA |
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What are the platinums?
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Cisplatin (CDDP)
Carboplatin Oxaliplatin |
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What is the most common toxicity associated with cisplatin?
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Nephrotoxicity
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Which platinum is not concentrated in the renal tubules and is more efficiently cleared?
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Carboplatin
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What is the most active single agent in the treatment of cervical cancer?
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Cisplatin
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The platinums treat what cancers?
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Testicular, ovarian, metastatic bladder, lung, and other solid tumors
Non-Hodgkin's lymphoma Colorectal cancer |
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Which platinum is used to treat colorectal cancer?
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Oxaliplatin
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What are the two most common toxicities associated with cisplatin?
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Vomiting
Nephrotoxicity |
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What is the most common toxicity associated with carboplatin?
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Myelosuppression
|
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You should not give carboplatin with what other chemo drug?
|
Cyclophosphamide
|
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What is the most common toxicity associated with oxaliplatin?
|
Peripheral neuropathy
|
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What agent binds with cisplatin to prevent damage to normal tissue?
|
Amifostine (Ethyol)
|
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What are the side effects of Amifostine (Ethyol)?
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Hypotension
Vomiting Nausea |
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Besides preventing normal tissue damage, Amifostine is also used to do what?
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Prevent radiation-associated xerostomia
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What agent is a free radical scavenger?
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Amifostine
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Chlorambucil (Leukeran) is used in the treatment of what?
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CLL
|
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What is the toxicity of Busulfan (Myleran)?
|
Decreasing seizure threshold
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Busulfan (Myleran) is used to treat what?
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Leukemia
Transplant |
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Melphalan (Alkeran) is used to treat what?
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Multiple myeloma
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Temozolomide (Temodar) is used to treat what?
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Brain tumors
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DTIC is commonly used to treat what?
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Brain tumors
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What color is mitoxantrone?
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Blue
|
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What color are most of the anthracyclines?
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Dark red
When diluted....orange |
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What are the anthracyclines?
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Doxorubicin
Daunorubicin Idarubicin Epirubicin Mitoxantrone |
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Anthracyclines inhibit what?
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Topoisomerase II
|
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What is the MOA of anthracyclines?
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Inhibit topoisomerase II
Intercalation between DNA base pairs Formation of free radicals that damage DNA and cell membranes |
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What is the most active agent in the treatment of breast cancer?
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Doxorubicin
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What cancers does Doxorubicin treat?
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Breast cancer
Sarcomas GI tumors Lymphoma |
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What cancer does Epirubicin treat?
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Breast cancer
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Which three anthracyclines are useful in acute leukemia?
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Daunorubicin
Idarubicin Mitoxantrone |
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What are the most serious toxicities of anthracyclines?
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Myelosuppression
Cardiotoxicity Extravasation injury |
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Which anthracycline has less risk of cardiotoxicity?
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Mitoxantrone
|
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What cardioprotectant is typically used with the anthracyclines?
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Dexrazoxane (Zinecard)
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Mitoxantrone causes what unique side effect?
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Blue-green urine discoloration
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Bleomycin is used to treat what cancers?
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Testicular
Hodgkin's disease |
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What toxicity should you be worried about with bleomycin?
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Pulmonary toxicity
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Mitomycin C is used for what cancers?
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GI tumors
Bladder cancer |
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Which drug is sent to the OR for "shake and bake"?
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Mitomycin C
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What are the three categories of antimetabolites?
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Antifolates
Purine analogs Pyrimidine antagonists |
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What drug is typically used with Methotrexate to aid in the uptake of healthy cells?
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Leucovorin
|
|
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What are the clinical uses of Methotrexate?
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Heme/solid malignancies
ALL Non-Hodgkin's Breast & bladder cancer Osteosarcoma Rheumatoid arthritis |
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What are the toxicities of Methotrexate?
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Myelosuppression
Mucositis Nephrotoxicity Neurotoxicity Photosensitivity Pneumonitis Hepatotoxicity |
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What should you use to prevent renal damage with methotrexate?
|
Alkalinize the urine with sodium bicarbonate solutions
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What two drugs were we told can interfere with methotrexate?
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Bactrim
NSAIDS |
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What test should you definitely get before methotrexate dosing?
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Chest x-ray
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What enzyme can you give to aid in the breakdown of methotrexate in the circulation?
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Glucarpidase
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When should Leucovorin be administered after giving methotrexate?
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24 hours after methotrexate administration
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What drug can cause an ulcerative red rash?
|
Pemetrexed (Alimta)
Can prevent with dexamethasone |
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What is pemetrexed used to treat?
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Malignant pleural mesothelioma
Non-small cell lung cancer |
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What can you use to prevent hematologic and gastrointestinal toxicity when treating with Pemetrexed?
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Folic acid and B12
Start 1 week before treatment and continue for 21 days after treatment concludes |
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What drug is phosphorylated to an active component within cancer cells?
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Cytarabine - C
|
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What is the MOA of Cytarabine-C?
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Inhibits DNA polymerase
|
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What is cytarabine-C used to treat?
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Acute leukemias
Non-Hodgkin's lymphoma |
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What is cytarabine-C NOT active against?
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Solid tumors
|
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What are the normal-dose toxicities of Cytarabine?
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Myelosuppression
Alopecia Gastrointestinal Rash (plantar-palmer syndrome) |
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What are the high dose toxicities of Cytarabine?
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Nausea
CNS Chemical conjunctivitis Acral erythema |
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Gemcitabine (Gemzar) is more effective when dosed how?
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Intermittent rather than continuous
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What does Gemcitabine treat?
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Solid tumors
Pancreatic cancer Non-small cell lung cancer |
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Gemcitabine is neurotoxic, true or false?
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False
|
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What are the toxicities of Gemcitabine?
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Myelosuppression
Generalized rashes Fever, flu-like symptoms Peripheral edema Mild nausea & vomiting |
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What does Clofarabine (Clolar) treat?
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Relapsed pediatric ALL
|
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What is the toxicity of Clofarabine?
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skin toxicity
rash to desquamation |
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Nelarabine (Arranon) treats what?
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Tcell ALL or Tcell lymphoblastic lymphoma
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What is the toxicity of nelarabine?
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Neurotoxicity
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What is the MOA of Fluorouracil?
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Prevents conversion of uracil (RNA) to thymidine (DNA)
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What must Fluorouracil be metabolized to in order to be active?
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FdUMP
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What does Fluorouracil treat?
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Solid tumors
Breast cancer Colorectal cancer GI tumors Actinic keratoses Noninvasive skin cancers |
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What are the toxicities of fluorouracil?
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Myelosuppression
Bloody diarrhea Mucositis Dermatologic Ocular Mild nausea & vomiting |
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What is the oral prodrug of fluorouracil?
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Capecitabine (Xeloda)
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What does Capecitabine (Xeloda) treat?
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Metastatic colorectal & breast cancer
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What are the side effects of Capecitabine?
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Diarrhea
Palmar-plantar rash |
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What is the MOA of Capecitabine?
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Metabolized to active component in tumor tissue
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What is the MOA of the purine analogs?
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Inhibit de novo purine synthesis
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What are the purine analogs?
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Mercaptopurine
Thioguanine Fludarabine Cladribine |
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Which purine analog dosage needs to be adjusted when used with allopurinol?
|
Mercaptopurine
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Which purine analog dosage does NOT need to be adjusted when used with allopurinol?
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Thioguanine
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Which purine analogs are immunosuppressive?
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Fludarabine
Cladribine |
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What are the two categories of mitotic inhibitors?
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Vinca alkaloids
Taxanes |
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What are the vinca alkaloids?
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Vincristine (Oncovin)
Vinblastine (Velban) Vinorelbine (Navelbine) |
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What are the taxanes?
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Paclitaxel (Taxol)
Docetaxel (Taxotere) |
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Which category of mitotic inhibitors inhibits microtubule assembly?
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Vinca alkaloids
|
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Which category of mitotic inhibitors promotes microtubule assembly and interferes with microtubule disassembly?
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Taxanes
|
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What cancers does Vincristine treat?
|
ALL
Lymphomas Multiple myeloma Neuroblastoma |
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What cancers does Vinblastine treat?
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Lymphomas
Solid tumors (testicular) |
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What cancers does Vinorelbine treat?
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Non-small cell lung cancer
Breast cancer Ovarian cancer Lymphoma |
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What vinca alkaloid can you NOT give intrathecally?
|
Vincristine
|
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What is the most serious toxicity of Vincristine?
|
Neurotoxicity
|
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What are the toxicities of Vincristine?
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Neurotoxicity
Constipation Vesicant Extravasation SIADH |
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What are the toxicities of Vinblastine & Vinorelbine?
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Myelosuppression
Vesicant Extravasation |
|
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What should be used for extravasation of vinca alkaloids?
|
Warm compresses
Hyaluronidase |
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What are the clinical uses of taxanes?
|
Ovarian cancer
Breast cancer Melanoma NSCLC |
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What are the toxicities of paclitaxel?
|
Myelosuppression
Mucositis Peripheral neuropathy Alopecia Hypersensitivity reactions Rare nausea/vomiting |
|
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What are the toxicities of docetaxel?
|
Fluid retention
Palmar-plantar rash Polysorbate-80 |
|
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What drug is a semi-synthetic analog of epothilone B?
|
Ixabepilone/Ixempra
|
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What is the MOA of Ixabepilone (Ixempra)?
|
Binds directly to B-tubulin on microtubules
|
|
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What does Ixabepilone treat?
|
Breast cancer
Combo/mono therapy |
|
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What are the premeds for Ixabepilone?
|
H1 blocker - diphenhydramine
H2 blocker - ranitidine |
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What are the toxicities of Ixabepilone?
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Neurotoxitiy
Neutropenia |
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What are the epipodophyllotoxins?
|
Etoposide
Teniposide |
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What is the MOA of the epipodophyllotoxins?
|
Inhibits topoisomerase II
|
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What does Etoposide treat?
|
ALL
Non-Hodgkins Bone marrow transplant Solid tumors |
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What does Teniposide treat?
|
ALL
Small cell lung cancer |
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What are the toxicities of the epipodophyllotoxins?
|
Myelosuppression
Mucositis Hypotension |
|
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What are the camptothecins?
|
Irinotecan (Camptosar, CPT11)
Topotecan (Hycamptin) |
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What is the MOA of the camptothecins?
|
Inhibits topoisomerase I
|
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What is the clinical use of Irinotecan?
|
Colorectal cancer
|
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What are the toxicities of Irinotecan?
|
Severe diarrhea
Acute facial flushing, abdominal cramping |
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What should you use to treat the acute toxicities of Irinotecan?
|
Scopolamine
Atropine |
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What should you use to prevent the acute toxicities of Irinotecan?
|
5HT-antagonist
Antihistamines |
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What are the clinical uses of Topotecan?
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Ovarian cancer
Lung cancer Cervical cancer |
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What are the toxicities of Topotecan?
|
Myelosuppression
Diarrhea |
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What should you use to treat the toxicity of Topotecan?
|
Treat diarrhea with Ioperamide
|
|
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What is the MOA of L-asparaginase?
|
Degrades asparagine found in the serum, making it unavailable to lymphocytes and inhibiting their growth
|
|
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What is L-asparaginase used to treat?
|
ALL
|
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what are the side effects of L-asparaginase?
|
Pancreatitis
Decreased fibrinogen Hypersensitivity reactions |
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How would you treat a low fibrinogen level caused by L-asparaginase?
|
Cryoprecipitate
|
|
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How would you check for pancreatitis in a patient on L-asparaginase?
|
Check amylase
|
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How would you treat a hypersensitivity reaction in a patient on L-asparaginase?
|
Erwina asparaginase or
Peg-asparaginase |
|
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What cancer does Hydroxyurea (Hydrea) treat?
|
CML
|
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What does Hydroxyurea (Hydrea) cause?
|
Myelosuppression
|
|
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What is the MOA of Bortezomib (Velcade)?
|
Selective, reversible inhibitor of the proteasome; degrades proteins and regulates cell-cycle progression
|
|
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What are the clinical uses of Bortezomib?
|
Multiple myeloma
Non-Hodgkins Lymphoma Some leukemias |
|
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What are the toxicities of Bortezomib?
|
Peripheral neuropathy
Fatigue Malaise Weakness GI effects Thrombocytopenia |
|
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What is the MOA of All-trans retinoic acid (Vesinoid)?
|
Matures promyelocytes, blasts
|
|
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What is the clinical use of All-trans retinoic acid?
|
APL
|
|
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What drugs are given with All-trans retinoic acid?
|
Cytarabine
Daunorubicin |
|
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What are the side effects of All-trans retinoic acid?
|
Retinoic acid syndrome
Fever Dyspnea Pleural effusion Peripheral edema Hypotension |
|
|
What should be used to treat retinoic acid syndrome?
|
Dexamethasone
|
|
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What does arsenic trioxide (Trisenox) treat?
|
APL
|
|
|
What are the toxicities of arsenic trioxide?
|
Retinoic acid syndrome
QTC prolongation |
|
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What does thalidomide treat?
|
Multiple myeloma
|
|
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What are the toxicities of thalomide?
|
Thromboembolism
Drowsiness Peripheral neuropathies |
|
|
For what drug must patients, prescribers, and dispensers enroll in STEPS?
|
Thalidomide
|
|
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What does Lenalidomide (Revlimid) treat?
|
Myelodysplastic syndrome
Multiple myeloma |
|
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What is the toxicity of Lenalidomide?
|
Myelosuppression
|
|
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What are the hypomethylating agents?
|
Azacitadine
Decitabine |
|
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What is the MOA of the hypomethylating agents?
|
Removes methyl groups leading to cancer cell death
|
|
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What is Azacitadine (Vidaza) used to treat?
|
Myelodysplastic syndrome
|
|
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What does Decitabine (Dacogen) treat?
|
Myelodysplastic syndrome
|
|
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What is the MOA of histone acetylation?
|
Inhibits HDAC which allows the cell to develop normally instead of growing unregulated
|
|
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What is the clinical use of Vorinostat (Zolinza)?
|
Cutaneous manifestations in patients with cutaneous T-cell lymphoma
|
|
|
What is the most common side effect of Vorinostat?
|
Dehydration
Patients should drink at least 2 liters/day |
|
|
What are the serious adverse reactions of Vorinostat?
|
Pulmonary embolism
Squamous cell carcinoma Anemia |
|
|
What are the laboratory abnormalities associated with Vorinostat?
|
Increased serum creatinine
Hyperglycemia Proteinuria |
|
|
What are the possible hematologic abnormalities associated with Vorinostat?
|
Anemia
Thrombocytopenia |
|
|
What are the mild side effects of Vorinostat?
|
GI symptoms
Flu-like symptoms Taste disorders May prolong QTc interval |
|
|
What is the MOA of Temsirolimus (Torisel)?
|
mTOR inhibitor - blocks translation of mRNA and halts progression from G1 to S phase
|
|
|
What is the clinical use of Temsirolimus?
|
Advanced renal cell carcinoma
|
|
|
Why does Temsirolimus have many drug interactions?
|
It is metabolized by CYP450
|
|
|
What are the toxicities of Temsirolimus?
|
Hypersensitivity reactions
Hyperglycemia/Hyperlipidemia Immunosuppression Bowel perforation Renal failure Interstitial lung disease |
|
|
What is the MOA of monoclonal antibodies?
|
Destroys tumor cells through activation of complement and antibody-dependent cell-mediated cytotoxicity
|
|
|
What are monoclonal antibodies useful for?
|
Used as a means of targeting cytotoxic radioisotopes, toxins, or drugs to tumors, enhancing their delivery to tumors while minimizing systemic exposure
|
|
|
What are monoclonal antibodies derived from?
|
Animal (murine/equine)
Human Chimeric |
|
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What does -momab mean?
|
Radiolabeled
|
|
|
What does -zumab mean?
|
Human
|
|
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What does zimab mean?
|
Chimeric with murine & human
|
|
|
What are the infusion-related toxicities of monoclonal antibodies?
|
SOB
Increase in temperature Chills Nausea Asthenia Headaches Hypotension |
|
|
What are the premeds for monoclonal antibodies?
|
Acetaminophen
Diphenhydramine Hydrocortisone |
|
|
What are the first generation MABs?
|
Rituximab (Rituxan)
Gemtuzumab ozogamicin (Mylotarg) Alemtuzumab (Campath) |
|
|
What is Rituximab used for?
|
B-cell Non-Hodgkins Lymphoma
CLL Rheumatoid arthritis Neurology indications |
|
|
What type of antigen does Rituximab target, and where is it found?
|
Anti-CD-20 antigen found on B lymphocytes
|
|
|
What does Gemtuzumab ozogamicin treat?
|
AML
|
|
|
What type of antigen does Gemtuzumab target?
|
Anti-CD-33 antigen linked to ozogamicin
|
|
|
What is Alemtuzumab used to treat?
|
B-cell CLL
|
|
|
What is the toxicity of Gemtuzumab?
|
Profound bone marrow suppression
|
|
|
What type of antigen does Alemtuzumab target, and where is it found?
|
Anti-CD-52 antigen found on B and T lymphocytes
|
|
|
What is the toxicity of Alemtuzumab?
|
Profound immunosuppression
|
|
|
What are the radiolabelled MABs?
|
Ibritumomab (Zevalin)
Tositumomab (Bexxar) |
|
|
What does ibritumomab treat?
|
follicular Non-Hodgkin's lymphoma
|
|
|
What drug is ibritumomab given with?
|
Rituximab
|
|
|
What is the MOA of ibritumomab?
|
Antibody linked to radioactive isotope yttrium-90, directed against CD-20
|
|
|
What does tositumomab treat?
|
follicular Non-Hodgkin's lymphoma
|
|
|
What is the MOA of tositumomab?
|
Antibody linked to radioactive isotope iodine-131, directed against CD-20
|
|
|
What does trastuzumab (Herceptin) treat?
|
Metastatic breast cancer whose tumors overexpress the HER-2/neu protein
|
|
|
What serious side effect does trastuzumab have?
|
Congestive heart failure
|
|
|
What does bevacizumab (Avastin) treat?
|
Metastatic colorectal cancer
|
|
|
What is the MOA of bevacizumab?
|
Inhibits blood vessel formation (Vascular endothelial growth factor)
Do not give within a month of surgery |
|
|
What is the side effect of bevacizumab?
|
Hypertension
|
|
|
What is the MOA of cetuximab (Erbitux)?
|
EGFR target
|
|
|
What is the MOA of panitumumab (Vectibix)?
|
EGFR target
|
|
|
What does cetuximab treat?
|
Colon cancer
|
|
|
What is the toxicity of cetuximab?
|
Acneform rash
|
|
|
What EGFR target drug requires premeds?
|
Panitumumab (Vectibix)
|
|
|
What does Panitumumab (Vectibix) treat?
|
Colon cancer
|
|
|
What are the toxicities of panitumumab?
|
Pulmonary fibrosis
Dermatologic toxicity Infusion reactions Hypomagnesemia Nausea/vomiting Constipation |
|
|
What does EGFR stand for?
|
Epidermal growth factor receptor
|
|
|
What is the role of tyrosine kinase?
|
Regulates cellular proliferation, differentiation, function, & survival
|
|
|
What is the MOA of the small molecule TK inhibitors?
|
Blocks ATP binding to kinase domain
Stops intracellular signaling pathways Cellular apoptosis |
|
|
What is the MOA of the monoclonal antibody TK inhibitors?
|
Target receptor TKs or the ligand
Interrupt TK signaling Antibody-mediated cytotoxicity |
|
|
What are the small molecule TK inhibitors?
|
Imatinib (Gleevec)
Gefitinib (Iressa) Erlotinib (Tarceva) Sunitinib (Sutent) Sorafenib (Nexavar) |
|
|
What are the monoclonal antibody TK inhibitors?
|
Cetuximab (Erbitux)
Trastuzumab (Herceptin) Bevacizumab (Avastin) |
|
|
What TK inhibitors treat lung cancer?
|
Erlotinib (Tarceva) (Salvage treatment)
Gefitinib (Iressa) (for patients who are benefitting) |
|
|
What are the side effects of erlotinib?
|
Acneiform rash
Diarrhea Interstitial lung disease |
|
|
What are the side effects of geftinib?
|
Skin rash
Ocular symptoms Pulmonary symptoms |
|
|
What are the toxicities of the lung cancer TK inhibitors?
|
Skin rash (72%)
Diarrhea (35%) Nausea/vomiting Myelosuppression Pulmonary symptoms (SOB, cough, fever) |
|
|
What TK inhibitors treat CML?
|
Imatinib (Gleevec)
Dasatinib (Sprycel) Nilotinib (Tasigna) |
|
|
What is the MOA of the TK inhibitors that treat CML?
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Inhibits Bcr-Abl TK (caused by Philadelphia chromosome)
Inhibits TK for platelet derived growth factor, stem cell factor, and c-kit |
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What are the most common toxicities of the CML TK inhibitors?
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Musculoskeletal pain
Fluid retention QT prolongation |
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What does Imatinib (Gleevec) treat?
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CML + Philadelphia chromosome
Kit-positive GI stromal tumors (GIST) |
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What mutation is Imatinib ineffective against?
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T315I
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What does Dasatinib (Sprycel) treat?
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CML with resistance or intolerance to prior therapy
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What medication should be taken before or after administration of Dasatinib?
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Antacid 2 hours prior or after dose
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What are the major drug interactions of Dasatinib?
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Decrease dose with CYP3A4 inhibitor
Consider increase in dose if given with CYP3A4 inducer |
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What does Nilotinib treat?
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CML with resistance or intolerance to prior therapy
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What should patients NOT do around the time of administration of Nilotinib?
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No food 2 hours prior or 1 hour after dose
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What TK inhibitor treats renal cell cancer?
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Sorafenib (Nexavar)
Sunitinib (Sutent) |
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What does Sorafenib treat?
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Advanced renal cell carcinoma in adults
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What does Sunitinib treat?
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GIST after disease progression or intolerance to imatinib
Advanced renal cell carcinoma in adults |
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What is the major toxicity of Sunitinib?
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Skin toxicities
Periungual erythema Bullous lesions on fingers Plantar areas with erythema w/hyperacanthosis, intraepidermal cleavage |
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What agents are included in R-CHOP?
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Rituximab
Cyclophosphamide Doxorubicin Vincristine Prednisone (5 days) |
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What are the side effects of prednisone?
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Increased glucose
Insomnia Fluid retention |
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What should be monitored with rituximab?
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CBC
CMP Heme in urine Vital signs IV site for signs of extravasation |
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What side effects should be expected with consolidation treatment of AML?
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Conjunctivitis
Rashes Cerebellar toxicity Myelosuppression |
