Usmle Step 1 Fa Heme/onc-Pharmacology Neoplastic Agents

Front 1

Mechanism of Methotrexate

Back 1

S phase specific; folic acid analog inhibits DHF reductase (decr dTMP and DNA/protein synth)

Front 2

Clinical use of methotrexate

Back 2

Leukemias, lymphomas, choriocarcinoma, sarcomas
Abortion, ectopics pregnancy, RA, psoriasis

Front 3

Toxicity of methotrexate

Back 3

Myelosuppression, reversible w/leucovirin
Macrovesicular fatty change in liver
Mucositis

Front 4

Mechanism of 5-fluorouracil

Back 4

S phase specific antimetabolite
Pyrimidine analo bioactivated by 5-F-dUMP which covalently complexes folic acid
This complex inhibits thymidylate synthase

Front 5

Clinical use of 5FU

Back 5

Colon cancer/other solid tumors
Basal cell carcinoma (topical)
Synergy with MTX

Front 6

6-mercaptopurine (6-MP) mechanism

Back 6

Blocks de novo purine synthesis; activated by HGPRTase

Front 7

Clinical use of 6 mercaptopurine

Back 7

Leukemias/lymphomas (not CLL or Hodgkins)

Front 8

Toxicity of 6 mercaptopurine

Back 8

Bone marrow, GI, liver
Metabolized by xanthine oxidase so incr toxicity with allopurinol

Front 9

Mechanism of cytarabine

Back 9

Inhibits DNA polymerase

Front 10

Clinical use of cytarabine

Back 10

AML, ALL, high grade NHL

Front 11

Toxicity of cytarabine

Back 11

Leukopenia, thrombocytopenia, megaloblastic anemia

Front 12

Mechanism of cyclophosphamide, ifosfamide

Back 12

Alkylating agents; covalently x link (interstrand) DNA at guanine N-7. Requires bioactivation by liver.

Front 13

Clinical use of cyclophosphamide

Back 13

NHL
Breast and ovarian carcinomas
Immunosupression

Front 14

Mechanism of nitrosoureas (carmustine, lomustine, semustine, streptozocin

Back 14

Alkylate DNA
Require bioactivation
Cross BBB

Front 15

Clinical use of nitrosoureas

Back 15

Brain tumors (incl GBM)

Front 16

Toxicity of nitrosoureas

Back 16

CNS toxicity (dizziness, ataxia)

Front 17

Cisplatin, carboplatin mechanism

Back 17

Cross link DNA

Front 18

Clinical use of cisplatin, carboplatin

Back 18

Testicular, bladder, ovary, and lung carcinoma

Front 19

Toxicity of cisplatin

Back 19

Nephrotoxicity, acoustic nerve damage

Front 20

Busulfan mechanism

Back 20

Alkylates DNA

Front 21

Clinical use of busulfan

Back 21

CML
Also ablate bone marrow in BMSCT patients

Front 22

Toxicity of busulfan

Back 22

Pulmonary fibrosis, hyperpigmentation

Front 23

Doxorubicin, daunorubicin mechanism of action

Back 23

Generate free radicals and noncovalently intercalate in DNA 9create breaks to decr replication)

Front 24

Clinical use of doxorubicin

Back 24

Part of ABVD combo for Hodgkin's
Myelomas
Sarcomas
Solid tumors

Front 25

Toxicity of doxorubicin

Back 25

Cardiotoxicity
Myelosuppression
Marked alopecia

Front 26

Dactinomycin mechanism

Back 26

Intercalates in DNA

Front 27

Clinical use of dactinomycin

Back 27

Wilm's tumor
Ewing's sarcoma
Rhabdomyosarcoma

Front 28

Toxicity of dactinomycin

Back 28

Myelosuppression

Front 29

Mechanism of bleomycin

Back 29

Induces formation of free radicals which cause breaks in DNA

Front 30

Clinical use of bleomcin

Back 30

Testicular cancer
Hodgkin's lymphoma

Front 31

Toxicity of bleomycin

Back 31

Pulmonary fibrosis
Skin changes
MINIMAL myelosuppression

Front 32

Etoposide mechanism of action

Back 32

G2 phase specific agent aht inhibits topoisomerase II and incr DNA degradation

Front 33

Clinical use of etoposide

Back 33

Small cell carcinoma of lung/prostate/testicular carcinoma

Front 34

Toxicity of etoposide

Back 34

Myelosuppression, GI irritation, alopecia

Front 35

Prednisone mechanism of action

Back 35

May trigger apoptosis

Front 36

Clinical use of prednisone

Back 36

Most commonly usedglucocorticoid used in cancer chemo
Used in CLL, hodgkin's (MOPP regimen)
Also used in autoimmune diseases

Front 37

Mechanism of tamosifen, raloxifene

Back 37

SERMs-receptor antagonists in breast, agonists in bone, block binding of estrogen to estrogen receptor positive cells

Front 38

Clinical use of tamosifen, raloxifene

Back 38

Breast cancer, also useful to prevent osteoperosis

Front 39

Toxicity of tamoxifen, raloxifene

Back 39

Tamoxifen may incr risk of endometrial carcinoma via partial agonist effects "hot flashes"

Front 40

Trastuzumab mechanism

Back 40

Monoclonal antibody against HER-2 helps kill breast cancer that overexpressed possibly due to antibody dependent cytotoxicyt

Front 41

Clinical use of trastuzumab

Back 41

Metastatic breast cancer

Front 42

Mechanism of imatinib

Back 42

Philadephila chromosome tyrosine kinase inhibitor

Front 43

Clinical use of imatinib

Back 43

CML
GI stromal tumors

Front 44

Toxicity of imatinib

Back 44

Fluid retention

Front 45

Mechanism of vincristine, vinblastin

Back 45

M phase specific alkaloids that bind to tubulin and block polymerization of microtubules so that mitotic spindle cannot form

Front 46

Clinical use of vincristine

Back 46

MOPP regimen for Hodgkin's
Wilm's tumor
Choriocarcinoma

Front 47

Toxicity of vincristine/vinblastine

Back 47

Vincristine-neurotoxicity, paralytic ileus
Cinblastine does bone marrow suppression

Front 48

Mechanism of palitaxel/other taxols

Back 48

M phase specific
Bind to tubulin and hyperstabilizie polyerized tubules so that the mitotic spindle cannot break down (anaphase cannot occur)

Front 49

Clinical use of paclitaxel

Back 49

Ovarian and breast carcinoma

Front 50

Toxicity of paclitaxel

Back 50

Myelosuppression and hypersensitivity