Sbl2: Antineoplastic Agents, Mcrae

Front 1

MoA of the alkylating agents

Back 1

alkylate DNA resulting in strand breakage

Front 2

major limiting toxicity of alkylating agents

Back 2

myelosuppression (10 days to 4 weeks after therapy, recovery at 2-6 weeks after therapy)

Front 3

the most famous nitrogen mustard

Back 3

cyclophosphamide

Front 4

6 classes of alkylating agents

Back 4

nitrogen mustards
ethyleneimines
alkylsulfonate
nitrosureas
platinum analogs
triazene

Front 5

major adverse effect of cyclophosphamide

what is the toxic metabolite that causes it?

What can we use to treat this?

Back 5

sterile hemorrhagic cystitis (ifosfamide can cause this as well)

Acrolein

Mesna (Thiol group binds to acrolein)

Front 6

MoA of the nitrosureas (alkylating agents)

Back 6

cross-link DNA through alkylation

**note: these drugs cross the blood brain barrier

Front 7

major adverse effect of Cisplatin

What can be used for prevention

Back 7

nephrotoxicity (proximal tubule is most damaged, Mg and K+ wasting and acute renal failure) and

ototoxicity

Nephrotoxicity - hydration w/ normal saline

Ototoxicity - artificial tears

Front 8

platinum compound that causes peripheral neuropathy (cold exposure dysesthesia) and is used to treat colon cancer

Back 8

oxaliplatin

Front 9

three classes of antimetabolites

Back 9

folic acid analogs
purine analogs
pyrimidine analogs

Front 10

MoA of antimetabolites (general)

what phase of cell cycle is targeted?

Back 10

ultimately inhibit DNA replication or repair

S phase activity

Front 11

**folate antagonist that blocks dihydrofolate reductase

Back 11

**methotrexate

Front 12

antimetabolite that acts as a false base for DNA incorporation

pyrimidine antagonist

what is it's oral prodrug?

adverse effects include cardiotoxicity due to coronary vasospasms

Back 12

5-Fluorouracil

Capecitabine

Front 13

major side effect of Capecitabine (pyrimidine inhibitor)

Back 13

hand-foot syndrome

Front 14

MoA of the vinca alkaloids

what phase of the cell cycle is affected?

major side effect?

Back 14

inhibit/reverse tubulin polymerization, disrupting mitotic spindles

Metaphase of mitosis (M phase)

neurotoxicity

Front 15

vinca alkaloid w/ the most bone marrow suppression

What are the names of the other Vinca Alkaloids?

Back 15

Vinblastine

others: vinblastine and vinorelbine

Front 16

two topoisomerase II inhibitors

Back 16

etoposide
tenoposide

Front 17

MoA of the campothecins (Topotecan and irinotecan (CPT-11))

Back 17

inhibit topoisomerase I, the enzyme responsible for relaxing DNA

Front 18

MoA of the taxanes

What phase of the cell cycle is affected

Back 18

block progressthrough mitosis by stabilization of microtubules

affects M phase

Front 19

two taxanes

what is there dose limiting toxicity?

what should patients be pre-medicated w/?

Back 19

paclitaxel
docetaxel

delayed bone marrow suppression (specifically doxetaxel)

dexamethasone, diphenhydramine and ranitidine (to counter acute hypersensitivity reaction),

docetaxel only needs dexamethasone and fluid and water restriction

Front 20

MoA of asparaginase

main adverse effect?

Back 20

Bacterial enzyme that results in inhibition of protien synthesis (depletes asparagine normal cells can make this)

hypersensitivity (can be fatal)

Front 21

MoA of the anthracyclines

major adverse effect

what are the two major drugs that cause this?

Back 21

inhibit topoisomerase II

cardiotoxicity (arrhythmias, etc.)

doxorubicin and daunorubicin

Front 22

Prophylaxis for sterile hemorrhagic cystitis caused by cyclophosphamide?

Back 22

Hydration

Mesna (drug that detoxifies acrolein)

Bladder irrigation

Front 23

What is given during methotrexate treatment to prevent megaloblastic anemia?

Back 23

Leucovorin (Reduced folate)

Front 24

With which taxane is there no need to use premed treatment for acute hypersensitivity?

Back 24

Paclitaxel protein bound but increased risk for severe neuropathy compared to unbound counterpart (Paclitaxel)

Front 25

How does the acute hypersensitivity that is brought on by taxenes manifest itself

Back 25

Fluid retention

Front 26

signficant adverse effect of the anthracyclines (Specifically Doxorubicin)

cardioprotective agent that can be used in conjunction w/ the anthracylines to prevent this adverse effect?

Back 26

cardiotoxicity (CHF;irreversible, arrhythmias;reversible)
Gets worse w/ increased life-time cumulative dose

dexrazoxane

Front 27

hormones are typically used for which cancers?

Back 27

breast
prostate
endometrial
adrenal cortex cancers

Front 28

anti-estrogen commonly used to treat breast cancer

Back 28

tamoxifen

Front 29

effective differentiating agent for acute promyelocytic leukemia

Major ADR

binds to nuclear receptors and inhibits clonal proliferation and/or granulocyte differentiation

Back 29

all trans retinoic acid (ATRA)

ATRA syndrome - pulmonary infiltrates, leukocytosis and hypoxia

Front 30

chemo drug that causes acoustic nerve damage, can be irreversibele

aternative drug to use to avoid this effect?

Back 30

cisplatin

carboplatin

Front 31

chemo drug associated w/ pulmonary fibrosis

Back 31

bleomycin (anthracycline antiboiotic)

Front 32

chemo drug associated w/ neurotoxicity

Can Affects PNS: loss of DTR, motor changes, burning in hands and feet

Can affect ANS: constipation, bowel obstruction

Back 32

vincristine (all vinca alkaloids in general, but this one the most)

Front 33

chemo drug associated w/ peripheral neuropathy

Back 33

paclitaxel

Front 34

most significant toxicity of cytarabine

what additional toxicity does this drug have

Back 34

cerebellar toxicity

ocular toxicity (chemical conjunctivitis or keratitis, prophylaxis w/ artificial tears)

Front 35

most significant side effect of high dose methotrexate

Back 35

acute cerebellar dysfunction

Front 36

drug associated w/ severe fluid retention

Back 36

docetaxel

Front 37

**drug that is used for treatment of megaloblastic anemia due to methotrexate and also pre-treatment for 5-fluorouracil to enhance its affects

Back 37

**leucovorin

Front 38

What are the Anthracycline drugs?

Back 38

end in Rubicin and
Mitoxantrone

Front 39

Which Anthracycline antibiotic is very toxic to the bone marrow

MOA of this drug

Back 39

mitomycin

alkylates DNA

Front 40

Which anti-neoplastic agent inhibits ribonucleotide reductase: resulting in depletion of dNTP pools?

What is its major ADR

Back 40

Hydroxyurea

Myelosuppression

Front 41

This drug is used to treat acute promyeloctyic leukemia (APL) and has the ADR of cardiotoxicity (prolonged QT)?

Back 41

Arsenic trioxide

Front 42

Aloplecia is commonly caused by?

Back 42

Etoposide and Doxorubicin

Front 43

Two chemotherapy agents that have a high risk of emesis (greater than 90%)

Back 43

cisplatin and Cyclophosphamide

Front 44

After taking a chemotherapy agent the patient has ataxia, nystagmus and coordination abnormalities, what is this patient experiencing and what is most likley causing this?

Back 44

Cerebellar Toxicity

Cytarabine

Front 45

Patient on chemotherapy has confusion, drowsiness and hallucinations...increased levels of chloracetaldehyde in the blood, dx and cause

Back 45

Patient is experiencing a CNS reaction to Ifosfamide

Chloracetaldehyde is a neurotoxic metabolite

Front 46

What chemotherapy agent can cause cardiomyopathy and is associated w/ HER proteins?

Back 46

Trastuzumab

Front 47

What cardiac ADR can be seen in a small number of patients of 5-flurouracil

Back 47

Ischemic cardiac symptoms

Front 48

How do you prevent the Renal toxicity that can be caused by Methotrexate at very high doses?

Back 48

Urinary alkalinization w/ NaHCO3, acetazolamide- (MTX percipitates in acidic environments)

Hydration

Front 49

What are the Big hepatic toxic chemo drugs and what do they cause?

Back 49

Busulfan - hepatic veno-occlusive disease

Cytarabine (antimetabolite)- cholestasis

Methotrexate - Cirrhosis w/ chronic use

Front 50

Patient on chemotherapy presents w/ Tender, erythematous skin on palms of hands and soles of feet, dx and most likley cause?

Back 50

Hand and foot syndrome

capecitabine

Front 51

T-cell growth factor, indicated for renal cell carcinoma and malignant melanoma

significant adverse effects, including capillary leak syndrome

Back 51

IL-2

Front 52

two cytokines that are used as antineoplastic agents

Back 52

IFN alpha

IL-2

Front 53

monoclonal antibody that is used to treat breast cancer

what is the protein that is overexpressed?

Back 53

trastuzumab

HER2

Front 54

overexpression of ___ is common in many solid tumors

in the tyrosine kinase family

Back 54

EGFR

Front 55

monoclonal antibody that is a frontline agent in colocrectal cancer

Back 55

cetuximab

Front 56

growth factor involved in the blood supply to a tumor

antibodies against this factor help to reduce the tumor's blood supply

what monoclonal antibody is used?

Back 56

VEGF

Bevacizumab

Front 57

monoclonal antibody that targets CD20 on B cells in aggressive lymphomas

Back 57

rituximab

Front 58

monoclonal antibody that targets CD33 in AML

Back 58

gemtuzumab