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58 Cards in this Set
- Front
- Back
MoA of the alkylating agents
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alkylate DNA resulting in strand breakage
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major limiting toxicity of alkylating agents
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myelosuppression (10 days to 4 weeks after therapy, recovery at 2-6 weeks after therapy)
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the most famous nitrogen mustard
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cyclophosphamide
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6 classes of alkylating agents
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nitrogen mustards
ethyleneimines alkylsulfonate nitrosureas platinum analogs triazene |
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major adverse effect of cyclophosphamide
what is the toxic metabolite that causes it? What can we use to treat this? |
sterile hemorrhagic cystitis (ifosfamide can cause this as well)
Acrolein Mesna (Thiol group binds to acrolein) |
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MoA of the nitrosureas (alkylating agents)
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cross-link DNA through alkylation
**note: these drugs cross the blood brain barrier |
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major adverse effect of Cisplatin
What can be used for prevention |
nephrotoxicity (proximal tubule is most damaged, Mg and K+ wasting and acute renal failure) and
ototoxicity Nephrotoxicity - hydration w/ normal saline Ototoxicity - artificial tears |
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platinum compound that causes peripheral neuropathy (cold exposure dysesthesia) and is used to treat colon cancer
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oxaliplatin
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three classes of antimetabolites
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folic acid analogs
purine analogs pyrimidine analogs |
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MoA of antimetabolites (general)
what phase of cell cycle is targeted? |
ultimately inhibit DNA replication or repair
S phase activity |
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**folate antagonist that blocks dihydrofolate reductase
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**methotrexate
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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 |
5-Fluorouracil
Capecitabine |
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major side effect of Capecitabine (pyrimidine inhibitor)
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hand-foot syndrome
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MoA of the vinca alkaloids
what phase of the cell cycle is affected? major side effect? |
inhibit/reverse tubulin polymerization, disrupting mitotic spindles
Metaphase of mitosis (M phase) neurotoxicity |
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vinca alkaloid w/ the most bone marrow suppression
What are the names of the other Vinca Alkaloids? |
Vinblastine
others: vinblastine and vinorelbine |
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two topoisomerase II inhibitors
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etoposide
tenoposide |
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MoA of the campothecins (Topotecan and irinotecan (CPT-11))
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inhibit topoisomerase I, the enzyme responsible for relaxing DNA
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MoA of the taxanes
What phase of the cell cycle is affected |
block progressthrough mitosis by stabilization of microtubules
affects M phase |
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two taxanes
what is there dose limiting toxicity? what should patients be pre-medicated w/? |
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 |
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MoA of asparaginase
main adverse effect? |
Bacterial enzyme that results in inhibition of protien synthesis (depletes asparagine normal cells can make this)
hypersensitivity (can be fatal) |
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MoA of the anthracyclines
major adverse effect what are the two major drugs that cause this? |
inhibit topoisomerase II
cardiotoxicity (arrhythmias, etc.) doxorubicin and daunorubicin |
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Prophylaxis for sterile hemorrhagic cystitis caused by cyclophosphamide?
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Hydration
Mesna (drug that detoxifies acrolein) Bladder irrigation |
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What is given during methotrexate treatment to prevent megaloblastic anemia?
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Leucovorin (Reduced folate)
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With which taxane is there no need to use premed treatment for acute hypersensitivity?
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Paclitaxel protein bound but increased risk for severe neuropathy compared to unbound counterpart (Paclitaxel)
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How does the acute hypersensitivity that is brought on by taxenes manifest itself
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Fluid retention
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signficant adverse effect of the anthracyclines (Specifically Doxorubicin)
cardioprotective agent that can be used in conjunction w/ the anthracylines to prevent this adverse effect? |
cardiotoxicity (CHF;irreversible, arrhythmias;reversible)
Gets worse w/ increased life-time cumulative dose dexrazoxane |
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hormones are typically used for which cancers?
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breast
prostate endometrial adrenal cortex cancers |
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anti-estrogen commonly used to treat breast cancer
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tamoxifen
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effective differentiating agent for acute promyelocytic leukemia
Major ADR binds to nuclear receptors and inhibits clonal proliferation and/or granulocyte differentiation |
all trans retinoic acid (ATRA)
ATRA syndrome - pulmonary infiltrates, leukocytosis and hypoxia |
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chemo drug that causes acoustic nerve damage, can be irreversibele
aternative drug to use to avoid this effect? |
cisplatin
carboplatin |
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chemo drug associated w/ pulmonary fibrosis
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bleomycin (anthracycline antiboiotic)
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chemo drug associated w/ neurotoxicity
Can Affects PNS: loss of DTR, motor changes, burning in hands and feet Can affect ANS: constipation, bowel obstruction |
vincristine (all vinca alkaloids in general, but this one the most)
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chemo drug associated w/ peripheral neuropathy
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paclitaxel
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most significant toxicity of cytarabine
what additional toxicity does this drug have |
cerebellar toxicity
ocular toxicity (chemical conjunctivitis or keratitis, prophylaxis w/ artificial tears) |
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most significant side effect of high dose methotrexate
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acute cerebellar dysfunction
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drug associated w/ severe fluid retention
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docetaxel
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**drug that is used for treatment of megaloblastic anemia due to methotrexate and also pre-treatment for 5-fluorouracil to enhance its affects
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**leucovorin
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What are the Anthracycline drugs?
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end in Rubicin and
Mitoxantrone |
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Which Anthracycline antibiotic is very toxic to the bone marrow
MOA of this drug |
mitomycin
alkylates DNA |
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Which anti-neoplastic agent inhibits ribonucleotide reductase: resulting in depletion of dNTP pools?
What is its major ADR |
Hydroxyurea
Myelosuppression |
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This drug is used to treat acute promyeloctyic leukemia (APL) and has the ADR of cardiotoxicity (prolonged QT)?
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Arsenic trioxide
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Aloplecia is commonly caused by?
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Etoposide and Doxorubicin
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Two chemotherapy agents that have a high risk of emesis (greater than 90%)
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cisplatin and Cyclophosphamide
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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?
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Cerebellar Toxicity
Cytarabine |
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Patient on chemotherapy has confusion, drowsiness and hallucinations...increased levels of chloracetaldehyde in the blood, dx and cause
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Patient is experiencing a CNS reaction to Ifosfamide
Chloracetaldehyde is a neurotoxic metabolite |
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What chemotherapy agent can cause cardiomyopathy and is associated w/ HER proteins?
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Trastuzumab
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What cardiac ADR can be seen in a small number of patients of 5-flurouracil
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Ischemic cardiac symptoms
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How do you prevent the Renal toxicity that can be caused by Methotrexate at very high doses?
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Urinary alkalinization w/ NaHCO3, acetazolamide- (MTX percipitates in acidic environments)
Hydration |
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What are the Big hepatic toxic chemo drugs and what do they cause?
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Busulfan - hepatic veno-occlusive disease
Cytarabine (antimetabolite)- cholestasis Methotrexate - Cirrhosis w/ chronic use |
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Patient on chemotherapy presents w/ Tender, erythematous skin on palms of hands and soles of feet, dx and most likley cause?
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Hand and foot syndrome
capecitabine |
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T-cell growth factor, indicated for renal cell carcinoma and malignant melanoma
significant adverse effects, including capillary leak syndrome |
IL-2
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two cytokines that are used as antineoplastic agents
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IFN alpha
IL-2 |
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monoclonal antibody that is used to treat breast cancer
what is the protein that is overexpressed? |
trastuzumab
HER2 |
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overexpression of ___ is common in many solid tumors
in the tyrosine kinase family |
EGFR
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monoclonal antibody that is a frontline agent in colocrectal cancer
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cetuximab
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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? |
VEGF
Bevacizumab |
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monoclonal antibody that targets CD20 on B cells in aggressive lymphomas
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rituximab
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monoclonal antibody that targets CD33 in AML
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gemtuzumab
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