Term
| What is the moa of mechlorethamine (N2 mustard)? |
|
Definition
| Alkylating Agents: Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks. |
|
|
Term
| What is the moa of cyclophosphamide (cytoxan)? |
|
Definition
| Alkylating Agents: Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks. |
|
|
Term
| What is the moa of ifosfamide (ifex)? |
|
Definition
| Alkylating Agents: Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks. |
|
|
Term
| What is the moa of cisplatin (platinol)? |
|
Definition
| Alkylating Agents: Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks. |
|
|
Term
| What is the moa of carboplatin (paraplatin)? |
|
Definition
| Alkylating Agents: Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks. |
|
|
Term
| What is a cytoprotectant that binds to acrolein and deactivates it? |
|
Definition
|
|
Term
| What is a metabolite that is excreted in the urine and can cause hemorrhage cystitis? |
|
Definition
|
|
Term
| What is needed when a pt is exposed to acrolein? |
|
Definition
| adequate po and iv hydration |
|
|
Term
| what are 2 alkylating prodrugs which are converted by hepatic metabolism to several active and inactive metabolites. |
|
Definition
| cyclophosphamide and ifosfamide |
|
|
Term
| What drug can be nephrotoxic- Patients should maintain oral hydration. IV hydration/Mannitol should be considered at higher doses. This drug is also highly emetogenic; causes both acute and delayed nausea/vomiting? |
|
Definition
|
|
Term
| What class do the following drugs belong to: cisplatin, carboplatin and oxaliplatin? |
|
Definition
|
|
Term
| What are derivatives of cisplatin engineered to improve efficacy and decrease toxicities? |
|
Definition
| carboplatin and oxaliplatin |
|
|
Term
| What class of drugs is structurally related to normal cellular components and interferes with the availability of normal purine or pyrimidine precursors by: (1) inhibiting their synthesis, or (2) competing with them in the process of DNA or RNA synthesis? |
|
Definition
|
|
Term
| What agents are cell cycle specific and generally exert their effect in the S-phase of the cell cycle? |
|
Definition
|
|
Term
| What aspect of dosing is important when dealing with antimetabolites? |
|
Definition
|
|
Term
| The following belong to what class of drugs: fluorouracil (5fu), cytarabine (ara-c), methotrexate, gemcitabine? |
|
Definition
|
|
Term
| The following 3 major moa's are found in what class of drugs: intercalate within the DNA molecule, interfere with transport process across cell membrane, and generate free oxygen free radicals? |
|
Definition
|
|
Term
| Doxorubicin and daunorubicin are examples of which drug class? |
|
Definition
|
|
Term
| Cardiotoxicity is a side affect of which drug class? |
|
Definition
|
|
Term
| Irreversible & dose-dependent congestive cardiomyopathy which is a result of generation of free radicals which cause cardiac cell damage is a side effect of what drug class? |
|
Definition
|
|
Term
| In which drug class must you monitor LVEF (left ventricular ejection fraction) routinely – MUGA (A MUGA scan (Multi Gated Acquisition Scan) is a nuclear medicine test to evaluate the function of the heart ventricles) or 2D ECHO? |
|
Definition
|
|
Term
| What increases cardiotoxicity with anthracyclines? |
|
Definition
|
|
Term
| What type of additive dose limit is associated w/anthracyclines? |
|
Definition
| cumulative dose lifetime limit |
|
|
Term
| When prescribing anthracyclines, what is a cytoprotectant which prevents free radical formation? |
|
Definition
| dexrazoxane (zinecard) is a cytoprotectant which prevents free redical formation. liposomal doxorubicin (doxil) may also be considered. |
|
|
Term
| What is defined as an inadvertent extravasation can cause severe local tissue necrosis and ulceration which often requires surgical attention? With what drug class is this associated? |
|
Definition
| anthracyclines. vesicant hazard. |
|
|
Term
| The following toxicities are associated with what drug class: Alopecia, Myelosuppression, Mucositis (this could be a dose-limiting toxicity), Nausea? |
|
Definition
|
|
Term
| What is the moa of vinca alkaloids? |
|
Definition
| mitotic inhibitors: promote de-polymerization and destabilization of tubulin. |
|
|
Term
| What is the moa of taxanes? |
|
Definition
| mitotic inhibitors- promote polymerization and overstabilization of tubulin. |
|
|
Term
| To what drug class do the following belong: vincristine, vinblastine, and vinorelibine? |
|
Definition
|
|
Term
| To what drug class do paclitaxel and docetaxel belong? |
|
Definition
|
|
Term
| What drug class is extensively metabolized & require dose modification in hepatic dysfunction? |
|
Definition
|
|
Term
| What agent have different uses and toxicities despite structural similarities and MOAs? |
|
Definition
|
|
Term
| What drug is used in a variety of hematologic and solid tumors? The main DLT (dose limiting toxicity) is neurotoxicity. Fatal if given intrathecally. |
|
Definition
|
|
Term
| What drug is used in fewer cancers: lymphoma, breast, bladder, ovarian and testicular? Main DLT is myelosuppression. |
|
Definition
|
|
Term
| What drug is used in NSCLC and breast cancer. Causes myelosuppression and peripheral neuropathy? |
|
Definition
|
|
Term
| Which vinca alkaloids are vesicant hazards? |
|
Definition
|
|
Term
| What drug is a semisyn derivative of vinblastine? |
|
Definition
|
|
Term
| What drug class are enzymes which allow the coiling and uncoiling of the DNA strands which is needed during the replication and transcription of DNA? |
|
Definition
| dna topoisomerases (topo I and topo II) |
|
|
Term
| The following are examples of what drug class: etoposide (vp-16)- sclc, topotecan (hycamptin)- sclc, ovarian, and irinotecan (camptosar)- colon? |
|
Definition
|
|
Term
| Which topoisomerase inhibitors are used for sclc? |
|
Definition
| etoposide (vp-16) and topotecan (hycamptin) |
|
|
Term
| Which topoisomerase inhibitor is used for ovarian? |
|
Definition
|
|
Term
| Which topoisomerase inhibitor is used for colon? |
|
Definition
|
|
Term
Which topoisomerase inhibitor is generally well tolerated
and is considered synergistic with platinum analogues? |
|
Definition
|
|
Term
| Which topoisomerase inhibitor was first approved for colorectal cancer? |
|
Definition
|
|
Term
| Which topoisomerase inhibitor involves a dlt of (not myelosuppresion) diarrhea? |
|
Definition
|
|
Term
| Which topoisomerase inhibitor produces severe diarrhea in some patients? |
|
Definition
|
|
Term
| What might you give with irinotecan to reduce severe diarrhea? |
|
Definition
| atropine, loperamide (imodium) |
|
|
Term
| Which cancers are hormone dependent and respond well to hormonal manipulation? |
|
Definition
|
|
Term
| What is the moa of hormonal therapy? |
|
Definition
| interact with hormonal receptors at cell membrane or within nucleus |
|
|
Term
What hormone-sensitive disease can be treated with:
Oophorectomy or ovarian ablation w/ Zoladex
Antiestogens – classical antagonist (Tamoxifen)
Aromatase inhibitors – prevents peripheral
estrogen synthesis postmenopausal
women only (Femara, Arimidex, Aromasin)? |
|
Definition
|
|
Term
| In what 3 settings can hormonal therapy be used? |
|
Definition
| Prevention, Adjuvant, Metastatic setting |
|
|
Term
| What are engineered to bind to specific receptors (antigens) located on the surface of the malignant cells which are responsible for signaling cell growth and regulation? |
|
Definition
|
|
Term
| How does monoclonal Ab binding produce antitumor effects? |
|
Definition
| in various ways: prevents receptor stimulation leading to cell growth. the binding causes the apoptosis. attracts “natural killer” cells. can fuse Moab to cytotoxic complex (“Magic bullet”). |
|
|
Term
| Targeted therapy involves what 2 types of inhibition and what 3rd mechanism? |
|
Definition
Epidermal Growth Factor inhibition – Herceptin (breast), Erbitux (colon)
Tyrosine Kinase inhibition – Tarceva (lung), Gleevec (CML, GIST) Antiangiogenesis – Avastin (colon, lung, breast cancers in metastatic setting as of now) |
|
|
Term
|
Definition
| Absolute Neutrophil Count (ANC) = [% segs + % bands] X WBC count |
|
|
Term
| What occurs when a patient has a fever and a significant reduction in their white blood cells? |
|
Definition
|
|
Term
| How should febrile neutropenia/infection pts be assessed? |
|
Definition
| Patients should be promptly assessed and appropriate empiric antibiotic therapy initiated |
|
|
Term
| In febrile neutropenia/infection, what factors are used to shortened the duration and lessened the degree of the WBC nadir? What are 2 specific examples? |
|
Definition
| WBC colony stimulating factors are used to shortened the duration and lessened the degree of the WBC nadir. filgrastim (Neupogen) pegfilgrastim (Neulasta) |
|
|
Term
| What is the most distressing symptom commonly reported by cancer patients? |
|
Definition
|
|
Term
| What are the side effects of protracted vomiting? |
|
Definition
| Protracted vomiting may lead to dehydration and electrolyte depletion |
|
|
Term
| How do antiemetic therapies work? |
|
Definition
| Used to block one or more of these signals and prevent or decrease nausea and vomiting. |
|
|
Term
| What appears to be the most sensitive signal during the first 24 hours after chemotherapy? |
|
Definition
|
|
Term
| What agents are widely used as first line agents in the prevention of chemotherapy induced nausea/vomiting? What are 4 specific examples? |
|
Definition
| 5-HT3 receptor antagonists are widely used as first line agents in the prevention of chemotherapy induced nausea/vomiting. Common 5-HT3 include: granisetron (Kytril), ondansetron (Zofran), dolasetron (Anzemet), palonsetron (Aloxi) |
|
|
Term
| What ranking is cancer for death in the us? |
|
Definition
|
|
Term
| What is the no one cause of cancer death? |
|
Definition
|
|
Term
| What is the definition of cancer? |
|
Definition
| a disease of cell proliferation which is characterized by a *loss of nml control mechanisms* which regulate orderly cell growth/differentiation and function |
|
|
Term
| What is the main problem with cancer? |
|
Definition
| Malignant cancer cells break away from the original tumor and travel in the circulatory or lymphatic systems until they are lodged in a small capillary network in another area of the body and begin to grow in the new location. (before it metastasizes it is curable. after metasasis it is treatable but not curable.) |
|
|
Term
| What are thre ca tx modalities? |
|
Definition
|
|
Term
| What are some pt specific faactors in chemo? |
|
Definition
| Performance status, Comorbidities / End organ dysfunction, Personal choice |
|
|
Term
| What is the goal of chemo? |
|
Definition
| To eradicate the malignant cells by exploiting the differences between the malignant and normal host cells while minimizing the toxic effect of normal host cells. |
|
|
Term
| What are disease stage considerations in chemo? |
|
Definition
| Early, Locally Advanced, Recurrent, Metastatic |
|
|
Term
| What are therapeutic intent considerations in chemo? |
|
Definition
Cure vs. Palliation
Chemosensitivity of tumor cells |
|
|
Term
| How are chemotherapy drugs together generally used to tx most ca? |
|
Definition
| Combination chemotherapy is generally used to treat most cancers. |
|
|
Term
| In what time frame are chemo drugs usually given? |
|
Definition
| Chemotherapy drugs are usually given in cycles. Cycles are repeated weekly or monthly for a few months or several months with a recovery period after each treatment |
|
|
Term
| What is used after the definitive, local therapy (surgery) to reduce the risk of recurrence? |
|
Definition
|
|
Term
| What is used prior to definitive local therapy (surgery) in an attempt to shrink tumor and may make an “inoperable” tumor operable? |
|
Definition
|
|
Term
| Why might chemo be given for metastatic disease? |
|
Definition
| to minimize the extent/size of tumor burden, pain control, palliation; weigh side effects of chemo vs. symptom management |
|
|
Term
| What must be considered when using chemo for recurent disease? |
|
Definition
| ? Length of disease free interval. ? Same agents |
|
|
Term
| What might be be used for refractory disease? |
|
Definition
| drugs no longer effective; use 2nd line, 3rd line, etc |
|
|
Term
| What might be be used for leukemia in which bone marrow is completely infiltrated? |
|
Definition
|
|
Term
| What might be used for colon, head/neck ca? |
|
Definition
| radiation sensitizer-colon and head/neck CA |
|
|
Term
| Chemo might also be used for prevention. this is not a question, just a pt on a slide for which i couldn't think of an adequate question. |
|
Definition
|
|
Term
| What are 2 considerations due to narrow therapeutic windows? |
|
Definition
| Importance of Dose Intensity, Dose Limiting Toxicity |
|
|
Term
What is the term for Certain anatomic areas of the body do not allow drug penetration. Most notably, the blood brain barrier, allow tumor cells, but not cytotoxic drug to the enter the CNS?
In certain circumstances, chemotherapy may be given intrathecally. |
|
Definition
| Pharmacologic sanctuaries |
|
|
Term
| What phenomenon occurs as tumor cells may develop drug efflux pumps which remove drug from the cytoplasm? |
|
Definition
|
|
Term
| How are chemo agents generally dosed? |
|
Definition
| Chemotherapy agents are generally dosed using a patients body surface area (BSA) as “mg/m2” |
|
|
Term
| What are a few exceptions to the rule "Chemotherapy agents are generally dosed using a patients body surface area (BSA) as “mg/m2”?" |
|
Definition
A few exceptions: Carboplatin (AUC), intrathecal doses (Doses are adjusted based on hepatic / renal dysfunction
Subsequent doses are adjusted based on toxicity experienced in previous cycle. (Important to know the toxicity profile of each agent.) |
|
|
Term
| Why might the Mostellar equation be used? |
|
Definition
| Chemotherapy agents are generally dosed using a patients body surface area (BSA) as “mg/m2” |
|
|
Term
| What is the MOA of the following drugs: Topoisomerase inhibitors, Alkylating Agents, Antimetabolites, Anthracyclines Mitotic Inhibitors |
|
Definition
|
|
Term
| How do classical chemo drugs usually act? |
|
Definition
| Classical chemotherapy drugs usually act by interfering with vital processes involved within the cell cycle of the cancer cell |
|
|
Term
| How do alkylating agents act? |
|
Definition
| Covalently bind to guanine bases of DNA and thereby interfere with normal function resulting in single- or double-stranded DNA breaks |
|
|
Term
| In what cells are alkylating agents active? In what cells are akylating agents most active? |
|
Definition
| Active in both cycling and resting cells; but most toxic in rapidly dividing cells. |
|
|
Term
| (what chemo agent increases cold sensitivity?) |
|
Definition
|
|
Term
| The following belong to what class of drug: fluorouracil (5fu)? |
|
Definition
|
|
Term
| To what drug class does cytarabine (ara-c) belong? |
|
Definition
|
|
Term
| To what drug class does methotrexate belong? |
|
Definition
|
|
Term
| To what drug class does gemcitabine belong? |
|
Definition
|
|
Term
| (what hazard associated with anthracyclines will burn pt's skin?) |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the main dlt of vincristine? |
|
Definition
|
|
Term
| What is the main dlt of vinblastine? |
|
Definition
|
|
Term
| What medication ablates ovaries thus reducing estrogen release? |
|
Definition
|
|
Term
| What antiestrogen is a classical antagonist? |
|
Definition
|
|
Term
| What breast ca tx prevents peripheral extrogen synthesis postmenopausal? What are 3 specific drugs in this category? |
|
Definition
| aromatase inhibitors: femara, arimidex, aromasin |
|
|
Term
| What is the moa of Herceptin (breast), and Erbitux (colon)? |
|
Definition
| Epidermal Growth Factor inhibition |
|
|
Term
| What is the moa of Tarceva (lung),Gleevec (CML, GIST)? |
|
Definition
| Tyrosine Kinase inhibition |
|
|
Term
| What is the moa of Avastin (colon, lung, breast cancers in metastatic setting as of now)? |
|
Definition
|
|
Term
| What ca is tx w/herceptin? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| colon, lung, breast cancers in metastatic setting as of now |
|
|
