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Chemotherapy Agents

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  1. Cisplatin, Carboplatin, and Oxaliplatin are what types of agents?
    Heavy Metal Alkylating Agents
  2. What is the MOA of cisplatin, carboplatin, and oxaliplatin?
    Forms intrastrand and interstrand DNA cross-links; binding to nuclear and cytoplasmic proteins
  3. What are the major toxicites associated with cisplatin?
    • Nephrotoxicity
    • Severe N/V
    • Ototoxicity
    • Neuropathy
    • Electrolyte depletion (Mg, K)
  4. What are the major toxicities associated with carboplatin?
    • Myelosuppression
    • Moderate to severe N/V
    • Hypersensitivity
  5. What are the major toxicities associated with oxaliplatin?
    • Neuropathy
    • Moderate to severe N/V
    • Myelosuppression
    • Hypersensitivity
  6. What are the monitoring parameters of heavy metal alkylating agents?
    • CBC
    • SCr/BUN
    • Ins/Outs
    • N/V status
    • Neurologic function
  7. Types of cancers that are treated with heavy metal compounds include:
    • Lung
    • Testicular
    • Bladder
    • Breast
    • Ovarian
    • Colorectal
    • Head and Neck
    • Gastric
  8. What type of agent are busulfan and bendamustine?
    Alkylating agents
  9. How do alkylating agents work?
    Form DNA cross-links, resulting in ihibition of DNA synthesis and function
  10. Major toxicities of Busulfan and Bendamustine include:
    • Myelosuppression
    • N/V
    • Alopecia
    • Sterility/infertility
  11. What are the monitoring parameters for Busulfan and Bendamustine?
    • CBC
    • SCr/BUN
    • Ins/Outs
    • N/V status
    • Pulmonary Function
  12. What are two AEs of alkylating agents specifically related to busulfan?
    • Pulmonary Fibrosis
    • Skin Pigmentation
  13. What types of cancer are treated with busulfan and bendamustine?
    • Leukemias
    • Lymphomas
    • Melanoma: by other alkylating agents
  14. What is the MOA of bleomycin?
    DNA strand breakage and free radical formation
  15. What is the major toxicity associated with bleomycin?
    Pulmonary
  16. Name three Anthracyclines
    • Doxorubicin
    • Daunorubicin
    • Idarubicin
  17. What is the MOA of anthracyclines?
    • Alkylation or intercalation of DNA (insertion of drug molecule between DNA strands)
    • Topoisomerase II Inhibition
  18. Major toxicities of anthracyclines include:
    • Myelosuppression
    • N/V
    • Extravasation
    • Mucositis
    • Alopecia
    • Red urine
    • Cardiovascular toxicity
  19. Monitoring parameters for anthracyclines
    • CBC
    • T. bilirubin
    • Cardiovascular Function
  20. What are the types of cancers that are treated with anthracyclines?
    • Breast
    • Ovarian
    • Bladder
    • Thyroid
    • Lymphomas
  21. Which class of drugs have different adverse effect profiles due to liposomal formulations? [Not sure about this]
    Anthracyclines
  22. Name two folate antagonists
    • Pemetrexed
    • Methotrexate (MTX)
  23. What is the MOA of pemetrexted and MTX?
    • Inhibits dihydrofolate reductase resulting in blockage of thymidylate and purine synthesis
    • Pemetrexted: multitargeted antifolate (GARFT, IT, and dihydrofolate reductase)
  24. What are the major toxicities of folate antagonists?
    • Myelosuppression
    • Mucositis
    • Pulmonary pneumonitis
    • Alopecia
    • Stomatitis
  25. Is hypersensitivity more common in pemetrexed or MTX?
    Pemetrexted
  26. Monitoring parameters for folate antagonists include:
    • CBC
    • SCr/BUN
    • Ins/Outs with high dose
  27. What is an AE associated with high doses of MTX? What drug is used as a rescue agent for MTX?
    • Renal tubular necrosis
    • Leucovorin
  28. How is MTX administered?
    • IV
    • IT
    • PO
  29. What must patients be pre-medicated with if being treated with pemetrexed?
    Dexamethasone
  30. What medications may patients needed after treatment with pemetrexted?
    • Folic Acid
    • Vitamin B12 Supplements
  31. What types of cancers are treated with MTX and pemetrexed?
    • Lymphoma
    • Head & Neck
    • Lung: Specifically pemetrexed
  32. List the pyrimidine antagonists
    • Capecitabine
    • Cytarabine (Ara-c)
    • Fluorouracil (5-FU)
    • Gemcitabine
  33. What is the MOA of 5-FU?
    • Inhibits thymidylate synthase (TS)
    • Incorporation into DNA and RNA resulting in inhibition of synthesis and function
  34. Which drug is a pro-drug of 5-FU?
    Capecitabine
  35. What is the MOA of pyrimidine antagonists?
    Incorporation into DNA and RNA resulting in inhibition of synthesis and function
  36. Another name for a pyrimidine antagonists is
    Antimetabolite
  37. What are the major toxicities associated with pyrimidine antagonists?
    • Myelosuppression
    • Mucositis/Stomatitis
    • Diarrhea
    • Flu-like syndrome
    • "Hand-foot syndrome"
    • Neurologic
  38. Monitoring parameters for pyrimidine antagonists include:
    • CBC
    • SCr/BUN
    • Electrolytes
    • Neurologic function
  39. Capecitabine is available in what formulations?
    Capecitabine
  40. What drug does capecitabine have a black box warning against?
    Warfarin
  41. Rash and conjunctivitis are related to which pyrimidine antagonist?
    Cytarabine
  42. What is a dose limiting rxn with bolux dosing of 5-FU?
    Myelosuppression
  43. What are toxicities that are dose liminting with 5-FU infusion?
    • GI toxicities
    • Hand-foot Syndrome: palmar-plantar erythrodysesthia
  44. What types of cancers are treated with pyrimidine antagonists?
    • Leukemias
    • Lymphomas (Ara-c)
    • Pancreatic
    • Lung
    • Breast (Capecitabine)
    • Ovarain (Gemcitabine)
    • Head & Neck
    • Gastric (5-FU)
    • Colon
  45. Name the vinca alkaloids
    • Vincristine
    • Vinblastine
    • Vinorelbine
  46. How do vinca alkaloids work?
    Bind tubulin and interfere with microtubule assembly (depolymerize microtubule) preventing spindle formation and interfering with mitosis
  47. What are the toxicities associated with vinca alkaloids?
    • Peripheral neuropathy
    • Myelosuppression
    • Constipation
    • SIADH: rare
  48. Which drugs can never be given intrathecally?
    Vinca Alkaloids
  49. Which vinca alkaloid is more commonly associated with neuropathy? 
    Vincristine
  50. What are the monitoring parameters for vinca alkaloids?
    • T bilirubin: Hepatic dose adjustment
    • CBC
    • Neurologic Function
  51. True or False: Vinca alkaloids are cell cycle specific
    True
  52. What types of ccancer are treated with vinca alkaloids?
    • Lymphoma
    • Testicular
    • Lung
  53. Name the taxanes
    • Paclitaxel
    • Docetaxel
  54. What is the MOA of taxanes?
    • Bind tubulin and stabilize microtubules and prevent depolymerization of the mitotic spindle
    • Freeze cell in anaphase/telophase
    • Microtubules present intracellularly and in neurons
  55. What are the toxicities associated with taxanes?
    • Myelosuppression
    • Stomatitis
    • Peripheral neuropathy
    • Total alopecia
    • N/V
    • Nail Changes
    • Hypersensitivity: Paclitaxel
    • Fluid retention: Docitaxel
  56. True or False: Taxanes do not have to be dose adjusted for hepatic dysfunction
    False
  57. What are the monitoring parameters for taxanes?
    • CBC
    • Neurologic symptoms
  58. What are the predmedications needed for paclitaxel to minimize hypersensitivity?
    • Corticosteroid + H1 blocker + H2 blocker
    • ex. dexamethasone + diphenhydramine + famotidine 30 minutes prior to chemo
  59. What are the premedications given before docetaxel to reduce fluid retention?
    • Dexamethasone
    • ex. 3-5 days starting 1 day prior to chemo
  60. What types of cancer are treated with taxanes?
    • Breast
    • Ovarian
    • Lung
  61. In what class do irinotecan and topotecan belong?
    Camptothecans
  62. What is the MOA of camptothecans?
    • Topoisomerase I Inhibitors
    • DNA topoisomerase enzymes relieve torsional strain by inducing strand breaks
    • Inhibitors inhibit the resealing of the breaks
  63. What is the toxicites associated with camptothecans?
    • Myelosuppression
    • Diarrhea
  64. Monitoring parameters for camptothecans include:
    • CBC
    • Electrolytes
  65. Which medication has the AE of acute and delayed diarrhea syndromes?
    Irinotecan
  66. Topotecan is approved in what type of cancer? Irinotecan?
    • Ovarian: topotecan
    • Colorectal: irinotecan
  67. Give an example of a podophyllotoxin
    Etoposide
  68. What is the MOA of etoposide?
    • Topisomerase II Inhibitor
    • DNA topoisomerase enzymes relieve torsional strain by inducing strand breaks
    • Inhibitors inhibit the resealing of the breaks
  69. What AEs are associated with etoposide?
    • Hypotension
    • Myelosuppression
    • Alopecia
    • Mucositis
  70. Monitoring parameters for etoposide?
    • CBC
    • Blood Pressure
  71. True or False: Etoposide should be given slowly to avoid hypotension
    True
  72. The oral etoposide dose is ___ x greater than IV.
    2
  73. What is the MOA of hydroxyurea?
    Ribonucleoside diphosphate reductase inhibitor
  74. What is the MOA of L-Asparaginase?
    Inhibits protein synthesis by hydrolyzing asparagine to aspartic acid and ammonia
  75. What is the MOA of arsenic trioxide?
    Damages/degrades the PML-RAR alpha fusion protein
  76. What is the MOA of Imatinib?
    Inhibits Bcr-Abl tyrosine kinase and other receptor tyrosine kinases
  77. What is the MOA of erlotinib?
    Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor
  78. What is the MOA of lapatinib?
    multiple receptor tyrosine kinase inhibitor (mrTKI)
  79. What is the MOA of nilotinib?
    mrTKI
  80. What is the MOA of Dasatinib?
    mrTKI
  81. What is the MOA of everolimus?
    Mammalian target of rapamycin (mTOR) inhibitor
  82. Toxicities for hydroxyurea include:
    • Myelosuppression
    • Mucositis
    • Hepatotoxicity: rare
    • Renal Toxicity: rare
  83. In which medication is a test dose often recommended?
    L-Asparaginase
  84. What are the toxicities associated with L-asparaginase?
    • Hypersensitivity
    • Hyperglycemia
    • Pancreatitis
    • CNS effects
  85. Hydroxyurea: PO or IV?
    PO
  86. What are the toxicities associated with arsenic trioxide?
    • Increased QTc
    • Peripheral neuropathy
    • Musculoskeletal pain
    • Hyperglycemia
  87. Which drugs are known to have p450 interactions?
    • Imatinib
    • Erlotinib
    • Lapatinib
    • Nilotinib
    • Dasatinib
  88. Name the AEs associated with imatinib
    • D/N/V
    • Rash
    • Fluid Retention
    • Myalgias
    • CHF
  89. What AEs are associated with erlotinib?
    • Rash
    • Diarrhea
    • Anorexia
    • Interstitial Lung Disease
  90. What are the AEs of Lapatinib?
    • D/N/V
    • Rash
    • QT prolongation
  91. What are the AEs of nilotinib?
    • QT prolongation
    • Myelosuppression
    • Electrolyte abnormalities
    • LFT alterations
    • Rash
    • Myalgia
    • Hyperthyroidism
  92. Toxicities associated with everolimus include:
    Hyperglycemia
  93. Hydroxyurea is used as treatment for ________
    sickle cell disease
  94. L-asparaginase is used as treatment for ________
    • Leukemia
    • Elspar: will be D/C in December of 2012
  95. Arsenic Trioxide is used as treatment for ________
    Acute promyelocytic leukemia (APL)
  96. Imatinib is used as treatment for what cancers?
    • Leukemia
    • GI stromal tumors (GIST)
    • Myelodysplastic diseases
  97. What cancers are treated with erlotinib?
    • Lung
    • Advanced Pancreatic
  98. What medication is used in the treatment of breast cancer after failure with other therapies?
    Lapatinib
  99. Dasatinib is used as treatment for ________
    Leukemia
  100. Everolimus is used for treatment in what type of cancer after failure with sunitinib or sorafenib?
    Renal cell carcinoma
  101. What drug was approved in 2012 for combination treatment with exemestane in advanced breast cancer?
    Everolimus
  102. What is the major toxicity associated with interferon alpha-2B?
    Flu like syndrome: fever, myalgia, weakness, headache
  103. What do you monitor in a patient receiving interferon alpha-2B?
    • LFT
    • CBC
    • Thyroid function
  104. Which drug has a black box warning for potential to "cause or exacerbate fatal or life-threatening neuropsychiatric, autoimmune, ischemic, or infections"
    Interferon alpha-2b
  105. What are the AEs associated with interferon alpha-2B?
    • Bone marrow suppression
    • CNS & neurological effects
    • Thyroid changes
    • Hepatotoxicity
  106. What is the MOA of Interleukin-2 (aldesleukin)?
    Enhances the proliferation and activation of T-cells and NK cells
  107. What are the major toxicities associated with interleukin-2?
    • Flu like syndrome
    • Capillary leak syndrome
    • N/V
    • Diarrhea
    • Bone marrow suppression
    • CNS effects
  108. What is the black box warning for interleukin-2?
    Patients should have normal cardiac and pulmonary function
  109. What are the monitoring parameters for interleukin-2?
    • BP
    • EKG
    • CBC
    • SCr
    • Ins/Outs
    • Signs of pulmonary edema
  110. Name the Estrogen Receptor antagonists
    • Tamoxifen
    • Toremifene
    • Raloxifene: selective-estrogen receptor modulator
  111. What is the MOA of tamoxifen and toremifene?
    Inhibit nuclear binding of the estrogen receptor, blocking estrogen stimulation of hormone
  112. What is the MOA of raloxifene?
    Activation and inhibition of various estrogen pathways
  113. What are the AEs associated with estrogen receptor therapy?
    • Hot flashes
    • N/V
    • Thromboembolic events
  114. Which class of drug may have decreased efficacy if combined with SSRIs?
    Tamoxifen and toremifene
  115. True or False: Raloxifene can be used in premenopausal women
    False
  116. Anastrozole, letrozole, and exemestane belong to which class of drugs?
    Aromatase inhibitors
  117. What is the MOA of aromatase inhibitors?
    Inhibit conversion of androgens to estrogens
  118. List the AEs associated with aromatase inhibitors
    • Hot flashes
    • Weight gain
    • Edema
    • Fatigue
    • Bone/joint pain
    • Potential for increased fracture risk
  119. Give an example of a GnRH agonist
    Goserelin
  120. What is the ultimate goal of GnRH agonists?
    Decrease testosterone and estrogen concentrations
  121. What are two examples of LHRH agonists?
    • Leuprolide
    • Triptorelin
  122. What is the intial AE associated with Goserelin?
    A tumor flare
  123. Antiandrogenic effects common with GnRH and LHRH agonists include:
    • Hot flashes
    • Decreased libido
    • Gynecomastia
    • GI disturbances
    • Injection site pain
    • Decreased bone density
  124. What type of drugs can be used to treat prostate cancer?
    • GnRH
    • LHRH
    • Antiandrogens
  125. Name the antiandrogen medications
    • Bicalutamide
    • Flutamide
    • Nilutamide
  126. What is the MOA of bicalutamide?
    • Inhibits testosterone and dihydrotestosterone uptake and binding
    • Blocks testosterone surge
  127. AEs associated with antiandrogens
    • Hot flashes
    • Gynecomastia
    • CNS
    • Elevated liver enzymes
    • Diarrhea
  128. Trastuzumab is a ______.
    Anti HER-2
  129. AEs associated with trastuzumab include:
    • Infusion related reactions: Fever, Chills, Rigors, hypotension
    • Hypersensitivity
  130. What premedications are required with anti-HER2 therapy?
    • Antihistamines
    • APAP +/- corticosteroids
  131. An example of an anti CD 20 medication
    • Rituximab
    • Ofatumumab
  132. CD20 surface antigens are found on what types of cells
    B-lymphocytes
  133. What is the MOA of rituximab?
    Activate complement system by binding to CD20
  134. AEs associated with anti-CD20 therapy
    • Infusion related rxns: fever, chills, rigors, hypotension
    • Hypersensitivity
  135. Rituximab is used to treat what type of cancer?
    Lymphoma
  136. Alemtuzumab is a _______
    anti CD-52
  137. What drug binds to CD-52 antigens present on leukemic lymphocytes and induces cell lysis and death?
    Alemtuzumab
  138. AEs of Alemtuzumab include:
    • Infusion like rxns
    • Neutropenia
    • Lyphopenia
    • Infections
  139. Are pre-medications required for alemtuzumab?
    • Yes
    • Antihistamine
    • APAP +/- corticosteroid
  140. Which drug is currently used to treat leukemia however may be taken off the market and reformulated for MS treatment?
    Alemtuzumab
  141. Name a VEGF inhibitor
    Bevacizumab
  142. List the major toxicities associated with bevacizumab
    • GI perforation
    • Impaired wound healing
    • Hemorrhage
    • Thrombotic events
    • Hypertension
    • Nephrotic syndrome
  143. Which medication cannot be given within 28 days of surgery?
    Bevacizumab: AE includes impaired wound healing
  144. Bevacizumab is indicated for what type(s) of cancer?
    • Colon
    • Lung
  145. Cetuximab is what type of drug?
    EGFR
  146. Major toxicites of cetuximab include:
    • Rash
    • Infusion rxns
    • Nausea
    • Diarrhea
    • Hypomagnesemia
  147. Cetuximab is indicated for what type of cancer(s)?
    • Colon
    • Head/neck
  148. AEs associated with ofatumumab
    • Infusion reactions
    • Cytopenias
    • Progressive multifocal leukoencephalopathy
  149. What drug is indicated as second-line for chronic lymphocytic leukemia?
    Ofatumumab
  150. What drug binds to HER-2 extracellulary and blocks it from binding to other signaling factors?
    Pertuzumab
  151. List the major toxicities associated with pertuzumab
    • Fetal toxicity
    • LV dysfunction
    • Infusion reactions
  152. True or False: Pertuzumab is used for patients with HER-2 local breast cancer in combination with trastuzumab and docetaxel in patients who have failed previous chemotherapy regimens
    • False:
    • Indicated in metastatic chemotherapy naive patients
Author:
 rclee06
ID:
 181036
Card Set:
 Chemotherapy Agents
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