Pharm 5 set 1

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Pharm 5 set 1
2013-11-19 12:11:07

pharm 5 Cancer lecture
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  1. we find persistent proliferation in what?
    Neoplastic cells
  2. cancer cells are the type with this active enzyme
  3. 8 barriers to successful treatment
    • 1 toxicity to  nl cells
    • 2 low host defense
    • 3 first order kinetics= a constant % of cells will be killed w/ each round, so an equally strong dose is needed each time
    • 4 no visible end point
    • 5 solid tumors do not respond well= most tumor cells are in G0 phase
    • 6 drug resistance
    • 7 heterogeneity of tumor cells
    • 8 limited drug access to tumor
  4. what type of therapy is recommended for cancer tx?
    • Combination therapy
    • - resistance suppression
    • - inc. cancer cell kill
    • - reduced injury to nl cells
  5. why are cancer drugs on of the few drugs given Intra-arterial?
    direct attack on solid tumor
  6. toxicities associated with cancer tx
    • Bone marrow suppression- most prevalent
    • GI - epithelial lining of tract
    • Alopecia - b/c fast dividing cells
    • Hyperuricamia - inc. uric acid breakdown of DNA
    • Extravasation - tissue damage from IV site, so given central line to vena cava
    • Carcinogenesis - from DNA damage
  7. 3 types of cancer drugs
    • cytotoxic agents= direct kill
    • Hormones and hormone antagonists= interfere with hormone dependent tissues
    • Targeted drugs= created to bind to specific molecules
    •   = monoclonal antibodies
  8. cytotoxic drugs

    admin of
    • direct attack on cells
    • -cell cycle specific OR non-specific
    • -Usually disrupt DNA synthesis

    • admin= need to follow safe handling procedures to avoid  nurse toxicity
    •   = Central line IV access is best
  9. alkylating agents / Platinum compounds
    cytotoxic dx

    • Alkyl groups form abnormal cross links b/w DNA strands
    • Drug resistance is common
    •   - inc. production of enzymes that repair DNA

    SE= found in high-growth tissues like GI
  10. Anti-Metabolites
    cytotoxic dx

    Disrupt metabolic processes (imposter)

    Folic acid, Pyrimidine, and Purine analogs
  11. Methotrexate / Rheumatrex
    Anti-metabolite (Cytotoxic)

    • Folic Acid Analog (imposter)
    • - DNA, RNA, and proteins

    • Inhibits folic acid entry into cells, which decreases dna, rna, & protein productions
    • Need LARGE doses b/c cancer cells are often resistant
  12. Cytarabine / ARA-C
    Anti-metabolite (Cytotoxic)

    • Pyrimindine analog (imposter)
    • - DNA and RNA
  13. Mercaptopurine / Purinethol
    anti-metab (Cytotoxic)

    • Purine Analog
    • -proteins and nucleic acids
  14. Leucovorin Rescue
    Leuc= a form of folic acid that can bypass the metabolic blocks of methotrexate

    cancer cells lack uptake mechs for Leuc's

    • Therefore, nl cells get folic acid
  15. anti-tumor antibiotics
    cytotoxic agents

    used only to treat cancer --> direct interaction with DNA

    Administered IV only --> GI toxic

    Delayed cardiomyopathy may arise after Tx
  16. Mitotic Inhibitors
    Cytotoxic agent

    Act during the M phase of cell division

    Cause peripheral nueropathy
  17. Topoisomerase Inhibs
    Cytotoxic agent

    act during the S phase

    Prevent the creation of single strand DNA for replication
  18. what classification drug is used for prostate cancer?
    Androgen Deprivation
  19. Leuprolide / Lupron
    Gonadotropin-Releasing Hormone AGONIST (GnRH)

    • Initial inc. in hormone causes down regulation of receptors in testes
    • Initital INCREASE and then DECREASE in cancer growth
    • Does NOT block androgen from Adrenals or Prostate

    1st defense for prostate cancer
  20. Flutamide / Eulexin
    • Androgen Receptor blocker
    • -blocks recept, depriving cells of all androgen needed for growth
    • -in combo with GnRH to suppress the initial growth of cancer

    for advanced forms post-castration :( poor guy
  21. SERMS
    • Selective estrogens receptors modulators
    • 'Anti-estrpgens'

    Used for Breast cancer
  22. Tamoxifen / Nolvodex

    Raloxifene / Evista

    • Block  some estrogen receptors
    • - tumor deprived of estrogen needed to grow
    • Stimulate other estrpgen recepts
    • - Inc. bone density
    • - dec. LDL, inc. HDL

    used for prevention in high risk pt.s
  23. Aromatase Inhibitors
    SERMS used in Post-menopausal breast cancer

    • block only breast tumor estrogen, NOT ovarian
    • Well tolerated
  24. Side effects of SERMS and Post-menopausal SERMS
    SERMS= Thromboembolism, endometriosis / cancer

    Post-men= flushing, headache, n/v, HTN, increased risk for osteoporosis
  25. Trastuzumab / Herceptin

    side effects
    Monoclonal Antibody used for breast cancer

    • HER2 receptor controlling cell growth
    • Human Epidural growth factor receptors
    • -binds to receptors and stops cell prolif.

    SE= cardiotoxicity, hypersensitivity, & pulmonary events
  26. 3 types of Targeted Drugs
    Monoclonal antibodies= good, but can cause a lot of cell death and therefore toxicity

    Small molecules= inhibit intra-cellular communication

    Angiogenesis INhibitors= stop blood flow to tumor
  27. Why are Hematopoietic and Thromopoietic Growth Factors given in combo with Chemo Therapy?
    They have Colony stimulating factors

    They act on bone marrow to stimulate formation of blood cells
  28. Hematopoietic growth factor effects what cells?
    red and white
  29. Thrombopoietic growth factor effects what cells?
  30. Epoetin Alfa / Epogen, Proctrit
    • Hemat g-factor --> RBC's
    • For HCT <35%
    • Need iron, folic acid, & B12 or WILL NOT work

    • Uses= chronic renal failure, chemo, anemia in pt.s facing surgery
    •   = inc. RBC count like erythropoietin

    SE= HTN-monitor and control BEFORE use
  31. other info about Procrit
    • Vial MUST NOT be shaken
    • Should not be mixed other drugs
    • Should not be frozen

    Now is given SubQ
  32. Filgrastim / Neupogen
    Hemat g-factor --> WBC's

    • uses= elevation of neutrophil counts in pt.s w/ cancer
    •   = Tx of severe chronic nuetropenia

    SE= bone pain
  33. Oprelvekin / Neumega
    • (Interleukin-11)
    • Thrombopoietic g-factor  --> platelets

    Uses= used w/ myelosuppressive chemo to minimize thrombocytopenia

    • SE= fluid retention
    •  = cardiac dysrrhythmias
    •  = allergic rxns
  34. What 3 things need replaced in Anemia?
    • Iron --> oral or IV (Iron Dextran)
    • -high incidence of anaphylactic rxns

    • Vit. B12
    • - essential for DNA synthesis in all cells
    • - given orally, nasal, IM, IV

    • Folic Acid
    • - essential for DNA synthesis and cell division
    • -given orally