Fundamentals of Chemotherapy 2023 with 100% correct questions and answers

Alkylating Agents MOA -Inactive until metabolized by the microsomal P450 system -Metabolism forms highly reactive electrophils that react with neutrophiic groups cross-linking DNA and interfering with its function Classical = carmustine, cyclophosphamide, mechlorethamine Non-Classical = procarbazine, dacarbazine, temazolamide, bendamustine Cyclophosphamide -Classical alkylating agent Toxicity - bone marrow suppression (days 8-14), cystitis, cardiac toxicity (high doses), immunosuppression -Acrolein byproduct causes severe hemorrhagic cystitis - MESNA used as cytoprotectant Carmustine -Classical alkylating agent -Nitrosourea -Hydrophobic, administered in alcohol Toxicity - causes delated myelosuppression, administer every 6-8 weeks -Available in wafers for brain Procarbazine -Non-classical alkylating agent Toxicity - MAO inhibitor Cisplatin -Non-classical alkylating agent -Forms platinum coordination complexes Toxicity - nephrotoxic, N/V, neuropathy Carboplatin -Non-classical alkylating agent -Forms platinum coordination complexes Toxicity - Add to dictionary, some N/V Methotrexate -Antimetabolite, folic acid antagonist MOA - inhibits DHF reductase, cell loses its pool of reduced folate, no generation of thymidine, no DNA synthesis Toxicity - myelosuppression, N/V, mucositis, hepatotoxicity, neurotoxicity, nephrotoxicity -Patients at high risk for toxicity = renal dysfunction, ascites, GI obstruction, dehydration, acidic urine, competing weakly acidic drugs excreted by kidneys -Treatment of intoxication includes leucovorin, hemodialysis, thymidine infusion, glucarpidase infusion 5-Fluorouracil -Antimetabolite, pyrimidine antagonist MOA - irreversibly inhibits thymidylate synthase -Augemented with leucovorin Toxicity - depends on dose/sched, mucositis, myelosuppression, hand-foot syndrome Cytarabine -Antimetabolite, pyrimidine antagonist MOA - DNA chain terminator Toxicity - myelosuppression, fever, arthralgia, cerebellar neurotoxity, ocular toxicity Fludarabine -Antimetabolite, purine antagonist Irinotecan (cytosine arabinoside) -Topoisomerase I inhibitor, camptothecin Toxicity - myelosuppression, transaminitis, fever, acute and delayed diarrhea (cholinergic syndrome) -Treat acute diarrhea with atropine -Treat delayed diarrhea with loperamide Docetaxel -Antimitotic agent, natural product -Taxane MOA - stabilizes microtubules Toxicity - hypersensitivity, myelosuppression, fluid retention Paclitaxel -Antimitotic agent, natural product -Taxane MOA - microtubule inhibitor, stabilizes microtubules Toxicity - hypersensitivity reactions, cardiotoxic, myelosuppression, N/V, alopecia -Pre-medicate with H1 antagonist, H2 antagonist and steroids Vinblastine -Antimitotic agent, natural product -Vinca alkaloid MOA - microtubule inhibitor Vincristine -Antimitotic agent, natural product -Vinca alkaloid MOA - mitotic spindle poison Toxicity - neuropathy including constipation