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WEEK 23:
Chemotherapy:
| Question | Answer |
|---|---|
| cancer treatment armamentarium (treatment and techniques available to give) - 4 | surgery, radiotherapy, chemotherapy (neoadjuvant and adjuvant) and palliative care |
| neo adjuvant chemotherapy | chemotherapy before surgery or radiation therapy in the case of Hodgkin's disease |
| adjuvant chemotherapy | chemotherapy after surgery or radiation therapy in the case of breast cancer |
| solid tumour meaning | can be removed but keeps reoccurring |
| chemotherapy meaning | use of drugs (chemicals) to manage malignancies by targeting DNA synthesis and mitosis (as cancer cells are similar to host cell so its difficult to target them) |
| cytotoxic drugs | kill rapidly dividing cells - carried out in cycles with induction and maintenance phases- and are dosed based on body surface area (BSA) |
| cell reproductive cycle | G1 (growth preparation for DNA synthesis), S (DNA synthesis), G2 (growth preparation for mitosis), and mitosis |
| why are multiple drug regimens given (2) | different classes work different ways and attack different sites of cell division and to reduce toxicity |
| why do we give cycles of chemotherapy | achieve total cell kill and limit toxicity given typically 3 week cycles |
| effect of multiple course of chemotherapy | maintain normal cells but reduce tumour cells |
| cell cycle specific agents (CCS) | antimetabolites and plant alkaloids (Vinca alkaloids, taxanes , and Podophyllin alkaloids) |
| cell cycle non specific (CCNS) agents | alkylating agents and antibiotics (anthracyclines) |
| examples of CCS | |
| examples of CCNS | |
| antimetabolite examples | Methotrexate (folate antagonist) and 5-Fluorourcil (pyrimidine antagonist or false substrates) |
| plant alkaloids examples | |
| alkylating agents examples | |
| antibiotics examples | |
| hormonal agents examples | |
| biologics examples | |
| miscellaneous drugs examples | |
| antimetabolites^^ | interfere with metabolic pathways in DNA synthesis eg methotrxate and 5-fluoruracil |
| mechanism of action of methotrexate^^ | |
| mechanism of action of 5-fluorouracil^^ | |
| plant alkaloids | |
| mechanism of action of vincristine**^^ | inhibit microtubule (spindle) needed for cell division |
| mechanism of action of paclitaxel**^^ | stabilise microtubule (spindle fibres) producing similar effects to vinca alkaloids affecting cell division |
| mechanism of etoposide^^ | |
| alkylating agents | |
| mechanism of action of cyclophosphamide | chemical cross linking leading to defective DNA replication |
| cisplatin | methogenic and necrotoxic agent causing inhibition of DNA synthesis by cross linking guanine residues |
| combination of cisplatin and vinblastine | |
| alkylating agents | |
| mechanism of action of doxorubicin | **3£"*$*"$ free radicals are toxic to heart so cannot give to those with cardiovascular disease |
| side effects of anticancer drugs** | inhibit all fast growing cells eg hair follicles, myelosuppression (bone marrow no make enough RBC- except vincristine and bleomycin) leading to anaemia and decreased resistance to infection (neutropenic fever) and increased bleeding |
| how to overcome side effects of anticancer drugs | |
| Chemotherapy-induced nausea and vomiting (CINV): | |
| palliative care | pain relief (strong opioids - morphone and diamorphone, oramorph which is oral morphine), syringe driversm and hospice care (end of life care), fentanyl pathces |
| side effects of opioids | constipation and nausea |
| REMEMBER MECHANISMS OF ACTIONS OF ALL DRUGWPDIS;KLNAWJKDS |
Created by:
kablooey
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