Download Pharmacology Exam 3!

CHEMO TUTORING
ALAINA DARBY
INTRODUCTION TO CHEMO STUFF
 Which of the following describes carcinogenesis?
a. Cells do not differentiate following genetic mutation
b. Cells undergo altered regulation following genetic mutation
c. Cells continually undergo apoptosis following differentiation
d. Cells adhere to strict mechanisms of cell division and differentiation
 Which of the following is not true of cancer?
a. It more prevalent in old age due to accumulation of mutations
b. It is a single disease characterized by unrestricted cell growth
c. It may involve abnormal regulation of the cell cycle
d. It is dependent upon the mutation of proto-oncogenes
 Which of the following is not a path that stem cells might take?
a. Division into more stem cells when proliferation when more cells are
needed
b. Dormancy when additional cells are not necessary
c. Differentiation into cells that are less specific to that tissue type
d. Death of the cell when there are more stem cells than are needed
 Which of the following types of cells may differentiate into the widest
variety of cell types?
a. Adult stem cells
b. Terminally differentiated cells
c. Embryonal stem cells
d. Lineage stem cells
 Which of the following occurs at the G1 phase in mitosis?
a. Gene replication
b. Cell division
c. Check that DNA is replicated
d. Direction on which path the cell should take
 Which of the following is not a cell type that is normally found in a
genome?
a. Proto-oncogenes
b. Oncogenes
c. Tumor suppressor genes
d. Adult stem cells
 Which of the following is not a mechanism by which inflammation can
cause cancer?
a. Increase in neutrophils at site of inflammation
b. Increase of reactive oxygen species at the site
c. Destruction of telomeres in cancer cells
d. Release of cytokines that cause cell replication
 Which of the following is a surface receptor that can be mutated to
cause loss of growth regulation?
a. Ras
b. EGF
c. STAT
d. JAK
 Which of the following will be most likely to result in cancer?
a. Cells with some mutations that possess significant vascularization and
significant telomerase activity
b. Cells with significant mutations that possess significant vascularization and
little telomerase activity
c. Cells with significant mutations that possess significant vascularization and
significant telomerase activity
d. Cells with significant mutations that possess little vascularization and
significant telomerase activity
 Which of the following is not true of metastasis?
a. Angiogenesis may aid in metastasis
b. Certain types of cancers only circulate to specific types of tissues
c. Cancer cells have the ability to break through the basement membrane
of tissues
d. Cancer cells may spread through blood or lymph
 Which of the following is not a hallmark of a cancer cell?
a. Sustained angiogenesis
b. Self-sufficiency in growth signals
c. Insensitivity to anti-growth signals
d. Evasion of cell signaling
 Which of the following is not a cause of enhanced oncogene activity?
a. Point mutation in the coding sequence resulting in a hyperactive protein
made in normal amounts
b. Gene amplification resulting in the overproduction of a normal protein
c. Chromosome rearrangement of DNA sequence resulting in
overproduction of a normal protein
d. Chromosome rearrangement of DNA sequence resulting in decreased
transcription of a tumor suppressor gene
 Which of the following models is described by the following: doubling
time of cancer cells is constant and death results when malignant cells
reach a critical number or fraction of body weight?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models is described by the following: mutations
randomly result in altered phenotypes that confer cellular resistance to
chemotherapeutic drugs and the probability of resistant cells depends on
tumor size?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models assumes that tumors have inherently
higher mutation rate than normal cells and that progression leads to an
increase in the mutation rate?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models is described by the following: only
therapy that completely eradicates all tumor cells will be curative?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models concludes that cancer is entirely curable?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models is described by the following: tumor
growth follows a non-linear curve with slowing of growth rate being due to
tumor outgrowing blood and nutrient supply?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following models is described by the following: a tumor is
composed of faster-growing cells that are sensitive to therapy and slowergrowing cells that are resistant?
a. Gompertzian Cell Growth
b. Goldie-Coldman Hypothesis
c. Norton-Simon Hypothesis
d. Skipper’s Laws
 Which of the following is an example of kinetic resistance?
a. Pharmacological sanctuary
b. Systemic non-absorption
c. Poor tumor vascularization
d. Enhanced liver metabolism
 Which of the following methods of cellular resistance is conferred by
HER-2 cells that are treated with HER-2 antibodies?
a. Transport defects
b. Induction of alternate pathway
c. Target molecule overproduction
d. Insufficient drug activation
 Which of the following is the reason that heart failure has become more
prominent as a side effect of chemotherapy in recent years?
a. More toxic therapies have become necessary due to resistance
b. Patients live long enough to have long-term effects
c. Chemotherapies have become more targeted to the heart
d. Modern therapies are longer courses of treatment
 Which of the following is not an absolute indication for chemotherapy?
a. Basal cell carcinoma
b. Leukemia
c. Brain tumor
d. Metastatic lung carcinoma
SWEATMAN
GENERAL

Chemo drugs cause improvement and toxicity!

Which areas of the cell cycle each drug works…

Bleomycin: G2

Podophyllotoxins: G2 and S

Antimetabolites: S

Adjuvant = after radiation, neoadjuvant = before radiation

Use a combo for resistance!! Think about MOA’s, impacts on the other drugs’ effectiveness, spectrum of toxicity (don’t overlap)

Chemo is the main treatment for SYSTEMIC cancers

Most dugs affect rapidly dividing cells (blood, mouth and GI lining, hair)

Not all drugs kill tumors

Know how each drug differs from ideal (selective, no toxicity, eradication)

Tumor lysis syndrome causes organ toxixity… treat with allopurinol or **rasburicase

Specific vs nonspecific
ALKYLATING AGENTS
 Not specific
 Which don’t require activation?
 Chlorethyl functional group attaches to DNA (different for BCNU)
 Adverse effects: CNS (ifosfamide), lungs (ALL), renal (cyclophosphamide and ifosfamide), urotoxicity via acrolein
(cyclophosphamide and ifosfamide)
 BCNU/CCNU: enter CNS!!
 BCNU: hepatotoxicity
 Dose limiting factor for cisplatin is renal insufficiency (amifostine)
 Emesis… use steroids
ANTIMETABOLITES
 Compare anti-folates
 MTX requires polyglutamination (resistance!)
 5-FU and capecitabin: cause hand & foot syndrome
 MTX: rescue with leucovorin
 Cytarabine is most specific for S phase
TOPOISOMERASES AND SPINDLE INHIBITORS
 Vincas block tubulin POLYMERIZATION, taxels inhibit DISASSEMBLY
 Microtubules… neurotoxicity, blood disorders
 Acute diarrhea with itinotecan (different mechanism)
 Doxorubicin = heart!!! (also, “rub”icin… red urine)
 Bleomycin = lungs!!!
 Pegasparagase = pancreas!!!
 Retinoids… think about Accutane