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Medicine /USMLE - Hematology/Oncology Part 3

USMLE - Hematology/Oncology Part 3

Medicine23 CardsCreated 4 days ago

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked enzymatic disorder more common in African American males.

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Azathioprine, 6MP, 6-Thioguanine

Class of drug

MoA

Use

Tox

Metabolism

Antimetabolite

Purine analog --/ de novo purine synthesis

Activated by HGPRT

Leukemias

Bone Marrow, GI, Liver

Metabolized by Xanthine Oxidase

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Key Terms

Term
Definition

Azathioprine, 6MP, 6-Thioguanine

Class of drug

MoA

Use

Tox

Metabolism

Antimetabolite

Purine analog --/ de novo purine synthesis

Activated by HGPRT

Leukemias

Bone Marrow, GI, Liver

Meta...

Dactinomycin

AKA

Class of drug

MoA

Use

Tox

Actinomycin D

Antitumor antibiotic

Intercalates DNA

Wilms Tumor, Ewing Sarcoma, Rhabdomyosarcoma, (Childhood tumors: "Children A...

Doxorubicin (Adriamycin), Daunorubicin

Class of drug

MoA

Use

Tox

How to prevent certain toxicity

Antitumor antibiotic
Generates free radicals. Noncovalently intercalate in DNA --> breaks in DNA --> ↓ replication
Solid tumors, Leukem...

Bleomycin

Class of drug

MoA

Use

Tox

Antitumor antibiotic
Induces free radical formation which causes breaks in DNA strand
Testicular cancer, Hodgkin's Lymphoma
Pulmonary Fibr...

Cyclophosphamide, Ifosfamide

Class of drug

MoA

Bioactivation

Use

Tox

How to prevent toxicity?

Cyclophosphamide, Ifosfamide

Class of drug

MoA

Bioactivation

Use

Tox

How to prevent toxicity?

Nitrosoureas

Names

Class of drug

MoA

Bioactivation?

Use

Tox

Carmustine, Lomustine, Semustine, Streptozocin

Alkylating Agents

Alkylates DNA

Requires bioactivation

Brain tumors

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USMLE - Hematology/Oncology Part 3
TermDefinition

Azathioprine, 6MP, 6-Thioguanine

Class of drug

MoA

Use

Tox

Metabolism

Antimetabolite

Purine analog --/ de novo purine synthesis

Activated by HGPRT

Leukemias

Bone Marrow, GI, Liver

Metabolized by Xanthine Oxidase

Dactinomycin

AKA

Class of drug

MoA

Use

Tox

Actinomycin D

Antitumor antibiotic

Intercalates DNA

Wilms Tumor, Ewing Sarcoma, Rhabdomyosarcoma, (Childhood tumors: "Children ACT out")

Myelosuppression

Doxorubicin (Adriamycin), Daunorubicin

Class of drug

MoA

Use

Tox

How to prevent certain toxicity

Antitumor antibiotic
Generates free radicals. Noncovalently intercalate in DNA --> breaks in DNA --> ↓ replication
Solid tumors, Leukemias, Lymphomas
Cardiotoxicity (dilated cardiomyopathy), Myelosuppression, Alopecia
Dexrazoxane (Fe chelator) used to prevent cardiotoxicity

Bleomycin

Class of drug

MoA

Use

Tox

Antitumor antibiotic
Induces free radical formation which causes breaks in DNA strand
Testicular cancer, Hodgkin's Lymphoma
Pulmonary Fibrosis, Skin Changes, Minimal Myelosuppression

Cyclophosphamide, Ifosfamide

Class of drug

MoA

Bioactivation

Use

Tox

How to prevent toxicity?

Cyclophosphamide, Ifosfamide

Class of drug

MoA

Bioactivation

Use

Tox

How to prevent toxicity?

Nitrosoureas

Names

Class of drug

MoA

Bioactivation?

Use

Tox

Carmustine, Lomustine, Semustine, Streptozocin

Alkylating Agents

Alkylates DNA

Requires bioactivation

Brain tumors

CNS toxicity

Vincristine, Vinblastine

Class of drugs

MoA

Use

Tox

Alkaloids that bind to tubulin in M phase and blocks polymerization of MT. Mitotic spindle cannot form

Solid tumors, Leukemias, Lymphomas

Vincristine: Neurotoxicity (Areflexia, Peripheral Neuritis, Paralytic Ileus)

VinBLASTine: Blasts Bone marrow (suppression)

Paclitaxel

Class of drug

MoA

Use

Tox

Paclitaxel

Class of drug

MoA

Use

Tox

Cisplatin, Carboplatin

MoA

Use

Tox

How to prevent toxicity

Cross-links DNA

Testicular, Bladder, Ovary, Lung Carcinoma

Nephrotoxicity, Acoustic nerve damage

Amifostine (free radical scavenger) and Chloride Diuresis

Etoposide, Teniposide

MoA

Use

Tox

--/ topoisomerase II --> ↑ DNA degradation
Solid tumors, Leukemias, Lymphomas
Myelosuppression, GI irritation, Alopecia

Hydroxyurea
MoA
Use
Tox

--/ Ribonucleotide Reducatse --/ ↓ DNA synthesis
Melanoma, CML, Sicle Cell Disease (↑ HbF)
Bone marrow suppression, GI upset

Prednisone as a cancer drug?

| Tox

CLL, Non-Hodgkin's Lymphoma

| Cushing's, Immunosuppression, Cataracts, Acne, Osteoporosis, Peptic ulcers, Hyperglycemia, Psychosis

Tamoxifen, Raloxifene
MoA
Use
Tox

SERM: Receptor antagonist in breast and agonist in bone
Breast cancer. Prevents osteoporosis
T: Partial agonist at endometrium --> ↑ endometrial cancer; Hot flashes

Trastuzumab

AKA

MoA

Use

Tox

Trastuzumab

AKA

MoA

Use

Tox

Imatinib

AKA

MoA

Use

Tox

Imatinib

AKA

MoA

Use

Tox

Rituximab

MoA

Use

Ab against CD20 (found in most B cell lymphomas)

| Non-Hodgkin's Lymphoma, RA (w/ MTX)

Vemurafenib

MoA

Use

--/ B-Raf Kinase with V600E mutation

| Metastatic melanoma

Bevacizumab
MoA
Use

Ab against VEGF inhibits angiogenesis

| Solid Tumors

Common Chemotoxicities

Cisplatin/Carboplatin: C looks like like ears and kidney

Vincrisine: V like arms and legs

Bleomycin, Busulfan: B like lungs

Doxorubicin: D like heart

Trastuzumab: a T in the heart

CYclophosphamide: CY looks like bladder

5FU, 6MP, Methotrexate: Myelosuppression

Busulfan
MoA
Uses
Tox

Alkylates DNA

Alkylates DNA

CML, Ablates bone marrow before transplantation

Pulmonary Fibrosis, Hyperpigmentation

Heme degeneration

Heme --> [Heme oxygenase] --> Biliverdin --> Bilirubin

Black man on TMP/SMX with anemia and dark urine

G6PD deficiency

Dysphagia + Spoon nails

Iron deficiency

Plummer Vinson (esophageal webs)