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Cancer and Immune System Pharmacology
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1.While reviewing charts in a general medicine cl inic you see that a patient, 55-year-old and with no history of cancer at all, i s taking methotrexate (MTX). What i s the most l ikely condition for which this “anticancer drug” i s being given?
- Asthma or emphysema
- Hyperuricemia or cl inical gout
- Myasthenia gravis
- Rheumatoid arthritis or psoriasis
2. A 47-year-old woman with choriocarcinoma i s treated with methotrexate (MTX), given at dosages that you believe may cause s ignificant host cell Which drug would you give to l imit the toxic effects of the drug on normal host cells?
- Vitamin K
3. You order vincristine, the prototype of the vinca alkaloids, to a patient with a tumor that i s l ikely to be responsive to this What i s the most l ikely adverse response to this drug?
- Nephrotoxicity, renal dysfunction or failure
- Peripheral sensory and motor neuropathy
- Pulmonary damage
- Thrombocytopenia, bleeding
4. A cancer patient develops severe, i rreversible cardiomyopathy because the maximum l i fetime dose of an anticancer drug was exceeded. What drug was most l ikely responsible for this?
- Cyclophosphamide Doxorubicin
5. A patient with Wilms tumor i s receiving a chemotherapeutic agent that i s described as working by intercalating into DNA strands, and that i s efficacious regardless of which stage of the cell cycle the tumor cells are Which drug best fi ts this description?
- Cytarabine (cytosine arabinoside)
6. A 42-year-old woman i s diagnosed with metastatic breast You consider use of tamoxifen, toremifene, or fulvestrant. Why might fulvestrant be the best choice, all other factors being equal?
- Exerts antiplatelet, rather than thrombotic, effects
- Lacks ability to cause hot flashes or other disturbing s ide effects
- Lower ri sk of causing endometrial cancer
- Provides cl inical cure, rather than palliation, in all patients
- Significantly improves mineral density in, strength of, long bones
7. A patient with chronic myelogenous leukemia (CML) i s being treated with Which s ide effect or other s i tuation should you anticipate in response to imatinib therapy?
- A high rate of therapeutic failure, and the need to switch to interferons α-2a and -2b
- Hypotension and hypovolemia due to s ignificant drug-induced diuresis
- Interactions with other drugs that depend on or affect the cytochrome P450 system
- Significant toxicity to normal host cells due to profound inhibition of tyrosine kinase
- Thrombocytosis, with a high ri sk of intravascular clotting
8. As a rule, large (and older) solid tumors are more difficult to eradicate when chemotherapy i s Which tumor-based property explains best the reason for this chemotherapeutic l imitation?
- Growth fraction s lows, more cells enter G0
- Higher tumor blood flow washes away anticancer drugs faster
- P-glycoprotein activity decreases as tumors get older
- Their higher metabolic rate makes them less vulnerable to chemotherapeutic agents
- Topoisomerase activity (ability to self-repair DNA strand damage) increases with tumor s i ze
9. A man has prostate cancer that will be treated with Which drug are you most l ikely to use adjunctively when starting chemotherapy?
- An aromatase inhibitor (eg, anastrozole)
- Prednisone or another potent glucocorticoid
10. As part of the treatment plan for a Hodgkin disease patient we have given Which phrase best describes the anticancer mechanism of action of this drug?
- Alkylates DNA, causing cross-links between parallel DNA strands
- Blocks microtubular assembly and mitosis during M-phase
- Inhibits topoisomerase, preventing repair of DNA strand breaks
- Intercalates in DNA strands, thereby preventing DNA replication by mRNA.
- Stabilizes microtubular arrays, thereby preventing mitosis
11. The oncology team has treated many patients with acute lymphocytic leukemia using a combination of One drug tends to cause a high incidence of lumbar and abdominal pain, s ignificant increases of plasma amylase and transaminase activity, and other symptoms of hepatic and/or pancreatic dysfunction. Some patients developed serious hypersensitivity reactions upon drug administration, and there have been occasional sudden deaths. Which drug best fi ts this description?
12. A 30-year-old woman being treated for ovarian cancer develops high frequency hearing loss and declining renal function in response to anticancer drug Which drug i s the most l ikely cause?
13. A 41-year-old woman comes to the outpatient area of the hematology-oncology center for her fi rst course of adjuvant chemotherapy for metastatic breast cancer following a left modified radical mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma of the Two biopsies were positive for cancer.
Following premedication with dexamethasone and ondansetron, she will receive combination chemotherapy with doxorubicin, cyclophosphamide, and fluorouracil. Twenty-four hours after the fi rst course of chemotherapy she will start a 10-day regimen with fi lgrastim. What i s the most l ikely reason for administering the fi lgrastim?
- Control of nausea and emesis
- Potentiate the anticancer effects of the chemotherapeutic agents
- Prevent doxorubicin-induced cardiotoxicity
- Reduce the ri sk/severity of chemo-induced neutropenia, and related infections
- Stimulate the gastric mucosa to repair damage caused by the chemotherapy drugs
14. A cancer patient receives prophylactic allopurinol before a course of What i s the main reason for giving the allopurinol?
- Facilitate host cell detoxification of the chemotherapeutic drug, thereby reducing host cell toxicities
- Inhibit the potential for DNA repair, by topoisomerases, that otherwise might lead to chemotherapy failure
- Potentiate the action of a nitrogen mustard or nitrosourea to bind to (cross-link) purine moieties in DNA strands
- Prevent myelosuppression and related blood dyscrasias
- Reduce the ri sk of hyperuricemia and i ts main consequences (renal damage, gout) that can occur with a massive cell ki l l
15. The FDA requires manufacturers of an anticancer drug to avoid concomitant administration of certain SSRI antidepressants (fluoxetine, paroxetine, and sertraline) to woman receiving a particular anticancer The drug in question i s mainly used to treat certain types of breast cancers and i s also used to prevent breast cancer recurrence. It commonly causes hot flashes and i s associated with a high incidence of nausea and vomiting. The SSRIs l i sted above are strong inhibitors of CYP2D6 and so they can interfere with the anticancer drug’s metabolic activation, which i s required for their chemotherapeutic effects. Which drug i s the most l ikely target of interactions with these SSRIs?
- Interferon alpha
16. Allopurinol or the newer related drug febuxostat i s commonly administered before initiating chemotherapy of leukemias and other blood- based cancers to prevent hyperuricemia and i ts It i s also important in preventing hyperuricemia in response to chemotherapy of some solid tumors. However, i t may potentiate the host toxicity of certain anticancer drugs by inhibiting their metabolic inactivation and detoxification. With which drug should concomitant use of allopurinol or febuxostat be avoided?
17. A 48-year-old patient was in renal failure, but fortunately she received a kidney We start her on cyclosporine to reduce the ri sk of graft rejection. What are the most common and worrisome adverse responses associated with this immunosuppressant?
- Cardiotoxicity and hepatotoxicity
- Hepatotoxicity and nephrotoxicity
- Hypotension and pulmonary fibrosis
- Nephrotoxicity and infection ri sk
- Thrombosis and pulmonary embolism or i schemic stroke