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Questions and Answers

Which of the following is a folate analog commonly used in cancer chemotherapy?

  • Fluorouracil
  • Methotrexate (correct)
  • Cytarabine
  • Paclitaxel
  • What is the primary mechanism of action for fluorouracil (5-FU)?

    Inhibits DNA synthesis by inhibiting thymidylate synthase.

    Capecitabine is a prodrug that is activated to FdUMP in target cells.

    True

    What is the name of the prodrug for 5-FU?

    <p>Capecitabine</p> Signup and view all the answers

    What is the name of the prodrug for Cytarabine (ara-C)?

    <p>Cytosar</p> Signup and view all the answers

    What drug is a competitive inhibitor of thymidylate synthase, leading to inhibition of DNA synthesis?

    <p>Raltitrexed (Tomudex)</p> Signup and view all the answers

    Gemcitabine is a prodrug that is activated to dFdCTP, which inhibits DNA polymerase.

    <p>True</p> Signup and view all the answers

    What are the two main topoisomerase inhibitors mentioned in the provided content?

    <p>Etoposide and Irinotecan</p> Signup and view all the answers

    Which of the following drugs is a microtubule inhibitor and is highly specific to M-phase?

    <p>All of the above</p> Signup and view all the answers

    What is the name of the drug that is a prodrug activated by carboxylesterase, and is commonly used to treat cancer?

    <p>Irinotecan (Camptosar)</p> Signup and view all the answers

    Match the following drugs with their main mechanism of action:

    <p>Methotrexate = Inhibits dihydrofolate reductase, an enzyme essential for the synthesis of DNA and RNA Fluorouracil (5-FU) = Inhibits thymidylate synthase, a key enzyme responsible for DNA replication Cytarabine (Ara-C) = Inhibits DNA polymerase, an essential enzyme present in many cancerous cells Paclitaxel = Promotes the stability of microtubule polymers, arresting cells in metaphase of mitosis Irinotecan = Inhibits topoisomerase I, preventing the enzyme's activity and disrupting DNA replication Cyclophosphamide = Alkylates nucleophilic moieties on DNA and protein</p> Signup and view all the answers

    Study Notes

    Cell Cycle Specific Agents

    • Mechanism of Action: Drugs function by inhibiting dihydrofolate reductase, interfering with purine and thymine synthesis, or competing with enzymes within specific phases (S-phase mostly). Some drugs compete with thymidylate synthase for thymidine.

    • Pharmacokinetics: Many drugs are well absorbed orally or administered intravenously (IV). Plasma protein binding, renal excretion, and other pathways vary depending on the individual drug.

    • Toxicity: Common side effects include gastrointestinal disturbances, myelosuppression, and nephrotoxicity. Some drugs cause organ-specific effects like pulmonary toxicity.

    • Resistance: Impaired cellular uptake, drug export by multidrug resistance protein, or enzyme mutations can lead to drug resistance.

    Anti-metabolites: Pyrimidine Analogs

    • Mechanism of Action: Inhibiting specific enzymes in thymidine synthesis or by mimicking natural molecules (e.g. acting as nucleosides).

    • Pharmacokinetics: Variable oral or IV absorption; significant metabolism by liver or other enzymes.

    • Toxicity: Common GI side effects, myelosuppression, and potential for cardiovascular issues. Other toxicities include rare cases of cerebellar or ocular toxicity.

    • Resistance: Decreased enzyme activity, altered drug uptake mechanisms, and drug activation changes can lead to resistance.

    Anti-metabolites: Purine Analogs

    • Mechanism of Action: Acting as analogs to purine compounds, these agents block or interfere with purine synthesis at different levels.

    • Pharmacokinetics: Varied oral and IV absorption and metabolism.

    • Toxicity: Myelosuppression (bone marrow suppression), other organ-related toxicities.

    • Resistance: Mutational changes in enzymes or alterations in drug export mechanisms can lead to resistance.

    Topoisomerase Inhibitors

    • Mechanism of Action: Inhibition of DNA topoisomerase enzyme, influencing DNA replication and repair.

    • Pharmacokinetics: Primarily intravenous administration. Rapid and extensive metabolism by various enzymes.

    • Toxicity: Myelosuppression, gastrointestinal discomfort, and potential for severe diarrhea or cholinergic syndrome.

    • Resistance: Altered enzyme activity, impaired accumulation of active metabolites or altered drug export mechanisms can influence resistance.

    Microtubule Inhibitors

    • Mechanism of Action: Interference with microtubule assembly, crucial for cell division.

    • Pharmacokinetics: Varied routes, with primary administration being intravenous.

    • Toxicity: Peripheral neuropathy, myelosuppression, and/or emetogenicity are commonly seen side effects.

    • Resistance: Mutations in specific cellular processes, or changes in the cellular machinery involved in the process can lead to resistance.

    Other Antineoplastic Agents

    • Mechanism of Action: Varies significantly; may involve alkylation, inhibition of specific enzymes (e.g. topoisomerases), or immunesystem-modulating properties.

    • Pharmacokinetics: Drug administration by various routes and notable metabolic pathways.

    • Toxicity: A wide range of possible toxicities including myelosuppression, gastrointestinal issues, and various organ-specific effects are possible.

    • Resistance: Several mechanisms including increased drug efflux, altered drug metabolism, overexpression of drug resistance proteins and/or cellular mutations.

    Genotoxic Agents

    • Mechanism of Action: Alkylating agents that directly damage DNA.

    • Pharmacokinetics: Can be absorbed orally or intravenously.

    • Toxicity: Bone marrow suppression, nausea, vomiting, and other effects.

    • Resistance: Decreased DNA damage through increased DNA repair systems.

    Anthracyclines

    • Mechanism of Action: Intercalate into DNA, and interfere with DNA replication and repair. Also can cause oxidative stress.

    • Pharmacokinetics: Intravenous administration and metabolism.

    • Toxicity: Potential cardiovascular issues, myelosuppression, and secondary cancer.

    • Resistance: Altered cellular defenses against reactive oxygen species.

    Molecular Targeted Agents

    • Mechanism of Action: Inhibit specific enzymes or proteins involved in cell signaling and proliferation.

    • Pharmacokinetics: Varies by agent, frequently requiring oral or intravenous administration.

    • Toxicity: Myelosuppression, other possible organ related toxicities, cardiovascular issues, and others.

    • Resistance: Genetic mutations that change the specific target of the drug, resulting in its decreased effectiveness.

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