Dental Pharmacology Cancer chemotherapy
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Questions and Answers

Which type of therapy is used as an adjunct to other treatments like surgery and radiation?

  • Antibiotics
  • Preparative therapy
  • Primary therapy
  • Adjuvant therapy (correct)

    • What are the major disadvantages of cancer chemotherapy?

  • Loss of specificity of action against bacterial infection (correct)
  • Perturbation of cell functions
  • Ease in distinguishing tumor cells from normal cells
  • Modification of cellular macromolecules

    • What is the primary goal of a cure in cancer treatment?

  • Improve quality of life
  • Eliminate all tumor cells (correct)
  • Reduce tumor size
  • Prevent tumor metastasis

    • What is the significance of the number of tumor cells in relation to the appearance of disease symptoms?

    <p>More tumor cells lead to earlier symptoms</p> Signup and view all the answers

    Which type of cells are difficult to distinguish from self due to their similarity to normal cells?

    <p>Cancer cells</p> Signup and view all the answers

    What is the recommended sequence of treatment for LARGE gastrointestinal stromal tumors (GIST), colorectal cancer, and osteogenic sarcoma?

    <p>Chemotherapy followed by surgery and/or radiation</p> Signup and view all the answers

    Which type of therapy is contraindicated when surgery and radiation are not possible due to tumor size?

    <p>Preparative therapy</p> Signup and view all the answers

    What is the approximate number of tumor cells needed for symptoms of disease to appear?

    <p>10^9-10^10 cells</p> Signup and view all the answers

    According to the Skipper Hypothesis, repetitive treatment with the same drug will kill an equal ________ of cells.

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

    What is the significance of the Skipper Hypothesis in treatment regimens?

    <p>It explains the variability in treatment response</p> Signup and view all the answers

    When does Delayed Toxicity of cancer chemotherapeutic agents occur?

    <p>Within days or weeks</p> Signup and view all the answers

    Which enzyme is primarily inhibited by 5-Fluorouracil (5-FU) as a mechanism of action?

    <p>Thymidylate synthetase (synthase)</p> Signup and view all the answers

    Which of the following is an indication for the use of 5-Fluorouracil (5-FU) as a chemotherapeutic agent?

    <p>Colon cancer</p> Signup and view all the answers

    What is the recommended route of administration for 5-Fluorouracil (5-FU)?

    <p>Intravenous (IV) only</p> Signup and view all the answers

    What are the delayed toxicities associated with 5-Fluorouracil (5-FU) administration?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which class of cancer drugs inhibits RNA synthesis?

    <p>CCS drugs</p> Signup and view all the answers

    Which enzyme does Methotrexate primarily inhibit as a mechanism of action?

    <p>Dihydrofolate reductase</p> Signup and view all the answers

    What is the route of administration for Methotrexate?

    <p>IV or oral</p> Signup and view all the answers

    What are the indications for Methotrexate therapy?

    <p>Acute lymphocytic leukemia, acute myelogeneous leukemia, choriocarcinoma, and lung cancer</p> Signup and view all the answers

    What are the adverse effects associated with Methotrexate?

    <p>Oral and GI ulceration, bone marrow depression, leukopenia, thrombocytopenia</p> Signup and view all the answers

    What is the role of leucovorin rescue in Methotrexate therapy?

    <p>Used to counteract the delayed toxicities of Methotrexate</p> Signup and view all the answers

    Which of the following is NOT a mechanism of action of Methotrexate?

    <p>Inhibits covalent interaction</p> Signup and view all the answers

    What does it inhibit in Methotrexate's mechanism of action?

    <p>1-carbon transfer reactions</p> Signup and view all the answers

    What is the role of Methotrexate as a folic acid antagonist?

    <p>Inhibits 1-carbon transfer reactions</p> Signup and view all the answers

    Which phase of the cell cycle does CYTARABINE primarily target?

    <p>S phase</p> Signup and view all the answers

    What is the primary mechanism of action of CYTARABINE?

    <p>Competitive inhibition of dNTP synthesis</p> Signup and view all the answers

    What are the common adverse effects associated with CYTARABINE therapy?

    <p>Erection and stomatitis</p> Signup and view all the answers

    What are the recommended administration schedules for CYTARABINE?

    <p>Continuous infusion or every 8-12 hours for 5-7 days</p> Signup and view all the answers

    Which of the following best describes the mechanism of action of CYTARABINE?

    <p>It inhibits chain elongation and induces defective ligation</p> Signup and view all the answers

    What is the primary indication for therapy with CYTARABINE?

    <p>Acute myelocytic leukemia</p> Signup and view all the answers

    Which nucleotides are affected by the inhibition of purine synthesis?

    <p>Guanine nucleotides</p> Signup and view all the answers

    What is the administration route for 6TG?

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

    What is the primary indication for therapy with 6MP?

    <p>Childhood leukemia</p> Signup and view all the answers

    What are the adverse effects of purine antagonists?

    <p>Delayed toxicity, bone marrow depression</p> Signup and view all the answers

    What is the role of Allopurinol in supportive therapy?

    <p>Protection against purine and pyrimidine analogues toxicity</p> Signup and view all the answers

    What is the primary indication for therapy with 6TG?

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

    Which of the following drugs acts as a spindle poison by depolymerizing microtubules and thus disrupting cytoskeletal structure?

    <p>Vincristine and Vinblastine</p> Signup and view all the answers

    Which drug enhances tubulin polymerization?

    <p>Paclitaxel and Docetaxel</p> Signup and view all the answers

    Which drug is indicated for systemic Hodgkin’s Disease?

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

    Which drug is used in combination chemotherapy with prednisone in acute leukemia in children?

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

    Which drug is commonly used for ovarian cancer and advanced breast cancer?

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

    Which drug is used for breast, prostate, and non-small cell cancers?

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

    Which drug exhibits only delayed toxicity and has a significant incidence of neurotoxicity?

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

    Which drug has acute toxicity including nausea, vomiting, hypotension, and arrhythmias with delayed toxicity leading to bone marrow suppression?

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

    Which drug has delayed toxicity including alopecia and hematological effects?

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

    Why is the mouth at special risk for developing drug-induced toxicity?

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

    Which of the following is the mechanism of action of alkaloid derivatives of plants?

    <p>Depolymerize microtubules disrupting cytoskeletal structure</p> Signup and view all the answers

    What is the acute effect of vinblastine toxicity?

    <p>Nausea and vomiting</p> Signup and view all the answers

    Which drug specifically binds to the dimeric form of tubulin resulting in mitotic arrest at metaphase?

    <p>Vincristine and Vinblastine</p> Signup and view all the answers

    Which drug binds specifically to the dimeric form of tubulin resulting in mitotic arrest at metaphase?

    <p>Vincristine and Vinblastine</p> Signup and view all the answers

    What are the delayed toxicities associated with vinblastine?

    <p>Marrow depression and alopecia</p> Signup and view all the answers

    Which drug exhibits acute toxicity including nausea, vomiting, hypotension, and arrhythmias with delayed toxicity leading to bone marrow suppression?

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

    Study Notes

    Cancer Treatment Overview

    • Adjuvant therapy complements other treatments like surgery and radiation.
    • Chemotherapy disadvantages include severe side effects, risk of resistance, and impact on healthy cells.
    • The primary goal of curing cancer treatment is to eradicate the disease completely.

    Tumor Cells and Disease Symptoms

    • A high number of tumor cells correlates with the onset of disease symptoms.
    • Approximately 1 million tumor cells are needed for symptoms to manifest.
    • Cells that closely resemble normal cells pose identification challenges for the immune system.

    Treatment Recommendations

    • Large gastrointestinal stromal tumors (GIST) are best treated with surgical resection followed by imatinib.
    • Colorectal cancer typically follows a sequence of surgery, potentially chemotherapy, and targeted therapies.
    • Osteogenic sarcoma treatment often starts with chemotherapy followed by surgery.

    Contraindications and Treatment Strategies

    • Hormonal therapy is contraindicated when surgery and radiation are ineffective due to tumor size.
    • The Skipper Hypothesis suggests that repeated dosing with the same drug results in a constant proportion of cell death.

    Chemotherapeutic Agents

    • 5-Fluorouracil (5-FU) inhibits thymidylate synthase as its mechanism of action. Its administration route is intravenously or orally.
    • Common indications for 5-FU include colorectal cancer and head and neck cancers. Delayed toxicities involve myelosuppression and hand-foot syndrome.

    Methotrexate Insights

    • Methotrexate primarily inhibits dihydrofolate reductase, impacting folic acid metabolism. It is administered either intravenously or orally.
    • Indications for Methotrexate therapy include lymphomas, leukemias, and certain solid tumors. Adverse effects can range from hepatotoxicity to myelosuppression.
    • Leucovorin rescue mitigates toxicity in high-dose Methotrexate therapy.

    CYTARABINE and Purine Antagonists

    • CYTARABINE primarily targets the S phase of the cell cycle, inhibiting DNA synthesis.
    • Adverse effects of CYTARABINE can include myelosuppression and nausea. Recommended schedules vary based on the treatment regimen.
    • 6-Thioguanine (6TG) and 6-Mercaptopurine (6MP) are used for acute leukemia, with common adverse effects involving liver toxicity and risk of infection.

    Supportive Therapies

    • Allopurinol is used in supportive therapy to manage hyperuricemia due to cell turnover from chemotherapy.

    Specific Drug Actions and Toxicities

    • Vincristine acts as a spindle poison, disrupting microtubule formation and leading to mitotic arrest.
    • Common agents include doxorubicin for systemic Hodgkin's disease and bleomycin as part of combination therapy for acute leukemia.
    • Drugs like paclitaxel are indicated for breast and ovarian cancer, while tamoxifen is utilized for breast and prostate cancers.
    • Delayed toxicities such as alopecia or hematologic effects can occur with various chemotherapeutic agents.

    Drug-induced Toxicity

    • The oral cavity is especially susceptible to drug-induced toxicity due to rapid cell turnover and exposure.
    • Alkaloid derivatives of plants often act by disrupting microtubule function during the cell division process.
    • Acute effects of vinblastine toxicity can include neurotoxicity, nausea, and anti-mitotic effects.

    Key Mechanisms of Action

    • The mechanism of action for alkaloids includes interaction with tubulin to inhibit mitotic spindle formation, crucial for cell division.

    Miscellaneous Findings

    • Specific drugs that lead to delayed toxicities include vincristine and doxorubicin, both of which also have acute side effects such as nausea and bone marrow suppression.

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    Description

    Test your knowledge on the general principles of adjuvant therapy for gastrointestinal stromal tumors (GIST) and colorectal cancer. Learn about the use of chemotherapy as an adjunct to surgery and radiation, as well as when surgery and radiation may be contraindicated. Discover the importance of preparative therapy and the role of chemotherapy in reducing tumor size prior to other treatments.

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