A 22 year-old woman has been diagnosed with leukemia. All of the following would be good treatment options for her EXCEPT:
C. flurouracil (ineffective against leukemias; effective against solid tumors only)
All of the following are possible adverse reactions of methotrexate EXCEPT:
B. pain and swelling of palms and soles of feet (flurouracil)
Which of the following is a mechanism of action descriptive of cytosine arabinoside?
a. inhibition of dihydrofolate reductase b. inhibition of thymidylate synthesis
c. competitive inhibition of deoxycytidine triphosphate into DNA
d. mimicry of adenine
e. cross-linking at 7-amino position of guanine molecule
c. competitive inhibition of deoxycytidine triphosphate into DNA
All of the following are contraindicated in patients with impaired renal function EXCEPT:
C. doxorubicin (contraindicated in patients with liver dysfunction only)
Which of the following can block the effects of fluorouracil?
C. methotrexate
A patient with granulocytic leukemia is given a mystery IV drug for treatment. She is otherwise healthy, is not immunocomprised and has sufficient renal function. After a few weeks of therapy she begins to experience unexpected CNS complications. The dose is adjusted to a lower amount and after a few weeks she is relieved of the CNS symptoms. What is the mystery drug?
D. cytosine arabinoside
A 35 year-old man has been diagnosed with leukemia. He has a history of gout and is currently taking allopurinol. If chosen for therapy, which of the following would have to be monitored closely in this patient?
E. mercaptopurine (DDI with allopurinol b/c it could increase the concentration of mercaptopurine to toxic levels; needs to be monitored closely)
All of the following are involved with the interference of DNA synthesis via alkylation EXCEPT:
B. actinomycin D (inhibits DNA and RNA synthesis through binding but it does not alkylate -- it intercalates)
a. immunosuppression
b. estrogen antagonist
c. arrests cell in metaphase via microtubule dissociation
d. inhibition of metaphase via tubulin polymerization
e. interacts with topoisomerase and inhibits DNA and RNA synthesis
1. doxorubin - e. interacts with topoisomerase and inhibits DNA and RNA synthesis
2. vinca alkaloids - c. arrests cell in metaphase via microtubule dissociation
3. taxol - d. inhibition of metaphase via tubulin polymerization
4. prednisone - a. immunosuppression
5. tamoxifen - b. estrogen antagonist
A 68 year-old woman, 72 kg, is admitted to the hospital because of non-small cell lung cancer. Initially, she has normal renal function: serum creatine concentration of 118 micromoles/L. The patient will be treated with carboplatin as 1-hour infusion. The target AUC is 5mg/ml*min.
Determine an appropriate dose of carboplatin to achieve the desired AUC of 5mg/ml*min, by using the methods of Calvert.
Scr = serum creatinine concentrationAUC = area under plasma concentration-time curve
GFR = [1.04 * (140 - age) * BW/ (Scr)] * 0.85 because female
= [1.04 * (140 - 68) * 72/(118)] * 0.85
= 38.84 ml/min
Dose = target AUC * (GFR + 25)
= 5 * (38.84 + 25)
= 319.20 mg
A 68 year-old woman, 72 kg, is admitted to the hospital because of non-small cell lung cancer. Initially, she has normal renal function: serum creatine concentration of 118 micromoles/L. The patient will be treated with carboplatin as 1-hour infusion. The target AUC is 5mg/ml*min. Her GFR is 38.84 ml/min and she was given a dose of 319.20 mg.
After one-cycle of treatment, the patient develops thrombocytopenia. Plasma carboplatin concentrations at 2.7 hours was determined as 15.5 mg/L. Estimate the actual AUC using LSM. We want to decrease the dosage to attain the original target AUC. Determine a modified dose for the patient using the new information.
AUC = area under plasma concentration-time curve
LSM = limited sampling models
actual AUC = 0.52 * C at 2.75 hours + 0.92 = 0.52 * 15.5 + 0.92
