Nursing Pharmacology Chemotherapy Practice Exam Quiz

Nursing Pharmacology Chemotherapy Practice Exam Quiz

 

Question 1:

What is the primary mechanism of action for alkylating agents in chemotherapy?
A. Inhibiting DNA synthesis
B. Inducing DNA cross-linking
C. Targeting microtubules
D. Blocking enzyme activity

Question 2:

Which of the following is a common side effect of most chemotherapy drugs?
A. Hyperglycemia
B. Diarrhea
C. Immunosuppression
D. Insomnia

Question 3:

What does the term “adjuvant chemotherapy” refer to?
A. Chemotherapy used alone
B. Chemotherapy given after surgery
C. Chemotherapy given to alleviate symptoms
D. Chemotherapy given in combination with radiation therapy

Question 4:

Which chemotherapeutic drug is classified as an antimetabolite?
A. Cisplatin
B. Methotrexate
C. Paclitaxel
D. Vincristine

Question 5:

What is the dose-limiting toxicity for doxorubicin?
A. Nephrotoxicity
B. Cardiotoxicity
C. Neurotoxicity
D. Hepatotoxicity

Question 6:

Which of the following is a cell cycle-specific chemotherapy agent?
A. Cyclophosphamide
B. 5-Fluorouracil
C. Vinblastine
D. Cisplatin

Question 7:

What is the most common route of administration for chemotherapy drugs?
A. Oral
B. Intramuscular
C. Intravenous
D. Subcutaneous

Question 8:

Which of the following drugs is used to treat nausea and vomiting caused by chemotherapy?
A. Ondansetron
B. Warfarin
C. Metformin
D. Lisinopril

Question 9:

Which chemotherapy agent is associated with peripheral neuropathy as a side effect?
A. Vincristine
B. Doxorubicin
C. Methotrexate
D. Cyclophosphamide

Question 10:

What is the role of leucovorin in combination with methotrexate?
A. Enhance its efficacy
B. Reduce its toxicity
C. Prolong its half-life
D. Prevent drug resistance

Question 11:

Paclitaxel is classified as:
A. An alkylating agent
B. A taxane
C. An antimetabolite
D. A monoclonal antibody

Question 12:

Which chemotherapy drug is known for causing hemorrhagic cystitis?
A. Cisplatin
B. Cyclophosphamide
C. Vincristine
D. Methotrexate

Question 13:

Why is filgrastim often administered to patients undergoing chemotherapy?
A. To increase red blood cell production
B. To stimulate white blood cell production
C. To prevent alopecia
D. To reduce gastrointestinal side effects

Question 14:

The term “neoadjuvant chemotherapy” refers to:
A. Chemotherapy given before surgery
B. Chemotherapy given after surgery
C. Chemotherapy given for palliative care
D. Chemotherapy given to prevent recurrence

Question 15:

Which of the following is a topoisomerase inhibitor?
A. Cisplatin
B. Irinotecan
C. Doxorubicin
D. Methotrexate

Question 16:

What is the main toxicity associated with cisplatin?
A. Neurotoxicity
B. Nephrotoxicity
C. Cardiotoxicity
D. Hepatotoxicity

Question 17:

Which of the following is a common side effect of 5-Fluorouracil?
A. Hypertension
B. Mucositis
C. Myopathy
D. Hypoglycemia

Question 18:

What is the primary target of monoclonal antibodies in chemotherapy?
A. Enzymes involved in metabolism
B. Specific proteins on cancer cells
C. DNA replication machinery
D. Microtubule assembly

Question 19:

Tamoxifen is most commonly used to treat which type of cancer?
A. Lung cancer
B. Breast cancer
C. Colon cancer
D. Pancreatic cancer

Question 20:

Which of the following is a mechanism of resistance to chemotherapy?
A. Increased apoptosis
B. Increased drug efflux pumps
C. Increased drug binding to target proteins
D. Increased immune response

Question 21:

Which of the following chemotherapy drugs is a platinum compound?
A. Doxorubicin
B. Methotrexate
C. Cisplatin
D. Vincristine

Question 22:

Which side effect is most commonly associated with anthracyclines?
A. Pulmonary fibrosis
B. Cardiotoxicity
C. Hemorrhagic cystitis
D. Ototoxicity

Question 23:

Which type of chemotherapy targets the M-phase of the cell cycle?
A. Antimetabolites
B. Alkylating agents
C. Microtubule inhibitors
D. Topoisomerase inhibitors

Question 24:

Which chemotherapy agent is used as a radiosensitizer?
A. Cisplatin
B. Methotrexate
C. Doxorubicin
D. Paclitaxel

Question 25:

What is the main purpose of combination chemotherapy?
A. Reduce costs of treatment
B. Improve efficacy and prevent resistance
C. Limit adverse side effects
D. Minimize treatment duration

Question 26:

What is the term for the lowest point of blood cell counts during chemotherapy?
A. Anemia
B. Leukopenia
C. Nadir
D. Thrombocytopenia

Question 27:

Bevacizumab inhibits which process to combat tumor growth?
A. DNA synthesis
B. Angiogenesis
C. Apoptosis
D. Protein synthesis

Question 28:

What is the most effective intervention for preventing chemotherapy-induced alopecia?
A. Scalp cooling
B. Topical corticosteroids
C. Regular haircuts
D. Avoiding sun exposure

Question 29:

What is the function of dexrazoxane in chemotherapy?
A. Enhance drug efficacy
B. Protect the heart from toxicity
C. Boost immune response
D. Reduce nausea

Question 30:

Which chemotherapeutic drug is a pyrimidine analog?
A. Cisplatin
B. Methotrexate
C. 5-Fluorouracil
D. Vinblastine

 

Question 31:

Which drug is commonly used to prevent chemotherapy-induced neutropenia?
A. Erythropoietin
B. Filgrastim
C. Methotrexate
D. Tamoxifen

Question 32:

Which type of cancer is often treated with carboplatin?
A. Ovarian cancer
B. Prostate cancer
C. Leukemia
D. Pancreatic cancer

Question 33:

What is a characteristic feature of targeted chemotherapy?
A. Non-selective action on dividing cells
B. Specific action on cancer cell receptors
C. High toxicity to normal tissues
D. Action only in G1 phase of the cell cycle

Question 34:

Which chemotherapy agent inhibits microtubule assembly?
A. Vincristine
B. Cisplatin
C. Cyclophosphamide
D. Irinotecan

Question 35:

Which of the following is used to manage chemotherapy-induced anemia?
A. Erythropoiesis-stimulating agents
B. Colony-stimulating factors
C. Corticosteroids
D. Antibiotics

Question 36:

What is the mechanism of action for the monoclonal antibody trastuzumab?
A. Inhibits EGFR
B. Targets HER2/neu receptor
C. Blocks VEGF
D. Inhibits PD-1

Question 37:

Which type of chemotherapy is often associated with ototoxicity?
A. Anthracyclines
B. Platinum-based agents
C. Taxanes
D. Alkylating agents

Question 38:

Which is the correct pairing of chemotherapy drug and its major toxicity?
A. Bleomycin – Pulmonary fibrosis
B. Methotrexate – Cardiotoxicity
C. Paclitaxel – Nephrotoxicity
D. Cyclophosphamide – Ototoxicity

Question 39:

Which of the following drugs can cause red discoloration of urine?
A. Cyclophosphamide
B. Doxorubicin
C. Cisplatin
D. Methotrexate

Question 40:

Which class of drugs does imatinib belong to?
A. Kinase inhibitors
B. Topoisomerase inhibitors
C. Alkylating agents
D. Antimetabolites

Question 41:

Which drug is used to reduce methotrexate toxicity?
A. Leucovorin
B. Filgrastim
C. Etoposide
D. Bleomycin

Question 42:

What is the major adverse effect of irinotecan?
A. Alopecia
B. Diarrhea
C. Nephrotoxicity
D. Cardiotoxicity

Question 43:

Which of the following is a checkpoint inhibitor used in cancer therapy?
A. Pembrolizumab
B. Paclitaxel
C. Cyclophosphamide
D. Doxorubicin

Question 44:

Which chemotherapy drug is a purine analog?
A. 6-Mercaptopurine
B. Methotrexate
C. Paclitaxel
D. Cisplatin

Question 45:

Which organ is most affected by methotrexate toxicity?
A. Liver
B. Kidney
C. Lungs
D. Heart

Question 46:

Which chemotherapy drug is known for causing cold sensitivity?
A. Oxaliplatin
B. Doxorubicin
C. Methotrexate
D. Vincristine

Question 47:

Which of the following agents is used to reverse the effects of irinotecan-induced diarrhea?
A. Loperamide
B. Ondansetron
C. Leucovorin
D. Filgrastim

Question 48:

What is the primary mechanism of action of antimetabolites?
A. Inhibit DNA synthesis
B. Induce apoptosis
C. Disrupt microtubule dynamics
D. Target cancer-specific proteins

Question 49:

Which of the following drugs targets VEGF to inhibit angiogenesis?
A. Bevacizumab
B. Trastuzumab
C. Imatinib
D. Cisplatin

Question 50:

Which phase of the cell cycle is specifically targeted by taxanes?
A. G1
B. S
C. M
D. G2

Question 51:

Which chemotherapy agent is derived from camptothecin?
A. Irinotecan
B. Paclitaxel
C. Cisplatin
D. Vincristine

Question 52:

Which drug is commonly used to treat HER2-positive breast cancer?
A. Trastuzumab
B. Bevacizumab
C. Tamoxifen
D. Paclitaxel

Question 53:

Which drug is classified as a proteasome inhibitor?
A. Bortezomib
B. Tamoxifen
C. Cisplatin
D. Methotrexate

Question 54:

What is the mechanism of action of cyclophosphamide?
A. Alkylation of DNA
B. Inhibition of microtubules
C. Topoisomerase inhibition
D. VEGF inhibition

Question 55:

Which agent is used to manage cisplatin-induced nephrotoxicity?
A. Amifostine
B. Leucovorin
C. Filgrastim
D. Dexamethasone

 

Question 56:

Which chemotherapy agent is most likely to cause cardiotoxicity?
A. Doxorubicin
B. Cisplatin
C. Methotrexate
D. Bleomycin

Question 57:

Which of the following is a taxane-based chemotherapy drug?
A. Paclitaxel
B. Doxorubicin
C. Vincristine
D. Cyclophosphamide

Question 58:

Which phase of the cell cycle is targeted by antimetabolites?
A. S phase
B. M phase
C. G0 phase
D. G1 phase

Question 59:

Which drug is used to treat chemotherapy-induced nausea and vomiting?
A. Ondansetron
B. Loperamide
C. Dexamethasone
D. Morphine

Question 60:

Which alkylating agent requires activation in the liver?
A. Cyclophosphamide
B. Methotrexate
C. Cisplatin
D. Vinblastine

Question 61:

Which chemotherapy drug is classified as a topoisomerase I inhibitor?
A. Irinotecan
B. Doxorubicin
C. Etoposide
D. Vincristine

Question 62:

What is the primary adverse effect of 5-fluorouracil (5-FU)?
A. Hand-foot syndrome
B. Ototoxicity
C. Nephrotoxicity
D. Pulmonary fibrosis

Question 63:

Which chemotherapy agent is known for causing hemorrhagic cystitis?
A. Cyclophosphamide
B. Methotrexate
C. Vinblastine
D. Cisplatin

Question 64:

Which of the following drugs is a pyrimidine analog?
A. 5-Fluorouracil
B. 6-Mercaptopurine
C. Cisplatin
D. Vincristine

Question 65:

Which drug can cause pulmonary fibrosis as a side effect?
A. Bleomycin
B. Doxorubicin
C. Methotrexate
D. Cisplatin

Question 66:

Which class of drugs does tamoxifen belong to?
A. Selective estrogen receptor modulators (SERMs)
B. Alkylating agents
C. Antimetabolites
D. Topoisomerase inhibitors

Question 67:

What is the mechanism of action of cisplatin?
A. DNA crosslinking
B. Microtubule stabilization
C. Topoisomerase II inhibition
D. Protein kinase inhibition

Question 68:

Which chemotherapy drug is used to treat testicular cancer?
A. Cisplatin
B. Methotrexate
C. Doxorubicin
D. Tamoxifen

Question 69:

Which of the following is a common side effect of paclitaxel?
A. Peripheral neuropathy
B. Nephrotoxicity
C. Pulmonary fibrosis
D. Cardiotoxicity

Question 70:

Which monoclonal antibody targets VEGF?
A. Bevacizumab
B. Rituximab
C. Cetuximab
D. Trastuzumab

Question 71:

Which drug is given to reduce the risk of hemorrhagic cystitis during cyclophosphamide therapy?
A. Mesna
B. Leucovorin
C. Filgrastim
D. Amifostine

Question 72:

Which of the following drugs is an anthracycline?
A. Doxorubicin
B. Paclitaxel
C. Cisplatin
D. Methotrexate

Question 73:

What is a dose-limiting toxicity of vincristine?
A. Neurotoxicity
B. Pulmonary toxicity
C. Myelosuppression
D. Cardiotoxicity

Question 74:

Which chemotherapy drug is most associated with secondary leukemia?
A. Etoposide
B. Cisplatin
C. Methotrexate
D. Paclitaxel

Question 75:

Which agent is used to manage chemotherapy-induced neutropenia?
A. Filgrastim
B. Erythropoietin
C. Ondansetron
D. Leucovorin

Question 76:

Which drug is a folic acid antagonist?
A. Methotrexate
B. Cisplatin
C. Doxorubicin
D. Vinblastine

Question 77:

What is the main adverse effect of anthracyclines like doxorubicin?
A. Cardiotoxicity
B. Pulmonary fibrosis
C. Neurotoxicity
D. Hand-foot syndrome

Question 78:

Which chemotherapy drug is commonly used in colorectal cancer?
A. Oxaliplatin
B. Tamoxifen
C. Vincristine
D. Methotrexate

Question 79:

Which drug is used to prevent cisplatin-induced nephrotoxicity?
A. Amifostine
B. Leucovorin
C. Filgrastim
D. Dexamethasone

Question 80:

Which of the following drugs inhibits the HER2 receptor?
A. Trastuzumab
B. Cetuximab
C. Bevacizumab
D. Rituximab

 

Question 81:

Which chemotherapy drug is known for causing ototoxicity?
A. Cisplatin
B. Doxorubicin
C. Methotrexate
D. Paclitaxel

Question 82:

Which agent is considered a pyrimidine antagonist?
A. Cytarabine
B. Cyclophosphamide
C. Doxorubicin
D. Etoposide

Question 83:

Which of the following is most associated with red/orange discoloration of urine?
A. Doxorubicin
B. Cisplatin
C. Methotrexate
D. Cyclophosphamide

Question 84:

What is the primary mechanism of action of vincristine?
A. Microtubule inhibition
B. DNA intercalation
C. Topoisomerase inhibition
D. Folic acid antagonism

Question 85:

Which chemotherapy agent works by cross-linking DNA?
A. Cisplatin
B. 5-Fluorouracil
C. Methotrexate
D. Vinblastine

Question 86:

Which drug is used in the treatment of HER2-positive breast cancer?
A. Trastuzumab
B. Rituximab
C. Cetuximab
D. Bevacizumab

Question 87:

What is a common side effect of irinotecan?
A. Severe diarrhea
B. Pulmonary fibrosis
C. Cardiotoxicity
D. Ototoxicity

Question 88:

Which of the following is an antitumor antibiotic?
A. Bleomycin
B. Methotrexate
C. Vinblastine
D. Cisplatin

Question 89:

Which drug inhibits topoisomerase II?
A. Etoposide
B. Irinotecan
C. Paclitaxel
D. Cisplatin

Question 90:

Which chemotherapy drug is associated with neuropathy?
A. Vincristine
B. Doxorubicin
C. Methotrexate
D. Cisplatin

Question 91:

Which drug is given as a rescue agent after methotrexate therapy?
A. Leucovorin
B. Mesna
C. Filgrastim
D. Amifostine

Question 92:

Which class of drugs does imatinib belong to?
A. Tyrosine kinase inhibitors
B. Topoisomerase inhibitors
C. Taxanes
D. Antimetabolites

Question 93:

What is the primary adverse effect of bevacizumab?
A. Hypertension
B. Ototoxicity
C. Myelosuppression
D. Neurotoxicity

Question 94:

Which chemotherapy agent requires hydration to minimize nephrotoxicity?
A. Cisplatin
B. Methotrexate
C. Doxorubicin
D. Vincristine

Question 95:

Which of the following is a mitotic inhibitor?
A. Paclitaxel
B. Cyclophosphamide
C. Doxorubicin
D. Methotrexate

Question 96:

Which of the following drugs is most commonly associated with hand-foot syndrome?
A. Capecitabine
B. Doxorubicin
C. Vinblastine
D. Cisplatin

Question 97:

Which drug can cause secondary cancers, such as leukemia?
A. Etoposide
B. Methotrexate
C. Tamoxifen
D. Cisplatin

Question 98:

Which of the following is a VEGF inhibitor?
A. Bevacizumab
B. Trastuzumab
C. Rituximab
D. Cetuximab

Question 99:

Which chemotherapy drug is used for non-Hodgkin lymphoma?
A. Rituximab
B. Trastuzumab
C. Bevacizumab
D. Paclitaxel

Question 100:

Which of the following is a platinum-based agent?
A. Carboplatin
B. Methotrexate
C. Paclitaxel
D. Cyclophosphamide

Question 101:

Which enzyme is inhibited by methotrexate?
A. Dihydrofolate reductase
B. Topoisomerase I
C. Topoisomerase II
D. Tyrosine kinase

Question 102:

Which drug is effective against chronic myeloid leukemia (CML)?
A. Imatinib
B. Vincristine
C. Cisplatin
D. Etoposide

Question 103:

Which drug is associated with blue discoloration of the skin?
A. Mitoxantrone
B. Cisplatin
C. Methotrexate
D. Vincristine

Question 104:

Which chemotherapy agent can cause severe hypersensitivity reactions?
A. Paclitaxel
B. Cyclophosphamide
C. Methotrexate
D. Cisplatin

Question 105:

Which drug is an anti-estrogen used for breast cancer?
A. Tamoxifen
B. Bevacizumab
C. Doxorubicin
D. Methotrexate

 

Question 106:

Which of the following drugs is used to manage chemotherapy-induced nausea and vomiting (CINV)?
A. Ondansetron
B. Metoprolol
C. Lorazepam
D. Digoxin

Question 107:

What is the purpose of mesna when administered with ifosfamide?
A. Prevent hemorrhagic cystitis
B. Reduce cardiotoxicity
C. Prevent ototoxicity
D. Reduce nausea

Question 108:

Which of the following is an antimetabolite used in chemotherapy?
A. 5-Fluorouracil
B. Cisplatin
C. Paclitaxel
D. Vincristine

Question 109:

Which chemotherapy drug is known for causing pulmonary fibrosis?
A. Bleomycin
B. Methotrexate
C. Cisplatin
D. Cyclophosphamide

Question 110:

What is the dose-limiting toxicity of doxorubicin?
A. Cardiotoxicity
B. Nephrotoxicity
C. Neurotoxicity
D. Pulmonary fibrosis

Question 111:

Which of the following drugs targets CD20 in lymphoma treatment?
A. Rituximab
B. Bevacizumab
C. Trastuzumab
D. Cetuximab

Question 112:

Which of the following is a common side effect of cyclophosphamide?
A. Hemorrhagic cystitis
B. Peripheral neuropathy
C. Cardiotoxicity
D. Pulmonary fibrosis

Question 113:

Which of the following is classified as a taxane?
A. Docetaxel
B. Methotrexate
C. Cisplatin
D. Bleomycin

Question 114:

What is the mechanism of action of bevacizumab?
A. Inhibition of VEGF
B. Inhibition of HER2 receptors
C. Alkylation of DNA
D. Microtubule destabilization

Question 115:

What should the nurse monitor in patients receiving cisplatin?
A. Renal function
B. Thyroid function
C. Pulmonary function
D. Blood glucose

Question 116:

Which chemotherapy drug is associated with cardiotoxicity and requires baseline echocardiography?
A. Doxorubicin
B. Vincristine
C. Cisplatin
D. Methotrexate

Question 117:

Which drug is used to reduce the toxic effects of methotrexate?
A. Leucovorin
B. Amifostine
C. Mesna
D. Filgrastim

Question 118:

What type of drug is imatinib?
A. Tyrosine kinase inhibitor
B. Topoisomerase II inhibitor
C. DNA alkylating agent
D. Microtubule stabilizer

Question 119:

Which chemotherapy drug is associated with severe constipation?
A. Vincristine
B. Cisplatin
C. Cyclophosphamide
D. 5-Fluorouracil

Question 120:

Which chemotherapy agent can cause irreversible ototoxicity?
A. Cisplatin
B. Doxorubicin
C. Vinblastine
D. Methotrexate

Question 121:

Which drug is often used to treat estrogen receptor-positive breast cancer?
A. Tamoxifen
B. Rituximab
C. Bevacizumab
D. Cetuximab

Question 122:

Which of the following is most associated with a risk of febrile neutropenia?
A. Paclitaxel
B. Methotrexate
C. Cisplatin
D. 5-Fluorouracil

Question 123:

What is the mechanism of action of etoposide?
A. Topoisomerase II inhibition
B. VEGF inhibition
C. Microtubule stabilization
D. DNA intercalation

Question 124:

Which of the following agents is commonly associated with alopecia?
A. Paclitaxel
B. Bevacizumab
C. Trastuzumab
D. Rituximab

Question 125:

Which of the following is the primary toxicity associated with bleomycin?
A. Pulmonary toxicity
B. Cardiotoxicity
C. Nephrotoxicity
D. Neurotoxicity

Question 126:

Which drug is a folate antagonist?
A. Methotrexate
B. Cyclophosphamide
C. Paclitaxel
D. Cisplatin

Question 127:

Which drug requires co-administration of dexamethasone to prevent hypersensitivity reactions?
A. Paclitaxel
B. Vincristine
C. Methotrexate
D. Cisplatin

Question 128:

Which medication is used to prevent tumor lysis syndrome in chemotherapy patients?
A. Allopurinol
B. Dexamethasone
C. Leucovorin
D. Filgrastim

Question 129:

Which of the following drugs can cause peripheral neuropathy?
A. Oxaliplatin
B. Methotrexate
C. Doxorubicin
D. Cyclophosphamide

Question 130:

Which chemotherapy drug is a HER2 receptor antagonist?
A. Trastuzumab
B. Cetuximab
C. Bevacizumab
D. Rituximab

 

Question 131:

Which chemotherapy drug is associated with red or orange discoloration of urine?
A. Doxorubicin
B. Cisplatin
C. Methotrexate
D. Vincristine

Question 132:

What is the mechanism of action of trastuzumab?
A. HER2 receptor inhibition
B. VEGF inhibition
C. Alkylating DNA strands
D. Topoisomerase I inhibition

Question 133:

Which drug is administered with cisplatin to protect against nephrotoxicity?
A. Amifostine
B. Leucovorin
C. Mesna
D. Filgrastim

Question 134:

Which of the following drugs is classified as a vinca alkaloid?
A. Vinblastine
B. Paclitaxel
C. Methotrexate
D. Cyclophosphamide

Question 135:

Which chemotherapy drug is known to cause cold-induced neuropathy?
A. Oxaliplatin
B. Cisplatin
C. Doxorubicin
D. Vincristine

Question 136:

What is a common side effect of methotrexate therapy?
A. Mucositis
B. Ototoxicity
C. Pulmonary fibrosis
D. Peripheral neuropathy

Question 137:

Which of the following chemotherapy drugs is a proteasome inhibitor?
A. Bortezomib
B. Imatinib
C. Rituximab
D. Paclitaxel

Question 138:

Which monoclonal antibody targets vascular endothelial growth factor (VEGF)?
A. Bevacizumab
B. Trastuzumab
C. Cetuximab
D. Rituximab

Question 139:

What is the purpose of filgrastim in chemotherapy patients?
A. Increase neutrophil counts
B. Reduce nausea
C. Prevent hemorrhagic cystitis
D. Alleviate neuropathy

Question 140:

Which chemotherapy drug is most likely to cause hand-foot syndrome?
A. 5-Fluorouracil
B. Cisplatin
C. Methotrexate
D. Doxorubicin

Question 141:

Which of the following drugs is a topoisomerase I inhibitor?
A. Irinotecan
B. Etoposide
C. Paclitaxel
D. Cisplatin

Question 142:

Which chemotherapy drug requires monitoring for ototoxicity?
A. Cisplatin
B. Vinblastine
C. Methotrexate
D. Cyclophosphamide

Question 143:

Which of the following drugs is classified as an alkylating agent?
A. Cyclophosphamide
B. Methotrexate
C. 5-Fluorouracil
D. Paclitaxel

Question 144:

What is a major side effect of irinotecan?
A. Severe diarrhea
B. Nephrotoxicity
C. Cardiotoxicity
D. Alopecia

Question 145:

Which of the following agents is known to cause “stocking and glove” neuropathy?
A. Vincristine
B. Cisplatin
C. Doxorubicin
D. Methotrexate

Question 146:

What is the mechanism of action of tamoxifen?
A. Estrogen receptor antagonist
B. VEGF inhibitor
C. HER2 receptor inhibitor
D. Topoisomerase inhibitor

Question 147:

Which of the following drugs is an antitumor antibiotic?
A. Doxorubicin
B. Methotrexate
C. Vincristine
D. Cisplatin

Question 148:

What is the primary toxicity concern with high-dose methotrexate therapy?
A. Renal toxicity
B. Cardiotoxicity
C. Pulmonary toxicity
D. Neurotoxicity

Question 149:

Which chemotherapy drug requires co-administration of atropine to prevent cholinergic symptoms?
A. Irinotecan
B. Methotrexate
C. Paclitaxel
D. Vincristine

Question 150:

Which chemotherapy drug is associated with secondary malignancies, such as leukemia?
A. Cyclophosphamide
B. Methotrexate
C. 5-Fluorouracil
D. Trastuzumab

Question 151:

Which chemotherapy drug is most associated with severe myelosuppression?
A. Cytarabine
B. Vincristine
C. Paclitaxel
D. Rituximab

Question 152:

Which of the following agents is classified as a pyrimidine analog?
A. Cytarabine
B. Cyclophosphamide
C. Cisplatin
D. Vincristine

Question 153:

What is a hallmark side effect of rituximab?
A. Infusion-related reactions
B. Nephrotoxicity
C. Alopecia
D. Ototoxicity

Question 154:

Which chemotherapy drug targets the EGFR receptor?
A. Cetuximab
B. Trastuzumab
C. Bevacizumab
D. Vinblastine

Question 155:

What is the purpose of leucovorin in patients receiving 5-fluorouracil?
A. Enhances the drug’s efficacy
B. Prevents nephrotoxicity
C. Alleviates neuropathy
D. Prevents mucositis

 

Question 156:

What is the mechanism of action of bevacizumab?
A. Inhibition of VEGF
B. Estrogen receptor modulation
C. DNA alkylation
D. Protein synthesis inhibition

Question 157:

Which chemotherapy drug is most likely to cause hemorrhagic cystitis?
A. Cyclophosphamide
B. Doxorubicin
C. Cisplatin
D. Paclitaxel

Question 158:

Which of the following chemotherapy drugs is a taxane?
A. Paclitaxel
B. Vincristine
C. Methotrexate
D. Doxorubicin

Question 159:

Which drug is given to reduce cardiotoxicity associated with doxorubicin?
A. Dexrazoxane
B. Filgrastim
C. Amifostine
D. Mesna

Question 160:

What is the primary mechanism of action of cisplatin?
A. Cross-linking DNA strands
B. Inhibiting topoisomerase II
C. Blocking microtubule formation
D. Binding to VEGF receptors

Question 161:

Which chemotherapy agent is used for the treatment of acute promyelocytic leukemia (APL)?
A. All-trans retinoic acid (ATRA)
B. Methotrexate
C. Rituximab
D. Cisplatin

Question 162:

Which class of drugs does imatinib belong to?
A. Tyrosine kinase inhibitors
B. Monoclonal antibodies
C. Alkylating agents
D. Antimetabolites

Question 163:

Which chemotherapy agent is most associated with pulmonary toxicity?
A. Bleomycin
B. Methotrexate
C. Vincristine
D. Doxorubicin

Question 164:

Which of the following drugs is an aromatase inhibitor?
A. Anastrozole
B. Tamoxifen
C. Methotrexate
D. Trastuzumab

Question 165:

Which chemotherapy drug is used to treat multiple myeloma by targeting plasma cells?
A. Bortezomib
B. Cyclophosphamide
C. Methotrexate
D. Vinblastine

Question 166:

Which chemotherapy drug is associated with the development of peripheral edema?
A. Docetaxel
B. Cisplatin
C. Methotrexate
D. Rituximab

Question 167:

What is the mechanism of action of 5-fluorouracil?
A. Inhibiting thymidylate synthase
B. Alkylating DNA strands
C. Blocking microtubule disassembly
D. Inhibiting VEGF receptors

Question 168:

Which drug is commonly used to manage anemia in chemotherapy patients?
A. Epoetin alfa
B. Filgrastim
C. Mesna
D. Amifostine

Question 169:

What is the mechanism of action of vincristine?
A. Inhibits microtubule assembly
B. Cross-links DNA strands
C. Blocks VEGF receptors
D. Inhibits topoisomerase I

Question 170:

Which chemotherapy drug is known to cause cardiac arrhythmias as a side effect?
A. Arsenic trioxide
B. Methotrexate
C. Doxorubicin
D. Vincristine

Question 171:

What is the major toxicity concern with high-dose cytarabine?
A. Cerebellar toxicity
B. Cardiotoxicity
C. Nephrotoxicity
D. Ototoxicity

Question 172:

Which of the following drugs is a checkpoint inhibitor targeting PD-1?
A. Pembrolizumab
B. Bevacizumab
C. Cetuximab
D. Vinblastine

Question 173:

Which chemotherapy drug can cause a syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
A. Cyclophosphamide
B. Methotrexate
C. Doxorubicin
D. Cisplatin

Question 174:

Which chemotherapy drug is most associated with febrile neutropenia?
A. Paclitaxel
B. Rituximab
C. Tamoxifen
D. Trastuzumab

Question 175:

Which chemotherapy agent is used in conjunction with leucovorin for colorectal cancer?
A. 5-Fluorouracil
B. Methotrexate
C. Cisplatin
D. Vincristine

Question 176:

Which chemotherapy drug can cause acute pancreatitis?
A. L-asparaginase
B. Cisplatin
C. Cyclophosphamide
D. Doxorubicin

Question 177:

Which drug is commonly used for ovarian cancer and is a platinum-based agent?
A. Carboplatin
B. Vincristine
C. Methotrexate
D. Doxorubicin

Question 178:

Which chemotherapy drug works by inhibiting DNA methylation?
A. Azacitidine
B. Vinblastine
C. Doxorubicin
D. Cisplatin

Question 179:

Which chemotherapy drug can cause retinal toxicity and blurred vision?
A. Tamoxifen
B. Methotrexate
C. Cisplatin
D. Paclitaxel

Question 180:

Which of the following drugs targets CD20 on B-cells?
A. Rituximab
B. Trastuzumab
C. Cetuximab
D. Pembrolizumab

Questions and Answers for Study Guide

 

Describe the mechanism of action of alkylating agents in chemotherapy and their associated adverse effects.

Answer:

Alkylating agents are a class of chemotherapy drugs that work by adding alkyl groups to DNA. This process causes DNA cross-linking and strand breakage, which ultimately disrupts DNA replication and transcription. The inability of the cancer cell to repair the DNA damage leads to cell cycle arrest and apoptosis (programmed cell death). Alkylating agents are cell cycle–non-specific, meaning they can act during any phase of the cell cycle.

Examples of alkylating agents include:

• Cyclophosphamide
• Ifosfamide
• Chlorambucil

Adverse effects of alkylating agents:

1. Myelosuppression: This is the suppression of bone marrow activity, leading to reduced production of red blood cells, white blood cells, and platelets.
2. Nausea and vomiting: These drugs stimulate the chemoreceptor trigger zone, causing emesis.
3. Hemorrhagic cystitis: Particularly associated with cyclophosphamide and ifosfamide, caused by the toxic metabolite acrolein.
4. Secondary malignancies: Long-term use of alkylating agents may increase the risk of developing secondary cancers such as leukemia.

Management of adverse effects includes administering mesna to prevent hemorrhagic cystitis and providing supportive care for myelosuppression with growth factors like filgrastim.

 

Explain the role of monoclonal antibodies in chemotherapy, highlighting an example and its clinical use.

Answer:

Monoclonal antibodies (mAbs) are targeted therapy agents designed to bind specifically to antigens expressed on cancer cells. By targeting these antigens, mAbs can block critical pathways essential for cancer cell survival, recruit immune cells to attack cancer cells, or deliver cytotoxic agents directly to the tumor.

Example: Trastuzumab (Herceptin)

• Target: Trastuzumab binds to the human epidermal growth factor receptor 2 (HER2), which is overexpressed in some breast cancers.
• Mechanism of Action: By binding to HER2, trastuzumab inhibits cell signaling pathways that promote cell proliferation and survival. It also induces antibody-dependent cellular cytotoxicity (ADCC) by recruiting immune cells to destroy HER2-positive cells.
• Clinical Use: Trastuzumab is used to treat HER2-positive breast cancer and gastric cancer.

Adverse effects:

1. Cardiotoxicity: Patients may develop heart failure, particularly when trastuzumab is combined with anthracyclines like doxorubicin.
2. Infusion-related reactions: These include fever, chills, and hypersensitivity.

The development of monoclonal antibodies represents a shift from traditional cytotoxic chemotherapy to precision medicine, improving patient outcomes while reducing off-target toxicities.

 

Discuss the importance of premedication and supportive care in patients receiving chemotherapy.

Answer:

Premedication and supportive care are essential components of cancer treatment to minimize the adverse effects of chemotherapy, improve patient comfort, and enhance treatment adherence.

Premedication:

1. Antiemetics: Chemotherapy-induced nausea and vomiting (CINV) is a significant concern. Medications like ondansetron (a 5-HT3 receptor antagonist), dexamethasone, and aprepitant (an NK-1 receptor antagonist) are used to prevent acute and delayed CINV.
2. Antihistamines and corticosteroids: Drugs like diphenhydramine and dexamethasone are used to reduce the risk of hypersensitivity reactions associated with agents like paclitaxel and rituximab.
3. Hydration and electrolyte supplementation: These are critical when administering nephrotoxic agents like cisplatin to prevent kidney damage.

Supportive care:

1. Growth factors: Filgrastim (G-CSF) is used to prevent neutropenia and reduce the risk of infections.
2. Erythropoiesis-stimulating agents (ESAs): Epoetin alfa is used to manage chemotherapy-induced anemia.
3. Pain management: Opioids and adjuvant medications help manage pain caused by tumor growth or treatment side effects.
4. Psychosocial support: Counseling and support groups help patients cope with the emotional and psychological challenges of chemotherapy.

By addressing the side effects of chemotherapy, premedication and supportive care improve the quality of life for patients and allow them to complete their treatment regimens.

 

Compare and contrast the use of cytotoxic chemotherapy with targeted therapy in cancer treatment.

Answer:

Cytotoxic Chemotherapy:

1. Mechanism of Action: Cytotoxic chemotherapy works by targeting rapidly dividing cells, interfering with cell division and DNA replication. Examples include alkylating agents, antimetabolites, and taxanes.
2. Advantages: Effective against a broad range of cancers and can be used in combination regimens.
3. Disadvantages: Lack of specificity often leads to damage to healthy cells, causing side effects like myelosuppression, alopecia, and gastrointestinal toxicity.

Targeted Therapy:

1. Mechanism of Action: Targeted therapy specifically interferes with molecular pathways critical for cancer cell survival and growth. Examples include tyrosine kinase inhibitors (imatinib) and monoclonal antibodies (trastuzumab).
2. Advantages: Greater specificity reduces off-target toxicities, leading to better tolerability. Often tailored to specific genetic mutations, improving treatment efficacy.
3. Disadvantages: Expensive and only effective in cancers with the targeted molecular abnormality. Resistance to therapy can develop over time.

Comparison:

• Cytotoxic chemotherapy is broader in action but less specific, leading to more side effects.
• Targeted therapy is more precise, improving outcomes in specific cancers but requiring detailed genetic and molecular profiling.

The integration of both approaches in clinical practice allows oncologists to tailor treatment to individual patient needs, improving outcomes while managing toxicities.

 

Explain the concept of dose-limiting toxicity (DLT) in chemotherapy and provide examples.

Answer:

Dose-limiting toxicity (DLT) refers to the most significant adverse effect of a chemotherapy drug that prevents further dose escalation. DLTs are critical in determining the maximum tolerated dose (MTD) during drug development and clinical trials.

Examples of DLTs:

1. Myelosuppression:
   • Drug: Cyclophosphamide, methotrexate
   • Effect: Severe suppression of bone marrow function, leading to anemia, neutropenia, and thrombocytopenia.
2. Cardiotoxicity:
   • Drug: Doxorubicin
   • Effect: Risk of irreversible heart failure limits cumulative dosing.
3. Nephrotoxicity:
   • Drug: Cisplatin
   • Effect: Kidney damage, requiring careful hydration and monitoring.
4. Neurotoxicity:
   • Drug: Vincristine
   • Effect: Peripheral neuropathy, characterized by numbness, tingling, and motor weakness.
5. Pulmonary Toxicity:
   • Drug: Bleomycin
   • Effect: Lung fibrosis, which can severely impair respiratory function.

By understanding DLTs, clinicians can optimize chemotherapy dosing, balancing efficacy against toxicity to ensure the best possible patient outcomes.

 

Describe the pharmacokinetics and pharmacodynamics of 5-fluorouracil (5-FU) and its role in chemotherapy.

Answer:

Pharmacokinetics of 5-FU:

1. Absorption: 5-FU is administered intravenously, as its oral bioavailability is highly variable due to extensive first-pass metabolism.
2. Distribution: It distributes widely in the body, including tumor tissues, and crosses the blood-brain barrier.
3. Metabolism: The drug is metabolized in the liver by the enzyme dihydropyrimidine dehydrogenase (DPD).
4. Excretion: Metabolites are excreted primarily through the kidneys.

Pharmacodynamics of 5-FU:
5-FU is a pyrimidine analog that inhibits DNA and RNA synthesis. It is converted intracellularly to fluorodeoxyuridine monophosphate (FdUMP), which inhibits thymidylate synthase, an enzyme essential for DNA synthesis. This leads to DNA damage and cancer cell death.

Role in Chemotherapy:

• 5-FU is used in the treatment of various cancers, including colorectal, breast, gastric, and pancreatic cancers.
• It is often combined with other agents like leucovorin, which enhances its cytotoxic effects by stabilizing the binding of FdUMP to thymidylate synthase.

Adverse Effects:

1. Myelosuppression: Neutropenia and thrombocytopenia.
2. Gastrointestinal toxicity: Diarrhea and mucositis.
3. Hand-foot syndrome: Palmar-plantar erythrodysesthesia characterized by redness, swelling, and pain.

5-FU remains a cornerstone of chemotherapy regimens due to its effectiveness and broad applicability.

 

Discuss the importance of combination chemotherapy and its advantages over single-agent therapy.

Answer:

Combination chemotherapy involves using multiple drugs with different mechanisms of action to treat cancer.

Advantages:

1. Enhanced Efficacy: Combining agents with different mechanisms maximizes cancer cell kill by targeting multiple pathways. For example, combining a DNA-damaging agent like cisplatin with a mitotic inhibitor like paclitaxel increases tumor cell death.
2. Reduced Resistance: Cancer cells are less likely to develop resistance when multiple drugs are used, as the probability of simultaneous mutations conferring resistance to all agents is low.
3. Synergistic Effects: Some drug combinations produce synergistic effects, where the combined action is greater than the sum of their individual effects.
4. Lower Doses: By combining drugs, lower doses of each agent can be used, reducing the severity of dose-dependent toxicities.

Challenges:

1. Increased Toxicity: The risk of cumulative toxicities may increase. For instance, combining anthracyclines with trastuzumab raises the risk of cardiotoxicity.
2. Complex Scheduling: Drugs must be carefully scheduled to minimize overlapping toxicities and maximize efficacy.

Example:
The FOLFOX regimen (5-FU, leucovorin, and oxaliplatin) is a standard combination for colorectal cancer, offering superior outcomes compared to single-agent therapy.

Combination chemotherapy is a cornerstone of modern oncology, improving survival rates and quality of life for many cancer patients.

 

Explain the significance of tumor lysis syndrome (TLS) in chemotherapy and how it is managed.

Answer:

Tumor Lysis Syndrome (TLS):

TLS is a potentially life-threatening condition that occurs when cancer cells release their intracellular contents into the bloodstream following rapid destruction during chemotherapy. It is most common in cancers with high tumor burden, such as leukemia, lymphoma, and high-grade tumors.

Pathophysiology:

1. Hyperkalemia: Release of potassium from lysed cells can cause cardiac arrhythmias.
2. Hyperuricemia: Breakdown of purines leads to elevated uric acid levels, resulting in acute kidney injury.
3. Hyperphosphatemia: Phosphate release can precipitate with calcium, leading to hypocalcemia and tetany.

Signs and Symptoms:

• Nausea, vomiting, muscle cramps, seizures, and cardiac abnormalities.

Management:

1. Prevention:
   • Hydration to maintain renal perfusion.
   • Allopurinol or rasburicase to prevent hyperuricemia.
   • Monitor electrolytes closely before and during treatment.
2. Acute Treatment:
   • Calcium gluconate for symptomatic hypocalcemia.
   • Dialysis for severe kidney dysfunction.
   • Sodium bicarbonate for metabolic acidosis.

Proactive prevention and early recognition are essential to reduce TLS-related morbidity and mortality.

 

Describe the principles of safe handling of chemotherapy drugs to protect healthcare workers.

Answer:

Chemotherapy drugs are hazardous substances that pose risks to healthcare workers due to their cytotoxic, mutagenic, and teratogenic properties. Safe handling practices are crucial to minimize exposure.

Key Principles:

1. Personal Protective Equipment (PPE):
   • Wear chemotherapy-resistant gloves, gowns, and eye protection.
   • Use a respirator or mask if there is a risk of aerosolization.
2. Preparation and Administration:
   • Prepare chemotherapy drugs in a biological safety cabinet (BSC) or compounding aseptic containment isolator.
   • Use closed-system drug transfer devices (CSTDs) to minimize spills and leaks during preparation and administration.
3. Disposal:
   • Dispose of all chemotherapy waste (e.g., vials, syringes, and gloves) in designated hazardous waste containers.
4. Spill Management:
   • Use chemotherapy spill kits to clean up spills promptly.
   • Follow institutional protocols for reporting and managing exposure incidents.
5. Education and Training:
   • Provide regular training on safe handling practices and emergency procedures.

Protecting healthcare workers is essential to ensure their safety while maintaining high-quality patient care.

 

Evaluate the ethical considerations in administering chemotherapy to terminally ill patients.

Answer:

Administering chemotherapy to terminally ill patients raises complex ethical questions balancing potential benefits with quality of life considerations.

Key Ethical Principles:

1. Autonomy: Patients have the right to make informed decisions about their care. Healthcare providers must ensure patients fully understand the risks and benefits of continuing chemotherapy.
2. Beneficence: Chemotherapy should be offered if it provides symptom relief or prolongs life meaningfully.
3. Non-Maleficence: Physicians must avoid causing harm by offering treatments that may lead to significant side effects without meaningful benefit.
4. Justice: Resource allocation must be considered, ensuring fair access to palliative care and chemotherapy.

Challenges:

• Over-treatment: Prolonged chemotherapy in terminal stages may reduce quality of life without improving outcomes.
• Emotional Considerations: Families and patients may have unrealistic expectations, complicating decision-making.

Approach:
Healthcare providers should adopt shared decision-making, integrating palliative care early and addressing the patient’s goals and preferences. The focus should be on maintaining dignity and quality of life.

 

Discuss the mechanism of action, therapeutic uses, and side effects of doxorubicin in cancer treatment.

Answer:

Mechanism of Action:
Doxorubicin is an anthracycline antibiotic that exerts its anticancer effects through:

1. DNA Intercalation: Inserts itself between DNA base pairs, disrupting DNA replication and transcription.
2. Topoisomerase II Inhibition: Prevents the re-ligation of DNA strands, leading to double-stranded breaks and apoptosis.
3. Generation of Free Radicals: Produces reactive oxygen species (ROS) that cause oxidative damage to cellular components.

Therapeutic Uses:
Doxorubicin is used in treating a wide range of cancers, including:

• Breast cancer.
• Lymphomas (Hodgkin’s and non-Hodgkin’s).
• Sarcomas.
• Ovarian and bladder cancers.

Side Effects:

1. Cardiotoxicity: Acute or chronic heart damage, including dilated cardiomyopathy.
2. Myelosuppression: Neutropenia, anemia, and thrombocytopenia.
3. Gastrointestinal Toxicity: Nausea, vomiting, and mucositis.
4. Alopecia: Hair loss is a common side effect.
5. Extravasation Risk: Can cause severe tissue necrosis if it leaks from veins.

Monitoring cardiac function through echocardiography and limiting cumulative doses are essential to reduce the risk of cardiotoxicity.

 

Examine the concept of dose-limiting toxicity (DLT) in chemotherapy and provide examples.

Answer:

Definition:
Dose-limiting toxicity (DLT) refers to the most severe side effect of a chemotherapy drug that prevents further dose escalation. It determines the maximum tolerated dose (MTD) during clinical trials.

Importance of DLT:

• DLT ensures that drugs are administered at doses high enough to be effective but not so high as to cause unacceptable toxicity.
• It serves as a guide in designing safe and effective treatment regimens.

Examples of DLTs:

1. Myelosuppression:
   • Example: Neutropenia and thrombocytopenia are common DLTs of paclitaxel.
2. Neurotoxicity:
   • Example: Peripheral neuropathy is the DLT for vincristine.
3. Cardiotoxicity:
   • Example: Doxorubicin’s cumulative cardiotoxicity limits its lifetime dose.
4. Renal Toxicity:
   • Example: Cisplatin can cause nephrotoxicity as its DLT.
5. Mucositis:
   • Example: Severe oral ulcers are a DLT for 5-fluorouracil.

Adjusting doses and implementing supportive care measures, such as growth factor support or hydration, can help manage DLTs and allow treatment continuation.

 

Analyze the role of monoclonal antibodies in chemotherapy and their advantages over traditional agents.

Answer:

Role of Monoclonal Antibodies (mAbs):
Monoclonal antibodies are targeted therapies that recognize and bind to specific antigens on cancer cells, leading to their destruction.

Mechanisms of Action:

1. Direct Targeting: Binding to receptors on cancer cells (e.g., HER2 by trastuzumab) to inhibit cell growth.
2. Immune System Activation: Recruiting immune cells to destroy cancer cells via antibody-dependent cellular cytotoxicity (ADCC).
3. Drug Conjugation: Acting as carriers for cytotoxic drugs or radioactive particles (e.g., brentuximab vedotin).

Advantages Over Traditional Chemotherapy:

1. Specificity: mAbs target cancer-specific antigens, reducing damage to normal tissues.
2. Reduced Side Effects: Fewer systemic toxicities compared to traditional agents.
3. Combination Potential: Can be used with chemotherapy or immune checkpoint inhibitors for enhanced efficacy.

Examples:

• Rituximab: Targets CD20 on B-cell lymphomas.
• Bevacizumab: Inhibits vascular endothelial growth factor (VEGF), preventing tumor angiogenesis.

Limitations:

• High cost and limited accessibility.
• Potential for immune-related adverse events, such as cytokine release syndrome.

Monoclonal antibodies represent a significant advancement in oncology, offering improved outcomes for many patients.

 

Evaluate the role of palliative chemotherapy and how it differs from curative treatment.

Answer:

Definition of Palliative Chemotherapy:

Palliative chemotherapy is aimed at alleviating symptoms and improving the quality of life in patients with advanced or incurable cancer. It is not intended to cure the disease.

Goals of Palliative Chemotherapy:

1. Symptom Management: Reducing tumor burden to alleviate pain, dyspnea, or obstruction.
2. Prolonging Survival: Extending life expectancy while prioritizing patient comfort.
3. Maintaining Quality of Life: Balancing treatment efficacy with tolerable side effects.

Differences from Curative Chemotherapy:

• Objective: Curative treatment aims to eradicate cancer, while palliative care focuses on symptom control.
• Intensity: Palliative regimens are often less aggressive to minimize side effects.
• Patient Selection: Palliative chemotherapy is offered to patients with metastatic or refractory cancer.

Ethical Considerations:

• Informed consent is critical to ensure patients understand the goals of therapy.
• The potential for overtreatment should be weighed against quality-of-life outcomes.

Example:
Palliative chemotherapy with gemcitabine is often used for advanced pancreatic cancer to relieve symptoms and modestly extend survival.

 

Discuss the concept of targeted therapy resistance in cancer and strategies to overcome it.

Answer:

Definition of Resistance:

Targeted therapy resistance occurs when cancer cells adapt to evade the effects of drugs designed to inhibit specific molecular pathways.

Mechanisms of Resistance:

1. Target Alterations: Mutations in the target protein prevent drug binding (e.g., EGFR T790M mutation in non-small cell lung cancer).
2. Alternative Pathways: Activation of bypass signaling pathways that sustain cancer cell growth.
3. Efflux Pumps: Increased expression of transporters that expel the drug from cells.
4. Tumor Microenvironment: Factors like hypoxia and stromal interactions protect cancer cells.

Strategies to Overcome Resistance:

1. Combination Therapy: Targeting multiple pathways simultaneously to prevent adaptation.
2. Next-Generation Inhibitors: Developing drugs to overcome specific resistance mutations (e.g., osimertinib for EGFR-mutant lung cancer).
3. Adaptive Dosing: Modifying treatment schedules to reduce selective pressure on cancer cells.
4. Immunotherapy Integration: Combining targeted therapies with immune checkpoint inhibitors to enhance tumor response.

Example:
In chronic myeloid leukemia (CML), resistance to imatinib led to the development of second-generation tyrosine kinase inhibitors like dasatinib and nilotinib.

Understanding resistance mechanisms and tailoring treatments can improve long-term outcomes for patients receiving targeted therapies.

 

Explain the role of chemotherapy in combination with immunotherapy in the treatment of cancer.

Answer:

Chemotherapy and Immunotherapy in Cancer Treatment:

Chemotherapy and immunotherapy are often used in combination to improve treatment outcomes for cancer patients. Chemotherapy targets rapidly dividing cells, while immunotherapy works by enhancing the body’s immune response against cancer cells.

Role of Chemotherapy:

1. Tumor Reduction: Chemotherapy helps shrink tumors, reducing their size and potentially making them more accessible to immune cells.
2. Induction of Immunogenic Cell Death: Certain chemotherapeutic agents, like anthracyclines, can stimulate the immune system by releasing tumor antigens and promoting immune activation.
3. Modulation of the Tumor Microenvironment: Chemotherapy can modify the immune microenvironment, making it more conducive to the activity of immune cells.

Role of Immunotherapy:

1. Immune System Activation: Immune checkpoint inhibitors (e.g., PD-1 inhibitors) block immune suppressive signals, allowing the immune system to recognize and attack cancer cells.
2. Cytokine Therapy: Drugs like interleukin-2 can stimulate the immune system to target cancer cells.
3. Adoptive T-cell Therapy: Involves infusing patients with T-cells engineered to recognize and destroy cancer cells.

Advantages of Combination Therapy:

• Synergistic Effects: Chemotherapy can enhance the immune response induced by immunotherapy, potentially improving the overall outcome.
• Broader Spectrum of Action: Chemotherapy targets tumor cells directly, while immunotherapy can work on multiple aspects of the immune system.

Example:
In non-small cell lung cancer (NSCLC), the combination of chemotherapy and PD-1 inhibitors (e.g., pembrolizumab) has shown improved survival rates compared to chemotherapy alone.

 

Describe the pharmacokinetics and pharmacodynamics of methotrexate in cancer therapy.

Answer:

Pharmacokinetics of Methotrexate:

1. Absorption: Methotrexate is administered orally or intravenously, with intravenous administration providing more reliable bioavailability. The absorption from the GI tract can be affected by food and drug interactions.
2. Distribution: It is widely distributed throughout the body, including the central nervous system (CNS), but does not cross the blood-brain barrier efficiently without high doses.
3. Metabolism: Methotrexate is primarily metabolized in the liver to inactive and active metabolites, such as 7-hydroxymethotrexate.
4. Elimination: Methotrexate is excreted largely unchanged by the kidneys. Renal dysfunction can lead to drug accumulation and toxicity.

Pharmacodynamics of Methotrexate:

1. Mechanism of Action: Methotrexate is a folate analog that inhibits dihydrofolate reductase (DHFR), an enzyme necessary for the synthesis of purines and pyrimidines. This inhibition disrupts DNA and RNA synthesis, leading to cell death, particularly in rapidly dividing cells.
2. Therapeutic Uses: Methotrexate is used in the treatment of various cancers, including acute lymphoblastic leukemia (ALL), non-Hodgkin lymphoma, and osteosarcoma. It is also used in autoimmune diseases like rheumatoid arthritis.
3. Dose-Dependent Effects: Low-dose methotrexate is used for autoimmune diseases, while high-dose methotrexate is utilized in cancer treatment. The high doses require leucovorin rescue therapy to protect normal cells from toxicity.

Side Effects:

• Myelosuppression, mucositis, hepatotoxicity, nephrotoxicity, and pulmonary toxicity are common adverse effects, particularly at higher doses.
• High-dose methotrexate therapy requires careful monitoring of kidney function and appropriate hydration to minimize renal toxicity.

 

Discuss the impact of drug resistance in chemotherapy, particularly focusing on multidrug resistance (MDR) mechanisms.

Answer:

Drug Resistance in Chemotherapy:

Drug resistance is a significant challenge in cancer therapy, as it can lead to treatment failure and disease progression. There are two main types of drug resistance: intrinsic (inherent resistance from the start) and acquired (develops after initial treatment).

Multidrug Resistance (MDR):

MDR refers to the phenomenon where cancer cells become resistant to multiple chemotherapy drugs, often of different classes. This resistance is mediated by several mechanisms:

1. Efflux Pumps (e.g., P-glycoprotein):
   • One of the most common mechanisms of MDR is the overexpression of efflux pumps such as P-glycoprotein, which actively expels chemotherapeutic drugs from the cancer cells, reducing their intracellular concentrations.
2. Alterations in Drug Targets:
   • Cancer cells may undergo genetic mutations that alter the drug’s target, making it less sensitive or entirely resistant to the drug. For example, mutations in the tubulin proteins can reduce the effectiveness of taxanes.
3. Increased DNA Repair Mechanisms:
   • Tumor cells may enhance their ability to repair DNA damage induced by chemotherapy drugs, allowing them to survive and proliferate despite treatment.
4. Increased Drug Metabolism:
   • Some cancer cells can enhance the metabolic breakdown of chemotherapeutic drugs through the overexpression of enzymes such as cytochrome P450, reducing drug efficacy.
5. Altered Apoptotic Pathways:
   • Resistance can also occur if cancer cells develop mechanisms to evade programmed cell death (apoptosis), such as mutations in p53 or upregulation of anti-apoptotic proteins like Bcl-2.

Strategies to Overcome MDR:

1. Use of MDR Inhibitors:
   • Drugs like verapamil and cyclosporine have been studied as potential inhibitors of P-glycoprotein, allowing chemotherapy drugs to remain inside cancer cells.
2. Combination Therapy:
   • Combining chemotherapy with agents targeting MDR mechanisms (e.g., agents that inhibit DNA repair or efflux pumps) may prevent or reverse resistance.
3. Targeted Therapy:
   • Using drugs that specifically target the molecular abnormalities in cancer cells can reduce the reliance on traditional chemotherapy, circumventing resistance.

Example:
In ovarian cancer, resistance to platinum-based drugs is common due to the overexpression of efflux pumps. Combination therapies with agents like carboplatin and bevacizumab (anti-VEGF) are often used to overcome this resistance.

 

Explain the role of supportive care medications in chemotherapy, including antiemetics and growth factors.

Answer:

Supportive Care Medications in Chemotherapy:

Chemotherapy often causes significant side effects that can affect a patient’s quality of life and lead to dose reduction or treatment discontinuation. Supportive care medications play a critical role in managing these side effects.

1. Antiemetics:

Chemotherapy-induced nausea and vomiting (CINV) are among the most common and debilitating side effects of treatment. Antiemetic drugs are essential for preventing and controlling these symptoms.

• Serotonin (5-HT3) Receptor Antagonists (e.g., ondansetron): These drugs block serotonin receptors in the gut and the central nervous system, reducing nausea and vomiting.
• NK1 Receptor Antagonists (e.g., aprepitant): These block substance P, a neurotransmitter involved in the vomiting reflex.
• Corticosteroids (e.g., dexamethasone): Often used in combination with other antiemetics to enhance effectiveness.
• Benzodiazepines (e.g., lorazepam): Used for anticipatory nausea and vomiting by reducing anxiety.

2. Growth Factors:

Chemotherapy can cause myelosuppression, leading to neutropenia, anemia, and thrombocytopenia. Growth factor medications stimulate the production of blood cells to reduce the risk of infections and anemia.

• Granulocyte Colony-Stimulating Factor (G-CSF, e.g., filgrastim): Stimulates the production of neutrophils, helping prevent infections.
• Erythropoiesis-Stimulating Agents (e.g., epoetin alfa): Stimulates red blood cell production to treat chemotherapy-induced anemia.
• Thrombopoietin Receptor Agonists (e.g., romiplostim): Used to stimulate platelet production and manage thrombocytopenia.

3. Other Supportive Care Medications:

• Analgesics for managing pain (e.g., opioids for breakthrough pain).
• Antibiotics to prevent or treat infections due to neutropenia.

By effectively managing these side effects, supportive care medications help ensure that patients can continue their chemotherapy regimen, improving outcomes and quality of life.

 

Discuss the ethical considerations in chemotherapy decision-making, particularly in the context of palliative care.

Answer:

Ethical Considerations in Chemotherapy Decision-Making:
Chemotherapy decisions, especially in palliative care, involve complex ethical considerations. The aim is to balance treatment benefits with quality of life, considering the patient’s values, preferences, and prognosis.

1. Informed Consent:
Patients must be fully informed about the goals of chemotherapy, the potential side effects, and the likelihood of benefit, especially in palliative care settings where the focus may shift from cure to symptom control. Ensuring that patients understand the risks and benefits is a fundamental ethical obligation.

2. Autonomy:
Respecting the patient’s autonomy is essential in decision-making. Patients should be allowed to make informed decisions regarding their treatment, including whether they wish to pursue chemotherapy, opt for palliative care, or discontinue treatment.

3. Beneficence vs. Non-maleficence:

• Beneficence requires that the healthcare team acts in the best interest of the patient by offering treatments that provide a meaningful benefit, such as symptom relief or life extension.
• Non-maleficence requires avoiding harm, particularly when the side effects of chemotherapy (e.g., severe toxicity) might outweigh the potential benefits in a palliative care setting.

4. Quality of Life:
In palliative care, the quality of life is often prioritized over the extension of life. The potential for chemotherapy to improve life expectancy must be weighed against its impact on the patient’s physical and emotional well-being.

5. Justice:
Healthcare resources must be distributed fairly, and the decision to administer chemotherapy should consider the cost-effectiveness of treatment, especially when it may not provide a cure or significant improvement in a terminally ill patient.

Example:
In end-stage cancer, the decision to offer chemotherapy may be guided by a patient’s preference for life extension versus the potential burden of treatment side effects. In some cases, hospice or palliative care may be a more appropriate option.

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