ERM Final 2.2

timing of pregnancy loss? types of pregnancy related mortality?

• full term = 40 wks (most 1st trimester loss = chromosomal abnormalities)

  • miscarriage/spon. abortion = loss b4 20 wks

  • fetal demise = loss after 20 wks

• maternal (related to preg. during-post 42 days, most deaths), preg. related (during-post 1yr), preg. ass. (any/unrelated during-post 1yr)

  • preg. related mortality most common cause = CVD, medi-cal, 40+, black

types of pregnancy loss?

• threatened → bleeding <20 wks, live embryo/fetus, closed cervical os (subset = potential loss)

• inevitable → bleeding, cramping, cervical dilation varies = loss

• complete → expulsion of entire pregnancy (gestational sac, villi, decidua)

• incomplete → bleeding, abdominal pain, cervical dilation, partially extrude/pass conception products

• missed → retain deceased/nonviable products of conception, closed cervical os (no heartbeat + anembryonic)

treatment/prevention of preterm labor? drugs of labor initiation/post partum hemorrhage? drugs of pregnancy disorders?

• tocolytics or uterine relaxants → hydroxyprogesterone, terbutaline (B-agonist), nifedipine (Ca channel blocker), indomethacin (NSAID), Mg (seizure + preeclampsia), atosiban

• oxytocin (Gq → inc. Ca SM contraction), dinoprostone (intravaginal) + carboprost (oxytocic activity), misoprostol

• methotrexate (term. ectopic preg.; cause limb/craniofacial abnormalities, NTD, abortion), doxylamine (nausea + vomit), brexanolone (PPD)

trophoblastic differentiation?

• cytotrophoblast → germinal cells; chorionic villi BM

• syncytiotrophoblast → invasive, multinucleated, secretes hCG (detected in maternal serum + urine); line outer chorionic villi

• into → villous (chorionic villi for nutrient/gas XC; floats), extravillous (invades decidua + vasculature for anchor + vasc. interface), intervillous (maternal blood, surround villi for XC)

  • maternal spiral a. feed intervillous space (no maternal + fetal blood mix)

  • placental membrane thins over time (efficient XC)

• placental site trophoblastic tumor → int. trophoblasts

ectopic pregnancy? risk factors? symptoms? diagnosis? treatment?

• blastocyst implantation outside uterine cavity → usually ampulla of fallopian tube

• risk factors= chronic salpingitis, PID, endometriosis, prior surgery, IUCD use

• symptoms (6-12 wks gestation) = acute abdominal pain + swelling, vaginal bleed, may rupture (hemoperitoneum, hemorrhagic shock)

• Dx w/ +hCG, absent IU gestational sac on US, laparoscopy for direct visual, histo confirm (chronic villi in resected tissue)

• Tx w/ salpingectomy or salpingostomy

hydatidiform molar pregnancy? complete vs partial? diagnosis? treatment?

• abnormal edematous chorionic villi + noninvasive trophoblastic proliferation

  • invasive = villi into myometrium or vessel; inc. hCG even w/ removal

• complete (no fetal tissue)= diffuse hydropic villi w/ trophoblastic hyperplasia (46XX)

• partial (abnormal tissue) = focal hydropic villi + smaller nonhydropic (chorionic vasc.) w/ limited hyperplasia (69XXY)

• Dx w/ high B-hCG, enlarged IU mass = snowstorm (complete), microscopic

• Tx w/ evacuation (e.g curettage) w/ hCG monitor

intrauterine infection? transcervical vs transplacental?

• cloudy amniotic fluid; malodorous; purulent exudate involving chorion-amnion grossly; fetal surface w/ green opaque membrane

  • causes preterm labor via inflammation + PG → rupture + induce labor

• transcervical (asc.) → via vaginal microorganism asc. to utero/amniotic fluid or infection @ canal

• transplacental (hematogenous) → viral, parasitic, few bacterial (heme access via chorionic villi ANY time during gestation)

  • rubella, CMV, VZV, malaria, toxoplasma gondii, treponoma pallidum, listeria mono, HIV, HepB

in- utero sepsis cause? symptoms? TORCH infections?

• via strep. agalactia → fever, chills, uterine tenderness, foul discharge, lower abdominal pain, ± tissue retention + typically polymicrobial

• TORCH = toxoplasmosis, others (syphilis, TB, listeriosis, parvovirus, CP), rubella, CMV, HSV → restricted fetal growth

  • = dev. delay, chorioretinitis, encephalitis, fever, HSM, pneumonitis, myocarditis, hemolytic anemia, skin lesion

preeclampsia? symptoms? eclampsia? treatment?

• endothelial cytotrophoblast fail to properly migrate → maternal spiral arteries remain narrow → HTN

• headaches, visual disturbances, hypercoagulable, abnormal liver fxn test → edema + proteinuria

• eclampsia → CNS involvement (convulsion, seizure, coma)

• Tx both w/ hydralazine, methyldopa, labetalol, Mg, aspirin, indomethacin

  • hypertensive moms love nifedipine

gestational diabetes? symptoms?

• diabetes developing during preg. due to genetic or environmental factors → hyperglycemia (can complicate preg.)

• cause CNS malformation, neural tube defect, congenital heart defect, renal abnormalities, craniofacial, MSK issues (diabetic embryopathy)

HELLP syndrome? symptoms?

• hemolysis, elevated liver enzyme, low platelets → severe cases may require termination

• subcapsular hematoma may result from expansile accumulation/coalescence of blood under pressure

• dissection → glisson capsule → hepatic rupture (catastrophic)

placental interruption types?

• creta → abnormal placental adherence to myometrium = partial or complete absence of decidua

• previa → placental implantation in lower uterine seg. or cervix = close to/covers int. cervical os

• abruption → early separation of placenta = retroplacental bleeding (can be via trauma)

multiple gestation effects?

• inc. risk of asymmetric growth, intra gestational loss, twin-reversed arterial perfusion (TRAP)

• monochorionic gestation (monozygotic twins) = inc. risk congenital anomalies, TRAP, twin-twin transfusion syndrome = vasc. anastomoses w/ shunting (recipient + donor)

• TRAP = large vasc. connection (umbilical cord, chorionic plate) w/o parenchymal anastomoses = backward flow → abortive somatic dev. related to hypoxia → dual demise or coexist

follicular development? HPG axis hormonal regulation?

• primordial → primary → secondary → graafian → ovulation → corpus luteum → corpus albicans

• GnRH → FSH + LH

  • theca cell (LH) → androgens

  • granulosa cells (FSH) → androgens to estrogen (via aromatase)

  • post ovulation = luteinization → prog. prod.

general ovarian cysts symptoms? types?

• regress spontaneously; some rupture → acute abdominal pain, nausea, bleeding, dizziness; reproductive age

• follicular (unruptured/ruptured sealed graafian follicle) = common, multiple

• luteal (corpus luteum cyst) = mimic preg., single

• theca-lutein (bilateral, hCG driven) = ass. w/ twins, molar preg., choriocarcinoma; predispose to torsion + hemorrhage; multiple + bilateral

• endometrioma (ectopic endometrial tissue in ovary) = pain, infertility, chocolate cyst

causes of anovulation?

• pregnancy

• hypothalamic (35%) → FHA + kallman syndrome (GnRH def. + anosmia)

• pituitary (50%) → prolactinoma, cushing, acromegaly, empty sella syndrome, sheehan syndrome

• ovarian → PCOS, POI, turner syndrome

PCOS? pathogenesis? symptoms? diagnosis? treatment?

• most common cause of anovulatory infertility; reproductive age

• insulin resistance (= inc. androgens @ AC), altered GnRH pulsatility (= inc. LH>FSH = inc. androgen from theca cells/hyperplastic), follicular arrest (= anovulation)

  • usually inhibited via prog.

• irregular menses, infertility, hirsutism, acne, insulin resistance + dyslipidemia (= CVD), inc. risk endometrial hyperplasia (possible endometrial cancer); ass. = obesity, acanthosis nigricans

• Dx w/ rotterdam criteria → hyperandrogenism, oligo/anovulation, polycystic ovaries (fibrotic tunica albuginea w/ subcortical cyst) on US (12+ follicles of >10cm3)

• Tx w/ clomiphene (GnRH agonist = inc. FSH/LH)

primary ovarian insufficiency (POI)? pathophysiology? symptoms? diagnosis?

• premature menopause/ovarian failure most often idiopathic BUT also ass. w/ BRCA1, fragile X, turner, autoimmune, chemo/radiation

• follicular atresia → dec. estrogen/prog. + inc. FSH/LH (stop responding to FSH/LH) = hypergonadotropic hypogonadism

• amenorrhea, infertility, menopausal symptoms (hot flashes/night sweat/vaginal dry, bone loss/osteoporosis, CV morbidity)

• Dx via dec. estrogen, inc. FSH/LH (possible hypothyroidism)

  • rule out preg., turner, thyroid problems, prolactin disorder

functional hypothalamic amenorrhea (FHA)? cause? pathogenesis? symptoms? diagnosis?

• 2ndary ovarian failure via hypothalamic hypogonadism/suppression; functional (correction = restore)

• via low energy availability (ED, athletes) or stress @ reproductive age

• dec. leptin (dec. fat), inc. cortisol → dec. GnRH pulsatility → dec. FSH/LH → dec. estrogen

• amenorrhea 3+ mths (check hCG 1st) , low bone density, disordered eating

• Dx w/ low gonadotropin + estradiol

surface epithelium serous ovarian tumors?

• surface cuboidal epi. @ fallopian tube (simple columnar ciliated); liquid/thin ascites

• serous cystadenoma → benign, most common ovarian neoplasm; lined w/ fallopian tube-like epithelium; single cavity

• serous carcinoma → most common malignant ovarian neoplasm; psammoma bodies (calcification); multilayer + atypia

• 70%, inc. risk w/ nulliparity, late menopause, infertility + age (50-80); more malignant + bilateral than mucinous

  • can be borderline (low malignancy, nuc. atypia, multilayer + no invasion)

surface epithelium mucinous ovarian tumor?

• surface cuboidal epi. @ endocervix (mucous prod. simple columnar); septa + glossy

• mucinous cystadenoma → benign, multiloculated, large; lined w/ mucus (2nd common)

• mucinous carcinoma → malignant, rate, may be metastatic from appendiceal or other GI tumors; can = pseudomyxoma peritonei (intraepithelial accumulation of mucinous material/ascites → omental caking + fullness)

• 70%, inc. risk w/ nulliparity, late menopause, infertility + age (50-80); can be borderline (low malignancy, nuc. atypia, multilayer + no invasion)

endometrioid adenocarcinoma?

• surface cuboidal epi. @ ovary (simple columnar); similar features as serous tumor; usually malignant

• coexist w/ endometriosis (both PTEN mut.)

• clear cell adenocarcinoma (coexist/variant) → solid-cystic mass replaces ovary, clear cytoplasm; mostly malignant

• brenner tumor (coexist) → benign; nest of urothelial-like (bladderlike) epithelium + fibroblast abundant w/ coffee bean nuclei

surface epithelial tumor pathogenesis?

• type 1 = cystadenomas or endometriosis (KRAS mut.) → low grade serous CA, mucinous CA, endometrioid CA

• type 2 = ovarian inclusion cyst or serous tubal intraepithelial carcinomas/STIC (TP53, BRCA, NF1, RB mut.) → high grade serous CA

  • STIC originates from distal FT

• any malignant can invade remains of ovary stroma + own capsule + cause coelomic/cavitary/peritoneal metastasis

primitive germ cell tumor? totipotential germ cell tumor of embryonic or somatic differentiation?

• dysgerminoma → most common malignant GCT, common in adolescents; sheets of fried egg cells, radiosensitive, primitive/undiff. w/ lymphocytes, inc. LDH + hCG

• teratoma (most common GCT, multiple embryonic layers) →

  • mature (benign, cystic, common) → dermoid cyst; incidental or rupture/torsion w/ necrosis/hemorrhage

  • immature (malignant, solid) → aggressive, contain fetal tissue + neuroectoderm/more = worse; fleshy w/ necrosis

  • monodermal (struma ovarii rare) → colloid nodules, >40, 1 tissue type, hyperthyroidism

• 20%, mostly in <30 y/o; more malignant in younger (location = mediastinum, retroperitoneum, sacrococcygeal area)

totipotential germ cell tumor of extraembryonic structure?

• yolk sac/vitelline (endodermal sinus tumor) → malignant + aggressive, mainly in children + YA; yellow, friable (hemorrhagic mass), contain schiller duval bodies (resemble glomeruli) + inc. AFP

• choriocarcinoma/trophoblast → hemorrhagic w/ extraembryoinc diff.; heme metastasis; hCG

  • usually mixed, from placenta or ovary; inc. risk w/ complete hydatiform mole

• 20%, mostly in <30 y/o.; more malignant in younger (location = mediastinum, retroperitoneum, sacrococcygeal area)

sex cord-stromal tumors?

• granulosa cell → most common sex cord tumor; females in 50s; estrogen + inhibin producing, contain carl-exner bodies

  • hyper estrogen = post menopausal → bleeding, endometrial hyperplasia, breast tender

• thecoma → benign, hyper estrogen (endometrial hyperplasia, adenocarcinoma)

• fibroma → benign, bundle of spindle shaped fibroblasts; meigs syndrome (benign ovary tumor, ascites, pleural effusion)

• sertoli-ledyig → benign, gray-yellow mass, androgen-producing = virilization

• 10%, females >50/adult

gonadotropic drugs MOA? indications? AE?

• follitropin alpha → FSH agonist (ovarian stim, infertility via MHH); AE= multiparity, gynecomastia

• hCG → LH agonist (initiate oocyte mat. + ovulation, MHH); AE= depression

• leuprolide → GnRH agonist = inc. LH/FSH w/ intermittent OR dec. LH/FSH w/ cont. (ovarian suppress/stim., CPP, prostate cancer, endometriosis, breast cancer); AE= headache, nausea

• ganirelix → GnRH antagonist = dec. LH/FSH (prevent premature LH surge during ovarian stim.); AE= headache, nausea

• clomiphene → ER agonist @ pit = prevent (-)FB inhibition of estrogen @ hypothalamus = LH/FSH release = ovulation (infertility); AE= blurred vision

risk factors for testicular and prostate cancer?

• FMHx → 8-10x if brother affected; 4x if father affected

• prior testicular cancer → 2-3x risk of CL tumor

  • physical, chest radiograph, markers + abd. CT every 3 mths for 2 yrs

• cryptorchidism (undescended testes) → 10-15x inc. risk + infertility

• HIV infection (esp. seminoma)

• genetic → klinefelter, DS (testicular); BRCA, HOXB13, lynch syn. (prostate)

• race → CA> AA (testicular), AA > CA (prostate)

• age → 50-70 (prostate)

testicular descent?

• embryo of testicular guided via gubernaculum

• int. descent: post abdominal wall → deep inguinal ring (12th wk)

• ext. descent: deep inguinal ring → scrotum (7th mth)

germ cell seminoma tumor? treatment?

• most common; remain primitive (may not diff.), related to cryptorchidism = painless testicular mass (US next)

• fried egg cells, hCG+, LDH (nonspecific → correlates w/ tumor burden)

• after orchiectomy → Tx w/ surveillance, RT, or single-agent carboplatin (SI), BEP chemo or RT (SII), BEP chemo ± surgery (SIII)

germ cell nonseminoma tumor?

• more aggressive → diff.; painless testicular mass (US next)

  • embryonal carcinoma → high-grade, necrosis, nuc. atypia; AFP, hCG, LDH

  • yolk sac → schiller-duval bodies <edematous/myxoid stroma; AFP

    • mediastinal GCT

  • teratoma (CXT res. = resection) → mature/imm. + metastasize, mult. germ layers (hair, neuroectoderm); LDH sometimes

  • choriocarcinoma → cyto. (polygonal) + syncytio.(multi. nucl. + eosinophilic); hCG

• mixed granuloma cell tumor → combination of above

germ cell nonseminoma tumor treatment?

• after orchiectomy

• stage I → surveillance, RPLND, or BEP chemo

• stage II → BEP chemo or RPLND

• stage III → BEP chemo ± surgery for residual disease

• BEP = bleomycin, etopside, cisplatin

sex chord stromal tumors (SCST) Dx? types? treatment?

• scrotal US, markers to rule out GCT (AFP, B-hCG, LDH), hormonal markers (test., LH/FSH, estradiol, prog., cortisol), radical inguinal orchiectomy, CT rule out metastatic

• ledyig (common SCST) → androgen-prod. (hirsutism/virilization or feminization); reinke crystal

• sertoli → ghost-like cell; hormonally silent, endocrine manifestation (possible feminization)

• Tx w/ observation (SI) or RPLND (SII)

  • chemo or radiation therapy for unresectable metastasis @ retroperitoneal LN (SCST = low response)

primary testicular lymphoma (PTL)? Dx? types? risk factors? treatment?

• firm + painless mass; uncommon + aggressive EN NHL

  • 66-68 (common testicular malignancy 60+/elderly men)

  • most common bilateral testicular neoplasm

• scrotal US ± MRI, inguinal orchiectomy

• DLBCL → pt. w/ HIV = more aggressive

  • can travel to CNS/brain

• Tx w/ bilateral orchiectomy or radiation, systemic CXT (R-CHOP), CNS prophylaxis w/ MTX

diagnosing testicular staging? clinical stages?

• scrotal US (if mass) + radical inguinal orchiectomy; markers (1) AFP, BhCG, LDH drawn b4 surgery

  • surgical resection for histopathology/biopsy required for Dx, Tx primary tumor, predicts metastasis risk

• staging (2) → T (extent of 1 tumor), N (regional LN), M (distant met.)

• CT w/ contrast (3)

• clinical stages → I (limited to testis), II (retroperitoneal/pelvic LN), III (distant metastases lung, liver, brain)

prostate zones? PSA levels? prostate cancer?

• transitional (site of BPH), peripheral (prostate cancers, asymptomatic, 2nd leading cancer death in males + most common male visceral cancer), central (aggressive cancer)

• PSA → normal <4, detect prostate cancer vs DRE alone, inc. w/ ejaculation, BPH, prostatitis (@40, 45, 50)

• Dx w/ DRE + PSA (free), MRI b4 US guided biopsy → staging w/ PSA, gleason, TNM

• asymptomatic or dec. force of stream, urgency, frequency (early) or sig. voiding/metastatic bone pain, lesions, weight loss anemia, hydronephrosis, LE edema, pelvic LN enlarged (late)

  • surgery + radiation w/ high risk

prostatitis causes? benign prostatic hyperplasia (BPH) cause?

• acute bacterial (pain, fever, dysuria, tender prostate, urine culture), chronic bacterial (recurrent UTIs, + culture, leukocytes) = Tx w/ antibiotics

  • chronic nonbacterial (pelvic pain >3 mths, dx of exclusion) → Tx w/ multimodal therapy, a-blocker

• DHT driven hyperplasia of prostate (non-neoplastic), common 50+ yrs → urinary obstruction, retention, painless hematuria

alpha blockers MOA? type? examples? AE?

• relax prostatic smooth muscle → improve urinary outflow

  • nonselective (blocks prostate + BV a subtype; Tx BPH + HTN) → terazosin, doxazosin, alfuzosin (-zosin)

  • selective → tamsulosin, silodosin (-osin)

• hypotension, dizziness (esp. nonselective)

5a-reductase inhibitors MOA? type? examples? AE?

• block conversion to DHT → shrink prostate

  • Type 1+2 (100% reduction) → dutasteride

  • Type 2 → finasteride

• gynecomastia, sexual dysfxn

  • CI: pregnancy

hypospadias characteristics? treatment?

• urethral opening on ventral penis via urethral groove maldevelopment (dev. issue)

• ass. w/ undescended testes (cryptorchidism)

• inc. risk of urinary obstruction, asc. infection, impaired ejaculation

• surgery

phimosis characteristics? treatment?

• inability to retract foreskin over glans → congenital or post inflammatory /infections scarring (balanitis via dev. issues)

• complications → pain, hygiene issues, infection

• stretching, circumcision

cryptorchidism characteristics? treatment?

• failure of testicular descent (dev. delay) → untreated = testicular torsion

• location → abdominal (15%), inguinal canal (25%), high scrotal (60%)

• inc. risk of infertility, testicular atrophy, torsion= torsion via inguinal trauma, hernia, germ cell tumors

• orchiopexy in infancy

benign scrotal lesions?

• hydrocele → fluid accumulates in tunica vaginalis (= painless swelling, transilluminates + US) via idiopathic, trauma, infection, tumor

  • aspiration, hydrocelectomy

• varicocele → dilated pampiniform plexus (L) = soft, bag of worms; worse w/ standing; inc. risk of infertility (via heat + oxidative stress)

  • surgery in symptomatic or infertile men

inflammatory disorders of penis?

• balanoposthitis (balanitis) → inflammation of glans + foreskin via poor hygiene, smegma, infections (STI) = red erosion, pain, discharge; complications = phimosis, meatal stricture

  • hygiene, topical antibiotics/antifungals

• peyronie’s disease → fibrotic plaques in tunica albuginea = penile curvature, painful erection, deformity, ED via microtrauma, dysregulated wound healing

  • collagenase injections, surgery

penile squamous cell carcinoma (SCC) cause? types? treatment?

• via HR HPV or lack of circumcision; ass. w/ PeIN3

• bowen disease (HSIL) → in shaft = leukoplakia, but can be erythematous

• erythroplasia of queyrat (HSIL) → in glans mucosa = erythroplasia

• Tx N/A

testicular inflammation types? characteristics? treatment?

• epididymitis → epididymis inflammation via STIs (chlamydia, gonorrhea), E. coli, TB = scrotal pain, swelling, dysuria, fever, abscess, infertility

  • antibiotics (azithromycin, cefixime), NSAIDs

• orchitis → testicular inflammation via epididymitis, STIs, mumps, ischemia post-surgery = hematuria, hematospermia, pain, swelling

  • antibiotics, anti-inflammatories

testicular torsion cause? symptoms? complications? treatment?

• spermatic cord twisting → ischemia

  • risk factor = cryptorchidism

  • Dx w/ doppler US

• sudden severe unilateral pain, high-riding testis, absent creamsteric reflex

• infarction, necrosis, impaired sperm fxn

• Tx w/ emergency detorsion (surgical), orchiopexy in infancy (cryptorchidism)

erectile dysfunction cause? treatment?

• vascular disease, diabetes, medication, low testosterone, mental issues

  • erection = NO + PGE1/2 → VD → venous occlusion (a-adrenergic VC = erection fails)

• Tx w/ PDE5 inhibitors (stop cGMP degradation = inc. NO; -fil → headache, dyspepsia, flushing), PGE1 analog (SM relax; alprostadil)

  • non-pharm → anti-depressant (dec. NO), anti-psychotic (block D2 → inc. prolactin → dec. test.)

androgen replacement therapy indications? administration? side effects?

• hypogonadism, delayed puberty, cachexia, short stature

• admin via injectable (fluctuating levels) or transdermal (stable serum testosterone)

• SE = testicular atrophy, infertility, gynecomastia, polycythemia, prostate disease exacerbation, inc. CVD risk, edema, acne, hepatotoxicity, virilization

leuprolide MOA? uses? AE? ganirelix, degarelix?

• both androgen synthesis inhibitors

• GnRH agonist; for adv. prostate cancer (cont. w/ bicalutamide)

  • osteoporosis (radiolucent lesions on xray)

• GnRH antagonist → dec. LH/FSH; for medical castration before brachytherapy

  • headache, nausea, hypersensitivity rxn

flutamide/bicalutamide MOA? uses? AE? aminoglutethimide? prednisone?

• androgen synthesis inhibitors

• androgen receptor antagonist; prevents initial test. flare/surge when using leuprolide

  • gynecomastia

• inhibits conversion of cholesterol to pregnenolone → dec. testosterone; for sensitive + resistant prostate cancer

  • rash, ataxia

• lowers PSA; along w/ abiraterone + docetaxel

  • osteoporosis, immunosuppression, hyperglycemia

abiraterone MOA? uses? AE? ketaconazole?

• androgen synthesis inhibitors

• irreversible inhibition of 17-a hydroxylase/ 17,20 lyase → dec. testosterone; for metastatic castration resistant + adv. prostate cancer (replace cortisol w/ prednisone + manage bony metastasis w/ denosumab/RANKL I)

  • HTN, hypokalemia, hypernatremia, fatigue

• inhibition of 17-a-hydroxylase/17,20 lyase → dec. testosterone; for adv. prostate cancer, fungal infection

  • gynecomastia, CYP450 inhibition, hepatotoxic, adrenal insufficiency

bleomycin MOA? uses? AE? etoposide? cisplatin, carboplatin?

• binds DNA + Fe, DNA bleomycin Fe complexes → DNA strand breaks; BEP regimen in testicular cancer

  • pulm. fibrosis, rash, hyperpigmentation

• inhibits topoisomerase; BEP regimen in testicular cancer

  • 2ndary malignancies, AML

• alkylation + formation of intra strand cross-link between guanine residues; BEP for testicular cancer or lung, breast, ovary, bladder, NHL

  • neuropathy, nephrotoxicity, ototoxicity, electrolyte depletion, nausea, vomit

pembrolizumab MOA? uses? AE? docetaxel, paclitaxel?

• PD-1 inhibitor → antitumor effect; for cancer w/ MMR def. or high microsatellite instability

  • fatigue, cough, nausea, pruritis, rash, arthralgia

• binds to tubulin, hyper stabilize polymerized microtubules in M phase so mitotic spindle can’t break down; for NSCLC, ovarian + breast carcinoma

  • myelosuppression, neuropathy, hypersensitivity