Patho exam 1 Medications & Markers

Cisplatin- Alkylating agent cell phase nonspecific

Indications: treatment of advanced bladder, ovarian, and testicular cancers. can be used off-label for variety of other cancers. typically used in combination with other medications

actions: inhibits DNA synthesis, disrupts DNA function

Adverse effects: bone marrow suppression, hypersensitivity, nausea, vomiting, neurotoxicity, ototoxicity, secondary malignancies

Capecitabine/Xeloda - Antimetabolite

Indication: treatment of metastatic breast cancer with resistance to paclitaxel or anthracyclines; treatment of metastatic colorectal cancer as first-line therapy treatment of breast cancer with docetaxel in patients with metastatic disease; postsurgery dukes c colon cancer

adverse effects: severe diarrhea, monitor hydration and nutrition, risk of severe-fatal bleeding if combined with warfarin

Fluorouracil/5-FU - Carac, Efudex, Fluoroplex - Antimetabolite

Indication: palliative treatment of GI cancers, breast cancers, pancreatic cancer; topical treatment of basal cell carcinoma and actinic and solar keratoses

Adverse: GI toxicity, bone marrow suppression, alopecia, and skin rash are common; avoid occlusive dressings with topic forms; wash hands thoroughly after contact with drug

Methotrexate - Antimetabolite

Indication: treatment of gestational choriocarcinoma; chorioadenoma destrucens; hydatidiform, meningeal leukemia; breast cancer, head and neck cancers, some lymphomas, and lung cancers; symptomatic control of severe psoriasis, rheumatoid arthritis, juvenile rheumatoid arthritis

adverse effects: hypersensitivity reactions, liver toxicity and GI complications, monitor for bone marrow suppression and increase susceptibility to infections; dose pack is available for the oral treatment of psoriasis and rheumatoid arthritis

Antimetabolites

Inhibit DNA production by inhibiting metabolites needed for the synthesis of DNA in susceptible cells. There are folic acid analogs (methotrexate and pemetrexed), pyrimidine analogs (fluorouracil), and purine analogs (mercaptopurine). They are S phase cell cycle specific and are used for a wide variety of types of cancers.

Adverse effects: bone marrow suppression, alopecia, kidney, liver impairment, GI effects, neurotoxicity, and cardiotoxicity. They also have teratogenic effects on fetal development.

Antineoplastic antibiotics

selective for bacterial cells and are also toxic to human cells. some break up DNA links while others prevent DNA and RNA synthesis or repair. they include bleomycin, dactinomycin, daunorubicin, doxorubicin, mitoxantrone, and valrubicin.

Doxorubicin - Antineoplastic Antibiotic

Indications: treatment of leukemias and caners, used to induce regression, available in liposomal form for the treatment of AID-associated Kaposi sarcoma

adverse effect: alopecia, GI toxicity, bone suppression, severe necrosis at sites of local extravasation requires immediate corticosteroids.

Bleomycin - Antineoplastic Antibiotic

Indication: palliative treatment of squamous cell carcinomas, testicular cancers, and lymphomas; used to treat malignant pleural effusion

adverse effects: GI toxicity, skin reaction, pulmonary fibrosis is an issue so baseline and periodic chest radiographs and pulmonary function tests are necessary

Dexrazoxane

protective drug given with doxorubicin to lower the risk of severe heart damage in patients that need higher lifetime doses. it has a maximum of 450-500mg/m2 to prevent permanent heart failure.

Imatinib - Protein tyrosine kinase inhibitors

Indications: treatment of CML patients in blast crisis or in chronic phase after interferon-alpha therapy; treatment of patients with Kit-positive malignant GIST; first-line treatment of CML; aggressive systemic mastocytosis

Adverse: give with a full meal and water, give analgesics for headache and muscle pain, monitor CBC and edema to arrange for dose reduction if needed; patient should receive consultation to deal with high cost of drug

Cetuximab - protein tyrosine kinase inhibitors

Indications: treatment of head and neck cancer; colorectal cancer

adverse: monitor for infusion reactions due to risk of fatal reaction, premedicate with H1 receptor antagoni

Erlotinib - Tarceva - protein tyrosine kinase inhibitors

Indications: treatment of advanced non-small cell lung cancer with specific mutations; treatment of locally advance, unresectable pancreatic cancer with gemcitabine

adverse: monitor for GI perforation, bleeding, interstitial pneumonitis, and serious skin disorders

Trastuzumab - HER2 Antagonists

targets the HER2 protein which is overactive in some breast cancers and drives rapid cell division. can cause left ventricular dysfunction or heart disease

Bortezomib - proteasome inhibitors

indications: proteasome inhibitor for the treatment of mantle cell lymphoma in patients with disease progression after at least one other therapy

adverse: monitor for neurologic changes and bone marrow suppression; not for use in pregnancy or lactation

Pembrolizumab - immune checkpoint inhibitors

blocs the PD-1 protein on immune cells which allows the immune system T-cells to attack cancer cells. some 5-cells will attack health organs by mistake and can lead to immune-related adverse effects.

Immune related adverse events (irAEs)

can cause inflammation anywhere in the body ex. colitis, pneumonitis, or hypothyroidism

G-CSF Growth Factors

filgrastim or pegfilgrasim given 24-72 hours after chemotherapy. they stimulate the bone marrow to rapidly produce and release white blood cells.

Allopurinol

Given to block new uric acid production which prevents crystal formations from blocking kidney pathways

Rasburicase

Degrades pre-existing uric acid. It’s an IV drug that breaks down uric acid into a harmless substance that is urinated out.

AFP Antigen

Source: fetal yolk sac and GI structures early in fetal life.

Associated cancers: primary liver cancers; germ cell cancer of the testis

High levels >15ng/ml indicate cancer

CEA

Source: embryonic tissues in gut, pancreas, liver, and breast

Associated cancers: colorectal cancer and cancers of the pancreas, lung, and stomach

High levels >5ng/ml indicate cancer

CA 125

Source: produced by mullerian cells of the ovary

Associated cancers: ovarian cancer

>35 U/ml cancer

PSA

Source: epithelial cells lining the acini and ducts of the prostate.

Associated cancer: prostate cancer

High levels >4ng/ml prostate cancer

hCG

Source: hormone produced by the placenta

Associated Cancer: gestational trophoblastic tumors and germ cell cancer of testis

Generally low in non-pregnant adults & men; high levels indicate cancer or pregnancy

Nuchal Translucency

Definition: ultrasound scan measuring the clear fluid space at the back of a fetus’s neck, done between 11-14 weeks

High level: indicate an increased risk for Down syndrome, trisomy 18, genetic syndromes, or heart defects

Low levels: not clinically significant

PAPP-A Pregnancy Associated Plasma Protein-A

Definition: protein produced by the developing placenta measure in the first trimester

Low Levels: Linked to increased risk for chromosomal abnormalities like Down Syndrome or trisomy 18, as well as poor placental function risks later in pregnancy

High levels: considered normal or favorable

Free beta-hCG & HCG

Definition: hormones produced by the placenta. free b-hcg is used in the first trimester while hCG is tracked across the second trimester

High levels during 1st/2nd trimester: associated with increased risk for down syndrome

low levels: increased risk for trisomy 18. extremely low or dropping early hCG can also point toward a failing pregnancy or ectopic risk

Alpha-Fetoprotein

Definition: protein made by fetal liver and measured in maternal blood during 2nd trimester

High levels: indicate a higher risk for open neural tube defects like spina bifida or anencephaly, abdominal wall defects, or incorrect dating of the pregnancy

Low levels: increased risk for down syndrome

Estriol

Definition: estrogen hormone produced jointly by the fetus, adrenal glands, liver, and placenta

Low levels: Combined with other markers to indicate a higher risk for down syndrome or trisomy 18

High levels: not indicative or a specific defect

Inhibin

Definition: hormone produced by the placenta, included in 2nd trimester quad screen

High levels: abnormally elevated level combined with other markers suggests an increased risk for down syndrome

Low levels: typical development or other distinct chromosomal patterns