Anti-Neoplastic Agents (Exam 4)

antineoplastic

agent that works against tumor/cancer growth

chemotherapeutic

a drug treatment that uses powerful chemicals to kill fast-growing cells in your body

- goal is to eradicate every viable tumor cell without significantly damaging normal host tissue

malignancy

the presence of cancerous cells that can spread to other parts of the body or invade nearby tissues

antiproliferative

a substance used to prevent the spread of cells into surrounding tissue

cell cycle

series of events that cells go through as they grow and divide

cancer

uncontrolled cell growth

- cell cycle is constantly one

- requires ample amounts of metabolites and nutrients

- high energy demand

- increased replication of DNA

- activation of oncogenes

- inactivation of tumor suppressors

tumor

mass of rapidly dividing cells that can damage surrounding tissue

alkylating agents

Nucleophilic substitution to form a cyclic sulfonium ion. This very reactive intermediate tends to cause permanent alkylation of the guanine nucleotide in DNA strands. This can prevent cellular division and lead to programmed cell death (Apoptosis) because of the DNA Damage response (DDR).

- very biologically active ion covalently bonds to DNA causing the DNA to be chemically modified --> damage to DNA --> cell death (apoptosis)

nitrogen mustards (uracil mustard); thiotepa; busulfan; nitrosoureas; mitomycin; -zine

What are the 6 alkylating agents?

anti-metabolites

also called anti-folates because folates are needed for DNA production, so not folates --> no DNA synthesis --> no cell replication

- molecules that look like folate bind to the enzyme (and prevent folate from binding) and block the synthesis of nucleotides which prevents DNA synthesis (inhibitor of enzyme)

methotrexate; purine antagonist; pyrimidine antagonist

What are the 3 antimetabolites?

tamoxifen

an estrogen antagonist that binds to estrogen receptors and blocking estrogen's effects in some parts of the body

- used for estrogen positive breast cancer

herceptin (trastuzumab)

Antibody against the HER2/Neu receptor for treatment of breast cancer

- blocks activation

- promotes Her-2 degradation

- antibody coated cells attract cytotoxic t cells

gingival inflammation; gingival bleeding; burning mouth; xerostomia; caries

What are the 5 oral effects of tamoxifen?

bone marrow suppression; osteonecrosis; immunosuppresion; oral mucositis

What are the 4 most important adverse effect of chemotherapeutics for dental hygienist?

bone marrow suppression; osteonecrosis; GI effects; skin effects; hair follicle; heaptotxicity; neurologic effects; nephrotoxicity; immunosuppresion; germ cells; oral mucositis

What are the 11 adverse effects of chemopetherapeutic drugs?

interfere with cell metabolism; interfere with the cells ability to divide

What 2 things do chemotheraputic drugs usually do?

pain reliever; saline rinses/topical; 2% viscous lidocaine (often mixed with diphenhydramine and antacid)

What are the 3 treatments for cancer patients with oral mucosisits?

bisphosphonates

- mimic pyrophosphate's structure, thereby inhibiting activation of enzymes that utilize pyrophosphate

- molecules preferentially "stick" to calcium and bind to it

- the largest store of calcium in the human body is in bones, so they accumulate to a high concentration only in bones

- when attached to bone tissue, are "ingested" by osteoclasts, the bone cells that break down bone tissue

- when the osteoclast breakdown the bone that has this in it, it dies

- not DNA damage based (IMPORTANT)

- used for treatment of bone cancer or cancer that have metastasized to the bone because cancer cell will induce the breakdown of bone so they can "feed" on the minerals that are released from it so these prevent (and kills) the osteoclast from breaking down the bone which prevents "feeding" cancer cells

bisphosphonates-related osteonecrosis

What is the oral effects of bisphosphonates?

-dronate

What do bisphosphonates end in?

alcohol

For cancer patients __________ containing products should be avoided because it is drying to the oral mucosa

before; during

Chemotherapy patient require appropriate maintenance of the oral cavity _________ and _________ antineoplastic therapy

mucositis; reactivation of viruses (HSV); xerostomia; neurotoxicity (causing pain in maxilla or mandible); taste dysfunction; fungal/bacterial infections

What are the 6 common oral effects of anti-neoplastic agents?

cytotoxic (target signal transduction for modern therapy) (overall kill cancer by targeting DNA synthesis and prevents cell division) (???)

What type of property do most antineoplastic agents have (on cells)?

uncontrolled cell division (???)

What is wrong (major defect) in cancer cells?

platinum drugs

Class of drugs that inhibit DNA synthesis by cross-linking DNA