For Numbers 1-5: Match the drug with the ADR *
A. Neurotoxicity
B. Pulmonary Fibrosis
C. Cardiotoxicity
D. Nephrotoxicity
E. Hemorrhagic Cystitis
- Cyclophosphamide
- Cisplatin
- Adriamycin
- Busulfan
- Vincristine
- Cyclophosphamide
- Match: E. Hemorrhagic Cystitis
- Rationale: Cyclophosphamide is metabolized to acrolein, which is toxic to the bladder epithelium and can cause hemorrhagic cystitis.
- Cisplatin
- Match: D. Nephrotoxicity
- Rationale: Cisplatin can cause damage to the renal tubules, leading to nephrotoxicity. It’s known to accumulate in the kidneys and can result in acute kidney injury.
- Adriamycin (Doxorubicin)
- Match: C. Cardiotoxicity
- Rationale: Adriamycin can lead to dose-dependent cardiotoxicity, which may result in dilated cardiomyopathy and congestive heart failure due to the generation of free radicals and oxidative stress on cardiac cells.
- Busulfan
- Match: B. Pulmonary Fibrosis
- Rationale: Busulfan is associated with causing interstitial pulmonary fibrosis, a well-known chronic adverse effect, which can be dose-limiting and potentially life-threatening.
- Vincristine
- Match: A. Neurotoxicity
- Rationale: Vincristine can cause peripheral neuropathy due to its mechanism of action on microtubules, which affects the axonal transport within neurons leading to neurotoxicity.
For Numbers 6-8: Match the drug with its source *
A. Etoposide
B. Tamoxifen
C. Vincristine
D. Paclitaxel
- Mandrake root
- Vinca rosea
- Taxus brevifolia
- Mandrake root
- Match: A. Etoposide
- Rationale: Etoposide is a semisynthetic derivative of podophyllotoxin, which is derived from the Mayapple plant, not mandrake root. However, given the options and traditional associations of the mandrake with medicinal properties, etoposide is the closest match, as the other listed drugs have well-known specific sources.
- Vinca rosea
- Match: C. Vincristine
- Rationale: Vincristine is an alkaloid derived from the Vinca rosea plant, also known as the periwinkle plant.
- Taxus brevifolis
- Match: D. Paclitaxel
- Rationale: Paclitaxel is a chemical compound derived from the bark of the Pacific yew tree, Taxus brevifolia.
Tamoxifen (B) is not derived from a plant; it is a synthetic compound and thus does not match with any of the sources listed.
For Numbers 9-12: Match the disease with the stage of its highest prevalence *
A. Adulthood
B. Reproductive Age
C. Childhood
- ALL
- Testicular Cancer
- Colon Cancer
- Brain Cancer
- ALL (Acute Lymphoblastic Leukemia)
- Match: C. Childhood
- Rationale: ALL is most commonly diagnosed in children, with the highest incidence in those aged 2-5 years.
- Testicular Cancer
- Match: B. Reproductive Age
- Rationale: Testicular cancer is most commonly diagnosed in younger men, typically between ages 15 and 35, which falls within the typical range of reproductive age.
- Colon Cancer
- Match: A. Adulthood
- Rationale: The risk of colon cancer increases with age, and it is more prevalent in adults over the age of 50.
- Brain Cancer (CNS Cancer)
- Match: A. Adulthood
- Rationale: Brain cancers can occur at any age, but certain types are more prevalent in adults, and overall incidence tends to increase with age.
For Numbers 13-21: Cell Cycle Specific or Non-Specific? *
A. Cell Cycle Specific
B. Cell Cycle Non-Specific
- Fluorouracil
- Cyclophosphamide
- Busulfan
- Bleomycin
- Mercaptopurine
- Daunorubicin
- Thiotepa
- Vinblastine
- Mitomycin
Antimetabolites (CLASSIFICATION)
Folic acid Antagonists:
* Methotrexate (MTX)
Purine Antagonists:
* 6-Mercaptopurine (6-MP)
* 6-Thioguanine (6TG)
Pyrimidine Antagonists:
* 5-Fluorouracil (5FU)
* Arabinose C (araC)
Alkylating agents (nitrogen mustard gases)
- Mustine
- Cyclophosphamide
- Nitrosoureas: Carmustine, lomustine, semustine
- Phenylalanine: Melphalan
- Alkyl sulfonates: Busulfan (myleran)
- Thiotepa : triethylene phosphoramide (TEPA)
For Numbers 22-25: Match the drug with its MOA *
A. Vinblastine
B. Paclitaxel
C. Methotrexate
D. Adriamycin
- enhance tubulin polymerization
- prevent microtubule assembly
- DNA intercalating agents
- Inhibit DHF reductase
- Enhance tubulin polymerization
- Match: B. Paclitaxel
- Rationale: Paclitaxel stabilizes microtubules by enhancing tubulin polymerization, preventing their disassembly which is necessary for cell division, and thus inhibiting the mitotic process.
- Prevent microtubule assembly
- Match: A. Vinblastine
- Rationale: Vinblastine binds to tubulin, inhibiting tubulin polymerization into microtubules, thus preventing the assembly of the mitotic spindle required for cell division.
- DNA intercalating agents
- Match: D. Adriamycin
- Rationale: Adriamycin (doxorubicin) is an anthracycline that intercalates into DNA, disrupting the DNA enzyme topoisomerase II, which prevents the relaxation of supercoiled DNA and thus inhibits DNA replication and transcription.
- Inhibit DHF reductase
- Match: C. Methotrexate
- Rationale: Methotrexate is an antimetabolite that inhibits dihydrofolate reductase (DHF reductase), an enzyme involved in the tetrahydrofolate synthesis necessary for the production of nucleotides for DNA synthesis.
For Numbers 26-30: Match the drug with the target receptor *
A. ER +
B. HER2/ NEU +
C. CD20 on B cells
D. VEGF
- Tamoxifen
- Anastrazole
- Trastuzumab
- Rituxumab
- Bevacizumab
- Tamoxifen
- Match: A. ER +
- Rationale: Tamoxifen is a selective estrogen receptor modulator (SERM) that binds to estrogen receptors (ER) on cells, commonly used in the treatment of ER-positive breast cancer.
- Anastrazole
- Match: A. ER +
- Rationale: Anastrozole is an aromatase inhibitor that lowers estrogen levels and is used to treat ER-positive breast cancer, though it doesn’t bind to the receptor directly like tamoxifen does. However, it is used for the same target receptor-positive condition.
- Trastuzumab
- Match: B. HER2/ NEU +
- Rationale: Trastuzumab is a monoclonal antibody that targets the HER2/neu receptor, which is overexpressed in some forms of breast cancer.
- Rituxumab
- Match: C. CD20 on B cells
- Rationale: Rituximab is a monoclonal antibody that targets the CD20 antigen on the surface of B cells, used particularly in the treatment of diseases which involve B cells, such as non-Hodgkin lymphoma.
- Bevacizumab
- Match: D. VEGF
- Rationale: Bevacizumab is a monoclonal antibody that binds to vascular endothelial growth factor (VEGF), inhibiting angiogenesis which is the formation of new blood vessels that tumors need to grow.
For Numbers 31-34: MABS AND NIBS
A. CD 52
B. CD 20
C. VEGF
- Sorefinib
- Sunitinib
- Ofatumumab
- Alemtuzumab
- Sorafenib
- Match: C. VEGF
- Rationale: Sorafenib is a tyrosine kinase inhibitor that targets multiple kinases, including those involved in VEGF signaling.
- Sunitinib
- Match: C. VEGF
- Rationale: Sunitinib is a multi-targeted receptor tyrosine kinase inhibitor, and among its targets are kinases involved in VEGF signaling.
- Ofatumumab
- Match: B. CD20
- Rationale: Ofatumumab is a monoclonal antibody that targets CD20 on B cells, used for the treatment of chronic lymphocytic leukemia and some other B-cell disorders.
- Alemtuzumab
- Match: A. CD52
- Rationale: Alemtuzumab is a monoclonal antibody that targets CD52, a protein present on the surface of mature lymphocytes and used in the treatment of chronic lymphocytic leukemia and multiple sclerosis.
The “nibs” (Sorafenib and Sunitinib) are small-molecule inhibitors that target intracellular signaling pathways, while the “mabs” (Ofatumumab and Alemtuzumab) are monoclonal antibodies that bind to specific cell surface proteins.
For Numbers 35-37: Chemotherapy Combinations *
A. MOPP
B. CHOP
C. Both
- Vincristine
- Mechlorethamine
- Cyclophosphamide
- Vincristine
- Match: C. Both
- Rationale: Vincristine is included in both MOPP and CHOP chemotherapy regimens.
- Mechlorethamine
- Match: A. MOPP
- Rationale: Mechlorethamine (also known as mustine) is part of the MOPP regimen and is not used in CHOP.
- Cyclophosphamide
- Match: B. CHOP
- Rationale: Cyclophosphamide is part of the CHOP regimen and is not used in the traditional MOPP regimen.
- Log Kill Hypothesis *
A. follows first order kinetics
B. kills fixed percentage of cancer cells
C. kills fixed number of cancer cells
D. A and B
E. B and C
D. A and B.
The log kill hypothesis posits that chemotherapy follows first-order kinetics, meaning that a given dose of chemotherapy kills a constant proportion (or fixed percentage) of cancer cells, rather than a fixed number.
For Numbers 39-43: Cell Cycle Specific Drugs *
A. G0 phase
B. S phase
C. G2 phase
D. M phase
- Paclitaxel
- Cisplatin
- 6 Mercaptopurine
- Bleomycin
- Etoposide
Cell Cycle Phases
G1 Phase: The cell prepares for DNA synthesis.
S Phase: The cell generates a complete copy of its genetic material.
G2 Phase: The cell prepares for mitosis.
M Phase: Replicated DNA is condensed and segregated into chromosomes.
G0 Phase: A resting state where the cell is not actively dividing.
- This is the dose limiting ADR of alkylating agents *
A. Agranulocytosis
B. Myelosuppression
C. Teratogenesis
D. Gonadal atrophy
B. Myelosuppression.
The most common and significant dose-limiting adverse reaction of alkylating agents is myelosuppression, which is the decrease in the production of blood cells, often leading to conditions such as anemia, leukopenia, and thrombocytopenia.
For Numbers 45-48: RESISTANCE *
A. Cisplatin
B. Dactinomycin
C. Vincristine
D. 6 Mercaptopurine
- Change in binding affinity
- Decrease drug accumulation
- Formation of Drug inactivating enzyme
- Increased nucleic acid repair mechanism
- Change in binding affinity
- Match: C. Vincristine
- Rationale: Resistance to vincristine can occur due to changes in tubulin’s binding affinity, which is the target of vincristine.
- Decrease drug accumulation
- Match: B. Dactinomycin
- Rationale: Dactinomycin resistance can occur due to decreased intracellular accumulation of the drug, possibly through changes in cell membrane permeability or active efflux mechanisms.
- Formation of Drug inactivating enzyme
- Match: D. 6 Mercaptopurine
- Rationale: Resistance to 6 Mercaptopurine can be due to the increased activity of drug-inactivating enzymes, such as thiopurine methyltransferase.
- Increased nucleic acid repair mechanism
- Match: A. Cisplatin
- Rationale: Cisplatin forms DNA adducts and cross-links within DNA strands; resistance can develop when cells enhance their ability to repair this type of DNA damage.
- Uses of Cyclophosphamide EXCEPT *
A. chemotherapy
B. immunosuppressant
C. for rheumatoid arthritis
D. antibiotic
E. for autoimmune nephritis
D. antibiotic.
Cyclophosphamide is used as a chemotherapy agent and an immunosuppressant, and it can be used in the treatment of rheumatoid arthritis and autoimmune nephritis. It is not used as an antibiotic because it does not have antibacterial activity.
- Carmustine is used for brain tumors because *
A. it is best for adult cancers
B. it penetrates the blood brain barrier excellently
C. it is lipophobic
D. all of the above
B. it penetrates the blood-brain barrier excellently.
Carmustine is used in the treatment of brain tumors largely because of its ability to cross the blood-brain barrier, allowing it to reach therapeutic concentrations within the central nervous system. It is not lipophobic; rather, it is lipophilic, which helps in crossing the blood-brain barrier.
Cancer that usually occurs during childhood
a. ALL
b. Testicular cancer
c. CNS cancer
a. ALL
Acute Lymphoblastic Leukemia (ALL) is the most common cancer in children and can occur at a young age
Cancer that usually occurs during reproductive age
a. ALL
b. Testicular cancer
c. CNS cancer
b. Testicular cancer
Testicular cancer predominantly affects younger men, typically between ages 15 and 35, which includes the reproductive years.
What is Log-Kill Hypothesis?
a. Kills fixed percentage of cells
b. Kills fixed number of cells
c. Kills fixed type of cancer cells
a. Kills fixed percentage of cells
The Log-Kill Hypothesis states that a given dose of chemotherapy kills a constant proportion of cancer cells, not a constant number, hence “kills fixed percentage of cells”
Drug that inhibits G2 phase
a. 6-MP
b. Bleomycin
c. Vincristine
b. Bleomycin
Bleomycin is known to cause breaks in DNA, thereby inhibiting the G2 phase of the cell cycle before mitosis.
Example of antibiotics that are also chemotherapeutic drugs?
(3)
a. Actinomycin
b. Adriamycin
c. Daunorubucin
d. Sulfonamide
a. Actinomycin
b. Adriamycin
c. Daunorubucin
Actinomycin, Adriamycin (doxorubicin), and Daunorubicin are all antibiotics with chemotherapeutic properties,
(6-7) Cite 2 features of vinca alkaloids
a. From plant
b. Alkaloid
c. ADR: Cardiotoxicity
a. From plant
b. Alkaloid
Vinca alkaloids are derived from the periwinkle plant (hence “from plant”) and are a class of cell cycle-specific chemotherapy drugs (hence “alkaloid”).
Which is cell cycle-specific (CCS) drug
a. Antimetabolites
b. Alkylating agents
a. Antimetabolites
Drug that target purine synthesis
a. 5-FU
b. 6MP
b. 6MP
6-MP is a purine antimetabolite, which interferes with the synthesis of purine nucleotides, essential components of DNA and RNA.
Indication of tamoxifen
a. Breast CA
b. Colon CA
c. Lymphoma
a. Breast CA
Tamoxifen is an estrogen receptor modulator used primarily in the treatment of breast cancer.
Indication of trastuzumab
a. Breast CA
b. Colon CA
c. Lymphoma
a. Breast CA
Trastuzumab is a monoclonal antibody that targets HER2/neu and is used in the treatment of HER2-positive breast cancers.
