APHON OVERVIEW EXAM WITH
COMPLETE SOLUTIONS
biotherapy -ANSmodality of tx: agents that resemble body's own defense and
surveillance systems. can augment/modulate/restore host's immune response, direct
antitumor activity, other biological effects. side effects typically hypersensitivity rx
immune surveillance -ANStumor cells express abnormal tumor antigens on surface that
can be recognized/destroyed by immune system
natural killer cells -ANSlymphocyte that recognizes/kills malignant cells
cytotoxic t cells -ANSrecognize tumor-assosiated antigens and kills cells
interferons -ANSmultiple moa's & produced w/ recombinant dna.
protein capable of protecting other cells from viral infections by interfering w/ viral
replication.
family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory
effects
cytokines -ANSproducts of immune cells to enhance cytotoxic activity of cells and
increase immune response
alpha-interferon -ANSleukocyte-derived. tx: hairy cell leukemia, melanoma, chronic
myeloid leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell lymphoma
beta-interferon -ANSfibroblast-derived. tx MS
gamma-interferon -ANSt-lymphocyte derived. tx chronic granulomatus disease
interleukin-2 -ANSproduced by t-helper cells & stimulate growth/maturation of t-cell
subsets, cytotoxic t-cells, production of lymphokines & cytokines.
act as chemical signals b/w wbc's (revs up immune system)
retinoids -ANSimmunomodulators that facilitate differentiation & suppress proliferation
of cancer cells
all-trans retinoic acid (atra) -ANStx: aml, aml m3 subtype, apl
increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
isotretinoin (accutane) -ANSretinoid tx neuroblastoma.
,have antitumor activity unknown moa. TERATOGENIC. male/female pt must register
iPledge (fetal exposure). can also affect hearing & vision
antibodies -ANSproteins produced by b-lymphocytes. part of humoral immunity of
adaptive system. includes immunoglobulins (igG, igA, igM, igE, igD)
murine -ANSmouse-derived MoAbs. pt develops human antimouse antibodies creating
high risk of hypersensitivity rx
end in -momab
Monoclonal antibodies -ANSvery specific. directed against single antigenic determinant
on cell surface causing antibody-dependent cellular toxicity, direct cell death, elimination
of antigen/target cell that expresses the antigen
low toxicity
-ximab -ANSmoab combo of human & mouse antibodies
-zumab -ANSmoab humanized, small part of mouse antibody fused w/ human antibody
-umab -ANSfully humanized moabs
chimeric moab -ANSmurine variable & human constant coupled using recombinant dna
purpose of moabs -ANSattach low-dose radioisotopes to image residual disease. target
chemo, radiation, biotherapy to tumor
purge autologous bone marrow of cancer cells before transplant
selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
efficacy increased w/ chemo or radioactive substances
rituximab -ANStx relapsed/refractory b-cell lymphoma, cd20+, non-hodgkins lymphoma
(w/ chop), posttransplant lymphoproliferative d/o, & chronic gvhd
rituximab moa -ANSact on CD20 antigen on surface of normal/malignant b lymphocytes
and works w/ immune system to induce b-cell lysis
radiopharmaceuticals -ANSmoabs that have radioactive source attached for cancer
killing effect
ibritumomab tiuxetan (zevalin) -ANSradiopharmaceutical tx relapse/refractory low-grade
follicular or transformed b-cell non-hodgkins lymphoma
rituximab + ibritumomab tiuxetan -ANStarget cd20 protein on b-cells. given prior to high
dose of radiation. causes increased toxicity and severe infusion rx
tositumomab + iodine 131 tositumomab (bexxar) -ANStx cd20+ follicular non-hodgkin's
lymphoma. moa: recognizes marker and signals immune response then radioactive
, source locks on to moab, delivers radiation directly to cd20 marked cells and kills
lymphoma b-cells
hematopoietic growth factors -ANSregulate different levels of hematopoietic cascade.
aka colony stimulating factors. primarily used for symptom management & expedited
recovery from chemo-induced bone marrow suppression
Colony Stimulating Factors -ANSptns that support hematopoiesis. decrease
myelosuppression, accelerate recovery from bmt, tx infections/parasitic diseases, help
w/ pancytopenia
gcsf (filgrastim) -ANSstimulates neutrophil colonies to enhance phagocytic activity and
antibody-dependent killing tendency. starting dose 5 mcg/kg/day
neulasta (pegfilgrastim) -ANSlong-acting gcsf. given 24h post chemo. given once per
chemo cycle. max dose is 6mg. kids <45kg dose is 0.1mg/kg
gm-csf (granulocyte macrophage csf; sargramostim) -ANSgiven post bmt w/ non-
hodgkins lymphoma, all, hodgkins disease. dose: 250 mcg/kg/day. typically iv over 2h
for 21 days. broader prod of neutrophil & monocyte colonies
epoetin alfa -ANShormone produced naturally by kidneys in response to decrease O2
levels. stimulates precursor cells in marrow to produce rbcs. dose 150 u/kg 3x/week
darbepoetin (aranesp) -ANSlong-acting epoetin. given weekly. dose 0.45mcg/kg sq.
titrate dosing to not get hgb >12
ESA APPRISE -ANSrisk management system associated w/ erythropoiesis-stimulating
factors. increase risk of tumor growth/progression, cv events, decreased survival rates
when hgb >12
oprelvekin (neumega) -ANSthrombopoietic growth factor. stim hsc & megakaryocyte
precursurs to pvt severe thrombocytopenia. dosing: qd sc @ 50mcg/kg 24h post chemo
until platelets >50k
tyrosine kinase inhibitors -ANSinterfere w/ cell comms & growth. primarily block
epidermal growth factor receptors to pvt cell proliferation, promo apoptosis & inh
antiangiogenesis
angiogenesis -ANSgrowth of new blood vessels from existing vessels. tumor viability is
dependent for growth. vascular endothelial growth factors (vegf) cascade major factor
bevacizumab (avastin) -ANSvegf inhibitor. pvt angiogenesis. tx in relapse/refractory
solid tumors
COMPLETE SOLUTIONS
biotherapy -ANSmodality of tx: agents that resemble body's own defense and
surveillance systems. can augment/modulate/restore host's immune response, direct
antitumor activity, other biological effects. side effects typically hypersensitivity rx
immune surveillance -ANStumor cells express abnormal tumor antigens on surface that
can be recognized/destroyed by immune system
natural killer cells -ANSlymphocyte that recognizes/kills malignant cells
cytotoxic t cells -ANSrecognize tumor-assosiated antigens and kills cells
interferons -ANSmultiple moa's & produced w/ recombinant dna.
protein capable of protecting other cells from viral infections by interfering w/ viral
replication.
family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory
effects
cytokines -ANSproducts of immune cells to enhance cytotoxic activity of cells and
increase immune response
alpha-interferon -ANSleukocyte-derived. tx: hairy cell leukemia, melanoma, chronic
myeloid leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell lymphoma
beta-interferon -ANSfibroblast-derived. tx MS
gamma-interferon -ANSt-lymphocyte derived. tx chronic granulomatus disease
interleukin-2 -ANSproduced by t-helper cells & stimulate growth/maturation of t-cell
subsets, cytotoxic t-cells, production of lymphokines & cytokines.
act as chemical signals b/w wbc's (revs up immune system)
retinoids -ANSimmunomodulators that facilitate differentiation & suppress proliferation
of cancer cells
all-trans retinoic acid (atra) -ANStx: aml, aml m3 subtype, apl
increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
isotretinoin (accutane) -ANSretinoid tx neuroblastoma.
,have antitumor activity unknown moa. TERATOGENIC. male/female pt must register
iPledge (fetal exposure). can also affect hearing & vision
antibodies -ANSproteins produced by b-lymphocytes. part of humoral immunity of
adaptive system. includes immunoglobulins (igG, igA, igM, igE, igD)
murine -ANSmouse-derived MoAbs. pt develops human antimouse antibodies creating
high risk of hypersensitivity rx
end in -momab
Monoclonal antibodies -ANSvery specific. directed against single antigenic determinant
on cell surface causing antibody-dependent cellular toxicity, direct cell death, elimination
of antigen/target cell that expresses the antigen
low toxicity
-ximab -ANSmoab combo of human & mouse antibodies
-zumab -ANSmoab humanized, small part of mouse antibody fused w/ human antibody
-umab -ANSfully humanized moabs
chimeric moab -ANSmurine variable & human constant coupled using recombinant dna
purpose of moabs -ANSattach low-dose radioisotopes to image residual disease. target
chemo, radiation, biotherapy to tumor
purge autologous bone marrow of cancer cells before transplant
selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
efficacy increased w/ chemo or radioactive substances
rituximab -ANStx relapsed/refractory b-cell lymphoma, cd20+, non-hodgkins lymphoma
(w/ chop), posttransplant lymphoproliferative d/o, & chronic gvhd
rituximab moa -ANSact on CD20 antigen on surface of normal/malignant b lymphocytes
and works w/ immune system to induce b-cell lysis
radiopharmaceuticals -ANSmoabs that have radioactive source attached for cancer
killing effect
ibritumomab tiuxetan (zevalin) -ANSradiopharmaceutical tx relapse/refractory low-grade
follicular or transformed b-cell non-hodgkins lymphoma
rituximab + ibritumomab tiuxetan -ANStarget cd20 protein on b-cells. given prior to high
dose of radiation. causes increased toxicity and severe infusion rx
tositumomab + iodine 131 tositumomab (bexxar) -ANStx cd20+ follicular non-hodgkin's
lymphoma. moa: recognizes marker and signals immune response then radioactive
, source locks on to moab, delivers radiation directly to cd20 marked cells and kills
lymphoma b-cells
hematopoietic growth factors -ANSregulate different levels of hematopoietic cascade.
aka colony stimulating factors. primarily used for symptom management & expedited
recovery from chemo-induced bone marrow suppression
Colony Stimulating Factors -ANSptns that support hematopoiesis. decrease
myelosuppression, accelerate recovery from bmt, tx infections/parasitic diseases, help
w/ pancytopenia
gcsf (filgrastim) -ANSstimulates neutrophil colonies to enhance phagocytic activity and
antibody-dependent killing tendency. starting dose 5 mcg/kg/day
neulasta (pegfilgrastim) -ANSlong-acting gcsf. given 24h post chemo. given once per
chemo cycle. max dose is 6mg. kids <45kg dose is 0.1mg/kg
gm-csf (granulocyte macrophage csf; sargramostim) -ANSgiven post bmt w/ non-
hodgkins lymphoma, all, hodgkins disease. dose: 250 mcg/kg/day. typically iv over 2h
for 21 days. broader prod of neutrophil & monocyte colonies
epoetin alfa -ANShormone produced naturally by kidneys in response to decrease O2
levels. stimulates precursor cells in marrow to produce rbcs. dose 150 u/kg 3x/week
darbepoetin (aranesp) -ANSlong-acting epoetin. given weekly. dose 0.45mcg/kg sq.
titrate dosing to not get hgb >12
ESA APPRISE -ANSrisk management system associated w/ erythropoiesis-stimulating
factors. increase risk of tumor growth/progression, cv events, decreased survival rates
when hgb >12
oprelvekin (neumega) -ANSthrombopoietic growth factor. stim hsc & megakaryocyte
precursurs to pvt severe thrombocytopenia. dosing: qd sc @ 50mcg/kg 24h post chemo
until platelets >50k
tyrosine kinase inhibitors -ANSinterfere w/ cell comms & growth. primarily block
epidermal growth factor receptors to pvt cell proliferation, promo apoptosis & inh
antiangiogenesis
angiogenesis -ANSgrowth of new blood vessels from existing vessels. tumor viability is
dependent for growth. vascular endothelial growth factors (vegf) cascade major factor
bevacizumab (avastin) -ANSvegf inhibitor. pvt angiogenesis. tx in relapse/refractory
solid tumors
