2. Anti cancer drugs acts on
1) Bone marrow : causes Bone marrow suppression
2) GIT : causes Nausea and vomiting
3) Hairs: Alopecia
4) Causes increase in Serum Uric Acid : Due to lysis of tumor cells
This Side effects are common to all anticancer drugs.
5. -M.O.A : It attaches to N7 of Guanine of DNA dimer and destroys DNA
-Side effects :
1) Bone marrow : causes Bone marrow suppression
2) GIT : causes Nausea and vomiting
3) Hairs: Alopecia
4) Causes increase in Serum Uric Acid : Due to lysis of tumor cells
5) Secondary Leukemias : MC : AML
6) Infertility
12. NITROSUREAS
Carmustine = Causes Persistent Neutropenia
Lomustine
Semustine
- Can cross Blood Brain Barrier. Hence used in Brain Tumors
13. -Treatment of Choice : CHOP +/- R
C - Cyclophosphomide
H - Hydroxyrubocin
O - Oncovin
P -Prednisolone
R -Rituximab
14. FOLFOX or FOLFIRI regimen
FOL - Folinic Acid
F - 5-FU
OX - Oxyplatinum
FOL - Folinic Acid
F - 5-FU
IRI - Irinotecan
15. Cisplatin -Most emitogenic Anticancer drug
-Most important side effect :
Nephrotoxicity
-Other S/E : Ototoxicity
-Marrow sparing drug
Carboplatin Maximum Bone marrow suppression
(Most hematotoxic)
Oxaliplatin Used for Colorectal cancers
16. 1) Nephrotoxicity is seen with: (DNB Dec 2010)
A Azathioprine
B Leflunomide
C Mycophenolate mofetil
D Tacrolimus
17. Ans. D) Tacrolimus
I. It is a Macrolide Antibiotic
II. Tacrolimus (FK 506) inhibits IL-2 transcription like cyclosporine does.
II. The drug is more potent than cyclosporine and requires therapeutic drug
monitoring.
III. Patients treated with the calcineurin inhibitors cyclosporine and tacrolimus
are at high risk of developing renal injury.
Side Effects
1) Nephrotoxicity
2) Neurotoxic
3) Precipitates DM
4) Hepatotoxic but not Ototoxic
Inhibits IL-2 transcription
IL-2 activates T cell
Thus Tacrolimus decreases T-cell
activity
18. -Prodrug of Anti Cancer drug 6-Mercaptopurine
- Drug of choice for Steroid Resistant Ulcerative Colitis
Side effects :
1) Bone marrow suppression ; Most Important
2) Hepatotoxicity
3) Nephrotoxicity : Rare
19. Leflunomide is an immunomodulator and is used in severe
rheumatoid arthritis.
SIDE EFFECTS
1) severe liver injury
2) interstitial lung diseases,
3) myelosupression and anemia.
20. -Mycophenolate is a prodrug
-It is an inosine monophosphate dehydrogenase inhibitor.
-Common Side Effect :
1) gastrointestinal upset
2) bone marrow depression.
21. -Immunomodulator
-Side Effects : SPORT Channel
S - Sedation
Po -Phocomelia /Peripheral Neuropathy
R - Rash
T - Thrombosis
Channel - Constipation
Phocomelia
Limb bud formation defect
22. 2. Cerebellar ataxia is caused by (DNB June 2012)
A Arabinofuranosyl cytidine
B Bleomycin
C Cisplatin
D Busulfan
23. Ans. A Arabinofuranosyl cytidine
Cytarabine (Arabinofuranosyl cytidine) is used intrathecally for meningeal
leukemia.
This can cause cerebellar toxicity – ataxia & slurred speech as well as cerebral
toxicity – seizures, dementia, coma etc.
The other side effects are potent myelosuppression, GIT & mucosal side effects,
dermatitis, reversible rise in LFT & pulmonary side effects.
24. Anti Folate Anti PyramidinesAnti Purines
-Methotrexate
-Pemetrexed
-Pralatrexate
-6-mercaptopurine
6-thioguanine
Cladribine
Fludrabine
-5-FU
-Capecitabine
-Gemcitabine
-Cytarabine
(Arabinofuranosyl
cytidine)
26. C - Choriocarcinoma
A - Autoimmune diseases
N -Non Hodgkin Lymphoma
C - Crohn’s Disease
E - Ectopic Pregnancy
R -Rheumatoid Arthritis
27. 1) Bone marrow : causes Bone marrow suppression
2) GIT : causes Nausea and vomiting
3) Hairs: Alopecia
4) Causes increase in Serum Uric Acid : Due to lysis of
tumor cells
5) Megaloblastic Anemia
6) Hepatotoxicity
28. -Methotrexate resistance is due to overproduction of Dihydrofolate
Reductase(DHFRase)
-Methotrexate is a weak acid and hence its excretion is increased by
Alkalinisation
29. Weak- Warfarin
A - Aspirin/ Antiepileptics
C -Chlorthiazide
I - Ibuprofen
D - Dopa (Levodopa)
30. Drug Feature
6-mercaptopurine -Metaboliosed by Xanthine Oxidase
- S/E : Hepatotoxicity
6-thioguanine S/E : Hepatotoxicity
Cladribine DOC in Hairy cell Leukemia
Fludrabine DOC in CLL
-Purines : Adenine and Guanine
31. 5-FU S/E: Hand and foot Syndrome
Capecitabine -Prodrug and is metabolised to 5-FU
-S/E: Hand and foot Syndrome
Gemcitabine DOC in Pancreatic Cancers
Cytarabine S/E: Cerebellar ataxia
-Pyramidines : Cytosine, Thymine and Uracil.
32. Cute - Chloroquine
P - Penicillamine
A - Azathioprine
G -Gold Salts
L - Leflunomide
I - Immunosuppresant drugs
Malika - Methotrexate (DOC)
Sherawat - Sulfasalazine
TNF-@ Inhibitors
1) Adalizumab
2) Etanarcept
3) Infliximab
IL-1 Receptor Antagonist
Anakinra
IL-6 Inhibitor
Tocilizumab
Disease Modifying Anti Rheumatoid Drugs
33. 3. Which of the following is highly emetogenic:
A Cisplatin
B High dose methotrexate
C High dose cyclophosphamide
D Carboplatin
34. Ans. A) Cisplatin as well as option
C. High dose Cyclophosphamide
Nausea & vomiting is a prominent feature of many of cytotoxic drugs.
This is due to CTZ stimulation as well as generating the emetogenic stimuli from
upper GIT as well as other areas.
A. High emetogenic – cisplatin, mustine,cyclophosphamide, actinomycin D,
dacarbazine, lomustine.
35. -Located in Area Postrema
- Remember its location: Can come in exam.
36. Drugs which are effective in
chemotherapy induced vomiting:
A. 5-HT3 receptor antagonists – granisetron, palanocetron, ondansetron
etc.
B. NK1 antagonists (Substance P antagonist): Aprepitant
C. Dexamethasone
CHEMOTHERAPY INDUCED VOMITING DOC
Early Onset Ondansetron
Late Onset Aprepitant
37. 4. Which is not a alkylating agent
A Cyclophosphamide
B Chlorambucil
C 5-FU
D Melphalan
38. Ans. C 5-FU
5-FU( 5 Fluro Uracil) is a antimetabolite – classified as anti-pyrimidine
compound.
Rest all are alkylating agents – act by formation of active carbonium ion which
damages DNA.
The alkylating agents are further classified as
Nitrogen mustards – mechlorethanamine, cyclophosphamide’s, ifosfamide,
melphalan &chlorambucil
Ethyleneimine & methylmelamines – altretamine & thiotepa
Methyl hydrazine derivatives – procarbazine.
Alkyl sulfonates – busulfan
Nitrosoureas – carmustine, lomustine.
Triazenes – Dacarbazine, temozolomide
Platinum co-ordination complexes – cisplatin, carboplatin and oxiliplatin.
39. 5. Ifosfamide is a (DNB Dec 2012)
A Alkylating agents
B Antimetabolite
C Folate antagonists
D Plant Alkaloids
40. Ans. A alkylating agent
Ifosfamide is a synthetic isomer of cyclophosphamide.
Importantly, it is not a metabolite of cyclophosphamide.
It causes greater neurotoxicity and cystitis than cyclophosphamide
42. 6. All of the following are side effects of thalidomide except (AIIMS Nov 2009)
A Hypothyroidism
B Diarrhea
C Teratogenicity
D Deep Vein Thrombosis
43. Ans. B Diarrhea
Thalidomide causes constipation and not diarrhea
The most common adverse effects are sedation and constipation
the most serious one is treatment-emergent peripheral sensory
neuropathy.
44. -Immunomodulator
-Side Effects : SPORT Channel
S - Sedation
Po -Phocomelia /Peripheral Neuropathy
R - Rash
T - Thrombosis
Channel - Constipation
Phocomelia
- Teratogenic S/E
- Limb bud formation defect
45. 7.
Which of the following is cell cycle specific
A Ifosfamide
B Bleomycin
C Vinblastine
D Cyclophosphamide
46. Ans. C Vinblastine
Vinblastine is a M phase specific vinca alkaloid.
It blocks the mitotic spindles and produces metaphase arrest.
Since it produces an interference with chromosomal segregation it is useful in
tumors that are rapidly dividing.
The drug is used in blood and reproductive cancers.
Side effects
nausea, vomiting, myelosupression and bone marrow depression.
47. DRUGS INHIBITING
FORMATION OF SPINDLE
FEATURES
VINCRISTINE -Doesn’t cause bone marrow
suppression(marrow sparing
drug)
-S/E : SIADH and Peripheral
Neuropathy
VINBLASTINE S/E; Bone marrow suppression
-M Phase Specific
48. DRUGS INHIBITING BREAK
OF SPINDLE
FEATURES
PACLITAXEL -Stabilises Microtubule
-S/E :
1) Allergy
2) Peripheral Neuropathy
49. TOPOISOMERASE –I Inhibitor TOPOISOMERASE –II Inhibitor
Irinotecan Etoposisde
Anthracyclines
Doxorubocin
Daunorubocin
Used in Colorectal Cancer
(FOLFORI Regimen)
-Etoposide causes Secondary
Leukemias
-Anthracyclines causes Cardiotoxicity
51. 1) ALKYLATING AGENTS
2) ETOPOSIDE
-MC Secondary Leukemia due to Anti cancer drugs is : AML
ALKYLATIN
G AGENTS
ETOPOSIDE
Secondary
Leukemias
Develops long
4-5yrs
1-2yrs
Myelodysplasia Occurs Doesn’t occur
53. 8) Bleomycin toxicity affects which type of cells.
A Type 1 pneumocyte
B Type 2 pneumocyte
C Endothelial cell.
D Alveolar macrophages
54. Ans. A Type 1 pneumocytes
Bleomycin
causes destruction of type 1 pneumocyte thereby causing hyperplasia of
type-II pneumocytes.
-Bleomycin is an Anticancer Antibiotic
-Bone marrow sparing drug
56. 9) ‘Hand Foot’ syndrome can be caused by?
A 5FU
B Vincristine
C Capecitabine
D Mitomycin-C
57. Ans. A 5FU as well as C. Capecitabine
5-FU can cause hand foot mouth disease. It is given I.V.
Generally, this disease affects infants and children.
Adults with immunodeficiency can also be affected.
Capecitabine is a oral 5FU analog, that obviate the need for I.V.
58. 5-FU S/E: Hand and foot Syndrome
Capecitabine -Prodrug and is metabolised to 5-FU
-S/E: Hand and foot Syndrome
Gemcitabine DOC in Pancreatic Cancers
Cytarabine S/E: Cerebellar ataxia
-Pyramidines : Cytosine, Thymine and Uracil.
59. 10) Topical MITOMYCIN-C is used in: (DNB Dec 2009)
A Sturge weber syndrome
B Urinary bladder cancer
C Endoscopic angiofibroma
D Skull base osteomyelitis
60. Ans. B Urinary bladder cancer
I. Mitomycin is an anti-tumor antibiotic with alkylating agent like property. It is
used in superficial cancer of urinary bladder.
II. The drug has radiomimetic effects, and also sensitizes hypoxic tumor cells to
the effects of hypoxia. Hemolytic uraemic syndrome is a known
complication of mitomycin.
III. The drug also produces bone marrow depression.
The drug of choice for superficial cancer of urinary bladder is BCG
given intravesically.
61. 11) Which of the following statement is false regarding vincristine? (AIIMS May 2012)
A It is an alkaloid
B Its use is associated with neurotoxicity
C It does not cause alopecia
D It is useful drug for induction of remission in acute lymphoblastic leukemia
62. Ans. C It does not cause alopecia
(Mnemonics :
Vincristine: CNS side effect;
Vinblastine: Blood/Bone marrow side effect)
a. Vincristine is a vinca alkaloid.
Vincristine is very useful for inducing remission in childhood acute leukemia.
b. It is also used for treatment of chronic lymphocytic leukemia and chronic
myelocytic leukemia.
Prominent adverse effects are peripheral neuropathy and alopecia.
63. DRUGS INHIBITING
FORMATION OF SPINDLE
FEATURES
VINCRISTINE -Doesn’t cause bone marrow
suppression(marrow sparing
drug)
-S/E : SIADH and Peripheral
Neuropathy
VINBLASTINE S/E; Bone marrow suppression
-M Phase Specific
64. 12. Allopurinol should be avoided, or reduced doses should be used if given
with which of the chemotherapeutic agent ?
A Bleomycin
B Cisplatin
C Cyclophosphamide
D Mercaptopurine
65. Ans. D Mercaptopurine
I. Mercaptopurine and other thiopurine are purine antimetabolites that are
metabolically inactivated by xanthine oxidase.
-Allopurinol inhibits Xanthine Oxidase
As a result Xanthine oxidase is not available to degrade Mercaptopurine
Leads to Toxicity of Mercaptopurine i.e Severe hepatotoxicity
Thus decreased dose of Mercaptopurine should be given if co-administered with
Allopurinol.
66. 13. AMIFOSTINE is protective to to all except:
A Salivary gland
B Skin
C CNS
D GIT
67. Ans. C) CNS
-Amifostine is a cytoprotective drug .
-It doesn’t cross Blood Brain Barrier. Hence is not protective to CNS.
-Amifostine is protective to salivary glands (reduces xerostomia) and GIT
(prevents esophagitis).
-Its xerostomia preventing action can also be considered to be protective to
skin.
68. 14. Which of the following causes persistent leucopenia? (AIIMS Nov 2011)
A Cisplatin
B Vinblastin
C Doxorubicin
D Carmustine
70. 15. Temozolomide is a (DNB June 2011)
A Carbonic anhydrase inhibitor
B Alkylating agent
C Anti metabolite
D Tyrosine kinase inhibitor
71. Ans. B Alkylating agents
- Temozolomide is a Newer alkyalting agent
- It can cross BBB , hence used for brain cancer (anaplastic astrocytoma
and glioblastoma multiforme)
- commonly used oral and intravenous
S/E: Nausea, vomiting, headache, constipation , myelosuppression
72. 16. SIADH is caused by the following drugs except?
A Vincristine
B Vinblastine
C Actinomycin D
D Cyclophosphamide
73. Ans. C Actinomycin D
Drugs Causing SIADH
1. Intravenous cyclophosphamide
2. Carbamazepine
3. Vincristine or vinblastine
4. Phenothiazines
5. Haloperidol
6. Tricyclic antidepressants or serotonin-reuptake inhibitors
7. Monoamine oxidase inhibitors
8. Bromocriptine
9. Clofibrate
10. Narcotics, opiate derivatives
74. 17. Alkalinisation of urine ameliorates the toxicity of which of the
following drugs? (AIIMS May 2009)
A Arabinoside-cytosine
B Ifosfamide
C Cisplatin
D Methotrexate
75. -Methotrexate resistance is due to overproduction of Dihydrofolate
Reductase(DHFRase)
-Methotrexate is a weak acid and hence its excretion is increased by
Alkalinisation
76. Weak- Warfarin
A - Aspirin/ Antiepileptics
C -Chlorthiazide
I - Ibuprofen
D - Dopa (Levodopa)
77. 18) Which anticancer drug causes hypercoagulable syndrome?
A 5-FU
B L-asparaginase
C Melphalan
D Carmustine
79. 19. Methotrexate resistance is due to:
A Depletion of Folate
B Overproduction of DHFRase
C Overproduction of Thymidylate kinase
D Decreased DHFRase
80. Ans. B Overproduction of DHFRase
Mechanisms of methotrexate resistance
I. Impaired transport of methotrexate into cells
II. Production of altered forms of DHFR that have decreased affinity for the
inhibitor
III. Increased concentrations of intracellular DHFR through gene amplification or
altered gene regulation
IV. Decreased ability to synthesize methotrexate polyglutamates
V. Increased expression of a drug efflux transporter, of the MRP (multidrug
resistance protein) class.
81. 21. High dose methotrexate is given in:
A Osteosarcoma
B Colon Cancer
C Retinoblastoma
D Ewing's sarcoma
82. Ans. A Osteosarcoma
Drugs effective in osteosarcoma are: .
doxorubicin,
ifosfamide,
cisplatin, and
high-dose methotrexate with leucovorin.
Osteosarcoma is radioresistant; radiation therapy has no role in the routine
management.
84. CML INDia Imatinib (DOC)
Nilotinib
Dasatinib
Lung cancer After ECG we look for
Lungs
After – Afatinib
E-Erlotinib
C- Ceritinib
G - Geftinib
RCC We PASS urine due to
kidney
P -Pazotinib
A - Axitinib
S - Sorafenib
S - Sunitinib
HCC We feel Sorry for Liver
cancer
Sorry - Sorafenib
GIST Imatinib (DOC)
Malignant Melanoma DVT D - Dabrefinib
V - Vemurafenib
T - Trameltenib
Medullary carcinoma thyroid Vandematram Vandetanib
85. 22) Which of the following drug acts by inhibiting tyrosine kinase activated by EGF
receptor as well as HER2
A Imatinib
B Geftinib
C Erlotinib
D Lapatinib
87. 23) Paclitaxel acts by (DNB June 2011)
A Topoisomerase inhibitor
B Inhibition of Microtubule formation
C Mitotic cell inhibitor
D Exaggerates polymerization and causes the stabilization of the microtubules
88. Ans. D Exaggerates polymerization and causes the stabilization of the
microtubules
II. It enhances polymerization of tubulin: a mechanism opposite to that of vinca
alkaloids.
III. The microtubules are stabilized and their depolymerization is prevented.
IV. This stability results in inhibition of normal dynamic reorganization of the
microtubule network that is essential for vital interphase and mitotic functions.
V. Abnormal arrays or ‘bundles’ of microtubules are produced throughout the
cell cycle.
89. 24. ATRA is useful in the treatment of which of the following type of AML?
(AIIMS Nov 2012)
A Monocytic leukemia
B Myelomonocytic leukemia
C Promyelocytic leukemia
D Erythro leukemic leukemia
90. Ans. C Acute Promyelocytic leukemia {APL}
Treatment of promyelocytic leukemia is by tretinoin.
It is an oral drug that induces the differentiation of leukemia cells bearing the t
(15,17)
It is not effective in other forms of AML.
91. 25. Leucovorin is used as Rescue therapy for patients who are on one of the
following drug therapies
A Asparagine
B Methotrexate
C 6-mercaptopurine
D Cyclophosphamide
92. Ans. B Methotrexate
a. Methotrexate toxicity: Folinic acid (Leucovorin, citrovorum factor),is an
active coenzyme form which does not need to be reduced by DHFRase before
it can act.
b. Methotrexate is a DHFRase inhibitor; its toxicity is not counteracted by folic
acid, but antagonized by folinic acid.
c. Folinic acid is expensive and not needed for the correction of simple folate
deficiency for which folic acid is good enough.
93. 26. Which phase of the cell cycle is resistant to most chemotherapeutic agents:
A G0
B G1
C G2
D M
94. Ans. A G0
a. The G0 phase is the resting or dormant stage of the cell cycle.
b. No cell division takes place. This phase is, overall, the most resistant to
chemotherapeutic agents because most of the (phase-specific) anti cancer
drugs produce their lethal effects quickest and best on cells that are actively
proliferating, whether synthesizing or preparing to synthesize DNA, or to
undergo mitosis.
Good examples of drugs that are reasonably effective against cells in G0 (or
any other phase) are the alkylating agents (e.g., cyclophosphamide) and
several of the antitumor antibiotics (e.g., dactinomycin, doxorubicin).
95. 27.A cancer patient develops severe, irreversible cardiomyopathy because the
maximum lifetime dose of an anticancer drug was exceeded. Which of the following
is most likely responsible for this patient’s symptoms? (AIPG 2011)
A Asparaginase
B Bleomycin
C Cisplatin
D Doxorubicin
96. Ans. D Doxorubicin
I. Doxorubicin, an antitumor antibiotic, is cardiotoxic, and the risk for and
severity of cardiomyopathy is dose-related.
II. [There is a maximum recommended lifetime (cumulative) dose for this
drug, and if it exceed the risk of cardiac damage rises significantly]
97. 28. Which of the following are the most common and worrisome adverse
responses associated with cyclosporine therapy? (AIPG 2010)
A Cardiotoxicity and hepatotoxicity
B Hepatotoxicity and nephrotoxicity
C Hypotension and pulmonary fibrosis
D Nephrotoxicity and infection risk
98. Ans. D Nephrotoxicity and infection risk
a. Nephrotoxicity; occurs in about 8 of 10 patients receiving cyclosporine. It is
typically dose-dependent and, particularly in renal transplant patients, could
be due to either the drug (too much) or to rejection. Infection occurs about as
often as renal dysfunction.
b. Cyclosporine can cause hepatotoxicity, but the incidence is far lower than that
of renal responses or infection. Blood pressure changes can occur, but with
cyclosporine the change usually involves increased pressure, and it is common.
c. Cardiac or pulmonary toxicities and thromboembolism due to the drug itself
are extremely uncommon. The drug blocks transcription of IL-2 and thus reduces
activity of CD-4 lymphocytes. This increases risk of infections.
