Wattle Pharmacy Prep

Chemotherapy and immunomodulators
Practice questions with explanations

Chemotherapy and immunomodulators belongs to Pharmacology and toxicology, which makes up about 15% of the Overseas Pharmacist Readiness Assessment (OPRA®). Answer each question yourself before opening the explanation.

1. How do tyrosine kinase inhibitors differ from conventional cytotoxics?

  1. They target specific signalling proteins that drive particular tumours, giving different toxicities such as rash, diarrhoea and hypertension rather than marrow suppression
  2. They have no adverse effects
  3. They act on all dividing cells equally
  4. They are always given intravenously
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A. They target specific signalling proteins that drive particular tumours, giving different toxicities such as rash, diarrhoea and hypertension rather than marrow suppression

Targeting a driver mutation, as imatinib does for BCR-ABL in chronic myeloid leukaemia, transformed outcomes and shifted the toxicity profile toward class-specific effects reflecting the pathway's normal roles. Most are oral, many are CYP3A4 substrates with important interactions, and resistance through new mutations is the usual mode of failure.

2. Which mechanism do the taxanes use?

  1. They alkylate DNA
  2. They inhibit dihydrofolate reductase
  3. They prevent microtubule assembly
  4. They stabilise microtubules and prevent their disassembly, arresting mitosis
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D. They stabilise microtubules and prevent their disassembly, arresting mitosis

Taxanes freeze the mitotic spindle by preventing depolymerisation, while vinca alkaloids act at the opposite end of the same process by preventing polymerisation; both arrest mitosis. Taxane toxicities include peripheral neuropathy, myelosuppression and hypersensitivity reactions to the vehicle, which is why premedication with corticosteroid and antihistamine is used.

3. Which principle applies to hormonal therapy for hormone receptor-positive breast cancer?

  1. Tamoxifen blocks the oestrogen receptor and aromatase inhibitors reduce oestrogen synthesis, with the choice depending on menopausal status
  2. Aromatase inhibitors are preferred in premenopausal women without ovarian suppression
  3. Both work equally regardless of menopausal status
  4. Hormonal therapy is used only in receptor-negative disease
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A. Tamoxifen blocks the oestrogen receptor and aromatase inhibitors reduce oestrogen synthesis, with the choice depending on menopausal status

Aromatase inhibitors block peripheral conversion of androgens to oestrogen, which is the main source after menopause, so they are ineffective in premenopausal women unless ovarian function is suppressed. Tamoxifen carries thromboembolism and endometrial cancer risk, and aromatase inhibitors cause arthralgia and accelerated bone loss requiring bone monitoring.

These are 3 of the 20 questions on chemotherapy and immunomodulators in the app.

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More topics in Pharmacology and toxicology

Adverse drug reactions · Analgesics and anti-inflammatories · Antimicrobial pharmacology · Autonomic pharmacology · Cardiovascular pharmacology · CNS pharmacology · Endocrine pharmacology · Respiratory and gastrointestinal pharmacology · Toxicology and antidotes