When PDL1 binds to PD1 inhibits the cytotoxic activity of the T cell - cancer cells have evolved to be able to turn off the body's defense
pembrolizumab is going to bin to PD1 so that PDL1 cannot and the T cell is not inhibited
nitrosoureA - - alkylating agent
very lipid soluble - can cross B...
Nervousness, Agitation, Insomnia, Diarrhea, Headaches, Heart Palpitation
Do not take with MAO inhibitors. Can alter affects with heart medications. Can increase the risk of
bleeding when taken with blood clotting drugs
CI: Neuro, Heart, MAO, bleeding, coag drugs
Ma Huang (Ephedra) - ✔✔✔ - Dangerously elevate blood pressure, stimulate heart rate, and CNS
Associated with stroke, MI, and death
Banned > 10 mg in U.S. with exception of traditional Asian medicine
Metabolite
Used for weight loss, allergies, asthma, bronchitis, fever, headache
Arginine - ✔✔✔ - Arginine is used for treatment of heart and blood vessel conditions including
congestive heart failure (CHF), chest pain, high blood pressure, and coronary artery disease.
Don't use if:
Excess body acid
High levels of potassium in the blood
sickle cell anemia
heart attack within the last 30 days
renal tubular acidosis
decreased kidney function
Don't use with nitro
Pt. education for herbs and nutrients - ✔✔✔ - 1. herbs and nutrients have bioactive properties and
have the same safety issues as drugs
, 2. always consult a reliable source before adding
3. consider when researching what are the credentials of the author of the website, what evidence is
there to support their claims, are there any financial interests to influence the claims of the auther
Biological basis of drug/herb/nutrient interactions - ✔✔✔ - absorption (changing pH or motility of
the GI tract)
Distribution (displacing agents that are bound to plasma proteins
Biotransformation (inducing or inhibiting CYP450 enzymes)
Receptor binding (competitive and noncompetitive antagonism
Gompertzian Kinetics - ✔✔✔ - Cancer cells lack of normal regulating factors leading to abnormal
growth
You can go from 0 to 10^9 before symptoms
This bounces because you go on and off of chemo
That's why we do multiple rounds - so you initiate the next round of chemo before you get back to
where we started
If you initiate chemo at a lower tumor mass you will get a better response in a shorter amount of time
Mechanisms of drug resistance - ✔✔✔ - reduced intracellular drug concentration through drug
inactivation mechanisms, reduced uptake, drug efflux pumps
change in target due to mutation in drug target
insensitivity to apoptosis due to mutation in p53
chemotherapeutics: antemetabolites - ✔✔✔ - inhibit DNA synthesis enzymes
works in the s phase
5FU binds to tymidylase synthase
catalizes the reaction of converting dUMP to dTMP
if you interrupt this you interrupt synthesis of DNA
chemotherapeutics: alkylating agents - ✔✔✔ - Bind to DNA
binds to DNA at the alkyl group between two guanines that would have gotten cross linked
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