Agent Specific Supportive Care Flashcards
What drugs are alkylating agents?
cyclophosphamide/ifosfamide
What is the enzyme that metabolizes cyclophosphamide?
CYP3A4 and CYP2B6
What are the toxicities associated with Cyclophosphamide?
- interstitial pneumonia
- SIADH
- myelosuppression (dose limiting toxicity)
- nausea/vomiting
- alopecia
- amenorrhea/infertility
- cardiotoxicity
- secondary malignancies (bladder cancer or leukemia)
- hemorrhagic cystitis (ifosfamide>cyclophosphamide)
What are the toxicities associated with Ifosfamide?
- CNS toxicity/encephalopathy
- nephrotoxicity
- myelosuppression (dose limiting toxicity)
- nausea/vomiting
- alopecia
- amenorrhea/infertility
- cardiotoxicity
- secondary malignancies (bladder cancer or leukemia)
- hemorrhagic cystitis
What are the symptoms of hemorrhagic cystitis?
hematuria, dysuria, frequency
What are the monitoring parameters to assess hemorrhagic cystitis?
daily urine analysis
What is the preventative treatment for hemorrhagic cystitis?
hydration, mesna
What is the treatment for hemorrhagic cystitis?
continuous bladder irrigation
What are the symptoms of encephalopathy?
somnolence, confusion, hallucinations, psychosis
What is the treatment of encephalopathy?
methylene blue 50mg IV q6h
What drugs are alkylating-like agents/platinum agents?
- cisplatin
- carboplatin
- oxaliplatin
What are the common uses of Cisplatin?
bladder, cervical, head and neck, lung, ovarian, testicular cancer
What are the toxicities associated with Cisplatin?
- severe nausea/vomiting
- severe nephrotoxicity (dose limiting toxicity)
- neuropathy
- ototoxicity
- mild myelosuppression (anemia)
How is nephrotoxicity addressed associated with Cisplatin?
- may be reversible
- pre/post hydration +/- diuresis
- avoid dehydration associated with N/V
- replace potassium and magnesium
What are the toxicities associated with Carboplatin?
- myelosuppression (dose limiting toxicity)
- nephrotoxicity
- ototoxicity
- N/V
- hypersensitivity
What are the toxicities are associated with oxaliplatin?
- neuropathy (dose limiting toxicity)
- mild/moderate myelosuppression
- N/V
What drugs are antifolate agents?
aka antimetabolites
- methotrexate
- pemetrexed
- pralatrexate
What drugs are pyrimidine analogs?
aka antimetabolites
- fluorouracil (5-FU)
- capecitabine
- cytarabine
- gemcitabine
What drugs are prine analogs?
- 6-mercaptopurine
- 6-thioguanine
- clabribine
- pentostatin
- clofarabine
- fludarabine
- nelarabine
What is the mechanism of action of methotrexate?
inhibits dihydrofolate reductase which limits the avaliability of reduced folates for purine synthesis
What is the toxicity associated with methotrexate?
- myelosuppression (dose limiting toxicity)
- mucositis (dose limiting toxicity)
- hepatotoxicity/nephrotoxicity
accumulation in ascites/pleural effusion
What drugs should be discontinued with methotrexate use?
- penicillins
- aspirin
- probenecib
- NSAIDs
What is the use of Leucovorin?
repletes reduced folate stores from methotrexate therapy- allowing large doses to be administered and is REQUIRED for high dose methotrexate therapy (~1+g/m2), generally continued until methotrexate levels < 0.05-1 umol/L
What is the use of Glucarpidase?
reduces methotrexate level >97% within 15 minutes (not to be administered within 2 hours of leucovorin)
What can increase the risk of 5-Fluorouracil toxicities?
deficiency in dihydropyrimidine dehydrogenase (DPD)
What are the toxicities associated with 5-Fluorouracil?
- hand-foot syndrome (dose limiting toxicity)
- mucositis
- diarrhea
- myelosuppression (dose limiting toxicity associated with bolus infusions)
What is the use of Uridine triacetate?
5-FU/capecitabine overdose- early-onset, severe or life-threatening toxicity within 96 hours of infusion
What are the toxicities associated with Cytarabine?
- low dose= myelosuppression, N/V, mucositis
- high dose= myelosuppression, neurotoxicity, chemical conjuctivitis
What are the risk factors associated with Cytarabine neurotoxicity?
- age 40+
- SCr 1.2+
- alk phos 3x normal
What can be used to treat chemical conjunctivitis associated with Cytarabine?
steroid eye drops (dexamthasone or prednisolone 2 drops 4x day, d/c 24 hours after last dose)
What drugs are Anthracyclines?
- doxorubicin
- daunorubicin
- epirubicin
- idarubicin
What is the mechanism of action of anthracyclines?
topoisomerase II inhibition, intercalates with DNA, free radical formation
drugs: doxorubicin, daunorubicin, epirubicin, idarubicin
What are the adverse effects of anthracyclines?
- acute/cumulative cardiotoxicity
- vesicant (“blistering agents” used in chemical warfare)
- myelosuppression
- N/V
- mucositis
- alopecia
- radiation recall
- red/orange urine
- secondary leukemias
drugs: doxorubicin, daunorubicin, epirubicin, idarubicin
What can be used to prevent anthracycline cardiotoxicity?
- continuous infusion vs bolus dosing
- dexrazoxane
- lipid formulation
drugs: doxorubicin, daunorubicin, epirubicin, idarubicin
What is the monitoring parameters for anthracycline therapy?
baseline EF measurement with lifetime monitoring
drugs: doxorubicin, daunorubicin, epirubicin, idarubicin
What is the mechanism of action of camptothecins (Irinotecan)?
inhibits topoisomerase I
What is the mechanism of action of Epipodophyllotoxins (Etoposide)?
inhibits topoisomerase II
What are the toxicities associated with Irinotecan?
Camptothecins
- diarrhea (I-RUN-TO-THE-CAN): DLT
- myelosuppression: DLT
- mucositis
What is the treatment for diarrhea associated with Irinotecan?
Camptothecins
- acute: atropine
- chronic: loperamide
What are the toxicities associated with Etoposide?
Epipodophyllotoxins
- myelosuppression
- mucositis
- diarrhea
- alopecia
- secondary leukemia
- infusion reaction (due to benzyl alcohol, polysorbate 80)
What drugs are antimicrotubule agents?
- vinca alkaloids
- halichondrins
- taxanes
- epothilones
What are the associated side effects of antimicrotubule agents?
drugs: vinca alkaloids, halichondrins, taxanes, epothilones
NEUROPATHY
Which vinca alkaloid is associated with the most neuropathy?
vincristine
DLT!
What vinca alkaloid is associated with myelosuppression?
vinblastine and vinorelbine
What drugs are vinca alkaloids?
- vincristine
- vinblastine
- vinorelbine
What drug can be fatal if administered intrathecal (IT) route?
vinca alkaloids
drugs: vincristine, vinblastine, vinorelbine
What drugs are taxanes?
- paclitaxel
- docetaxel
- carbazitaxel
What taxane has less hypersensitivity reaction?
albumin-bound paclitaxel
What taxane has an adverse effect of edema?
docetaxel
What drugs may be given to prevent infusion reactions associated with taxanes?
- dexamathasone
- H1 and H2RA
What drugs are anti-VEGF therapy?
- anti-VEGFR antibodies= ramucirumab
- anti-VEGF antibodies= bevacizumab
- soluble VEGF receptors= Ziv-aflibercept
- small molecule VEGFR inhibitors (TKIs)= pazopanib, sorafenib, sunitinib, axitinib, cabozatinib, regorafenib, lenvatinib, vandetanib, tivozanib
What are the adverse effects of Anti-VEGF drugs?
- bevacizumab/ramucirumab= infusion reaction, hypertension, proteinuria, GI perforation, wound healing complications, hemorrhage, arterial/venous thrombosis
- all the other f-ing ones: diarrhea, rash, hand-foot syndrome, hypertension, bleeding, wound healing complications, GI perforation
Which Anti-VEGF drug can cause QT prolongation?
pazopanib
