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Tyler's Cards > Alkylating Agents > Flashcards

Alkylating Agents Flashcards

1
Q

What drugs are in the Alkylating Agents class?

A

Drugs in this class are:
- Cyclophosphamide
- lfosfamide
- Busulfan
- Melphalan
- Bendamustine

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2
Q

What is the brand name of Cyclophosphamide?

A

The brand name of this generic drug is:
- Cytoxan

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3
Q

What is the brand name of lfosfamide?

A

The brand name of this generic drug is:
- Ifex

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4
Q

What is the brand name of Busulfan?

A

The brand name of this generic drug is:
- Busulfex
- Myleran

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5
Q

What is the brand name of Melphalan?

A

The brand name of this generic drug is:
- Alkeran
- Evomela

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6
Q

What is the brand name of Bendamustine?

A

The brand name of this generic drug is:
- Belrapzo
- Bendeka
- Treanda
- Vivimusta

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7
Q

What is the generic of name of Cytoxan?

A

The generic name of this brand name drug is:
- Cyclophosphamide

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8
Q

What is the generic of name of Ifex?

A

The generic name of this brand name drug is:
- lfosfamide

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9
Q

What is the generic of name of Busulfex?

A

The generic name of this brand name drug is:
- Busulfan

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10
Q

What is the generic of name of Myleran?

A

The generic name of this brand name drug is:
- Busulfan

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11
Q

What is the generic of name of Alkeran?

A

The generic name of this brand name drug is:
- Melphalan

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12
Q

What is the generic of name of Evomela?

A

The generic name of this brand name drug is:
- Melphalan

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13
Q

What is the generic of name of Belrapzo?

A

The generic name of this brand name drug is:
- Bendamustine

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14
Q

What is the generic of name of Bendeka?

A

The generic name of this brand name drug is:
- Bendamustine

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15
Q

What is the generic of name of Treanda?

A

The generic name of this brand name drug is:
- Bendamustine

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16
Q

What is the generic of name of Vivimusta?

A

The generic name of this brand name drug is:
- Bendamustine

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17
Q

What are the main indications for use of Cyclophosphamide?

A

The main indications of this drug are:
- Non-Hodgkin lymphoma
- Hodgkin lymphoma
- Hematopoietic stem cell transplant
- Acute lymphoblastic leukemia
- Breast cancer
- Ewing sarcoma
- Graft-vs-host disease prophylaxis
- Multiple myeloma
- Osteosarcoma
- Rhabdomyosarcoma
- Small cell lung cancer

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18
Q

What are the main indications for use of lfosfamide?

A

The main indications of this drug are:
- Non-Hodgkin lymphoma
- Hodgkin lymphoma
- Ewing sarcoma
- Osteosarcoma
- Testicular cancer
- Bladder cancer
- Cervical cancer
- Ovarian cancer
- Soft tissue sarcoma

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19
Q

What are the main indications for use of Busulfan?

A

The main indications of this drug are:
- Hematopoietic stem cell transplant
- Polycythemia vera
- Essential thrombocythemia

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20
Q

What are the main indications for use of Melphalan?

A

The main indications of this drug are:
- Hematopoietic stem cell transplant
- Multiple myeloma

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21
Q

What are the main indications for use of Bendamustine?

A

The main indications of this drug are:
- Chronic lymphocytic leukemia
- Non-Hodgkin lymphoma
- Hodgkin lymphoma

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22
Q

What is the class and MOA of Cyclophosphamide?

A

This drug in the following class:
- Alkylating Agents

This drug’s MOA is as follows:
- Alkylates and cross-links DNA preventing DNA synthesis and cell division

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23
Q

What is the class and MOA of lfosfamide?

A

This drug in the following class:
- Alkylating Agents

This drug’s MOA is as follows:
- Alkylates and cross-links DNA preventing DNA synthesis and cell division

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24
Q

What is the class and MOA of Busulfan?

A

This drug in the following class:
- Alkylating Agents

This drug’s MOA is as follows:
- Alkylates and cross-links DNA preventing DNA synthesis and cell division

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25
Q

What is the class and MOA of Melphalan?

A

This drug in the following class:
- Alkylating Agents

This drug’s MOA is as follows:
- Alkylates and cross-links DNA preventing DNA synthesis and cell division

26
Q

What is the class and MOA of Bendamustine?

A

This drug in the following class:
- Alkylating Agents

This drug’s MOA is as follows:
- Alkylates and cross-links DNA preventing DNA synthesis and cell division

27
Q

What are the notable monitoring parameters for Cyclophosphamide?

A

The notable monitoring parameters for this drug are:
- Monitor for blood in urine (either through patient report or urine dipstick depending on protocol)

28
Q

What are the notable monitoring parameters for lfosfamide?

A

The notable monitoring parameters for this drug are:
- Monitor for blood in urine (either through patient report or urine dipstick depending on protocol)

29
Q

What are the notable monitoring parameters for Busulfan?

A

The notable monitoring parameters for this drug are:
- Monitor hepatic function for signs of veno-occlusive disease
- Monitor pharmacokinetics when giving high dose for stem cell transplant

30
Q

What is the emetic potential of Cyclophosphamide?

A

The emetic potential of this drug is:
- High if >1500 mg/m2
- Moderate if <1500 mg/m2

31
Q

What is the emetic potential of lfosfamide?

A

The emetic potential of this drug is:
- High if >2 g/m2
- Moderate if <2 g/m2

32
Q

What is the emetic potential of Busulfan?

A

The emetic potential of this drug is:
- Moderate

33
Q

What is the emetic potential of Melphalan?

A

The emetic potential of this drug is:
- High if >140 mg/m2
- Moderate if <140 mg/m2

34
Q

What is the emetic potential of Bendamustine?

A

The emetic potential of this drug is:
- Moderate

35
Q

Describe the emetic potential of the Alkylating Agents class.

A

The emetic potential of this drug class is:
- All are either moderate or high

36
Q

What drugs in the Alkylating Agents class have a high emetic potential?

A

Drugs in the class with a high emetic potential are:
- Cyclophosphamide >1500 mg/m2
- Ifosfamide >2 g/m2
- Melphalan >140 mg/m2

37
Q

What drugs in the Alkylating Agents class have a moderate emetic potential?

A

Drugs in the class with a moderate emetic potential are:
- Cyclophosphamide <1500 mg/m2
- Ifosfamide <2 g/m2
- Melphalan <140 mg/m2
- Busulfan
- Bendamustine

38
Q

What drugs in the Alkylating Agents class have a low emetic potential?

A

Drugs in the class with a low emetic potential are:
- None (all are moderate or higher)

39
Q

What drugs in the Alkylating Agents class have a minimal emetic potential?

A

Drugs in the class with a minimal emetic potential are:
- None (all are moderate or higher)

40
Q

Describe the extravasation risk and management strategies for Bendamustine.

A

The extravasation risk and management strategies for this drug are as follows:
- Carries risk as it is an irritant with vesicant like properties.
- If extravasation occurs:
- Stop infusion
- Aspirate extravasated solution
- Elevate extremity
- Apply cold compress for 20 minutes 4 times daily
- Consider sodium thiosulfate (2 mL SQ for each mg of drug suspected to have extravasated)

41
Q

Describe the extravasation risk and management strategies for the Alkylating Agents class.

A

The extravasation risk and management strategies for this drug class are as follows:
- Bendamustine carries extravasation risk as it is an irritant with vesicant like properties.

42
Q

Describe the metabolism of the Alkylating Agents class.

A

The metabolism of this drug class is as follows:
- All agents are hepatically metabolized
- lfosfamide/cyclophosphamide are converted into active metabolites and acrolein

43
Q

What is acrolein?

A

This metabolite is what cyclophosphamide and ifosfamide are converted into. It is toxic and causes bladder irritation and hemorrhagic cystitis.

44
Q

Which alkylating agent(s) is most notable for causing mucositis (most common and most severe)?

A

Of the agents in this drug class, this ADR is most notable with melphalan.

45
Q

What are the notable ADRs of melphalan?

A

The notable ADRs of this drug are:
- Mucositis ranging from mouth sores to irritation of the GI tract leading to severe diarrhea.

46
Q

What are the notable ADRs of Ifosfamide?

A

The notable ADRs of this drug are:
- Hemorrhagic cystitis (irritation and bleeding of the bladder) due to accumulation of the toxic metabolite acrolein in the bladder.
- Rare cases of neurotoxicity (<15%) with symptoms developing hours to days after the dose (typical onset is 48-72 hours)

47
Q

What are the notable ADRs of cyclophosphamide?

A

The notable ADRs of this drug are:
- Hemorrhagic cystitis (irritation and bleeding of the bladder) due to accumulation of the toxic metabolite acrolein in the bladder.

48
Q

What are the notable ADRs of busulfan?

A

The notable ADRs of this drug are:
- Veno-occlusive disease (VOD)/Sinusoidal Obstructive Syndrome (SOS) (when used in high doses for bone marrow transplantation)

49
Q

Which alkylating agent(s) is most notable for causing veno-occlusive disease?

A

Of the agents in this drug class, this ADR is most notable with busulfan (high dose as is used in stem cell transplant).

50
Q

Which alkylating agent(s) is most notable for causing hemorrhagic cystitis?

A

Of the agents in this drug class, this ADR is most notable with cyclophosphamide and ifosfamide.

51
Q

What are the notable/common ADRs of the Alkylating Agents class?

A

The notable/common ADRs of this drug class are:
- Mucositis
- Hemorrhagic cystitis
- Neurotoxicity
- Hepatic veno-occlusive disease/sinusoidal obstructive syndrome

52
Q

Describe the strategy and rationale for management of mucositis caused by melphalan.

A

The strategy and rationale for management of this condition caused by this drug are:
- Oral mucositis can be prevented with cryotherapy. Due to short half-life, patients can chew on ice chips during and shortly after infusion causing vasoconstriction in the mouth and preventing chemotherapy from reaching the mucous membranes.
- GI mucositis is managed with anti-motility agents after ruling out infectious causes of diarrhea

53
Q

Describe the strategy and rationale for management of hemorrhagic cystitis caused by alkylating agents (cyclophosphamide and ifosfamide).

A

The strategy and rationale for management of this condition caused by this drug are:
- Mesna is used as a chemoprotectant.
- Hemorrhagic cystitis is caused by accumulation of the toxic metabolite acrolein in the bladder.
- Mesna is oxidized to dimesna which in turn is reduced back to mesna in the kidneys supplying a free thiol group which binds and inactivates acrolein.
- Mesna is always given with ifosfamide and is often given with high dose cyclophosphamide.
- Mesna dose if typically 20% of the total daily ifosfamide/cyclophosphamide dose and is given for 3 doses
- Vigorous hydration is also used as both prevention and treatment of hemorrhagic cystitis.
- Additional treatments include bladder irrigation, hyperbaric oxygen, prostaglandin E2, and cystectomy for refractory cases.

54
Q

Describe the strategy and rationale for management of neurotoxicity caused by ifosfamide.

A

The strategy and rationale for management of this condition caused by this drug are:
- Patients should monitor for S/Sx with a daily signature log.
- Symptoms generally resolve within 3 days of treatment discontinuation and can be managed with supportive care or methylene blue.

55
Q

Describe the strategy and rationale for management of veno-occlusive disease (VOD) caused by busulfan.

A

The strategy and rationale for management of this condition caused by this drug are:
- Also called sinusoidal obstructive syndrome (SOS)
- Most commonly seen with high dose regimens use for stem cell conditioning
- Risk increases with higher areas under the curve
- Thus, pharmacokinetics measurements are often monitored, and doses are adjusted to target a specific AUC
- Patient should be monitored for hepatic dysfunction, unexplained weight gain, edema, abdominal pain, and jaundice
- Treatment options range from supportive care to defibrotide

56
Q

Describe the half-life of drugs in the alkylating agents class.

A

The half-life of drugs in this class is described as follows:
- All are relatively short, ranging from 40 minutes with Bendamustine to 15 hours with ifosfamide
- This becomes especially important when managing adverse effects of melphalan with cryotherapy

57
Q

Describe the history of alkylating agents.

A

The history of this drug class is as follows:
- These drugs were the first anti-cancer drugs and remain a cornerstone of anti-cancer therapy.
- The utility was discovered during World War I when researchers at Yale noticed that soldiers affected by mustard gas had low WBCs. They speculated that if mustard gas could destroy healthy WBCs, that it could destroy cancerous WBCs - this led to the use of alkylating agent as chemotherapy.

58
Q

What is the frequency of emesis for an agent with a minimal emetic potential?

A

The frequency of emesis for an agent with this emetic potential is:
- <10%

59
Q

What is the frequency of emesis for an agent with a low emetic potential?

A

The frequency of emesis for an agent with this emetic potential is:
- 10-30%

60
Q

What is the frequency of emesis for an agent with a moderate emetic potential?

A

The frequency of emesis for an agent with this emetic potential is:
- 30-90%

61
Q

What is the frequency of emesis for an agent with a high emetic potential?

A

The frequency of emesis for an agent with this emetic potential is:
- >90%

Tyler's Cards (37 decks)

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