Alkylating Agents

Question 1

Name alkylating agents

Answer 1

Cyclophosphamide
Ifosfamide
Busulfan
Carmustine

Question 2

MOA of alkylating agents

Answer 2

Cross-linking DNA strands, which inhibits DNA and protein synthesis

Question 3

Which drug(s) cause hemorrhagic cystitis

Answer 3

Cyclophosphamide and Ifosfamide

Question 4

How is hemorrhagic cystitis caused

Answer 4

Caused by the toxic metabolite ACROLEIN which concentrates in the bladder

Question 5

What monitoring parameters are used for hemorrhagic cystitis

Answer 5

HEMATURIA, lower urinary tract sx’s (urinary urgency, DYSURIA)

Question 6

What is the prevention for hemorrhagic cystitis

Answer 6

1. Adequate HYDRATION
2. use of a chemoprotectant (MESNA)

Question 7

When should Mesna be given

Answer 7

with ALL Ifosfamide doses and HIGH DOSES of Cyclophosphamide ( > 1 gram)

Question 8

Q. Which alkylating agents cause pulmonary toxicity
Q. What is the Tx

Answer 8

1. Busulfan and Carmustine
2. Symptomatic care (ex: oxygen)

Question 9

Which alkylating agents cause Neurotoxicity

Answer 9

Ifosfamide and Carmustine

Question 10

Q. Which alkylating agents can cause seizures
Q. What is the prevention/ treatment

Answer 10

1. Busulfan and Carmustine
2. Anti-seizure medications (ex: levetiracetam)

Question 11

What is the prevention/ treatment for Ifosfamide neurotoxicity (encephalopathy: confusion, incordination, imbalance)

Answer 11

Methylene Blue