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tyler's cards > Anthracyclines > Flashcards

Anthracyclines Flashcards

1
Q

What drugs are in the anthracycline class?

A

Drugs in this class are:
- Daunorubicin
- Daunorubicin Liposomal
- Daunorubicin and Cytarabine Liposomal
- Doxorubicin
- Doxorubicin Liposomal
- Idarubicin
- Epirubicin
- Valrubicin

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2
Q

What is the brand name of Daunorubicin?

A

The brand name of this generic drug is:
- Daunomycin

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3
Q

What is the brand name of Daunorubicin Liposomal?

A

The brand name of this generic drug is:
- DaunoXome

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4
Q

What is the brand name of Daunorubicin and Cytarabine Liposomal?

A

The brand name of this generic drug is:
- Vyxeos

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5
Q

What is the brand name of Doxorubicin?

A

The brand name of this generic drug is:
- Adriamycin

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6
Q

What is the brand name of Doxorubicin Liposomal?

A

The brand name of this generic drug is:
- Doxil

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7
Q

What is the brand name of Idarubicin?

A

The brand name of this generic drug is:
- Idamycin

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8
Q

What is the brand name of Epirubicin?

A

The brand name of this generic drug is:
- Ellence

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9
Q

What is the brand name of Valrubicin?

A

The brand name of this generic drug is:
- Valstar

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10
Q

What is the generic of name of Daunomycin?

A

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

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11
Q

What is the generic of name of DaunoXome?

A

The generic name of this brand name drug is:
- Daunorubicin Liposomal

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12
Q

What is the generic of name of Vyxeos?

A

The generic name of this brand name drug is:
- Daunorubicin and Cytarabine Liposomal

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13
Q

What is the generic of name of Adriamycin?

A

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

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14
Q

What is the generic of name of Doxil?

A

The generic name of this brand name drug is:
- Doxorubicin Liposomal

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15
Q

What is the generic of name of Idamycin?

A

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

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16
Q

What is the generic of name of Ellence?

A

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

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17
Q

What is the generic of name of Valstar?

A

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

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18
Q

What is the class and MOA of Daunorubicin?

A

This drug in the following class:
- Anthracycline

This drug’s MOA is as follows:
- Inhibits DNA and RNA synthesis via:
- Intercalation (direct binding to DNA)
- Inhibition of topoisomerase II (a repair enzyme)
- Steric obstruction

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19
Q

What is the class and MOA of Doxorubicin?

A

This drug in the following class:
- Anthracycline

This drug’s MOA is as follows:
- Inhibits DNA and RNA synthesis via:
- Intercalation (direct binding to DNA)
- Inhibition of topoisomerase II (a repair enzyme)
- Steric obstruction

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20
Q

What is the class and MOA of Idarubicin?

A

This drug in the following class:
- Anthracycline

This drug’s MOA is as follows:
- Inhibits DNA and RNA synthesis via:
- Intercalation (direct binding to DNA)
- Inhibition of topoisomerase II (a repair enzyme)
- Steric obstruction

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21
Q

What is the class and MOA of Epirubicin?

A

This drug in the following class:
- Anthracycline

This drug’s MOA is as follows:
- Inhibits DNA and RNA synthesis via:
- Intercalation (direct binding to DNA)
- Inhibition of topoisomerase II (a repair enzyme)
- Steric obstruction

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22
Q

What is the class and MOA of Valrubicin?

A

This drug in the following class:
- Anthracycline

This drug’s MOA is as follows:
- Inhibits DNA and RNA synthesis via:
- Intercalation (direct binding to DNA)
- Inhibition of topoisomerase II (a repair enzyme)
- Steric obstruction

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23
Q

What is the emetic potential of Daunorubicin?

A

The emetic potential of this drug is:
- Moderate

24
Q

What is the emetic potential of Daunorubicin Liposomal?

A

The emetic potential of this drug is:
- Low

25
Q

What is the emetic potential of Daunorubicin and Cytarabine Liposomal?

A

The emetic potential of this drug is:
- Moderate

26
Q

What is the emetic potential of Doxorubicin?

A

The emetic potential of this drug is:
- Moderate if <60 mg/m2
- High if >60 mg/m2

27
Q

What is the emetic potential of Doxorubicin Liposomal?

A

The emetic potential of this drug is:
- Low

28
Q

What is the emetic potential of Idarubicin?

A

The emetic potential of this drug is:
- Moderate

29
Q

What is the emetic potential of Epirubicin?

A

The emetic potential of this drug is:
- Moderate (pediatrics and adults)
- High when used in combination with cyclophosphamide (adults)

30
Q

What is the emetic potential of Valrubicin?

A

The emetic potential of this drug is:
- Minimal

31
Q

Describe the emetic potential of the Anthracycline class.

A

The emetic potential of this drug class is:
- Mainly moderate (Daunorubicin, Doxorubicin (<60 mg/m2), Doxorubicin and Cytarabine, Idarubicin, Epirubicin)
- High for Doxorucibin >60 mg/m2, and Epirubcin when used in combination with Cyclophosphamide (adults)
- All the others are low (Daunorubicin Liposomal, Doxorubicin Liposomal) or minimal (Valrubicin)

32
Q

What drugs in the Anthracycline class have a high emetic potential?

A

Drugs in the class with a high emetic potential are:
- Doxorucibin >60 mg/m2
- Epirubcin when used in combination with Cyclophosphamide (adults)

33
Q

What drugs in the Anthracycline class have a moderate emetic potential?

A

Drugs in the class with a moderate emetic potential are:
- Daunorubicin
- Doxorubicin (<60 mg/m2)
- Doxorubicin and Cytarabine
- Idarubicin
- Epirubicin

34
Q

What drugs in the Anthracycline class have a low emetic potential?

A

Drugs in the class with a low emetic potential are:
- Daunorubicin Liposomal
- Doxorubicin Liposomal

35
Q

What drugs in the Anthracycline class have a minimal emetic potential?

A

Drugs in the class with a minimal emetic potential are:
- Valrubicin

36
Q

What are the main indications of Daunorubicin?

A

The main indications of this drug are:
- ALL
- AML
- Kaposi sarcoma (Daunorubicin Liposomal)

37
Q

What are the main indications of Daunorubicin Liposomal?

A

The main indications of this drug are:
- Kaposi sarcoma

38
Q

What are the main indications of Daunorubicin and Cytarabine Liposomal?

A

The main indications of this drug are:
- AML

39
Q

What are the main indications of Doxorubicin?

A

The main indications of this drug are:
- AML
- Bladder Cancer
- Breast Cancer
- Hodkin Lymphoma
- Non-Hodkin Lymphoma
- Osteosarcoma
- Soft Tissue Sarcomas

40
Q

What are the main indications of Doxorubicin Liposomal?

A

The main indications of this drug are:
- Breast Cancer
- Kasposi Sarcoma
- Ovarian Cancer

41
Q

What are the main indications of Idarubicin?

A

The main indications of this drug are:
- AML

42
Q

What are the main indications of Epirubicin?

A

The main indications of this drug are:
- Breast Cancer
- Bladder Cancer
- Soft Tissue Sarcomas

43
Q

What are the main indications of Valrubicin?

A

The main indications of this drug are:
- Baldder Cancer

44
Q

What are the main/common indications of the Anthracycline class?

A

The main/common indications of this drug class are:
- Doxorubicin is the workhourse
- AML
- Bladder Cancer
- Breast Cancer
- Hodkin Lymphoma
- Osteosarcoma
- Soft Tissue Sarcomas

45
Q

What are the notable/common monitoring parameters for the Anthracycline class?

A

The notable/common monitoring parameters for this drug class are:
- Echocardiogram to assess left ventricular ejection fraction (LVEF) prior to start of therapy, repeat if S/Sx of HF
- History and cardiac exam prior to every cycle

46
Q

What drug(s) require cardiac surveillance and monitoring for heart failure?

A

Drug(s) requiring this monitoring are:
- Anthracyclines

47
Q

Describe the extravasation risk and management strategies for the Anthracycline class.

A

The extravasation risk and mangement strategies for this drug class are as follows:
- All Anthracyclines are vesicants except for Valrubicin (intra-vesical) and liposomal products.
- For intravenous administration only through a free flowing central IV line: not for intramuscular or subcutaneous administration.
- If extravasation occurs, stop infusion, aspirate, give antidote (dexrazoxane [Totect] 1000 mg/m2 via remote IV site over 1-2 hours x 2 days or dimethyl sulfate [DMSO]), apply dry cold compresses.

48
Q

What are the notable/common ADRs of the Anthracycline class?

A

The notable/common ADRs of this drug class are:
- Cardiac toxicity (through reactive oxygen species, apoptosis, DNA damage (via topoisomerase II inhibition), and inhibition of protein synthesis
- Body fluid discoloration (urine, tears, sweat, and saliva)

49
Q

What are the risk factors for developing cardiac toxicity with an Anthracycline?

A

Risk factors for developing this ADR with this drug class are:
- High cumulative exposure (most consistent risk factor)
- Older age (>65 years)
- Very young age (<4 years)
- Female gender
- Pre-existing cardiovascular disorders and comorbidities:
- Hypertension
- Smoking
- Hyperlipidemia
- Obesity
- Diabetes

50
Q

What is the recommended maximum lifetime dose of Anthracyclines?

A

The recommended maximum lifetime dose of this class is:
- 450-550 mg/m2 Doxorubicin equivalents

51
Q

Describe the strategy and rationale for management of cardiac toxicity caused by Anthracyclines.

A

The strategy and rationale for management of this condition caused by this drug class are:
- Limit lifetime exposure (<450-550 mg/m2 Doxorubicin equivalents)
- Perform baseline testing (echocardiogram)
- Dexrazoxane (Zinecard) can be used for prevention.

52
Q

Describe the use of dexrazoxane in the management of cardiac toxicity associated with Anthracyclines.

A

The use of this drug in the management of cardiac toxicity associated with this class is as follows:
- Given IV in a 10:1 ratio of dexrazoxane:doxorubicin.
- Doxorubicin must be administered within 30 minutes of the completion of the dexrazoxane infusion.
- Its FDA labeled indication is in women with metastatic breast cancer with a cumulative doxorubicin dose exceeding 300 mg/m2.
- May also be used off label and in some pediatric protocols.
- It is not recommended for use with initial doxorubicin therapy.
- Dexrazoxane is marketed under two different brand names (Totect and Zinecard), however they are not interchangeable.
- Totect is indicated for Anthracycline extravasations.
- Generic dexrazoxane and Zinecard are indicated for reducing doxorubicin-induced cardiomyopathy.

53
Q

Describe the strategy and rationale for management of urine discoloration caused by Anthracyclines.

A

The strategy and rationale for management of this condition caused by this drug class are:
- This discoloration is harmless and will resolve 1-2 days after the anthracycline dose
- Patients should be counselled that urine discoloration from an anthracycline should be painless. If the discoloration (especially if red) is accompanied by symptoms such as urgency, frequency, or discomfort, they should be evaluated by their healthcare provider as these could be signs of blood in the urine.

54
Q

Describe the metabolism of the Anthracycline class.

A

The metabolism of this drug is as follows:
- All drugs in this class are hepatically metabolized and generally require dose adjustments in patients with hepatic dysfunction

55
Q

What agent was given the nickname “the red devil” and why?

A

This nickname was given to this drug due to its bright red color, vesicant properties, and side-effect profile.

56
Q

What is the nickname given to Doxorubicin and why?

A

This drug was the nickname “the red devil” due to its bright red color, vesicant properties, and side-effect profile.

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