Anthracyclines

Question 1

Name the 4

Answer 1

Daunorubicin
Doxorubicin hydrochloride
Epirubicin hydrochloride
Idarubicin hydrochloride

Question 2

Name the 2 anthracycline derivative

Answer 2

Mitoxantrone
Pixantrone

Question 3

Which 2 are available as both conventional and liposomal formulations

Answer 3

Doxorubicin, daunorubicin

Question 4

Which complication is most often associated with FU, MTX and anthracyclines?

Answer 4

oral mucositis

Question 5

What is a main important SE that they are associated with

Answer 5

dose-related, cumulative and potenitally life threatening cardiotoxic SE

Question 6

Are conventional and pegylated liposomal formulations of doxorubicin, daunorubicin interchangeable

Answer 6

NO

Question 7

Important safety info- doxorubicin & daunorubicin re liposomal and lipid-complex formulations name change to reduce medication errors

Answer 7

• serious harm and fatal overdoses have occured due to mix up between the different forms
• therefore medicines now will explicitly inlude ‘liposomal’, ‘pegylated-liposomal’, or ‘lipid complex’ within their name to reduce risk of potentially fatal medical errors
• they are not interchangeable
• clear distinction between forms required when prescribing, dispensing, administering, communicating about doxorubicin
• verify produce name and dose before admin and do not exceed max dose

Question 8

Caution is necessary with the concurrent use of anthracyclines and ….. drugs

Answer 8

cardiotoxic drugs, or drugs that reduce cardiac contracility

Question 9

Where is doxorubicin largely excreted?

Answer 9

Bile

Question 10

What is the significance of bilirubin concentrations with doxorubicin?

Answer 10

Doxorubicin is largely excreted in the bile and an elevated bilirubin concentration is an indication for reducing the dose.

Question 11

Doxorubicin & cardiomyopathy - doses

Answer 11

Higher cumulative doses are associated with cardiomyopathy and it is usual to limit total cumulative doses to 450 mg/m2.

Question 12

What are the adv and disadv of liposomal forms of doxorubicin

Answer 12

• they may reduce incidence of cardiotoxicity and lower the potential for local necrosis
• however infusion rwactions, sometimes severe may occur
• hand-foot syndrome (painful, macular reddening skin eruptions) occurs commonly with liposomal doxorubucin and may be dose limiting

Question 13

What is hand-foot syndrome, what drug does it most often occur with and how can it be prevented

Answer 13

Hand-foot syndrome (painful, macular reddening skin eruptions) occurs commonly with liposomal doxorubicin and may be dose limiting.
It can occur after 2–3 treatment cycles and may be prevented by cooling hands and feet and avoiding socks, gloves, or tight-fitting footwear.
It may also occur with non-liposomal formulations.

Question 14

Conception & contraception advice with doxorubicin

Answer 14

effective contraception during and for at least 6 months after treatment in men or women.

Question 15

Cardiac contraindications include

Answer 15

• myocardiopathy
• recent MI
• severe arrhythmia
• severe myocardial insufficiency
• unstable angina

Question 16

epirubicin - conception and contraception advice

Answer 16

Females of childbearing potential should use effective contraception during treatment and for at least 6.5 months after last dose; male patients should use effective contraception during treatment and for at least 3.5 months after last dose.

Question 17

Epirubicin doses & congestive HF

Answer 17

Manufacturer advises extreme caution with cumulative doses exceeding 900 mg/m2—risk of congestive heart failure increased.

Question 18

daunorubicin & cardiotoxicity

Answer 18

Cardiotoxicity is cumulative and may be irreversible, however responds to treatment if detected early.

Question 19

CI of all anthracyclines re previous treatment with anthracyclines

Answer 19

Contraindicated if pt has had previous treatment with maximum cumulative dose of anthracycline

Question 20

Idarubicin conception and contraception advice

Answer 20

Females of childbearing potential should use effective contraception during treatment and for at least 6 and a half months after last treatment; male patients should use effective contraception during treatment and for at least 3 and a half months after last treatment.

Question 21

Is cardiac toxicity still a SE of the 2 anthracycline derivatives mitoxantrone, pixantrone

Answer 21

Yes

Question 22

Cardiac toxicity SE – mitoxantrone

Answer 22

Cardiac toxicity, including irreversible and fatal congestive heart failure, may occur either during treatment with mitoxantrone or months to years after discontinuation; the risk increases with cumulative dose.

Question 23

Mitoxantrone

Answer 23

Manufacturer advises effective contraception during and for at least 6 months after treatment in men or women.

Question 24

CI for pixantrone

Answer 24

Active severe infection; risk factors for severe infection

Question 25

Photosensivity is a theoretical risk for this drug and pt should be advised to follow sun protection strategies

Answer 25

Pixantrone

Question 26

Photosensivity is a theoretical risk and pt should be advised to follow sun protection strategies for one of the following drugs
- doxorubicin
- daunorubicin
- epirubicin
- pixantrone
- mitocantrone

Answer 26

• pixantrone

Question 27

How to prevent chronic cumulative cardiotoxciity cuased by anthracyclines, and also anthracycline extravasation

(antidote)

Answer 27

Dexrazoxane is an antidote - iron chelator

Question 28

name 2 important SE of the antracyclines

Answer 28

cardiotoxicity and extravasation injury

reduced by liposomal forms, however they are associated with infusion reactions e.g. hand food syndrome which is likely following doxorubicin liposomal admin after 2-3 treatment cycles

Question 29

patient has cardiotoxicity from anthracycline. what do you do

Answer 29

The antidote for anthracyclines is dexrazoxane, which is administered intravenously. Dexrazoxane is used to treat anthracycline-induced cardiotoxicity and extravasation.

Question 30

patient has extravasation injury from anthracycline - tissue necrosis! what do you do

Answer 30

The antidote for anthracyclines is dexrazoxane, which is administered intravenously. Dexrazoxane is used to treat anthracycline-induced cardiotoxicity and extravasation.

Question 31

what is dexrazoxane

Answer 31

The antidote for anthracyclines is dexrazoxane, which is administered intravenously. Dexrazoxane is used to treat anthracycline-induced cardiotoxicity and extravasation.