Antineoplastics Toxicities

Question 1

Methotrexate

Answer 1

Myelosuppression. Can reverse with leucovorin (folinic acid) “Rescue.”
Macrovesicular fatty change in liver.
Mucositis
Teratogenic

Question 2

Leucovorin

Answer 2

Folinic acid

Question 3

5-fluorouracil

Answer 3

Myelosuppression, which is not reversible with leucovorin.
Overdose: Rescue with uridine.
Photosensitivity

Question 4

Cytarabine

Answer 4

Leukopenia, thrombocytopenia, megaloblastic anemia. [CYTarabine causes panCYTopenia]

Question 5

6-MP/Azathioprine/6-TG

Answer 5

Bone marrow, GI, liver.

Aza and 6-MP are metabolized by xanthine oxidase, increased toxicity with allopurinol, which inhibits their metabolism.

Question 6

Dactinomycin

Answer 6

Myelosuppression

Question 7

Doxorubicin (Adriamycin), daunorubicin

Answer 7

Cardiotoxicity(dilated cardiomyopathy), myelosuppression, alopecia. Toxic to tissues following extravasation.
Dexrazoxane (iron chelating agent), used to prevent cardiotoxicity.

Question 8

Bleomycin

Answer 8

Pulmonary fibrosis, skin changes, mucositis. Minimal myelosuppression.

Question 9

Cyclophosphamide, ifosfamide

Answer 9

Myelosuppression; hemorrhagic cystitis, partially prevented with mesna (thiol group of mesna binds toxic metabolites)

Question 10

Nitrosoureas

Answer 10

CNS toxicity (convulsions, dizziness, ataxia)

Question 11

Busulfan

Answer 11

Severe myelosuppression (in almost all cases), pulm. fibrosis, hyperpigmentation

Question 12

Vincristine, vinblastine

Answer 12

Vincristine: neurotoxicity (areflexia, peripheral neuritis), paralytic ileus.
Vinblastine BLASTS Bone marrow (suppression)

Question 13

Paclitaxel, other taxols

Answer 13

Myelosuppression, alopecia, hypersensitivity

Question 14

Cisplatin, carboplatin

Answer 14

Nephrotoxicity and acoustic nerve damage, prevent nephrotoxicity with amifostine (free radical scavenger) and chloride diuresis.

Question 15

Etoposide, teniposide

Answer 15

Myelosuppression, GI irritation, alopecia

Question 16

Irinotecan, topotecan

Answer 16

Severe myelosuppression, diarrhea

Question 17

Hydroxyurea

Answer 17

Bone marrow suppression, GI upset

Question 18

Prednisone

Answer 18

Cushingoid sxs

Question 19

Tamoxifen, raloxifene

Answer 19

Tamoxifen: partial agonist in endometrium inc. breast CA risk; hot flashes
Raloxifene: no inc. in endometrial carcinoma because it is antagonist in endometrium

Question 20

Trastuzumab (Herceptin)

Answer 20

Cardiotoxicity. “HEARTceptin” damages the HEART

Question 21

Imatinib (Gleevec)

Answer 21

Fluid retention

Question 22

Rituximab

Answer 22

Inc. risk of progressive multifocal leukoencephalopathy

Question 23

Vemurafenib

Answer 23

Arthralgia, skin lesions (found on wikipedia)

Question 24

Bevacizumab

Answer 24

Hemorrhage and impaired wound healing