Atineoplastic Flashcards
BSA formula
square root of kg x cm /3600
which drugs are the intrathecal route absolutely contraindicated
vinca alkaloids
alkylating agents MOA
inhibit dna replication by causing cross linking and abnormal base pairing of the dna strands
reactive alkyl groups form a highly electrophilic immonium ion which can bind covalently to any nucloephilic compound
resistance mechanisms to alkylating agents
increased ability to repair dna lesion
decreased permeability to the agents
increased production of glutathione which reacts with the alkylating agent
adverse effects of alkylating agents
myelosupression
NV
alopecia
what results of myelosuppression (bone marrow suppression)
neutropenia (decreased WBC)
thrombocytopenia (decreased platelets), anemia (decreased RBC) - not as common due to long lifespan
examples of alkylating agents
nitrogen mustards
alkl sulfonates
nitrosoureas
triazenes
antimetabolites MOA
structural analogues of naturally occuring substrates for biochemical reactions
act as false substitues in the production of nucleic acids
examples of antimetabolites
folic acid analogs - methotrexate
purine analogs - mercaptopurine
pyrimidine analogs - 5FU
antibiotics MOA
intercalation of sliding between DNA base pairs and inhibiting DNA synthesis
examples of antibiotics
anthracyclines
examples of plant alkaloids
vinca alkaloids
podophyllotoxins
taxanes
onset and recovery of myelosuppression
onset 7-10day
lowest counts seen 10-14d after tx
recovery takes 2-3 wks
what is filgrastim
growth factor that increases the rate neutrophil count recovers
may prevent febrile neutropenia and allow chemo to continue
what is erythropoietin
promotes production of RBC
acute nausea
symptoms begin in 1-2 hrs, peak in 4-6 and subside after 12-24
cause of acute nausea
stimulation of chemoreceptor trigger zone through serotonin release
treatment of acute nausea
ondansetron combined with dexamethasone
anticipitory nausea
triggered by stimuli associaated with the therapy
conditioned response
management of anticipatory nausea
erlexation techniques
aromatherapy
lorazepam
ensure good acute phase control to prevent
delayed nausea
begins 24hr post chemo
persist for 2-5d
usually with highly emetogenic drugs like cisplatin
3 effects due to the mucous membranes containing rapidly dividing cells
diarrhea
mucositis
extravasation
timeline of alopecia
begins 7-10d after tx
peaks in 1-2 mon
regrows about a month after tx stopped
often new hair is diff in color and texture
signs and sx of pulmonary toxicity
SOB
non productive cough
agent causing pulmonary toxicity
bleomycin
cause of pulmonary toxicity
direct cytotoxic effects on pul monary epithelium and subsequent fibrosis
cause of cardiac toxicity
tissue damage from teh generation of free radicals while also suppression of the enzymes which protect the cells from free radical damage
acute vs chronic cardiac toxicity
acute - transient electrocardiograph abnormalities
chronic - irreversible congestive heart failure
drugs associated with cardiac toxicity
anthrycycline
doxorubicin
increased with increasing cumulative lifetime dose
cadioprotective drug
dexrazoxane
neurological effects with vinca alkaloids is related to
total cumulative dose
age >40
agents associated with neurotoxic adverse effects
vinca alkaloids
cisplatin, carboplatin
neurotoxic adverse effects
numbness of hands and feet
gait disturbance
severe motor weakness
maybe reversibile if drug stopped early enough
ototoxicity seen with
cisplatin
neurotoxicity of platinum compounds due to
demyelination
drugs causing nephrotoxicity
cisplatin
ifosfamide
methotrexate
hwo to reduce nephrotoxicity
aggressively hydrating tha patient prior to treatemtn
IV admin of annitol an osmotic diuretic
will make pt pee more so drug not in kidney
hemorrhagic cystitis associated wiht
cyclophosphamide
ifosfamide
prevention of hemorrhagic cystitis
aggressive hydration prior to treatment
admin of mensa which binds to the active metabolite acrolein
permanent or temporary infertility associated with
cyclophosphamide
chlorambucil
mechlorethamine
melphlan
category X in pregnancy
methotrexate
sources of medication errors
prescription and ordering process
compounding/dispensing
storage and administration
