Chemo Flashcards
Platinol
CisPlatin
IV ONLY
- NEPHROTOXIC & OTOTOXIC*
- Highest occurence of N/V
Protect kidneys - amifostine (Ethyol) & Mannitol
Carboplatin
IV ONLY
Less nephrotoxic
Busulfex - IV
Myleran - PO
BuSulfan
ALKYLATING AGENT
- PULMONARY FIBROSIS
- SEIZURES ( pre-medicate)
- $$ SKIN RASH
- Bone Marrow SUPRESSION
Increase URIC ACID; use Allopurinol
CyTOXAN
Cyclophosphamide
IV/ PO
- Hemorrhagic cystitis
- alopecia
Protect bladder -> IV Fluids, MESNA ( binds to acrolein)
BICNU
CarMUSTINE
IV ONLY
- Pulmonary Fibrosis (CXR)
- Hepatotoxic (LFT)
- Nephrotoxic (CMP)
- LIPID SOLUBLE* —> BRAIN TUMORS!
Carmustine; Prepare in GLASS ONLY
CEENU/ Gleostine
Lomustine
PO ONLY
Zanosar
Streptozocin - IV ONLY
Pancreatic tumors
Patients develop T1DM as a result of killing all cells in the pancreas
ALKERaN
Melphalan IV/PO
Oral: EMPTY STOMACHE
IV: limited STABILITY; use W/I 60 mins
- Fertility Impairment *
Mustargen-IV
Valchlor - GEL
Mechlorethamine
Extravasation- use Na+ THIOSULFATE
Fertility Impairment
Sancuso
Sustol
Granisetron
IV SQ PO TRANSDERMAL PATCH - sustol SOLUTION
Anzemet
DolaSETRON
IV/ PO
AloXi
Palonosetran
IV ONLY
Zofran
OndanSETRON
IV
ORAL TAB
ODT
*Soluble film
AkynZEO
Netupitant 300mg + palonoSETRON
NEPAp
Emend
Aprepitant ORAL
Emend IV
Fosaprepitant IV
Neurokinin-1 antagonist
Compazine
ProchloroPERAZINE
D1 , D2 antagonist
Blocks alpha adrenergic
Blocks cholinergic
Used as an anti-emetic
HexALEN
AltretAMINE
- Neurotoxicity
- CNS
- Peripheral Neuropathy
Fertility Impairment
MAO INHIBITORS may cause severe Orthostatic HYPOTENSION
Methotrexate
Indications/ dosage forms
Indication: RA, Psoriasis, Oncology,
Off-label: Crohn’s, ectopic pregnancy
Forms: 1) Intrathecal
2) IV
3) IM
4) SC
5) PO
Methotrexate
Adverse Events/Precautions
Hepatotoxic: Avoid alcohol
Nephrotoxic: HYDRATE + Na Bicarb
Drug Interactions: NSAIDS, aspirin, penicillins, probenecid, BACTRIM, PPI’s, IMPAIR MTX EXCRETION.
Pulmonary toxicity—> CXR
Pregnancy category —> X
Photosensitivity —> Use sunscreen
Mucositis ( mouth ulcers)
VoRAXAze
GLUCARpiDASE
Used for MTX elimination for patients with RENAL IMPAIRMENT
AdruCIL- IV
Efudex - CREAM
Fluorouricil (5-FU)
Increase INR
HAND-FOOT syndrome, Alopecia, neurotox, phototoxicity, mucositis.
Leucovorin added to INCREASE EFFICACY
XeLODA
Capecitabine
PRODRUG OF 5-FU
Forms: PO ONLY
BBW: increase INR w/ COUMADIN
Indications: resistant breast cancer
Colorectal carcinoma
PuriNETHOL/puriXAN
Mercaptopurine (6-MP)
Form: oral tabs
Oral susp
SE: hepatoxic, HYPERURICEMIa, rash, mucositis, hyperpigmentation of skin
DI: allopurinol/febuxostat increase levels of 6-MP
Bactrim may enhance myelosupp effects of 6-MP
ANALOGUE OF AZATHIOPRINE USED FOR RA
CytoSTAR
CyTARABINE
Forms: IV
IntraThecal - GIVE RIGHT AWAY
Indications: AML
Meningeal LEUKEMIA
FluDARA
FludaraBINE
Forms: IV ONLY
SIGNIFICANT IMMUNOSUPP
“AIDS IN A BOTTLE”
Neurotoxicity (IRREVERSIBLE BLINDNESS)
Bleomycin
Forms: IV,IM, SUBQ
SE: pulmonary fibrosis - (CXR)
Skin TOXICITY
No more than 400 units of lifetime doses
AdriaMYCIN
DoxoRUBicin/ DaunoRUBicin
IRREVERSIBLE CHF - due to IRON
Give DEXrazoxane (Zinecard: Fe chelator) PROTECTS AGAINST CARDIOTOXICITY
Lifetime DOSAGE: 550mg/m^2
URINE: RED LIKE RUBY
Extravasation$$
ValSTAR
ValRUBicin
BLADDER CANCER: intraVESICAL
Urine: RED FOR RUBY
Dactinomycin
- IV ONLY
- EXTREME EXTRAVASATION
- toxic inhalation of VAPORS
- contraindicated w/ active chk pox or HERPES zoster
NovoANTRONE
MitoxANTRONE
Indication: Acute leukemias; Prostate cancer; multiple sclerosis.
Forms: IV ONLY
Urine-EYES: BLUE DISCOLORATION
*CARDIOTOXICITY: CHF
CARDIOTOXICITY: doxorubicin, daunorubicin, idarubicin, epirubicin, mitoxantrone.
TaxoTERE/ DocefrEZ
Docetaxel
Form: IV ONLY
- SEVERE HYPERSENSITIVITY*
- premedicate with CORTICOSTEROIDS
- FLUID RETENTION/ Pulmonary EDEMA: Lasix
- PERIPHERAL NEUROPATHY
- HEPATIC
- OCULAR ADVERSE EFFECTS
TaXOL
PacliTAXEL
IV ONLY
Hypersen: premedicAte
Non-PVC piping ONLY
Ethanol in diluent “drunk-like”
Disulfram rxn w/ meds: Flagyl
CASTOR OIL ALLERGY AVOID
TOpoSTAR/ VP-16
Etoposide
Forms: PO - capsules
IV
Caution: HYPOTENSION Infuse slowly over 30-60 mins
EtopoSIDE (VP-16) - capsules: REFRIGERATE
TenipoSIDE
Forma: IV
CAUTION: HYPOTENSION***
OniVYDE - Liposomal
Camptosar - Conventional
Hycamtin
Irinotecan: onivyde, camptosar
Topotecan: hycamtin
Forms: irinotecan IV ONLY
TOPOTECAN IV AND PO
I RAN TO THE CAN
** SEVERE DIARRHEA AND DEHYDRATION**
-If early —> atropine
If late —> loperamide
Oncovin/ Marqibo
VinCRISTINE
MOST CNS TOX
NEVER GIVE INTRATHECALLY
Vinblastine
Most BONE MARROW SUPP
Navelbine
VinOrelBINE
Most alopecia
Iv ONLY
All vinca alkaloids cause PERIPHERAL NEUROPATHY
**CONSTIPATION VERY COMMON SO RECOMMENDED TO START WITH A STOOP SOFTENOR
GLEEVEC
Imatinib mesylate
: TK Inhibitor
With FOOD
TarCEVA
Erlotinib
Moa: targets EGFR
Treats: lung and pancreatic cancer
W/ empty STOMACHE
Tykerb
Lapatinib
Treats: breast cancer
Moa: mixed EGFR and HER-2 (ERBB2) inhibitors
Take on EMPTY STOMACH
SITTING ON THE CURB, While someone sitting on your lap
DI: MAJOR CYP4A4 substrate
SE: DIARRHEA, $$HAND-FOOT$$ syndrome
TasigNA
Nilotinib
Treats: leukemiA
- take on EMPTY STOMACHE
- watch for QT
VectiBIX
Panitumumab
Form: IV ONLY
MOA: EGFR Inhibitor
Treats: colorecal cancer
ErbiTUX
Cetuximab
Form: IV ONLY
- USED FOR SOLID TUMORS*
SE: Acneiform RASH
AvasTIN
Bevacizumab
Form: IV ONLY - mix with NS
USED FOR SOLID TUMORS
MOA: binds to Vascular EndotheliAl Growth Factor
(VEGF)
SE: GI perforation, hemorrhage, hemoptysis, GI bleeding, CNS hemorrhage, epistaxis
Zolinza
Vorinostat
Indication: lymphoma
Form: PO ONLY
Caution: QT PROLONGATION
Moa: Histone Deacetylase Inhibitors
Beleodaq
Belinostat
Form: IV ONLY
MOA: Histone Deacetylase Inhibitors
Istodax
Romidepsin
Treats: Lymphom
Form: IV ONLY
MOA: Histone Deactylase Inhibitors
Hydrea, droxia
HydroxyUREA
Treats: chronic myeloid leukemia
Sickle cell Anemia
Gloves should be worn
Thalomide
Thalidomide
BIRTH DEFECTS
STEPS PROGRAM
PomaLYST
Pomalidomide
Used for Multiple myeloma
Soltamox: oral sln
Tamoxifen
Form: tabs; oral sln
MOA: Non-steroidal antiestrogen (SERM)
Dose: 20mg daily
AR: Hot flashes, CLOTS, Endometrial cancer, hypercalcemia, cataracts, CONTRAINDICATED WITH WARFARIN THERAPY.
SE are like taking estrogen.
Tomoxifen
DRUG INTERACTIONS
Tamoxifen is a prodrug and not activated until converted by CYP2D6
Strong 2D6 Inhibitors: paroxetine, fluoxetine, sertraline, duloxetine, bupropion, amiodarone
SUGGEST —> other SSRI’s or Venlafaxine if needed. Switching to aromatase inhibitor would be okay unless woman is premenopausal, which only Tamoxifen treats
EviSTA
Forms: ORAL
Treats: 1) decrease risk of breast cancer
2) Osteoporosis
Notes: for POST-MEN ONLY
ALT to Tamoxifen
AR: CLOTS
Evista
Cont info….
Raloxefene is less likely to cause UTERINE CANCER, HYSTERECTOMY, or CATARACTS
Tamoxifen STIMULATES uterine estrogen receptors while Raloxifene BLOCKS them
BBW: CLOTS/ STROKES
- D/C 72 hrs before
ArimiDEX
Anastrazole
MOA: aromatase INHIBITOR: blocks production of testosterone
SE: Hot Flashes, tumor flare, vaginal bleed, Wt gain, Gi upset
DI: tamoxifen may decrease levels of AI’s
Advantages —> NO INCREASE CALCIUM, CLOTS, OR UTERINE CANCER
Femara
Letrozole
2.5mg QD
Aromatase INHIBITOR: blocks production of estrogen
Aromasin
Exemestane
25mg QD
AROMATASE INHIBITORS: Block production of estrogen
Ibrance
Palbociclib
CDK 4/6 Inhibitor —> g1 and s
ADDED TO AI’s
SE: NEUTROPENIA, PULMONARY EMBOLISM
DI: CYP3A substrate
KisQALI
Ribociclib
MOA: CDK 4/6 Inhibitor
Treats: Hormone receptor +
HER-2 -
Used in COMBO with Aromatase Inhibitors
DI: substrate of CYP3A4
Afinitor
Everolimus
MOA: blocks mTOR
Treats: Hormone (+)
HER-2 (-)
They are used along with aromatase Inhibitors
Faslodex
Fulvestrant
Forms: IM ONLY
MOA: *ESTROGEN RECEPTOR ANTAGONIST
Dose: 500mg IM once a month
Precaut/ warning: BLEEDING
THROMBOCYTOPENIA
ANTICOAGULANT USE
HEPATIC IMPAIRMENT
Herceptin
Trastuzumab
Form: IV ONLY
Treats: HER-2 (+) breast cancer
Her-2 (+) stomache cancer
SE: FLU-LIKE SYMPTOMS
BBW: CARDIOTOXICITY (CHF)
PULMONARY TOXICITY
ANAPHYLAXIS OR ANGIOEDEMA
Perjeta
Pertuzumab
form: ONLY ONLY
MOA: HER-2 receptor antagonist
Indication: ALWAYS given in combination with TRAZTUZUMAB and chemo in HER-2 (+) treatment naive patients
BBW: CARDIAC FAILURE
Kadcyla
Ado-trastuzumab emtansine
Form: IV ONLY - NS for dilution
BBW: Hepatoxicity, CARDIAC TOX, embryo-fetal toxicity
LAST LINE
Ixempro
Ixabepilone (PACITAXEL SIMILARITIES)
Treats: BC refractory to other meds
MOA: pothilone microtuble inhibitor
Dosage: IV ONLY, contains CASTOR OIL AND ALCOHOL
SPECIAL NOTE: PRETREAT WITH H1 and H2 BLOCKER 1 hour before
DI: cyp3A4 substrate; AVOID CYP3A4 inducers and inhibitors
HalaVEN
Eribulin mesylate
Forms: IV
MOA: microtuble inhibitor
Indication: patients who have received anthracycline and taxane-based chemotherapy. Also for patients with TRIPLE-NEGATIVE breast cancer
MEGACE
Megestrol
Progestin
Indication: appetite stimulant in cancer patients
Advance breast + endometrial cancer
Form: PO
MOA: works like female hormone progesterone to make woman hungry during chemo therapy
SE: * THROMBOEMBOLISM*, wt gain, HOT-FLASHES
Zoladex
Gosrelin
Forms: SUBQ Q 1M or Q3M
MOA: LH-RH/GnRH Agonist
Indications: PROSTATE, ENDOMETRIOSIS, and Pre-menapausal hormone (+) breast cancer
AR: Tumor flare; give antiestrogen: Flutamide, Biclutamide, Nilutamide until starts working.
- Pulmonary Embolism and MI
Lupron
Leuprolide
MOA: LH-RH/GnRH AGONIST
forms: ELigard DEPOT IM
Viadur IMPLANT
Lupaneta Pack (co-package with leuprolide depot IM + norethindrone for endometriosis
SE: tumor growth AT FIRST. GIVE ANTI-estrogens
(Biclutamide, Flutamide,)
TrelSTAR
Triptorelin
MOA: LH-RH AGONIST
FORMS: IM Q1M or Q3M
Firmagon
DegaRELIX
Form: SUBQ every 28 days
MOA: LHRH Antagonist
AR: Hot flashes, wt gain, and LFT’s
Treats: prostate cancer
Casodex
BiclutAMIDE
ANTI-androgen
DI: interacts with WARFARIN
SE: diarrhea
Flutamide
Flutamide
- WORST DIARRHEA
- LIVER DF
- yellow-green* discoloration
Nilandron
Nilutamide
Anti-androgen used in combo with LHRH AGONIST
- Disulfiram like rxn with alcohol
- Diminished rxn to darkness: Watch Driving
XtanDi
EnzalutAMiDE
-Refractory to other anti-androgens
SE: SEIZURES
Avoid inducers/inhibitors Warfarin monitoring
Nizoral
Ketoconazole
- Reduces levels of test and cortisol
- SE: hepatic, gynecomastia, N/V, Rash
DI: needs ACIDIC environment
CYP3A4 inhibitor
ProscAr
FinasTERIDE
Form: oral
Indication: prevent PROSTATE CANCER
BPH
MOA: Inhibits 5-alpha-reductase, the enzyme that converts test —> DHT
Studies show that these drugs seem to lower the risk of less aggressive prostate cancers while increasing the risk of more aggressive cancers
AvoDART
DutasTERIDE
Indication: Prevention
MOA: Inhibits 5-alpha-reductase which converts test to DHT
Provenge
Sipuleucel-T
Vaccine to treat advance prostate cancer that is no longer responsive to hormone therapy.
Uses patients immune system to fight against cancer
KeytrudA
Pembrolizumab
PD-1 inhibitor
By blocking PD-1 keytruda allows the immune system to attack its own cancer cells
Indications: MELANOMA
NON-small cell lung cancer
HEAD & neck cancer
Granix/ Neupogen
Filgrastim (G-CSF)
TREATS: chemo induced neutropenic fever/infection
Neulasta
Peg-filgrastim
NeumegA
Oprelvikin
Chemo induced thrombocytopenia
Chemo agents with the MOST chemo-induced PERIPHERAL NEUROPATHY (CIPN)
Platinum : cis. Carbo, oxali PLATIN
Taxanes: taxels
Epothilones: ixabepilone (Ixempra)
Plant alk: vinblastine, vincristine, vinorelbine, etoposide (VP-16)
Phosphate binders used for TUMOR LYSIS SYNDROME
1) calcium CARBONATE
2) calcium ACETATE( Phos-Lo, Eliphos, Phoslyra,
3) sevelamer (Renagel, Renvela)
4 Lanthanum(Fosrenol)
Mannitol
Osmotic diuresis which inhibits tubular reabsorption of water and electrolytes and increases urinary output
ONCE the IV is made, inspect for crystals. If crystals are present, re-dissolve by warming solution and shaking to dissolve
How do you protect the heart from HYPERKALEMIA?
1) calcium gluconate or calcium chloride to protect the HEART
2) insulin with dextrose to DRIVE Potassium into the cells
3) kay-exalate ( sodium polysterene sulfonate) which will remove excess potassium from the body
Renagel
Sevelamer Hydrochloride (HCL)
Renvela
Sevelamer CARBONATE
Which vinca alkaloid has the MOST neurotoxicity?
VinCRISTINE
Which agent has the MOST chemo-Induced DIARRHEA
** 1) IrinoTECAN
2) 5-FU, capecitabine 3)
Which chemo drugs is most likely to cause CONSTIPATION?
1) Vincristine
2) Thalidomide
Aromatase Inhibitors
Letrozole (Femera)
Anastrozole (Arimidex)
Exemastane (Aromasin)
MOA: prevent conversion of androgens to estrogen in women.
They are NOT USED in premenopausal women as they have NO activity against breast cancer in presence of functional ovaries
Which Chemo-Drugs can cause pulmonary toxicity/fibrosis?
Amiodarone
Bleomycin
Busulfan
MTX
Chemo-Related drugs that can increase the risk of THROMBOEMBOLIC EVENTS
Tamoxifen, Raloxifene, Gosrelin, megestrol
