chemo drugs Flashcards
common ADRs of chemo drugs
Nausea/Emesis Anorexia Alopecia Myelosuppression Secondary malignancies
ways to give chemo
IV, oral, intravesical, intraperitoneal
alkylating drugs
cyclophosphamide
cisplatin
indications for cyclophosphamide
- CA
- nephrotic syndrome
- GPA
- SLE
cyclophosphamide ADRs
- sterility
- hemorrhagic cystitis *evaluated very aggressively!
cisplatin ADRs
- nephrotoxicity
- ototoxicity
monitoring for cisplatin
audiology
renal function
anti-metabolites
- MTX
- 5-FU
- cytarabine
MTX ADRs
- stomatitis
- pulmonary toxicity
- hepatotoxicity
reversal agents for MTX
leucovorin + glucarpidase
MTX interactions
- drugs that affect renal function (diuretics, NSAIDs, cyclosporine)
- other antimetabolites (TMP-SMX)
- PIs increase MTX (toxicity)
5-FU ADRs
- stomatitis
- enterocolitis
- hyperpigmentation
cytarabine ADRs
cytarabine syndrome
cerebellar toxicity
cytarabine syndrome characteristics & when it occurs
fever, bone pain, chest pain, MP rash, myalgia, malaise, conjunctivitis
occurs 6-12 hours following administration
how do you manage cytarabine syndrome
corticosteroids
chemo antibiotics
- doxorubicin
- bleomycin
doxorubicin baseline monitoring
cardiac eval via ECG, MUGA +/- ECHO
doxorubicin ADR
cardiotoxicity
radiation recall
who is doxorubicin contraindicated in
if LVEF is <30-40%
when can doxorubicin cardiotoxicity present
may be delayed for 7-8 years after tx
what is radiation recall
- occurs with doxorubicin in pts who have had prior XRT
- warmth, erythema, dermatitis at prior radiation port –> severe desquamation/ulceration
when does radiation recall occur
5-7 days after administration of doxorubicin
bleomycin ADRs
- rash, striae, induration, hyperkeratosis, vesiculation, peeling = most common on palmar/plantar surfaces
- acute/chronic interstitial pneumonitis > pulmonary fibrosis
major thing to monitor with Bleomycin
PFTs, CXR
plant alkaloids
- vinblastine
- paclitaxel
ADRs of vinblastine
- SIADH
- hyperuricemia
- myelosuppression
ADRs of paclitaxel
- peripheral neuropathy
- hypersensitivity rxn
- myelosuppression
- arthralgia/myalgia
- rhythm abnormalities
what should you monitor with paclitaxel
hypersensitivity rxn
what drugs help improve delayed CINV
substance P/NK inhibitors (-pitant)
what drugs help improve acute CINV
serotonin antagonists (-setron)
what serotonin agonist is only approved for CINV
palonosetron (2nd gen)
what is important to remember with serotonin antagonists for CINV
SCHEDULE THEM!
ADRs of serotonin antagonists
- QTc prolongation
- HA
dexamethasone’s role in CINV
helps with acute and delayed CINV
for highly emetogenic agents
marijuana CINV drugs
dronabinol
nabilone
dronabinol schedule
III
nabilone schedule
II
indication for dronabinol & nabilone
tx of CINV that hasn’t responded to other agents
EPO stimulating agents (ESAs)
- epoetin alfa
- darbepoetin alfa
- peginesatide
indications for ESAs
anemia in CKD, AZT-tx HIV pts, chemotherapy cancer pts
ESA monitoring
- hgb
- BP
- transferrin saturation
- CBC, BUN, K
3 big ADR/precautions for ESA
- ckd pts
- cancer pts
- major surgery
what is the big deal with giving ESA to CKD pts
more deaths, more HTN, CHF, progression to HD
how to prevent ADRs of ESA in CKD pts
keep hgb between 10-12, do not exceed 13
what is the big deal with higher Hgb in cancer pts
shortened survival, time-to-tumor progression, more thromboembolic events if target hgb was >/= 12
how to prevent ADRs of ESAs in cancer pts
prescribing and access restrictions to give ESAs to cancer pts (APPRISE oncology program)
what is the big deal with ESAs in surgery pts
associated with increase DVT after orthopedic surgery
how to prevent ADRs of ESAs in orthosurg pts
limit dosing to maintain the lowest HgB level needed to avoid transfusions
granulocyte-colony stimulating factor
Filgastrim
Pegfilgastrim
granulocyte-macrophage colony stimulating factor
sargramostim
indications for CSFs
cancer pts receiving myelosuppressive chemo
cancer pts receiving bone marrow transplant
ADRs of CSFs
- fever
- rash/petechiae
- splenomegaly
- bone pain
- myeloid leukemia
