Chemo Drugs Reduced 3 Flashcards
Doxorubicin
Topoisomerase 2 Intercalator
Intercalates in DNA leads to breaks in DNA
Cell cycle nonspecific
Excreted as thiol adduct in bile
-Dose reduction in presence of Jaundice
Myelosuppression is dose limiting
Cumulative toxicity: Cardiomyopathy
- obtain ejection fraction prior to instituting therapy
- max life dose: 400
- shorter infusion times more toxic than longerschedule dependent toxicity*
- pretreat with dexrazoxane (iron chelator) may help
P glycoprotein membrane bound efflux pump is causes MDR is what 2 drug classes?
Topo 1 and 2 Inhibitors
Tubulin inhibitors
Mitomycin C
Actinomycin D
Irinotecan
Topo 1 inhibitor
Hepatic metabolism
-reduce dose in presence of jaundice
Early Diarrhea: cholinergic-treat with atropine
Late Diarrhea: secretory-treat imodium, hydration
UGT1A128 decreases glucuronidation and increases myelosuppression and diarrhea-Gilbert’s syndrome
Treat: colon cancer
Bleomycin
Cell cycle specific (G2?)
Free radical damage to DNA
50% excreted in urine
-dose reduction necessary for renal insufficiency
liver and kidney inactivate drug (bleomycin hydrolase)
lungs and skin cannot inactivate drug
-skin pigmentation
Pulmonary toxicity dose limiting *** cumulative toxicity
- monitor with pulm function test-baseline prior to administration
- avoid high oxygen concentrations
- test dose for anaphylactoid reactions
Treat: Testicular Cancer
Prednisone
Treat: myeloproliferative or lymphoproliferative disorders
-multiple myeloma, Hodgkin’s and non hodgkin’s and some leukemias
Side effects: Weight gain, hypertension, edema, carb intolerance, suppression of pit-adrenal axis, weakness, euphoria, increased appetite
Dexamethasone
less mineralocorticoid activity than prednisone
-used in treatment of cerebral edema or spinal cord edema due to spinal cord compression
Tamoxifen
SERM
- can prevent breast cancer in high risk of developing breast cancer who take drug for 5 years
- must measure estrogen receptors on all breast cancer specimens
Side effects: hot flashes, thrombosis, endometrial cancer
-decrease rate of bone loss in postmenopausal women
-
Aromatase Inhibitors
Anastrozole, letrozole, exemestane
-rapidly decrease estrogen levels
Side effects: arthralgias, bone pain,bone loss, hot flashes
Flutamide and bicalutamide
inhibit cancer cell uptake of testosterone
Leuprolide acetate
Gonadotropin releasing hormone agonist
-decrease levels of testosterone by decreasing FSH and LH
-initial stimulation of FSH and LH lead to possible flare so pretreat with flutamide or bicalutamide
Side effects: weakness, decreased libido, erectile dysfunction, loss of muscle mass, gynecomastia, change in body fat distribution
