CHEMOSH-2 Flashcards
Antimetabolites work on the S phase of the cell cycle
T
Methotrexate indications
RA, Psoriasis, Oncology uses , and off label
RA: 7.5 mg /week PO single dose or 2. 5 mg PO q12 hR x 3 doses given once weekly. Max 20 mg weekly
Psoriasis : Oral 2.5 - 5 mg q12 hours for 3 doses per week or ORAL, IM, IV, SQ: 10 - 25 mg once weekly. Folic acid 1- 5 mg daily ( except MTX days ) to decrease side effects
Oncology uses: acute lymphoblastic leukemia ( ALL ), meningeal leukemia, intrathecal, breast cancer, head and neck cancer
10,000 mg/ mˆ2 ( really high dose) then we give leukovorin. So it works on faster replciatign cells ( like cancer ) then give leukovorin to stop it from working
Off label: Crohn’s disease, ectopic pregnancy
Pregnancy caterogy X
Methotrexate side effects
M- mucocytosis ( sores in mouth/ throat ) - magic mouthwash
H - Hepatotoxicity : avoid alcohol
O - make a sun : photosensitivity
R - methtRexate - renal toxicity ( keep the urine alkaline, give patient sodium bicarbonate to protect the kidneys and hydrate )
X- chest X-ray, : pulmonary fibrosis, and Pregnacy category X
drugs that impair MTX excretion: nsaids, Asa, PCN, probenaecid, bactrim, PPI, stop before giving methotrexate
Methotrexate ( drugs that are given with )
Leukovorin: folinic acid to stop methotrexate from working
1 mg of folate per day on day you dont do methotrexate to reduce common toxicities of methotrexate
• Glucarpidase ( vorxaze)
Say you have problems with kidneys ( methotrexate goes through kidneys ) so give voraxze injectable enzyme that breaks down methotrexate helps MTX exit kidneys easier.
Fluorouracil ( 5-FU )
Adrucil ( IV ) : when you give IV formulation, its opposite of MTX, we give leucovorin with 5FU at the same time to make 5FU better.
Increases INR and bleeding with warfarin / hand foot syndrome ( bottom of hand and feet get red, peeling, cracking)
Alopecia, mucocytosis , photosensitivity,
Topical cream : Efudex 5% ( cream with highest concentration of 5Fu in it. Use for actinic or solar keratosis/ superficial basal cell carcinoma ). Put on skin, it turns, red, painful, kills those cells, so we can kill skin cancer cells.
Others: Carac 0.5%, fluroplex 1%, tolak 4%,
Efudex
5% Fluorouracil cream used for superficial basal cell carcinoma
Capecitabine
( Xeloda )
Pro drug of 5Fu
So same: DDI with warfarin , hand foot syndrome,
Indications: metastatic breast cancer resistant to paclitaxel & metastatic colorectal carcinoma
Black box warning: DDI Coumadin
Mercaptopurine ( 6- MP )
What RA med turns into 6-MP: azathiopurine ( IMURAN ). DDI : imuran and allopurinol/febuxostat. If add allopurinol you decrease of imuran and or 6MP. both 6MP and IMURAN need Xanathine oxidase to be metabolized. If you add allopurinol and block xanithine oxidase, you cant metabolize 6MP and you’ll have to reduce the dose of the 6MP drug.
Too much 6MP you get hyperpigmentation of skin and skin .
2) DDI with bactrim. Bactrim itself can cause bone marrow suppression ( myelosuppressive ) and if you add 6MP you can enhance Myelosuppressive effect.
Cytarabine
Cytosar
IV and intrathecal ( Preservative free )
- used for meningeal leukemia
Fludarabine
Fludara
( AIDS In a bottle ) : significant immunosuppression
And severe neurotoxicity ( irreversible blindness, coma, death )
Bleomycin
IV IM SUBQ
Pulmonary fibrosis : dose released. Max 400 unites of total lifetime dose.
- freq xRay
Skin toxicity : hyper pigmentation of the skin
Doxorubicin / Daunorubicin
CHF that is irreversible : due to iron
- give DEXRAZOXANE ( zinecard : iron chelator ) protects against cardiotoxicity
Urine: red
Max 550 mg/mˆ2 bc cardiotoxicity
Pregnancy category D
Valrubicin
Valstsar
Only given for bladder cancer ; intravesical
Transient urine discoloration RED
Dactinomycin
IV
Extravastion: associated with severe necrosis. If it occurs stop infusion.
Contraindicated with active chicken pox or herpes zoster bc of risk of severe generalized disease which may result in death.
Mitoxantrone
Novoantrone
BLUE- urine eyes : blue green
used for MS.
Acute no lymphocytic leukemias; prostate cancer.
cardiotoxity : CHF risk with cumulative dose.
Plant alkaloids
Docetaxel , paclitaxel - tax: hypersensitivity reaction ( premedicate )
Etoposide, teniposide
Irinotecan, topotecan
DOCETAXEL
IV
( DOCEFREZ; TAXOTERE)
TAX: premedicate for hyper sensitivity with corticosteroids.
Fluid Retention/ pulmonary edema : use lasix
Peripheral neuropathy
Hepatic neuropathy
OCULAR Adverse effects: if vision impairment see opthalmogist immediately
PACLITAXEL
TAXOL
IV: use NON PVC : can leak into PVC bag
Tax: premedicate/ perphiral neuropathy
Disulfram rxn:
Contraindicated with castor oil allergy
Etoposide
TOPOSAR
Hypotension
Teniposide ( IV )
Hypotension
Irinotecan / topotecan
Hycamtin
Irinotecan : i ran : diarrhea: use Imodium. Tell them to replenish with electrolytes.
Loperimide ( Imodium ) : max 8 mg /day otc if rx 16 mg day, if giving Irinotecan you dont care about max.
Topotecan IV and PO
Vinca Plant Alkaloids
Vincristine, Vinblastine, VinOrelbine : V : give IV only ( it has been given intrathecally and that has killed the patient ) only IV!!!
All vinca alkaloids cause peripheral neuropathy
VinCristine: ( oncovin, marqibo ) most CNS tox
Vinblastine: Bone marrow suppression
VinOrelbine : ( navel bone ) most alopecia
Preparing Vinca plant alkaloids
Only IV
Fatal if given intrathecally
Intrathecal chemo will go at separate time as IV
T
Tyrosine Kinase inhibitors
Tinib
Tinib : PO : tyrosine kinase inhbitors : all strong Cyp3a4 substrate : all have GI effects N/V/D
1) GLEEVEC: imatinib mesylate - with food
2) Traceva ( erlotinib ) - EGFR , empty stomach
3) Tykerb ( Lapatinib ) - EGFR and HER2 , empty stomach
4) Tasigna ( nilotinib ): empty stomach
EGFR
Epidermal Growth factor Receptor inhibitor
Panitumumab ( vectibix ) - IV
Cetuximab ( erbitux ) - IV
VEGF
Vascular endothelial Growth factor
Bevacizumab ( avastin )
IV
Histone Deacetylase inbhitors
Vorinostat ( zolinza )
Belinostat ( belodaq)
Romidepsin ( Lstodax )
Micellaneous
Hydroxyurea : used for sickle cell anemia /
Used for chronic myeloid leukemia, head and neck cancers
Use folic acid with this
Thalidomide : birth defects
S.T.E.P.S.
Must use 2 form contraception
Pomalidomide ( Pomalyst ) : oral
