Chemotherapy Flashcards by Katie McLaughlin

Common Alkylating Agents

Nitrogen mustards - Cyclophosphamide + Ifosfamide, bendamustine + chlorambucil
Triazenes: Dacarbazine, temozolomide
Nitrosureas: streptozotocin, carmustine
Platins - carbo, cis, oxali
Other: Busulfan

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How to alkylating agents work + what are the routes

-impair cell function by breaking DNA helix + interfering with DNA replication
-IV and PO

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What to watch for with cyclophosphamide

-hemorrhagic cystitis
-transient SIADH

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What to look for with Busulfan

“Busulfan lung” - fibrosis

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what to watch for with cisplatin

-renal toxicity and electrolyte imbalance

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What alkylating agent is the least toxic

-Chlorambucil

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Administrating advice with Dacarbazine

-painful IV - reduce pain by withdrawing blood into syringe before injecting

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education for cyclophosphamide

-push fluids and empty bladder frequently

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Common Antimetabolites

-bines/dines/sines: Azacitidine, cladribine, clofarabine, cytarabine, cytosine, decitabine, fludarabine, capecitabine, gemcitabine, nelarabine - 10!!
-other: 5FU, leucovorin, pentostatin
-exes: Pemetrexed, pralatrexate, raltitrexed, trimetrexate

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How do antimetabolites work

-inhibit enzymes necessary for DNA synthesis

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what are routes for antimetabolites

-IV
-Intrathecal (cytarabine, MTX)
-PO
-Intracavity, topically - 5FU

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common side effect for cladribine

Fevers - 50%

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Common side effect for clofarabine

-LFT abnormalities (80%)

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Common side effect for capecitabine

hand-foot syndrome

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common side effect for decitabine

low K/low Mg

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Concern for intrathecal MTX

-acute aseptic meningitis

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Concern with high-dose Ara-C

-cerebellar toxicity + keratitis

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Concner with 5FU

photosensitivity

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What is contraindicated while on gemcitabine
What is contraindicated while on Fludarabine

-no gemcitabine while on radiation
-no fludarabine with pentostatin - causes fatal pulmonary toxicity

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how does leucovorin work with MTX

-rescue for antifol toxicity

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what do you do for giving pentoastatin

-2L D5NS

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education for patients getting 5FU bolus

-suck on ice

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Antitumor antibiotics

-mycin/icin
-Actinomycin, Bleomycin, Mitomycin, mitoxantrone
-Daunorbicin, Doxorubicin, Epirubicin, Idarubicin

how do antitumor antibiotics work

-prevent DNA replication and RNA production + other things

how can you give Antitumor Antibiotics

-Infusion -IVP -IM/SC/intrapleural (bleomycin) -intravesicular (mitomycin)

Bleo concerns + curiosities

-hypersensitivity -pneumonitis/pulmonary toxicity - need PFT -may produce a rancid smell about 10sec after injection

Daunorubicin concerns

-precipitous fatal cardiomyopathy months after administration

Doxorubicin concern

-"radiation-recall reaction" - former radiation sites will desquamate

Mitomycin concern

-Hemolytic Uremic Syndrome (HUS) - rare but potentially fatal - hemolysis leading to renal failure -with 6+ months of mitomycin therapy

Common plant alkaloids

-cabacitaxel, docetaxel, paclitaxel -Vs: Vincristine, vinblastine, vinorelbine, vindesine -Eribulin, estramustine, ixabepilone

how do plant alkaloids work?

-inhibit microtubule assembly which dissolves mitotic spindle structure

% alopecia with taxol

90%

big concern with cabazitaxel

-pancytopenia

concern with eribulin

-prolonged QT

Concern with estramustine + use

Gynecomastia and thromboembolism -only used with prostate cancer

Concern with Vinblastine and Vincristine

-Vinblastine - muscle cramps/pain -Vincristine - constipation

Contraindications with ixabepilone

-grape juice and St. John's wort

Common Topoisomerase inhibitors

-etop + teniposide -topotecan + irinotecan

how. totopoisomerase inhibitors work?

-inhibit topoisomerase which interferes with transcription/replication of DNA

Etop routes

can be oral or IV

Contraindication for etoposide

-administering <30 min infusion - causes hypotension -St. John's wort -watch for crystallization in tubing

Tyrosine Kinase Inhibitors (TKIs)

-NIBS -Crizotinib, Dasatinib, Erlotinib, IMatinib, .. and more

how do TKIs work

-prevent transfer of phosphate from ATP to a cell protein which prevents intracellular communication and activity like cell division -prevents mutated cells from proliferating

Routes for TKIs

-oral only

Dosing for TKIs

-set dosage and tolerance based, not weight

Crizotinib concern

-visual disturbances

Dasatinib concern

-Low ca/phos

Erlotinib concern

LOng QT, and rash

Imatinib concern

transient fluid retention

Pzopanib concern

-HTN

Contraindications for dasatinib

-antacids/PPIs

Sutinib + Sorafenib

-Sutinib - bleeidng (nose, etc) + yellow skin + diarrhea -Sorafenib - hand/foot reaction + Diarrhea

Contraindications erlotinib

-grapefruit juice, st. John's wort + smoking

administration for TKIs -Empty stomach -Meal + water

-empty: erlotinib, lapatinib, nilotinib, pazopanib, sorafenib -food - imotinib -DONT CRUSH