Chemotherapy

Question 1

Cisplatin common AEs?

Answer 1

Nephrotoxicity

Question 2

Mechanism of Cisplatin Nephrotoxicity?

Answer 2

Electrolyte disturbances, urinary excretion of protein and Mg, causing tubular dysfuntion

Question 3

Other AEs of Cisplatin?

Answer 3

High emetic, Neurotoxicity, Ototoxicity, Myelosuppression

Question 4

Common AE of Oxaliplatin? How to manage?

Answer 4

Neurotoxicity that can be cold induced (Acute) -> Avoid cold
Delayed neurotoxicity -> Dose reduction, Tramadol and SNRIs

Question 5

How to manage diarrhea of Irinotecan?

Answer 5

Acute: Atropine IV; Delayed: Loperamide PO

Question 6

Common Ifosfamide AEs?

Answer 6

Hemorrhagic Cystitis

Question 7

Describe the mechanism of Hemorrhagic Cystitis.

Answer 7

Acrolein cause inflammatory to the bladder wall, make the epithelium thinner

Question 8

Management of Hemorrhagic Cystitis?

Answer 8

Hydration; Mesna IV (60% dose of Ifosfamide if not continues) and Hydration, call urologist

Question 9

Toxicities other than Hemorrhagic Cystitis of nitrogen mustard?

Answer 9

Neurotoxicity, caused by the metabolite Chloroacetadehyde

Question 10

How to manage the neurotoxicity caused by Vinka alkaloid?

Answer 10

Duloxetine (SNRIs)

Question 11

How to manage the (extravasation) vesicants caused by Vinka alkaloid?

Answer 11

Stop infusion and elevate extremity and apply warm packs, + hyaluronidase

Question 12

Class and Common AEs of Doxorubicin

Answer 12

Class: Anthracyclines (Top2 inhibitor)

AEs: Cardiotoxicity

Question 13

How to manage Cardiotoxicity caused by Anthracyclines?

Answer 13

Prolonged infusion or Liposomal anthracycline (but HFS)

Question 14

Class and common AEs of Methotrexate

Answer 14

Class: antimetabolite

AEs: Renal tubular necrosis

Question 15

Renal tubular necrosis, how to mange?

Answer 15

Hydration (NaCl) and urine alkalization (Sodium bicarbonate)

Leucovorin rescue 24 hr after MTX to replenish the supply of folate metabolite depleted

Question 16

Common use of 5-Fluorouracil (5-FU)

Answer 16

Radio sensitization

Question 17

Common AE of 5-Fluorouracil (5-FU)

Answer 17

Dermatotoxicity: HFS
Cardiotoxicity: Angina

Question 18

Management of HFS

Answer 18

Avoid hot water, keep moisturizing, use analgesics

Question 19

Taxane: Common AEs?

Answer 19

Paclitaxel: Hypersensitivity due to Cremophor

Question 20

Hypersensitivity, how to manage?

Answer 20

Pre-medicate Paclitaxel with H1RA, H2RA and steroid

Question 21

DDI of paclitaxel

Answer 21

Doxorubicin before Paclitaxel 24 h
paclitaxel 24 h before Carboplatin
Phenytoin

Question 22

Why Pegybag used for Vinka Alkaloid?

Answer 22

Avoid IT infusion

Question 23

MOA of Taxanes?

Answer 23

Inhibit the depolymerisation of microtubules in the mitotic phase

Question 24

Matching AE to drugs
1) Tubular dysfunction
2) Renal Tubule Necrosis
3) Hemorrhagic Cystitis

Answer 24

1) Cisplatin
2) Methotrexate
3) Nitrogen mustard (Ifosfamide)

Question 25

MOA of alkylation agent

Answer 25

forming interstrand and intrastrand crosslink with 2 strand of DNA

Question 26

Carboplatin dose calculation formula

Answer 26

Dose = Target AUC x (GFR + 25)

Question 27

How to manage Oxaliplatin induced delayed neuropathy?

Answer 27

Sensory and motor changes observed
Reduce dose, use tramadol/SNRIs

Question 28

Treatment of Methotrexate overdose?

Answer 28

Glucarpidase (A Bacterial enzyme that hydrolyze folic acid and anti folate)

Question 29

Why Leucovorin can be used prior 5-FU?

Answer 29

Increase the binding affinity of 5-FU to TS, enhancing cytoxic activity

Question 30

Any notable AE of Cytarabine? And it’s premedication?

Answer 30

Pre-med: 1) Antiemetic, 2) Dexamethasone eye drops

AEs: CNS toxicity
Moderate emetogenicity
Conjunctivitis if high dose
Fever/Myalgia/Rash if high dose