Chemotherapy Flashcards
Paclitaxel
Plant Alkaloid
Breast, pancreatic, lung, H/N
Peripheral neuropathy, milky appearance, skin rash
Dactinomycin
Antitumor Antibiotic
Brentuximab Vedotin
Monoclonal Antibody-targets CD30
Hodgkin Lymphoma; NHL
Infusion related reactions, peripheral neuropathy, myelosuppression
Doxorubicin
Antitumor Antibiotic
Breast; Lymphoma; sarcoma; liver;
cardiomyopathy, vesicant, anthracycline, max cumulative dose of 550mg/m2 (with Cytoxan may be reduced to 450mg/m2)
Testing prior: ECHO/MUGA
Ado-Trastuzumab emtansine
Monoclonal Antibody- targets Her 2
Breast
Infusion related reactions, hepatic toxicity (elevated LFT’s), pulmonary toxicity, altered LVEF, thrombocytopenia, bleeding
Testing: ECHO/Muga
Everolimus
mTOR inhibitor
Renal; breast; liver
Mucositis, cyp3A interactions
Aldesleukin (IL-2)
Biologic Therapy
Melanoma; renal
Capillary leak
Alemtuzumab
Monoclonal Antibody-targets CD52
Lymphoma or CLL
Severe lymphodepletion need prophylactic antibiotics.
HSR
Pemetrexed
Antimetabolite
lung
Folic acid, Vit B12 replacement
Dex for fluid retention.
Melphalan
Alkylating Agent
CLL, MM
High dose- severe mucositis (oral cryotherapy)
Amifostine
Not Chemo- chemoprotectant
Hypotension, N/V, Not Chemo
cytarabine
Antimetabolite
Leukemia
High dose (greater than 1gm/m2)-cerebellar toxicity and ocular (keratitis), myelosuppression
Testing: Cerebellar assessment
Darbopoietin alfa
Growth Factor
Avoid in curable cancers- risk of progression and hyper viscosity (stroke)
Pamidronate
Bisphosphonate
Renal toxicity
Used for hypercalcemia and to prevent bone loss, osteonecrosis of the jaw
Testing: Check kidney function prior and make sure do dental work prior
Nelarabine
Nucleoside metabolite inhibitor
Ofatumumab
Blocks CD20 MAB
Lymphoma
Infusion reaction; Hepatitis reactivation
Testing: Hepatitis panel
Arsenic Trioxide
Prolonged QTc, correct K and Mag
Testing: EKG
Asparginase
Asparagine specific activity ALL Allergic reaction Coagulopathies Pancreatitis
All Trans Retinoic Acid (ATRA)
Retinoic acid receptor
AML
Pulmonary syndrome that requires dex
Atezolizumab
PDL-1 inhibitor
Urothelial cancer; lung
Immune mediated reactions
Bevacizumab
Antiangiogenesis
Colon; ovary; brain; lung
High Bp, headaches, nose bleeds.
Poor wound healing, GI perforation- wait 4 weeks for surgery
Avelumab
Monoclonal antibody- Targets PDL-1
urothelial
Infusion related reactions, Immune mediated reactions
Azaciditine
Hypomethylating Agent
MDS; AML
In SQ form- skin reaction (2 shots), IV short stability, don’t hold dose for low bld ct
Carmustine
Nitrosourea
Brain; NHL; MM
Delayed pulmonary toxicity
Mixed in alcohol
Belinostat
H-DAC inhibitor
Nausea, vomiting, fever, prolonged QT
Bendamustine
Alkylating Agent
Lymphoma
HSR*, rash
Inotuzumab Ozogamycin
Monoclonal antibody Targets CD22
ALL
Infusion related reactions; LFT abnormalities
VOD/SOS, protect from light, no filters, myelosuppression
Bleomycin
Antitumor Antibiotic Lymphoma; testicular (germ cell) Pulmonary toxicity Fevers HSR* suggest test dose with lymphoma Testing: PFT
Blinatumomab
Bispecific T cell engager- CD 19»CD3
ALL
Cytokine release syndrome, neurologic symptoms
Brentuximab Vedotin
Monoclonal Antibody
Bortezomib
Proteosome Inhibitor/
MM
Peripheral neuropathy, reactivation of viral infection. Green tea interaction
Busulfan
Alkylating Agent
Leukemia
Seizures in high dose
Cabazitaxel
Plant Alkaloid
Prostate
Low blood counts
Irinotecan
Camptothecans
GI (colon; rectal and pancreatic); lung
Diarrhea - Imodium and cholinergic diarrhea- atropine
Testing: check UGT1A1 for metabolism
Capecitabine
Antimetabolite
GI (colon and rectal); breast
Prodrug of 5FU and can be used interchangeably, Hand foot syndrome
Prolonged INR
Carboplatin
Alkylator like (nm) Lung; breast; ovary; endometrial; esophageal; H/N AUC dosing Delayed HSR* (8-10th dose)
Carmustine
Lomustine
Nitrosourea
Brain
Cetuximab
Monoclonal Antibody- Targets EGFR
H/N; colon
HSR*, acne like rash
K-ras mutation doesn’t respond
Chlorambucil
Alkylating Agent
Cisplatin
Alkylator like (platinum)
Lung; testicular (germ cell); esophageal; H/N; cervical
N/V; peripheral neuropathy-ototoxicity. Also called CDDP
Testing: Renal (check BUN/Cr)
Cyclophosphamide
Alkylating Agent Breast; lymphoma; non malignancy Cystitis- mesna sometimes used to prevent especially in high dose Void often Secondary malignancies
Dacarbazine
Burning during peripheral infusion
Daratumumab
Anti-CD 38 MAB
MM
Infusion reaction (first dose can take 10 hours to infuse; Interference with cross-matching and red blood cell antibody screening: Type and screen patients prior to starting treatment. Inform blood banks that a patient has received DARZALEX
Dasatinib
Tyrosine kinase inhibitor- BCR/ABL (Philadelphia chromosome)
Pleural effusion
Daunorubicin
Antitumor Antibiotic anthracycline ALL; AML cardiomyopathy, vesicant, Testing prior: ECHO/MUGA
Docetaxel
Plant Alkaloid
Breast; lung; prostate; ovary; endometrial
Tearing, nail changes, fluid retention (give dex); peripheral neuropathy
Liposomal Doxorubicin
Antitumor Antibiotic
Breast; ovary; endometrial; MM
Hand foot rash; use cold to prevent the rash on hands and in mouth (avoid hot in mouth)HSR*
Testing: Check ECHO/Muga for LVEF
Durvalumab
Monoclonal antibody -Targets PD-L1
Urothelial; lung
Immune mediated toxicities
Elotuzumab
IVGH inhibitor
MM
Infusion reaction , peripheral neuropathy, difficulty interpreting IgG Kappa response as the drug interferes with some testing
Epirubicin
Antitumor Antibiotic/ Breast Cardiac toxicity Vesicant, anthracycline Testing: Check ECHO/Muga for LVEF
Oxaliplatin
Alkylator like (platinum)/
GI (colon; rectum; pancreatic); lymphoma; esophageal
Cold dysesthesia
HSR* later doses (8-10)
Ox
Avoid ice and cold food during infusion
Flu vaccine before start of therapy
Wig
Can cause cold dysestheia
Erlotinib
Tyrosine kinase inhibitor (targets EGFR)
Lung; liver; pancreatic
Acne like Rash
Pulmonary (interstitial lung disease)
Etoposide
Plant alkaloid
Lung; lymphoma; testicular (germ cell)
Low blood pressure
Fluorouracil (5-FU)
Antimetabolite GI (colon; rectum; pancreatic); breast Ice to prevent mucositis Diarrhea Coronary vasospasms, light sensitivity DLT-mucositis
Floxuridine
Antimetabolite
Liver mets
Usually given through hepatic artery pump
Filgrastim
Sagramostim
Growth factor
Bone pain
Can be used to mob stem cells
To be taken 24 hours after chemo – daily dosage
Gemcitabine
Antimetabolite/
Pancreatic; lymphoma; bladder
Fever; pleural effusion; low counts with dose mods associated
Gemtuzumab ozogamicin
Monoclonal Antibody- Targets CD33/
AML
Infusion related reactions, VOD/SOS, myelosuppression
Obinutuzumab
Anti CD 20 MAB/
CLL; NHL
Infusion reaction, Hepatitis reactivation
Testing: Hepatitis panel
Imatanib
Tyrosine kinase inhibitor (BCR/ABL- Philadelphia chromosome)
Fluid retention; GI upset
Trastuzumab
Monoclonal antibody- targets Her 2 Breast; upper GI/lower esophageal Cardiac toxicity; HSR* Testing: ECHO/Muga- check LVEF
Topotecan
myelosuppression
Hydroxyruea
Antimetabolite/
Leukemia; PV; sickle cell
Leg ulcers, GI bloating
Ibrutinib
BTK inhibitor/
Lymphoma; CLL
Increased risk of bleeding especially if on blood thinners, A-Fib, hypertension, leukocytosis
Idarubicin
Antitumor antibiotic
Leukemia
Cardiac/vesicant, anthracycline
Testing: ECHO/Muga to check LVEF
Ifosfamide
Alkylating Agent/
Sarcoma; ovary; endometrial; lymphoma
Cystitis- mesna always
Neurologic (coma, hallucinations)
Ixazomib
Oral Proteasome inhibitor
Peripheral neuropathy, nausea
Ixabepilone
Mitotic inhibitor (plant alkaloid)/
Breast
Peripheral neuropathy
Pembrolizumab
PDL-1 inhibitor
Immune mediated reactions
Palifermin
Keratinocyte growth
To rebuild mucosa to prevent mucositis
Lapatinib
TKI
Prolonged QTc
Olaratumab
Monoclonal Antibody- targets platelet derived growth factor alpha
Sarcoma
Infusion related reactions, lymphopenia, neutropenia, thrombocytopenia, hyperglycemia, elevated aPTT, hypokalemia, and hypophosphatemia.
Lenalidomide
Immunomodulator
MM
Teratatogenic (part of a REMS program to assure no pregnancy r/t issues), rash, increased risk of blood clots
Leucovorin
Synergistic with 5FU and a rescue for high dose methotrexate, Not Chemo
Liposomal Daunorubicin + cytarabine
Combination of an antitumor antibiotic and antimetabolite/
MDS; AML
Purple in color, Bleeding, febrile neutropenia, rash, edema, nausea/vomiting, mucositis, diarrhea, constipation, musculoskeletal pain, fatigue, abdominal pain, dyspnea, headache, cough, decreased appetite, arrhythmia, pneumonia, sleep disorders.
Testing: ECHO/Muga to check LVEF
Mechlorethamine
Infertility, vesicant
Mesna
Binds to metabolite of ifosphamide and cyclophosphamide
Methotrexate
Antimetabolite
Lymphoma; breast; non malignancy
High dose renal toxic and need leucovorin rescue
Give sodium bicarbonate to maintain kidney function
Mitomycin
Antitumor antibiotic/
Rectal cancer IV; bladder
intrabladder
Mitoxantrone
Anti tumor antibiotic/
Lymphoma; breast
Cardiac, blue
Plerixafor
CXCR4 inhibitor/
Stem cell mobilization
Abd cramping
Used to mobilize stem cells for BMT
Vinorelbine
Plant alkaloid/
Breast; lung; sarcoma
Vesicant, give through side arm of running IV, severe pain at tumor site
Necitumab
Monoclonal Antibody- Targets EGFR
Infusion related reaction; Skin related reactions (EGFR-like); low mag, low phos, low calcium
Oprelvekin
Platelet growth factor- capillary leak
Sorafenib
Multikinase inhibitor
Rash, long eyelashes
Mechlorethamine
Sterility
Nivolumab
Monoclonal antibody (PD1 inhibitor)/
Lung; Hodgkin; many
Immune mediated effects
Vincristine
Plant alkaloid Lymphoma; ALL Peripheral neuropathy Cap at 2mg Jaw pain
Pamidronate
bisphophonate
Osteonecrosis of the jaw, elevated creatinine
Panitumumab
EGFR antagonist/
Colon cancer
Acne like rash, nail changes, Magnesium depletion
Pertuzumab
Monoclonal antibody against HER 2/
Breast cancer
Check LFTs and ECHO/Muga- LVEF
Pomolidomide
Immune modulator/
MM
REMS program for reproductive toxicity; Rash, somnolence, myelosuppression
Rituximab
MAB- targets CD20/
Lymphoma; CLL; autoimmune
HSR*
Reactivation of Hep
Temozolamide
Alkylating agent/
Brain tumor
Immune suppression – need to be on septra
Thalidomide
Immune modulator
MM
Peripheral neuropathy; constipation; STEPS (for reproductive issues)
Trabectedin
Alkylating agent/
Sarcoma
24 hour infusion (home pump); vesicant, nausea, elevated LFT’s and CPK (rhabdomyolysis), capillary leak syndrome
Vinblastine
Plant alkaloid/
Hodgkin disesae
Myelosuppressive
Peripheral neuropathy, jaw pain, vesicant
Venetoclax
BCL-2 inhibitor/
CLL; AML
Tumor lysis syndrome, myelosuppression, drug-drug interactions
Y90 Ibritumomab tiuxetan
Emits radiation out of the skin and thus will need to be away from family for about a week or so. Infused hot dose in lead lined room.
Zolodrenic acid
bisphosphonate
Used for breast cancer now to prevent bone mets
Used to prevent skeletal related events (fractures)
Renal toxic, osteonecrosis of the jaw
Supportive drugs: peripheral neuropathy
Duloxetine Gabapentin Pregabalin Amitriptyline Venlafaxine
Supportive drugs: Nausea
Metoclopramide
Supportive drugs: Antidepression
Mirtazapine Venlafaxine Duloxetine Amitriptyline Citalopram
Xgeva
To prevent skeletal fractures; low calcium is a risk
AE: peripheral neuropathy
Leuprolide
Blocks gonadotropin releasing hormone for breast and prostate cancer (can be used to preserve fertility- chemical menopause during treatment) Give as 2 injections in the buttocks. Side effects – hormonal symptoms and higher risk for blood clot
Goserelin
Blocks gonadotropin releasing hormone for breast and prostate cancer (can be used to preserve fertility- chemical menopause during treatment) Give as large injection in the abdomen (pellet). Side effects – hormonal symptoms and higher risk for blood clot
Dexrazoxane
Protective agent for the heart (zinecard) for anthracyclines; treatment for anthracycline extravasation (totect)
Tx
whale or flare and pain at injection site
Of doxorubicin and epirubicin
Dex-razoxane
Interleukin-2
Mets melanoma
RCC
Prochlorperazine
Side effect
Extrapyramidal reaction
- shuffling gait - loss of balance
- tremors
- difficulty speaking or swallowing
- twitching
Tx for n/v caused by emergencies chemo
Flare reaction
At iV site
May cause itching, blotchiness, or streak along or next to the vein receiving infusion
-without swelling or pain
Monoclonal antibody
-mab
Interfere with ?
Interfere with cell membrane bound targets by
Blocking ligand receptor activation and
Immune modulation
This preventing rapid growth of cancer cell
Bevacizumab
SE:
Hypertension
Proteinuria
Oral contraceptive >5 years can prevent which cancer?
In prevention of ovarian cancer families with lynch syndrome, not genetically at risk for breast cancer
Lynch syndrome - heredity non-polyploid colorectal cancer (HNPCC) is the most common cause of heredity colon rectal cancer before 59
Cancer patient
Experiencing from erectile dysfunction
What is the Tx
po Phosphodiesterase type 5 inhibitors
Have been a recommended practice
Hospice patient experiencing delirium
What med?
Haloperidol
Doxorubicin
SE
Fever- ruby red
Extravasation- tissue necrosis is usually evidence 2-3w after extravasation
Intrathecal safe chemo
Methotrexate
Cytarabine
-nib
Regotafenib
Anti VEGFR
Cororectal ca
Hcc
-po same time
Liver problems
Hypertension
Bleeding
SCT
Relapse and sinusoidal obstruction syndrome is most common life threatening complication
