Chemotherapy - Block 4 Flashcards
1
Q
Define dose limiting toxicity?
A
A toxicity that may lead to a dosage decrease, tx delay, or discontinuation
2
Q
Is hair loss a DLT?
A
No
3
Q
Factors that contribute to dosage adjustment?
A
- Patient hx
- Cure vs prolongation of life
- Renal and hepatic dysfunction
4
Q
MOA of antimetabolites??
A
Mimic nucleotides that disrupt replication and cell division
5
Q
What are the classes of antimetabolites?
A
- Pyrimidine analogs
- Purine analogs
- Folate antagonists
6
Q
What are the class toxicities for antimetabolites?
A
- Myelosuppression
- Diarrhea
7
Q
What are the types of pyrimidine analogs?
A
- 5FU
- Capecitabine
- Cytarabine
- Gemcitabine
8
Q
DLT for 5-FU?
A
- Stomatitis
- Myelosuppression
- Diarrhea
- Hand foot syndrome
9
Q
DLT for capecitabine?
A
- Diarrhea
- Hand foot syndrome
10
Q
What drug enhances activity and toxicity of 5-FU?
A
Leucovorin
11
Q
What patient factor contributes to increased toxicity of pyrimidine analogs?
A
DPD deficiency
12
Q
DDI of pyrimidine analog
A
Warfarin
13
Q
DLT of cytarabine?
A
- Leukopenia
- Thrombocytopenia
14
Q
What drug is sometimes given with allopurinol to prevent TLS?
A
6-MP (dose must be decreased to avoid toxicity)
15
Q
DLT of methotrexate?
A
- Myelosuppression
- Mucositis and diarrhea
16
Q
DLT of pemetrexed?
A
Neutropenia
17
Q
What medication is given for methotrexate tox?
A
Leucovorin
18
Q
What is the reversal agent for methotrexate nephrotoxicity?
A
Glucarpidase
19
Q
Counseling for pemetrexed administration?
A
Give folic acid, B12, and dexamethasone
20
Q
Examples of folate antagonists?
A
- Methotrexate
- Pemetrexed
21
Q
What is the class toxicity for microtubule-targeting agents?
A
Peripheral neuropathy
22
Q
What are the types of taxanes?
A
Paclitaxel (Taxol)
Paclitaxel NAB (Abraxane)
Docetaxel (Taxotere)
23
Q
DLT of paclitaxel?
A
PN
24
Q
DLT of paclitaxel NAB?
A
Myelosuppression
25
Which of the taxanes require pre-medication to avoid hypersensitivity?
Paclitaxel (diphenhydramine, steroid, H2RA)
Docetaxel (steroids prior to admin)
26
Are paclitaxel and paclitaxel NAB dosages interchangable?
No
27
What patient population requires taxane dosage adjustments?
Hepatic impairment
28
Type of epothilones? DLT?
Ixabepilone: PN and leukopenia
29
Example of non taxane microtubule inhibitors? DLT?
Eribulin: neutropenia
30
What do you give to pre-medicate when using ixabepilone?
Benadryl, H2RA, dexamethasone (if had previous rx)
31
Metabolism of ixabepilone?
CYP3A4
32
What are the types of vinca alkaloids?
1. Vincristine
2. Vinorelbine
3. Vinblastine
33
What is the max dose of vincrisitne?
2 mg/dose
34
How should vinca alkaloids be administered?
Potent vesicant: apply heat id extravastion occurs
**No IT admins: deliver in IVPB not syringe**
35
DLT of vincrisitne?
Severe PN
36
DLT of vinorelbine?
Myelosuppression
37
DLT of vinblastine?
Myelosuppression
38
What are the topoisomerase I inhibiotrs?
1. Irinotecan
2. Irinotecan liposomal
39
ADRs of irinotecan? Which one is DLT? How do you treat it?
**Acute diarrhea (12-24H):** Atropine
**Delayed diarrhea (DLT), >12-24H after dose:** Loperamide
40
What mutation increases the toxcity of irinotecan?
UGT1A1
41
What are the topoisomerase II inhibitors?
1. Etoposide
2. Teniposide
42
DLT of etoposide?
Myelosuppression
43
DLT of teniposide?
Myelosuppression
44
Infusion instructions for topoisomerase II inhibitors?
Infuse over at least 30-6 min due to risk of hypotension
45
What is the MOA of antracycline?
1. Intercalation in DNA
2. Topoisomerase II inhibitor
46
ADR of antracyclines? Which ones are DLTs?
1. Red urine
2. Potent vesicants: apply ice and Totect (dexrazoxane)
3. Delayed cardiomyopathy (DLT)
4. Myelosuppression (DLT)
47
Types of antacyclines?
1. Doxorubicin
2. Daunorubicin
3. Idarubicin
4. Epirubacin?
48
Considerations prior to antracycline admin?
Must get baseline LVEF, LVEF should be >50% to be administered
49
Max dose for doxorubicin?
450-550 mg/m2
50
Max dose for daunorubicin?
550 mg/m2
51
Max dose for idarubicin?
150 mg/m2
52
Max dose for epirubicin?
900 mg/m2
53
How do you calculate lifetime dose?
[Select dose of drug in mg/m2/cycle] x [total number of cycles received] = cumulative doxorubicin dose in mg/m2
54
Types of antracenedione?
Mitoxantrone
55
ADR of mitoxantrone?
Cardiotoxicity (DLT)
Blue urine, fingernails, sclera
56
Max dose for mitoxantrone?
140 mg/m2
57
ADRs of busulfan?
1. Pulmonary fibrosis
2. N/V
3. Seizure prophylaxis with stem cell transplant
58
Types of platinum agents?
1. Cisplatin
2. Carboplatin
3. Oxaliplatin
59
ADR of cisplatin?
1. N/V (100% with pretreatment)
2. Nephrotoxicity
3. Ototoxicity
60
Max dose for cisplatin?
100 mg/m2/cycle
61
What is the most emetic chemo agent?
Cisplatin
62
What are the steps required for administerating cisplatin?
1. Hydration with NS required
2. Supplement with K and Mg due to wasting
3. Baseline hearing and after each dose
4. Delayed hypersensitivity
63
ADRs of carboplatin?
1. Myelosuppression
2. NV
3. Less PN, ototoxicity, and nephrotoxicity than cisplatin
64
How is carboplatin dosed?
Dosed based on AUC using Calvert formula
65
ADR of oxaliplatin?
PN (DLT) in >50% of patients
Acute <14 days: reversible exacerbated by cold
Persistant >14 days: may be permanent
66
Calvert formula?
Dose = (CrCl + 25) x AUC
67
How should nitrogen mustards be dosed?
Hydrate and frequent urination to prevent pain, hematuria, urgency
**Cyclophosphamide:** may use mesna for high doses
**Ifosfamide:** alwasy use mesna
68
ADRs of nitrogen mustards?
Hemorrhagic cystitis
NV
Alopecia
69
How should you administer mesna?
1. Give IV liqud with juice, chocolate milk to mask taste
2. If patient vomits within 2 hrs of taking PO mesna should recieve an additional PO or IV dose
3. IV can be cmpounded to be given as PO solution
4. PO form is difficult to tolerate
70
ADR of bendamustine?
1. SJS
2. TENS
3. rash
4. Tumor lysis (administer with allopurinol)
71
ADR of nitroureas?
Pulmonary toxicity
Myelosuppression
Facial flushing
72
How is carmustine used?
IV and biogradable wafers are implanted to residual tissue after surgical resection
73
How is lomustine administered?
For PO, don't administer more than one dose at a time due to risk for fatal tox and OD
* Taken every 6 weeks
* Readily crosses BBB
74
ADR of procarbazine?
1. Disulfirum like rx with alcohol
2. Myelosuppression
3. Neurotoxicity and neuropathy
75
How should procarbazine be adminsitered? DDI?
1. Adminsiter on empty stomach
2. Tyramine free diet due to MOAI
**DDI:** SSRI, TCAs
76
What is the max lifetime dose for bleomycin?
400 units
* Must receive test dose prior to actual infusion
77
ADR of bleomycin?
1. Pulmonary fibrosis
2. Anaphylaxis
3. Hypersensitivity rx
78
ADR for arsenic?
1. Differentiation syndrome (corticosteroids)
2. Electrolyte abs (hype/hyper K, hypomag)
3. QT prolongation
79
How do you administer arsenic?
Treat with dexamethasone 10 mg IV BID to resolve s/s
80
What is the first line for APL?
tretinoin
81
ADR of tretinoin?
1. Retinoic acid syndrome-treat with corticosteroids
2. QT prolongation
82
ADR of coricosteroids?
Insomnia
Fluid retention
Nausea
Increased appetite
Hyperglycemia
| Prednisone or dexamethasone
83
Counseling on how to take corticosteroids?
1. Take in am to avoid insomnia
2. Take with food to avoid nausea
3. Check glucose levels in diabetics
84
How do you calculate BSA?
