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Therapeutics IV > Chemotherapy - Block 4 > Flashcards

Chemotherapy - Block 4 Flashcards

1
Q

Define dose limiting toxicity?

A

A toxicity that may lead to a dosage decrease, tx delay, or discontinuation

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2
Q

Is hair loss a DLT?

A

No

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3
Q

Factors that contribute to dosage adjustment?

A
  1. Patient hx
  2. Cure vs prolongation of life
  3. Renal and hepatic dysfunction
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4
Q

MOA of antimetabolites??

A

Mimic nucleotides that disrupt replication and cell division

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5
Q

What are the classes of antimetabolites?

A
  1. Pyrimidine analogs
  2. Purine analogs
  3. Folate antagonists
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6
Q

What are the class toxicities for antimetabolites?

A
  1. Myelosuppression
  2. Diarrhea
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7
Q

What are the types of pyrimidine analogs?

A
  1. 5FU
  2. Capecitabine
  3. Cytarabine
  4. Gemcitabine
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8
Q

DLT for 5-FU?

A
  1. Stomatitis
  2. Myelosuppression
  3. Diarrhea
  4. Hand foot syndrome
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9
Q

DLT for capecitabine?

A
  1. Diarrhea
  2. Hand foot syndrome
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10
Q

What drug enhances activity and toxicity of 5-FU?

A

Leucovorin

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11
Q

What patient factor contributes to increased toxicity of pyrimidine analogs?

A

DPD deficiency

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12
Q

DDI of pyrimidine analog

A

Warfarin

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13
Q

DLT of cytarabine?

A
  1. Leukopenia
  2. Thrombocytopenia
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14
Q

What drug is sometimes given with allopurinol to prevent TLS?

A

6-MP (dose must be decreased to avoid toxicity)

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15
Q

DLT of methotrexate?

A
  1. Myelosuppression
  2. Mucositis and diarrhea
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16
Q

DLT of pemetrexed?

A

Neutropenia

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17
Q

What medication is given for methotrexate tox?

A

Leucovorin

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18
Q

What is the reversal agent for methotrexate nephrotoxicity?

A

Glucarpidase

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19
Q

Counseling for pemetrexed administration?

A

Give folic acid, B12, and dexamethasone

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20
Q

Examples of folate antagonists?

A
  1. Methotrexate
  2. Pemetrexed
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21
Q

What is the class toxicity for microtubule-targeting agents?

A

Peripheral neuropathy

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22
Q

What are the types of taxanes?

A

Paclitaxel (Taxol)
Paclitaxel NAB (Abraxane)
Docetaxel (Taxotere)

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23
Q

DLT of paclitaxel?

A

PN

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24
Q

DLT of paclitaxel NAB?

A

Myelosuppression

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25
Q

Which of the taxanes require pre-medication to avoid hypersensitivity?

A

Paclitaxel (diphenhydramine, steroid, H2RA)
Docetaxel (steroids prior to admin)

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26
Q

Are paclitaxel and paclitaxel NAB dosages interchangable?

A

No

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27
Q

What patient population requires taxane dosage adjustments?

A

Hepatic impairment

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28
Q

Type of epothilones? DLT?

A

Ixabepilone: PN and leukopenia

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29
Q

Example of non taxane microtubule inhibitors? DLT?

A

Eribulin: neutropenia

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30
Q

What do you give to pre-medicate when using ixabepilone?

A

Benadryl, H2RA, dexamethasone (if had previous rx)

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31
Q

Metabolism of ixabepilone?

A

CYP3A4

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32
Q

What are the types of vinca alkaloids?

A
  1. Vincristine
  2. Vinorelbine
  3. Vinblastine
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33
Q

What is the max dose of vincrisitne?

A

2 mg/dose

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34
Q

How should vinca alkaloids be administered?

A

Potent vesicant: apply heat id extravastion occurs
No IT admins: deliver in IVPB not syringe

35
Q

DLT of vincrisitne?

A

Severe PN

36
Q

DLT of vinorelbine?

A

Myelosuppression

37
Q

DLT of vinblastine?

A

Myelosuppression

38
Q

What are the topoisomerase I inhibiotrs?

A
  1. Irinotecan
  2. Irinotecan liposomal
39
Q

ADRs of irinotecan? Which one is DLT? How do you treat it?

A

Acute diarrhea (12-24H): Atropine

Delayed diarrhea (DLT), >12-24H after dose: Loperamide

40
Q

What mutation increases the toxcity of irinotecan?

A

UGT1A1

41
Q

What are the topoisomerase II inhibitors?

A
  1. Etoposide
  2. Teniposide
42
Q

DLT of etoposide?

A

Myelosuppression

43
Q

DLT of teniposide?

A

Myelosuppression

44
Q

Infusion instructions for topoisomerase II inhibitors?

A

Infuse over at least 30-6 min due to risk of hypotension

45
Q

What is the MOA of antracycline?

A
  1. Intercalation in DNA
  2. Topoisomerase II inhibitor
46
Q

ADR of antracyclines? Which ones are DLTs?

A
  1. Red urine
  2. Potent vesicants: apply ice and Totect (dexrazoxane)
  3. Delayed cardiomyopathy (DLT)
  4. Myelosuppression (DLT)
47
Q

Types of antacyclines?

A
  1. Doxorubicin
  2. Daunorubicin
  3. Idarubicin
  4. Epirubacin?
48
Q

Considerations prior to antracycline admin?

A

Must get baseline LVEF, LVEF should be >50% to be administered

49
Q

Max dose for doxorubicin?

A

450-550 mg/m2

50
Q

Max dose for daunorubicin?

A

550 mg/m2

51
Q

Max dose for idarubicin?

A

150 mg/m2

52
Q

Max dose for epirubicin?

A

900 mg/m2

53
Q

How do you calculate lifetime dose?

A

[Select dose of drug in mg/m2/cycle] x [total number of cycles received] = cumulative doxorubicin dose in mg/m2

54
Q

Types of antracenedione?

A

Mitoxantrone

55
Q

ADR of mitoxantrone?

A

Cardiotoxicity (DLT)
Blue urine, fingernails, sclera

56
Q

Max dose for mitoxantrone?

A

140 mg/m2

57
Q

ADRs of busulfan?

A
  1. Pulmonary fibrosis
  2. N/V
  3. Seizure prophylaxis with stem cell transplant
58
Q

Types of platinum agents?

A
  1. Cisplatin
  2. Carboplatin
  3. Oxaliplatin
59
Q

ADR of cisplatin?

A
  1. N/V (100% with pretreatment)
  2. Nephrotoxicity
  3. Ototoxicity
60
Q

Max dose for cisplatin?

A

100 mg/m2/cycle

61
Q

What is the most emetic chemo agent?

A

Cisplatin

62
Q

What are the steps required for administerating cisplatin?

A
  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
Q

ADRs of carboplatin?

A
  1. Myelosuppression
  2. NV
  3. Less PN, ototoxicity, and nephrotoxicity than cisplatin
64
Q

How is carboplatin dosed?

A

Dosed based on AUC using Calvert formula

65
Q

ADR of oxaliplatin?

A

PN (DLT) in >50% of patients
Acute <14 days: reversible exacerbated by cold
Persistant >14 days: may be permanent

66
Q

Calvert formula?

A

Dose = (CrCl + 25) x AUC

67
Q

How should nitrogen mustards be dosed?

A

Hydrate and frequent urination to prevent pain, hematuria, urgency
Cyclophosphamide: may use mesna for high doses
Ifosfamide: alwasy use mesna

68
Q

ADRs of nitrogen mustards?

A

Hemorrhagic cystitis
NV
Alopecia

69
Q

How should you administer mesna?

A
  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
Q

ADR of bendamustine?

A
  1. SJS
  2. TENS
  3. rash
  4. Tumor lysis (administer with allopurinol)
71
Q

ADR of nitroureas?

A

Pulmonary toxicity
Myelosuppression
Facial flushing

72
Q

How is carmustine used?

A

IV and biogradable wafers are implanted to residual tissue after surgical resection

73
Q

How is lomustine administered?

A

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
Q

ADR of procarbazine?

A
  1. Disulfirum like rx with alcohol
  2. Myelosuppression
  3. Neurotoxicity and neuropathy
75
Q

How should procarbazine be adminsitered? DDI?

A
  1. Adminsiter on empty stomach
  2. Tyramine free diet due to MOAI

DDI: SSRI, TCAs

76
Q

What is the max lifetime dose for bleomycin?

A

400 units
* Must receive test dose prior to actual infusion

77
Q

ADR of bleomycin?

A
  1. Pulmonary fibrosis
  2. Anaphylaxis
  3. Hypersensitivity rx
78
Q

ADR for arsenic?

A
  1. Differentiation syndrome (corticosteroids)
  2. Electrolyte abs (hype/hyper K, hypomag)
  3. QT prolongation
79
Q

How do you administer arsenic?

A

Treat with dexamethasone 10 mg IV BID to resolve s/s

80
Q

What is the first line for APL?

A

tretinoin

81
Q

ADR of tretinoin?

A
  1. Retinoic acid syndrome-treat with corticosteroids
  2. QT prolongation
82
Q

ADR of coricosteroids?

A

Insomnia
Fluid retention
Nausea
Increased appetite
Hyperglycemia

Prednisone or dexamethasone

83
Q

Counseling on how to take corticosteroids?

A
  1. Take in am to avoid insomnia
  2. Take with food to avoid nausea
  3. Check glucose levels in diabetics
84
Q

How do you calculate BSA?

A

Therapeutics IV (39 decks)

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