Chemotherapy MOA Flashcards by Randi Carhart

Gemcitabine
MOA
excretion
side effect common after infusion
Rare bad S/E (4)

Antimetabolite (pyrimidine)
renal
fever, flu-like symptoms
Capillary leak syndrome, HUS/TTP, PRES, pneumonitis

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Abraxane what is it and what are the side effect differences
dose adj

nab-paclitaxel, protein-bound taxol (stabilizes microtubules)
hepatic adjustments, no renal
compared to taxol, abraxane has:
Less: hypersensitivity reactions, neutropenia
More: neuropathy, nausea, diarrhea

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5-Fluorouracil
specific MOA
metabolism
specific derm SE
overdose symptoms
rare bad SE (1)
Check med list and avoid this drug

Avoid concurrent use of this drug

Anti-metabolite (thymidylate synthetase inhibitor)
hepatic avoid in severe impairment but no renal dose adj even on HD
hand and foot syndrome
cytopenias, mucositis, diarrhea
Cardiac ischemia
Avoid with warfarin

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Oxaliplatin
MOA
dose adjust
Bad SE (5)

Alkylating platinum agent
Renal dose adjustment (no hepatic dose adj)
Allergic reactions at any time
Cold sensitivity/neuropathy
Immune-mediated TCP
PRES
Pneumonitis
Hepatotoxicity

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Irinotecan
MOA
metabolism/excretion
lab cut-off contraindication
infusion side effects and treatment
main SE (1)

Topoisomerase I inhibitor
liver
bilirubin >2 contraindicated
Cholinergic syndrome- pre-treated with atropine
Diarrhea

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Eribulin
Moa
Se

Microtubule destabilizing
Neutropenia, neuropathy, Qtc prolongation

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Docetaxel
moa
metabolism
lab cut-off contraindication
cause of the allergic reaction
premed needed and why

Microtubule stabilizer
hepatic
contraindicated with elevated bilirubin (above normal)
Mixed in castor oil which people can react to
dexamethasone ppx for fluid retention/capillary leak

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Paclitaxel
MOA
metabolism
specific cardiac side effect
allergy risk

Microtubule stabilizer
liver (no renal adj)
bradycardia
cremophor-based allergy, strong premed need

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If pt forgot steroid premedication

Increase dexametasone in infusion to 20

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Cabazitaxel
Use

Can be still used if taxane resistant
Not docetaxel candidate
Needs growth factor due to prolonged nadir

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Paclitaxel allergic reaction cause and symptoms

cremophor, slow infusion trial to see if improvement, redness, flushing, rash

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methotrexate MOA and excretion

antimetabolite
Dihydrofolate reductase

renal excretion

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topotecan MOA specific #, excretion

topo I, renal excretion

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Ifosfamide MOA, excretion, toxicity and the byproduct cause and sister drug given with it and why

alkylating agent, hepatic and renal,

acrolein induced hemorrhagic cystitis and chloroacetaldehyde nephrotoxicity and neurotoxicity

mesna

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Cetuximab
MOA
common SE
cause of allergy and what do you switch to
electrolyte issue

chimeric human/mouse IgG1 monoclonal antibody against EGFR
rash
mouse part of antibody –> switch to panitumumab (humanized anti EGFR)
magnesium low

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cardiac toxicity in 5-FU is associated with bolus or infusion

infusion, could consider trial of bolus in rechallenge

5-FU toxicity genetic issue
gene
symptoms of the toxicity

DPD deficiency
mucositis, pancytopenia, diarrhea

leucovorin when used with 5-FU goal

enhances 5-FU inhibition of thymidylate synthase

po morphine equivalent for iv morphine

3 (take IV morphine and multiply by 3 for po)

tramadol po to morphine po

1/10 (take po tramadol and divide by 10 for po morphine)

dilaudid po to morphine po

4 (take po dilaudid and multiply by 4 to get po morphine)

oxycodone to morphine po

2 (take oxy and mutiply by 2 to get po morphine)

vedolizumab
use
moa

grade 3-4 autoimmune colitis refractory to steroids
integrin antagoinst to block migration of T cells to the gut

infliximab
use
avoid in which scenario
moa

grade 3-4 autoimmune colitis refractory to steroids
avoid with autoimmune hepatitis
TNFa inhibitor

gene related to topoisomerase toxicity symptoms

UGT1A1 diarrhea predominant

Drugs associated with radiation recall (5)

Doxorubicin, docetaxel, paclitaxel, gemcitabine, capecitabine

Vincristine/vinblastine/vinorelbine MOA metabolism side effect to tell patients about (4) what happens if given intrathecally

Microtubule destabilization hepatic alopecia, constipation with prophylactic bowel reg, bronchospasm/pulm tox, needs port (vesicant) paralysis and death if IT

bevacizumab specific MOA dose adj? bad SE (5)

VEGF-A inhibitor no dose adj with liver or kidney dysfunction nephrotic syndrome, bowel perforation, thrombotic events including MI/stroke, PRES

ariprepitant MOA avoid with this chemo drug

antiemetic that antagonizes substance P/neurokinin 1 (NK1) ifosfamide due to CYP3A4 overlap

ondansetron, granisetron, palonosetron MOA

serotonin-5-HT3 antagonists (hydroxytryptamine)

proclorperazine MOA

D2 dopamine receptor and cholinergic receptors

high emetogenic drugs definition antiemetic treatment examples

>90% emesis risk 4 drug regimen with zofran, aprepitant, steroid, olanzapine AC doxorubicin >60 cisplatin ifosfamide melphalan sacituzumab govitecan carbo AUC >4 cyclophosphamide >1500

vandetanib use MOA cardiac SE

medullary thyroid cancer EGFR inhibitor Qtc prolongation

everolimus MOA lab to monitor side effect to tell patients

mtor inhibitor lipids mouth sores requiring steroid mouthwash

ixabepilone use moa

breast cancer metastatic single agent (TNBC or HR+HER2-) microtubule stabilizer hepatically cleared think about docetaxel, paclitaxel similar class

Pemetrexed dose adj MOA specific supportive meds bad SE (3)

antimetabolite that distrupts folate metabolic processes via inhibition of multiple targets in the pathway (TS, DHFR, FARFT, AICARFT)--> purine and thymidine nucleotide synthesis inhibition dose adj for renal, use not recommended with crcl <45 folic acid, b12 injections SJS/TEN, nephrotoxicity, pulmonary toxicity

Lenvatinib MOA SE bad (11)

Multi TKI QTc prolongation, hemorrhage, fistula, hepatotoxicty, renal toxicity/proteinuria, hypocalcemia, hypothyroidism, hyperthyroidism, PRES, thrombotic events, poor wound healing (hold for a week before and after surgery)