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Oncology Exam 1 > Clinical Aspects of Chemotherapy Drugs - DM > Flashcards

Clinical Aspects of Chemotherapy Drugs - DM Flashcards

1
Q

Nitrogen Mustard MOA

A

alkylating agent

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2
Q

Cyclophosphamide SE

& interactions

A
  • hemoragic cystitis due to acrolein *
  • myelosupression (nadir 10 - 14 d) *
  • cardiomyopathy
  • secondary malignancies (leukemia)

CYP 2B6, 2C9, 3A4

(Nitrogen mustard)

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3
Q

Cyclophosphamide Pearls

A
  • hydration
  • mesna (prevents hemorrhagic cystitis - acrolein)
  • watch urine output, blood in urine, pain c urination
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4
Q

Mechlorethamine, Procarbazine SE

A
  • myelosuppression
  • N/V
  • vesicant - Na thiosulfate / bicarb neutralizes
  • secondary malignancies / infertility (highly mutagenic)

(nitrogen mustard)

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5
Q

Mechlorethamine & Procarbazine Pearls

A
  • CI with live vaccines

- Procarbazine = mild MAO inhibitor

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6
Q

Platinum Analogues

A

Cisplatin & Carbaplatin PLATIN

  • oxaliplatin

(alkylating agents)

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7
Q

Platinum Analogues

& which is more likely to cause

A

N/V - Cis
myelosuppression - carbo
nephrotoxicity - cis (hydration & furosemide/mannitol)
neuropathy - cis
ototox - cis (will interact with other ototox meds)

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8
Q

Oxaliplatin SE

A
  • neuropathy
  • N/V/D
  • mucositis, stomatitis
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9
Q

Neuropathy signs

A

paresthesias
cold sensitivity
pharyngolaryngeal dysesthias

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10
Q

Oxaliplatin Pearls

A
  • avoid cold temp for up to 5 days

- chronic neuropathies

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11
Q

Dacarbazine SE

A
  • alopecia
  • LFT elevation
  • myelosuppression
  • N/V
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12
Q

Dacarbazine Pearls

A

oral version available = temozolomide

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13
Q

Pemetrexed SE & interactions

A
  • mucositis / stomatitis
  • myelosuppression
  • rash
  • neuropathy

drugs impairing renal function (NSAIDs)

START folic acid & vitamin B12 supplementation before & continue after

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14
Q

5-fluorouracil + leucovorin SE

& interaction

A
  • myelosuppression
  • mucositis
  • diarrhea

WARFARIN (monitor INR)
DPD

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15
Q

What type of patients do we need to watch for with antimetabolites - folate? Why?

A 
Dihydropyrimidine Dehydrogenase (DPD) deficiency
- poor metabolism, more toxicity
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16
Q

Why do we add leucovorin?

A

increases efficacy (can actually be more toxic in combo)

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17
Q

Carpecitabine SE & interactions

A
  • diarrhea
  • thrombocytopenia / neutropenia
  • hand/foot syndrome

DPD deficiency
inhibits 2C9

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18
Q

Mercaptopurine, Thioguanine SE

A
  • myelosuppression
  • rash
  • diarrhea
  • hepatotoxicity

TMPT enzyme deficiency –> incr. toxicity

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19
Q

What do we do if pt is on allopurinol?

A

stop allopurinol

allopurinol inhibit xanthine oxidase, which breaks down mercaptopurine

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20
Q

Fludarabine SE

A
  • neurotoxicity
  • severe hemolytic anemia
  • myelosuppression - severe
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21
Q

Fludarbine Pearls

A

consider PCP prophylaxis

helps combat the myelosuppression

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22
Q

What deficiency do we worry about with purine analogues?

A

TMPT (thiopurine methyltransferase) enzyme deficiency

it increases toxicity

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23
Q

Cytarabine SE

A
  • cerebellar toxicity
  • corneal toxicities (prednisolone eye drops for prophylaxis)
  • hand / food syndrome
24
Q

hand/foot syndrome grade

A

1: painless, no impairment
2: painful, cracking, numbness, activity is impaired
3: strong pain, blistering, self-sufficiency at risk!

25
Q

Gemcitabine SE

A
  • strong radiosensitizer

- rash

26
Q

What drugs are antimicrotubules?

A

paclitaxel & docetaxel

TAXANES

27
Q

Taxanes SE & interactions

A
  • hypersensitivity to cremophor vehicle in taxol (CI)
  • peripheral neuropathy
  • fluid retention (decetaxel)
  • CYP 2C8, 3A4
  • additive neuropathy
28
Q

taxane pearls

A

anaphylaxis risk

  • prophylaxis: steroid, H1 or H2 blocker 30 mins prior
  • tx: diphenhydramine, epinephrine, steroids)
  • abraxane: less chance for anaphylaxis

docetaxel = less neuropathy, more neutropenia (than paclitaxel)
- docetaxel fluid retention prophylaxis: dexamethasone

29
Q

Vincristine & Vinblastine SE

A
  • peripheral neuropathy / neurotox
  • constipation
  • vesicant
  • hypersensitivity
30
Q

Vincristine & Vinblastine Pearls

A
  • test for hypersensitivity
  • avoid high [O2]
  • no intrathecal use!
31
Q

topotecan & irinotecan SE

A
  • severe diarrhea

- severe myelosuppression

32
Q

does topotecan or irinotecan have more active metabolite?

A

irinotecan –> SN 38

33
Q

anthracycline SE

A
  • cardiotox, myopathy, HF
  • arrhythmias
  • vesicant
  • doxorubicin cummulative dose > 550 mg/m2 or 450 mg/m2
    (monitor EF baseline & after 250-300 mg/m2)
  • epirubicin cumulative dose of 935 mg/m2
34
Q

anthracyclines CI

A

cumulative doses & cardiac function

35
Q

anthracycline pearls

A
  • liposomal doxorubicin is NOT interchangeable
  • discolored body fluids
  • central catheters performed due to extravasation risk!
36
Q

Daunorubicin & Idarubicin SE

A
  • cardiotox
  • vesicant
  • alopecia
  • myelosuppression
  • discoloration of body fluids
37
Q

Etoposide SE

A
  • alopecia
  • myelosuppression
  • mucositis / stomatitis
  • secondary malignancies
  • diarrhea

CYP enzyme metabolized

38
Q

What should we watch for with etoposide formulation?

A

IV must be run SLOWLY

or risk HoTN

39
Q

Bleomycin SE

A
  • pulm tox
  • alopecia
  • hypersensitivity
  • increased LFTs
40
Q

Bleomycin Pearls

A
  • test dose for hypersensitivity

- avoid high inhaled [O2]

41
Q

L-asparagine, Pegasaraginase SE

A
  • hypersensitivity

- life-threatening coagulopathies

42
Q

hormonal SE

A
  • osteoporosis
  • menopause
  • hot flashes
  • heart disease
  • sexual characteristics
  • libido
  • blood clotting
  • wt gain
43
Q

Trastuzumab SE

A
  • cardiomyopathy
  • hypersensitivity
  • infusion reactions
  • rash
  • diarrhea
44
Q

Trastuzumab interactions

A
  • incr. cardiomyopathy with anthracyclines, cyclophosphamide
45
Q

Trastuzumab pearls

A
  • used in combo with other agents (HER2 positive)

- monitor EF

46
Q

Lapatinib SE

A
  • diarrhea
  • dyspepsia
  • rash
  • cardiac effects
47
Q

Lapatinib interactions

A

CYP 3A4, 2C8, PGPi

48
Q

Lapatinib pearls

A
  • metastatic cancer

- combo with other agents metastatic

49
Q

Gefitinib & Erlotinib SE

A
  • rash
  • diarrhea
  • interstitial lung disease
50
Q

Cetuximab & Panitumumab

A

…pts with wild-type (non-mutated) KRAS respond to tx

51
Q

Cetuximab & Panitumumab SE

A
  • rash
  • diarrhea
  • interstitial lung disease
  • infusion related rxn (less with panitumumab)
52
Q

Bevacizumab AE

A
  • bleed risk!

- HTN

53
Q

Bevacizumab CI/caution

A
  • serious wound
  • thrombotic risk
  • CHF
  • CNS metastasis
  • current anticoag
  • recent surgery
54
Q

Ofatumumab & Rituximab SE

A
  • HoTN
  • bronchospasm
  • angioedema
  • cytopenias
  • tumor lysis syndrome

can premedicate with APAP, diphenhydramine, steroids

55
Q

Imatinib, Dasatinib, Nilotinib SE

A
  • edema
  • N
  • muscle cramps
  • rash
  • myelosuppression
  • increased LFTs
  • QT prolonging
56
Q

Imatinib, Dasatinib, Nilotinib monitoring

A
  • hematologic response - CBC
  • cytogenic response - Ph+ cells
  • molecular response - BCL-ABL transcripts
57
Q

What are Imatinib, dasatinib, and nilotinib known as?

  • what is their MOA
A

magic bullet

target philadelphia chromosome BCR-ABL TKi (CML)

Oncology Exam 1 (10 decks)

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