cytotoxic

Question 1

cyclophosphamide - MOA, cell most affected, dose?

Answer 1

alkylating agent of DNA
derivative of nitrogen mustard - FDA + MF
B cells > T cels (best for vasculiditis, bullous disorders, etc)

1-3 mg/kg PO OD (typically dosed at 100-200 mg /day

Question 2

cyclophosphamide c/i?

Answer 2

hypersensitivity

relative:
hemorrhagic cystitis
bladder fibrosis
bladder cancer
other malignancy

Question 3

s.e of cyclophosphamide?

Answer 3

antimitotic:

GI: N/V/D
GU: hemorrhagic cystitis (5-41%), hematuria, fibrosis, contracture, urgency, dysuria
infectious
heme - anemia, leukopenia, etc
neoplastic - bladder, leukemia, lymphoma, cutaneous SCCs
repro: amenorrhea , azospermia, premature ovarian failure
preggo : contraindicated

Question 4

cyclophosphamide skin s/e

Answer 4

anagen, reversible
pigmentation of teeth, skin, nails
urticaria, mucosal ulcers, aSJS

Question 5

cyclophosphamide - way to avoid bladder damage?

Answer 5

mesna - binds to acrolin which is thought to create irritation in the first place

hydrate

surveil

Question 6

cyclophosphamide monitoring?

Answer 6

Initiate: history and physical, esp LNA and
#####age appropriate Ca screening ###
starting labs: CBCd, basic chem, LFTs, urinalysis
reduce dose or avoid if Q3M)
urinalysis + cytology after cumulative dose >50 g and Q6month thereafter or if ?hemorrhagic cystitis

Question 7

hydroxyurea - 5 cutaneous s/e

Answer 7

PIGMENT, PHOTOSENSITIZER!!!! (SUN AND RADIATION)

• DM-like eruption
• Hyperpigmentation of skin/nails
• Photosensitivity
• Radiation recall
• nonmelanoma skin Ca
• drug-induced LE
• leg ulcers
• lichenid drug eruptions (similar to cGVHD)
• alopecia (reversible)

Question 8

hydroxyurea monitoring

Answer 8

Monitoring (same for all cytotox drugs)

• history, physical,drug interactiosn
• baseline labs: CBCd, basic chem, LFTs, Cr, BUN, urinalysis, +- tuberculin testing, pregnancy test (category D)
• ongoing: CBCd, LFTs weekly, urinalysis -> biweekly - > monthly x 3 months, then Q3 months
• repeat with any dose changes
• d/c med If decree Hb decrease by 3 g/dl, WBC< 3.5 or plts <100
• complete physical with skin exams for skin Ca Q6M