Drugs With Cardiotoxicity

Question 1

Main drag cuisine cardiotoxicity

Answer 1

Cytotoxic drugs

Question 2

Type of cytotoxic drugs with cardiotoxicity effect

Answer 2

Anthracyclines 
Taxoids
5-fluorouracil
Cisplatin
Trastuzumab

Question 3

Anthracycline Cardiotoxicity effects

Answer 3

Cardiomyopathy
congestive heart failure
ECG alterations

Question 4

Early onset effects of anthracyclines occur within

Answer 4

1year

Question 5

In children for anthracyclines which one is more common late onset or early onset clinical cardiotoxicity

Answer 5

Late onset more frequent

Question 6

Risk factors for anthracycline induced cardiotoxicity

Answer 6

Cumulative dose
age 
Concominent administration with other chemotherapeutics
 underlying heart disease 
previous Radiotherapy

Question 7

Most important risk factor for cardiotoxicity in anthracycline

Answer 7

Cumulative dose

Question 8

Dose of the doxorubicin that can create cardiomyopathy and congestive heart failure

Answer 8

450-550 (normal is between 60-75 every 3 weeks )

Question 9

Which anthracycline has a lower frequency of cardiotoxicity at therapeutic dose
epirubicin or doxorubicin?

Answer 9

Epirubicin

Question 10

Mechanism of toxicity of Anthracyclien

Answer 10

Free radicals and superoxide formation
Semiquinone radical forms complex with iron -> anthracycline-iron free radicals complex -> reduces O2 -> superoxide production -> lipid peroxidation

Apoptosis

Calcium homeostasis disruption

Immunogenicity rxn

Question 11

Monitoring and markers of cardiotoxicity

Answer 11

Echocardiogram identify myocardial dysfunction

Endomyocardial biopsy - Measure the presence and extent of fibrosis

Troponin t indicates myocardial cell damage

Question 12

Prevention/treatment of anthracyclines induced cardiotoxicity

Answer 12

Cumulative dose imitations

Antioxidants ( not a success)

Iron chelators (Dexrazoxane - slow IV or fast infusion before treatment )

Lipid lowering agents

Liposomal drugs formulation of anthracyclines

Question 13

Type of taxoids

Answer 13

Paclitaxel

Docetaxel

Question 14

Cardiotoxic effects of paclitaxel

Answer 14

Brady  arrythmias 
Tachyarrythmias 
AV block
Cardiac ischemia 
Hypotension 
Congestive heart failure (especially when combined with doxorubicin)

Question 15

Risk factors of taxoid induced cardio toxicity

Answer 15

Unstable angina
Severe coronary heart diseases
Congestive heart failure
Atrial fibrillation

Question 16

When is paclitaxel safe to administer with cardiac risk factors

Answer 16

Single therapy

Question 17

Paclitaxel drug solubility enhancer name

Answer 17

Ctenophor El

Question 18

Mechanism of toxicity of taxoids

Answer 18

Ctenophor El causes massive histamine release

Damage via subcellular organelles

Pharmacokinetic interaction with doxorubicin (over 380). Paclitaxel decreases its hepatic elimination

Question 19

What should you do if you administer taxoids with anthracycline

Answer 19

Lower cumulative dose of anthracyclien

Question 20

5 fluorouracil cardiotoxicith mostly occur with what form of administrions

Answer 20

Continuous infusion

Question 21

Cardiotoxic effects of 5FU

Answer 21

Cardiac arrythmias
Silent myocardial ischemia
Congestive heart failure

Question 22

Risk factors of 5FU

Answer 22

Coronary artery disease

Concurrent radiotherapy

Question 23

5FU MOA

Answer 23

Unclear 
Vasospasm leading to ischemia 
Direct toxicity on myocardium 
Activation of coagulation system 
Thrombosis of coronary artery 
Immunoallergic

Question 24

Cyclophosohamide and ifosfamide alkylation agents MOA

Answer 24

Increase in free oxygen radicals

Question 25

Cisplatin cardiotoxic symptoms

Answer 25

Acute myocardial infarction

Question 26

Cisplatin MOA

Answer 26

Vascular damage
Altered platelet aggregation
Hypomagnesemia
Arachidonic pathway activation