Exam 3

Question 1

Mercaptopurine

Answer 1

Bone marrow suppression
liver toxicity
take antiemetic prior to emesis
monitor weight and I&Os
Wash fresh fruit & veggies, cook food properly
Frequent oral care prevent stomatitis

Question 2

Intrathecal Cytarabine

Answer 2

arachnoiditis-N/V, headache & fever

bone marrow suppression- Nadir 5-7 days WBC & platelets

Question 3

Methotrexate

Answer 3

bone marrow suppression
leucovorin antidote
neutropenic precautions neutrophils < 500

Question 4

Cyclophosphamide

Answer 4

Hyperkalemia, hyponatremia, leukopenia, hemorrhagic cystitis
Alopecia
Hemorrhagic cystitis prevented by giving mensa, voiding before each dose, and increasing fluid intake

Question 5

Carmustine

Answer 5

bone marrow suppression. Nadir 4-6 weeks
decreased lung function, monitor PFT
Not in joints or AC bc increased risk infiltration and extravasation. NaHCO3 0.9% NS in line and subq. cold compress.

Question 6

Cisplatin

Answer 6

bone marrow suppression, kidney toxicity, ototoxicity, peripheral neuropathy
antiemetic 30 mins prior. audiometric and KFT before each dose. 1-2 L fluid before tx with hydration for 24 hrs after

Question 7

Doxorubicin

Answer 7

Cardiac Toxicity (rapid HR, palp., SOB, angina) -dexrazoxane 
infil./extrav- not in joint or AC. Stop immediately
red streak bc histamine, slow rate

Question 8

Tamoxifen

Answer 8

Hot flashes, retinopathy, cataracts, decreased visual acuity. Thromboembolism (Stroke or PE). Endometrial hyperplasia (increased risk uterine cancer, vaginal bleeding)

Question 9

Anastrozole

Answer 9

Osteoporosis
Tylenol for muscle pain
Alendronate prevent osteoporosis, increase vitamin d and calcium.
Contraindicated: postmenopausal estrogen therapy

Question 10

Vincristine

Answer 10

Alopecia in 20%. Damage if infil & extrav-subQ hyaluronidase. Severe constipation. Peripheral neuropathy. IV in forearm

Question 11

Topotecan

Answer 11

Infused over 30 minutes. Bone marrow suppression- Neutropenia 12 days, thrombocytopenia 15 days. Alopecia in 50%. Frequent oral cares to prevent stomatitis

Question 12

Filgrastim

Answer 12

increases bone marrow suppression with topotecan. give 24 hrs topotecan infusion complete.

Question 13

Flutamide

Answer 13

gynecomastia, hot flashes, decreased libido and impotence. Liver toxicity-monitor AST & ALT. Begins when GnRH (leuprolide) starts. used to stop testosterone which promotes growth of prostate cancer.

Question 14

Interferon alfa-2a

Answer 14

Flu-like and CNS symptoms. Bone marrow suppression. GI symptoms (Severe enough for wt loss)

Question 15

Imatinib

Answer 15

fluid retention may lead to pulm edema. bone marrow suppression (WBCs & platelets). GI symptoms (Severe enough for wt loss).

Question 16

Paclitaxel

Answer 16

bradycardia (w/o symptoms continue med). Peripheral neuropathy. Allergic reaction (Premedicate with antihistamine, corticosteroid, and PPI 30 mins before infusion). Pt report s/s allergic reaction.

Question 17

Taxol

Answer 17

Non-PVC tubing and IV bag, in-line filter and infused over 3 hours.

Question 18

Trastuzumab

Answer 18

allergic reaction (wheezing, hypotens, SOB, urticaria)
Infusion reaction (flu-like symptoms)
Cardiac symptoms (HF and dysrhythmias)
CNS Symptoms

Question 19

Maraviroc

Answer 19

cough and URI. Allergic reaction signs lead to liver damage. Liver toxicity.
Delavirdine ^ blood levels, decrease dose.
Penytoin decrease blood levels, ^ dose.

Question 20

Ritonavir

Answer 20

Hyperglycemia and DM
Fat redistribution (abdominal fat, buffalo hump)
Increases cholesterol and triglycerides.
Decreased bone density (lead to osteoporosis)

Question 21

Zidovudine

Answer 21

Bone marrow suppression (Anemia 2-4 weeks, neutropenia 6 weeks).
Decrease/withhold for hemoglobin < 7.5 of 25% less baseline and neutrophils < 750 or 50% less baseline.
Filgrastim PRN to increase WBC.

Question 22

Enfuvirtide

Answer 22

pneumonia and allergic reaction.

inject subq, prep with sterile water, let vial sit until clear and no particulate (up to 45 minutes)

Question 23

Delavirdine

Answer 23

Rash, steven-johnson’s syndrome (fever, lesions mouth or eyes, blisters, muscle pain. DISCONTINUE DRUG).
Persistent N/V/D can lead to wt loss.
Increases liver enzymes.