HemeOnc More Drugs

Question 0

Drugs to overcome myelosuppression

Answer 0

• WBC growth factors
• WBC Colony Stimulating Factors (“stims”)
  
  • Sargramostim (GM-CSF)
  • Filgrastim (G-CSF)
  • Pegilgrastim

Question 1

Drugs for CINV

Answer 1

• Serotonin antagonists (odansetron)
• Corticosteroids (dexamethazone)
• NK1/Substance P Antagonist (“prepitants”)
• Benzodiazepines (“zepams”)

Question 2

Drugs to overcome CIA (Chemotx-induced anemia)

Answer 2

• Erythropoiesis-Stimulating Agents (ESAs)
  
  • decrease need for RBC transfusions
  • not used much be/c risk of embolism/death
  • don’t use if intent is cure

Question 3

Serotonin Antagonists

Answer 3

• Used for CINV
• affects acute phase
• Drug: Ondansetron (Zofran)
• blocks 5HT3 receptors (where serotonin binds) in GI tract
• side effects: headache, constipation

Question 4

Corticosteroids

Answer 4

• Used for CINV
• affects delayed phase
• Drug: Dexamethasone
• Side effects: Increased glucose, fluid retention, mood changes, insomnia, increased WBC (steroids)

Question 5

NK1/Substance P Antagonist

Answer 5

• tx for CINV
  Drug: “prepitant”
• works in delayed phase
• causes fatigue, nausea, hiccups, constipation, diarrhea, drug interactions

Question 6

Benzodiazepines

Answer 6

• Tx for CINV
• work best in anticipatory phase (pre-chemo)
• Drug: “azepam”
• works by anxiolytic, amnesic
• side effect: sedation

Question 7

WBC Colony Stimulating Factors

Answer 7

• Tx myelosuppression
• Drugs: “stim”s: Sargramostim (GM-CSF), Filgrastim (G-CSF), Pegfilgrastim
• give when risk of febrile neutropenia greater than/equal to 20%
• give 24-72 hrs post chemo

Question 8

What drug(s) cause CNS toxicity?

Answer 8

Cytarabine causes cerebellar toxicity

Question 9

What drugs cause PNS toxicity via cumulative doses?

Answer 9

Cisplatin
Vinca (esp cristine)
Taxanes

Question 10

What drugs cause Autonomic Nervous System toxicity?

Answer 10

Cisplatin

Vinca alkaloids

Question 11

What drugs cause cardiomyopathy?

Answer 11

1) Anthracyclines-> CHF
protect w/ dose of dextrazoxane

2) mitoxantrone

Question 12

What drugs cause arrythmias?

Answer 12

1) Anthracyclines
2) Arsenic
3) Taxanes

Question 13

What drugs cause ischemia?

Answer 13

Pyramidine Analogues

Fluorouracil & Capecitabine

Question 14

purine antagonist

Answer 14

6-mercaptopurine
- pt can have mutation at TPMT locus (homo or hetero)-> blocks major elimination path to 6-methyl mercaptopurine -> more active metabolite of the drug

Question 15

what drugs cause renal toxicity?

Answer 15

cisplatin-> renal tubular damage
–prevention: hydration, lasix, or use carboplatin

HD methotrexate-> high dose (>100) requires rescue with leucovorin and urine alkalinization

• -risk factors: renal impairment, cisplatin, NSAIDS
• -prevention: hydration, urine alkalinization

Question 16

what drugs cause bladder toxicity/hemorrhagic cystitis?

Answer 16

• typical alkylators (“amides”)
• cause direct toxicity
• prevention: hydration, mesna, bladder irrigation