Lung Cancer 1: Drugs Flashcards
What are the drug classes used in lung cancer
Alkylating drugs, antimicrotubules, antimetabolites, Topoisomerase inhibitors, and novel agents
What are is the dose limiting toxicity of alkylating agents, other side effects
Myelosuppresion/ Nausea and vomitting, secondary leukemias
What are the two classes of alkylating drugs
Platinum derivatives and nitrogen mustards
What are the platinum derivatives, nitrogen mustards
Cisplatin, Carboplatin, Oxaliplatin/ Ifosfamide and cyclophosphamide
T/F: Cisplatin is only reconstituted in NaCl, oxaliplatin is only reconstituted in D5W, and carboplatin can be reconstituted in both
True
`Which platinum derivates are most known for causing myelosuppresion
Oxaliplatin and carboplatin
What dose limiting toxicity is cisplatin most known for
Nephrotoxicity
What labs should be monitored for all three platinum derivates/ just cisplatin and carboplatin
SCr, CBC with differential/ Mg K Phos
How is nephrotoxicity avoided for these patients taking cisplatin
Vigourous hydration
How is neurotoxicity caused by cisplatin, risk factors
Damage to dorsal root ganglia and peripheral nerves causing slowing or reduction in nerve conductions (slow and reversible), DM and alcohol use
T/F: Oxaliplatin causes loss of hearing by damaging hairy cells in the cochlea and it is irreversible
True: Cisplatin causes loss of hearing by damaging hairy cells in the cochlea and it is irreversible
What is given for electrolyte disturbances due to cisplatin
Administer IV magnesium 2 to 4 grams, Replace K and Phos as needed
Cisplatin causes mostly anemia due to its myelosuppression instead of thrombocytopenia and neutropenia
True
Which platinum agent needs to be dosed using an equation due to being based on AUC and GFR
Carboplatin, Calvert Equation: Dose (mg) = Target AUC X (GFR + 25) (Cap CrCl is 125 ml/min)
What type of myelosuppresion is seen with Carboplatin,nadir
Thrombocytopenia, 17-21 days
What are parameters of acute neuropathy caused by oxaliplatin, delayed
Cold induced, minutes to hours after infusion/ over time (chronic)
What drugs can be given for delayed neuropathy caused by oxaliplatin
Tramadol, TCAs, gabapentin, SNRIs
What is the BBW for platinum agents,most likely causes, management
Type 1 hypersensitivity (IgE mediated) (carboplatin and oxaliplatin)/ antihistamines, corticosteroids, epinephrine
Which platinum agent is most likely to cause peripheral neuropathy
Oxaliplatin
What are the two classes of antimicrotubules that are used to treat lung cancer
Vinca alkaloids (destabilizing) and Taxanes (stabilizing)
What are the vinaca alkaloids
Vincristine, vinblastine, Vinorebline
T/F: Vinca alkaloids is IV only and highly protein bound
True
What enzyme metabolizes vinca alkaloids, what causes dose adjustements
CYP3A4/ bilirubin and AST/ALT
Which vinca alkaloid causes the most neurotoxicity, myelosuppresson, other side effects from all three
Vinicristine,Vinorebline then vinblastine/ constipation and alopecia
T/F: Vinicristine neuortoxicity that is irreversible includes foot drop ataxia, upper and lower extremity weakness,
True
What is the most recommended drug for vinicristine neurotoxicity
Duloxetine
What are the prefered methods to give vinca alkaloids , how can it never be administered
IVPB and IVP/ Intrathecally (caused ascending myeloencephelopathy)
What are extravastation side effects due to vinca alkaloids/ management
blistering, tissue damage, and necrosis/ Stop infusion, Apply warm packs to site, Hyaluronidase to the site of extravastation
T/F: Vinicristine causes more neurotoxicity while vinorelbine and vinablastine causes neutropenia (myleosuppression)
True
What are the taxanes
Paclitaxel (camaphor), nab-placlitaxel, docetaxel (tween 80), cabizitaxel (tween 80)
T/F: Taxanes also have dose adjustments due to bilirubin and AST/ALT
True
What are the paclitaxel drug-drug interactions
Doxorubicin: increases doxorubicin increasing toxicity (separate 24 hours), Carboplatin: decreased paclitaxel clearance and increased myelosuppresion (paclitaxel 24 hours before carboplatin, phenytoid: increased paclitaxel metabolism (potentially increase paclitaxel dose)
What liver enzyme metabolizes the taxanes
CYP3A4
What pre-medications should be given before paclitaxel is given to a patient
Diphenhydramine 50 IV PLUS Famotidine 20 mg IV PLUS Dexemethasone 20 mg PO or IV 30-60 min prior (or 10 mg PO/IV for two doses 6 and 12 hours before chemo)
What adverse effects does paclitaxel have
Myelosuppresion (incidence higher if infused longer), peripheral neuropathy, alopecia all over``
Which topoisomerases are used in lung cancer
Etoposide, Irinotecan, and tepotican
What is the prodrug for etoposide
Etoposide phosphate
T/F: IV Etoposide is half the oral dose
True
