Miscellaneous Agents Flashcards
What is bleomycin classified as?
Antitumor antibiotic
How does bleomycin work?
Inhibits DNA synthesis by creating single and double strand breaks (free radical production after binding to metal such as Fe or Cu) - dosed in units rather than milligrams
What is the most important toxicity of bleomycin?
Pulmonary fibrosis
What enzyme breaks down bleomycin?
Bleomycin hydralase
How should pulmonary fibrosis in bleomycin be monitored?
- PFT monitoring (DLCO - diffusion capacity of carbon monoxide)
- Cumulative lifetime exposure tracking - highest risk after 400 units lifetime exposure
Which cytotoxic chemotherapy drugs do NOT cause myelosuppression (all the others do!)
Bleomycin and vincristine
- bleomycin is a good option to add on to other therapies (hodkins, testicular cancer)
What drug class is procarbazine?
Alkylating agent and weak monoamine oxidase inhibitor
Procarbazine is an alkylating agent. What side effect can be expected?
Slightly higher rate of secondary leukemias than some other alkylating agents
What formulation is procarbazine available in?
PO
What education should be provided to patients taking procarbazine since it is a MAOI?
- Avoiding high tyramine-containing food and drink
- Drug interaction considerations - serotonin syndrome
What are the two “forgotten” alkylators?
Dacarabazine and temozolomide
What is the brand name of dacarabazine?
DTIC
What is the brand name of temozolomide?
Temodar
Dacarabazine and temozolomide are pro-drugs of which active metabolite?
MTIC (alkylane inhibitor)
What is the main side effect of dacarabazine?
Highly emetogenic (same class as cisplatin)
What formulation does temzolomide come in?
PO - great bioavailability and BBB penetration (used in brain tumors!)
What does long-term use of temozolomide cause (every day for 6 weeks)?
Lymphopenia - decreased WBCs and lymphocytes (T and B cells that prevent viral infections and pneumocysitis pneumonia)
- PCP prophylaxis is required!!
What drug class is hydroxyurea?
Antimetabolite
What does hydroxyurea do?
Inhibits ribonucleotide diphosphate reductase (blocks conversion of ribonucleotides to deoxyribonucleotides, leading to G1/S arrest)
What is hydroxyurea used for?
- Antineoplastic - reduce WBC in leukemia patients (cytoreduction)
- Most common use is for sickle cell disease (increases production of fetal hemoglobin)
What is the unique toxicity of trabectedin?
Hepatotoxicity, rhabdomyolysis
What drug class is mitomycin C?
Alkylating agent - creates guanine-cytosine crosslinks
What is something unique about mitomycin C?
Long nadir (lowest point of WBC and platelet count) - 4 to 8 weeks (hard to predict)
