Miscellaneous Chemo Agents Flashcards
which drug is an ANTI-TUMOR ANTIBIOTIC, that inhibits DNA synthesis via DNA strand breaks
Bleomycin
Safety concerns for Bleomycin
- Pulmonary toxicity
- Hypersensitivity reactions
what prevention strategy can be implemented on Bleomycin for risk reduction of pulmonary toxicity
Limit lifetime cumulative dose of Bleomycin to 400 units
what prevention strategies can be implemented for Bleomycin hypersensitivity reactions
Can consider a test dose for the first 2 doses and/ or premedication with APAP or Benadryl
which drug is a Retinoic Acid Derivative: decreases proliferation and increased differentiation of acute promyelocytic leukemia (APL) cells
Tretinoin (AKA all-trans retinoic acid = ATRA)
Tretinoin:
Q. Safety concerns
Q. prevention/ tx strategies
- Differentiation syndrome (or RA-APL; fever, SOB, wt gain, edema, pulmonary infiltrates, pericardial or pleural effusions)
- Systemic steroids / interupt therapy for severe cases
which drug increases apoptosis of APL cells and damages the fusion protein promyelocytic leukemia-retinoic acid receptor alpha (PML- RARA)
Arsenic Trioxide (Trisenox)
Arsenic Trioxide (Trisenox)
Q. Safety concerns
Q. Prevention/ tx
- QT PROLONGATION
Differentiation syndrome - Maintain K > 4 mEq/L and Mg > 1.8 mEq/L and avoid concurrent QT prolonging agents (QT prolongation)
Systemic steroids and interrupt therapy for severe cases (Differentiation syndrome)
List PI drugs
Protease Inhibitors: inhibit proteasomes, which help regulate intracellular protein homeostasis by inhibiting cell cycle progression and inducing apoptosis
Bortezomib (Velcade)
Carfilzomib (Kyprolis)
Q. Safety concerns for protease inhibitors (Bortezomib/ Carfilzomib)
Q. prevention/ treatment strategies
- *HERPES REACTIVATION (zoster and simplex)
Peripheral neuropathy - *ANTIVIRAL agents (ACYCLOVIR, VALACYCLOVIR)- prevention and txprevention peripheral neuropathy: administer bortezomib SC (less neuropathy than IV admin)
Tx peripheral neuropathy: symptomatic care
List Immunomodulator drugs
Immunomodulators: block angiogenesis (the formation of new blood cells) and kill abnormal cells in the bone marrow while stimulating the bone marrow to produce normal healthy cells
Lenalidomide (Revlimid)
Pomalidomide (Pomalyst)
Thalidomide (Thalomid)
List Immunomodulator drugs
Immunomodulators: block angiogenesis (the formation of new blood cells) and kill abnormal cells in the bone marrow while stimulating the bone marrow to produce normal healthy cells
Lenalidomide (Revlimid)
Pomalidomide (Pomalyst)
Thalidomide (Thalomid)
Immunomodulators safety concerns
- SEVERE BIRTH DEFECTS
- THROMBOSIS (DVT / PE)
Immunomodulators monitoring for severe birth defects
Pregnancy test: 2 negative pregnancy tests required BEFORE treatment initiation
prevention strategies for severe birth defects from immunomodulators
- Pt/ prescriber/ pharmacist must be registered with the REMS program (restricted distribution)
- 2 forms of contraception or abstain from sex
List Asparaginase Product
asparaginase product: inhibits protein synthesis by depleting asparagine in leukemic cells
Pegaspargase (Oncaspar)
note: modified form of L-asparaginase (derived from E.coli) conjugated with polyethylene glycol
what is the safety concern for Pegaspargase
Hypersensitivity reactions
note: pegylated form allows for LESS FREQUENT DOSING and LESS ALLERGIC REACTIONS
prevention strategies for pegaspargase for hypersensitivity reactions
premedicate with APAP, an antihistamine and an H2RA (famotidine)
