Oncology II Flashcards
Whats Dubois and Dubois Formular?
BSA (m^2) = 0.007184 x Height (cm)^0.725 x Weight (kg)^0.425
What’s the most commonly used calculations for dosing, body surface area (BSA)?
DuBois and DuBois formula
Whats Mosteller Formular? Also used for BSA calculation
BSA = | (Ht -cm x Wt -kg)/ 3600
List phases of cell cycle
M - mitosis - cell divides into 2 daughters
Go - Resting phase post mitosis - no cell division occurs
G1 - Post-mitotic phase - where enzymes & proteins are synthesized
S - DNA synthesis and duplication occurs
G2 - Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepare for cell division
What’s M-phase of the cell cycle? Drugs that work here?
Mitosis - cell divides into 2 daughter cell
Anti-mitotic drugs
Vinca alkaloids
Taxanes
What’s Go-phase of the cell cycle? Drugs that work here?
Resting phase (post mitosis) - no cell division occurs
None! No drugs work here
What’s G1-phase of the cell cycle? Drugs that work here?
Post-mitotic phase - where enzymes and proteins are synthesized (Cell growth and preparation for DNA replication)
None!
What’s S-phase of the cell cycle? Drugs that work here?
DNA synthesis and duplication occurs
Topoisomerase I inhibitors + Anti-metabolites
- Irinotecan
- Topocetan
- MTX
- 5-FU
- Capecitabine
- Pemetrexed
- Cytarabine
What’s G2-phase of the cell cycle?
Pre-mitotic phase - RNA and Topoisomerase I and II are produced to prepared for cell division
Which drugs work on both G2 and S-phase?
Topoisomerase II inhibitors eg
Etoposide
List non-cell cycle specific agents
Alkylating agents
Anthracyclines
Platinum agents
MOA of Alkylators?
Non-cell cycle specific: Cross-links DNA, preventing cell replication
List the main Alkylators?
Cyclophosphamide (Cytoxan)
Ifofsamide (Ifex)
Brand name of Cyclophosphamide? Alkylator (non-cell cycle specific)
Cytoxan
Brand name of Ifosfamide? Alkylator (non-cell cycle specific)
Ifex
Whats concern with High-dose Cyclophosphamide (Cytoxan) and all doses of Ifosfamide (Ifex)? What’s done to mitigate concern?
Bladder toxicity
Give MESNA (Mesnex) + High-dose Cyclophosphamide (Cytoxan)
MESNA (Mesnex) + ALL doses of Ifosfamide (Ifex)
Which Alkylators is a MAO-I?
Procarbazine (avoid interacting drugs/food)
Which Alkylators is used with non-PVC bag and tubing due to leaching of DEHP?
Carmustine
BBW of Alkylators?
Hemorrhagic cystitis (Ifosfamide, cyclophosphamide)
Secondary malignany
Main SE of Busulfan, Carmustine, Lomustine (Alkyaltors)?
Pulmonary toxicity
Which Alkylators is highly emetogenic and can cause flu-like sx?
Dacarbazine (DTIC)
MOA of Anthracyclines?
Non-cell specific: works by various MOA, including intercalation into DNA
List Anthracyclines agents
Doxorubicin (Adriamycin)
Idarubicin (Idamycin)
Daunorubicin (Cerubidine)
Mitoxantrone (Novantrone)
Brand name of Doxorubicin? Anthracyclines
Adriamycin
Brand name of Doxorubicin Liposomal? Anthracyclines
Doxil
Brand name of Idarubicin? Anthracyclines
Idamycin
Brand name of Daunorubicin? Anthracyclines
Cerubidine
Brand name of Mitoxantrone? Anthracyclines
Novantrone
What limits use of Anthracyclines?
Very effective but use limited by cardiac toxicity and N/V
Anthracyclines are vesicants… What’s used as an antidote for them?
Dexrazoxane (Totect)
Or
Dimethyl Sulfoxide
Don’t use both!
How do u mitigate Cardiotoxicity caused by Anthracyclines?
There’s max lifetime doses for most of the,
What’s the max lifetime dose of Doxorubicin (Adriamycin)? With mediastinal radiation?
Doxorubicin = 450-550 mg/m^2
Mediastinal radiation = 450 mg/m^2
What’s the cardioprotective agent used with Doxorubicin?
Dexrazoxane (Zinecard)
When should u consider adding Dexrazoxane (Zinecard) to Doxorubicin?
When doxorubicin doses are anticipated to continue beyond 300 mg/m^2
What color do anthracyclines turn body fluids into? Exception?
Red
Mitoxantrone (Novantrone) turns body fluid BLUE
BBW of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Irreversible myocardial toxicity
Potent vesicant
SEs of Anthracyclines (doxorubicin, idarubicin, daunorubicin, mitoxantrone)?
Alopecia
Extravasation
Red urine and body secretions (blue with mitoxantrone)
MOA of platinum-based compounds?
Non-cell cycle specific: cross-links DNA, leading to apoptosis
Agents under Platinum-based compounds?
Cisplatin (Platinol)
Carboplatin (Paraplatin-AQ)
Oxaliplatin (Eloxatin)
Brand name of Cisplatin? Platinum-based compounds
Platinol
Brand name of Carboplatin? Platinum-based compounds
Paraplatin-AQ
Brand name of Oxaliplatin? Platinum-based compounds
Eloxatin
Unique concerns of Ciplatin (Platinol) - Platinum-based compounds?
Nephrotoxicity (vigorous hydration & sometimes, mannitol)
Electrolyte wasting (req Mg and K supplementation)
Ototoxicity (audio grams recommended b4 each prior)
Severe N/V (use 3 drug combo antiemetic regimen)
What may be used prophylactically for renal protection when using Cisplatin (Platinol)?
Amifostine (Ethyol)
Unique concerns wrt Oxaliplatin (Eloxatin)? Platinum-based Compds
Neuropathy exacerbation by exposure to cold
BBW associated with Platinum-based Compds?
Cumulative renal toxicity
SEs associated with Platinum-based Compds?
Neuropathy
Moa of Folate Antimetabolites?
Cell cycle specific, S-phase: prevent DNA synthesis
Agents under Folate Antimetabolites?
Methotrexate (Trexail, Rheumatrex)
Pemetrexed (Alimta)
Pralatrexate (Folotyn)
What’s req with high-doses of MTX?
Leucovorin (or Levoleucovorin)
To reduce toxicity
What meds should be avoided with MTX? Why?
Aspirins, Beta-lactams, Probenecid and NSAIDs
Reduces active transport renal elimination => resulting in toxicity
What can be done to reduce toxicity of MTX?
Maintain hydration…drink fluids
Alkalinize urine (by giving bicarbonate IV)
What supplements should be used with Pemetrexed (Alimta)?
Folic acid supplements (1mg PO daily)
Vit. B12 (cyanocobalamin) + dexamethasone
BBWs of MTX?
Preserved formulation for intrathecal admin
SEs of MTX (Trexail, Rheumatrex)?
Myelosuppression
Mucositis
Hepatic and renal toxicity (renal is dose-related)
Pulmonary toxicity
Red-tender palms and feet (hand-foot syndrome)
MOA of Pyrimidine Analog Antimetabolites?
Cell cycle specific, S-phase: inihibits Pyrimidine synthesis
Agents under Pyrimidine Analog Antimetabolites?
Capecitabine (Xeloda)
Cytarabine (Ara-C, Cytosar)
Fluorouracil (5-FU, Adrucil)
Gemcitabine (Gemzar)
Brand name of Capecitabine? Pyrimidine Analog Antimetabolites
Xeloda
How should Capecitabine (Xeloda) be used?
PO — take with meal
What testing should done with Capecitabine (Xeloda) use?
Pharmacogenomics testing for Dihydropyrimidine dehydrogenase (DPD)
Deficiency increases risk of sever toxicity
Capecitabine (Xeloda) and INR?
Increases INR up to 91% due to 2C9 inhibition
CI to Capecitabine (Xeloda) use?
Dihydropyrimidine dehydrogenase (DPD) deficiency
SEs of Capecitabine (Xeloda)?
Hand-foot syndrome (more than 5-FU)
Diarrhea
Mucositis
Gastritis
Unique concerns wrt Cytarabine (Ara-C, Cytosar)?
Ara-C syndrome eg fever, gen weakness, fatigue, skin rash, reddened eyes, bone, muscle, joint and/or chest pain
Responds to Coticosteroids
Brand name of Fluorouracil (Pyrimidine Analog Antimetabolites)?
5-FU
What’s Fluorouracil given with? Why?
5-FU is given with Leucovorin
To increase efficacy of 5-FU
CI to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Dihydropyrimidine dehydrogenase (DPD) deficiency
SE to Fluorouracil (5-FU)? Pyrimidine Analog Antimetabolites?
Mucositis
Hand-foot syndrome (with continuos infusion)
Brand name of Gemcitabine? Pyrimidine Analog Antimetabolites
Gemzar
Unique concerns with Gemcitabine (Gemzar)? Pyrimidine Analog Antimetabolites
Prolonged infusion time may increased toxicities
MOA of Taxanes?
M-phase specific: Inhibit microtubule fxn
When used in combo, whys Taxanes given first?
Elimination of Taxanes is reduced when given immediately after admin of Cisplatin or Carboplatin
List Taxanes agents
Paclitaxel (Taxol)
Docetaxel (Taxotere)
Carbazitaxel (Jevtana)
Brand name of Paciltaxel? (Taxanes)
Taxol
Brand name of Docetaxel? (Taxanes)
Taxotere
Unique concerns of Paciltaxel (Taxol) - Taxanes?
Anaphylaxis, hypersensitivity rxn
What’s used to pre-.treat when using Paciltaxel (Taxol) - Taxanes?
Dexamethasone
Diphenhydramine
H2RA
(To reduce anaphylaxis, hypersensitivity rxns)
How should all Taxanes be given IV?
Use non-PVC IV bag and tubing, due to leaching of DEHP
SEs of Paciltaxel (Taxol); Docetaxel (Taxotere); Cabazitaxel - Taxanes?
Myelosuppression
Peripheral neuropathy
Unique concerns of Docetaxel (Taxotere)?
Hypersensitivity
Cardio-Pulmonary: Fluid retention
Pre-treat with dexamethasone 8mg bid x 3 days
SE unique to Docetaxel (Taxotere)? (In addition to Myelosuppression, peripheral neuropathy)
Fluid retention
MOA of Vinca Alkaloids?
M-phase specific: Inhibit microtubule fxn
List agents under Vinca Alkaloids
Vincristine (Vincasar, Oncovin)
Vinblastine (Velban)
Vinorelbine (Navelbine)
Brand name of Vincristine (Vinca Alkaloids)?
Vincasar
Oncovin
Brand name of Vinblastine (Vinca Alkaloids)?
Velban
Brand name of Vinorelbine (Vinca Alkaloids)?
Navelbine
Vinca alkaloids are vesicants, whats the preferred way they should be delivered to the body?
Via central line
How should Extravasation be treated in Vinca Alkaloids?
Warm compress + Hyaluronidase
What’s the only route of admin for vinca alkaloids?
IV only
Don’t admin intrathecally - fatal
Which Vinca Alkaloids causes only mild suppression?
Vincristine (Vincasar, Oncovin)
What’s the max single dose of Vincristine (Vincasar, Oncovin)?
2mg
BBWs of Vincristine (Vincasar, Oncovin)?
Intrathecal admin
Ses of Vincristine (Vincasar, Oncovin)?
Cumulative (dose-dependent) nerve damage/ peripheral neuropathy
BBWs of Vinblastine (Velban) and Vinorelbine (Navelbine)?
Myelosuppression
Peripheral neuropathy (less than vincristine)
Gastroparesis/constipation
MOA of Topoisomerase I inhibitors?
Blocks coiling uncoiling of DNA helix
Agents under Topoisomerase I inhibitors?
Irinotecan (Camptosar)
Topotecan (Hycamtin)
Brand name of Irinotecan? Topoisomerase I inhibitors
Camptosar
Types of diarrhea caused by Irinotecan (Camptosar) Topoisomerase I inhibitors? Tx?
Acute diarrhea (cholinergic sx) - treat with Atropine
Delayed diarrhea - treat with Loperamide (up to 24mg daily)