Pharmacology Flashcards
Radiation Sensitizers
Doxorubicin Dactinomycin Gemcitibine
Gross total volume
volume occupied by tumor at diagnosis
Clinical Target Volume
GTV + sires of suspected occult disease and involved adjacent lymph nodes
Planning Target Volume
CTV + area getting dose accounting for variability (less for protons)
Cranial irradtion for ALL
includes posterior half of eye and C2
Flank irradiation
includes whole vertebral bodies
tumor spillage irradation
includes pelvis
Spinal irradiation
includes thecal sac to S3
Radiation dose for brain necrosis
60 Gy
Radiation dose for IQ defects
12 Gy
Radiation dose for GH deficiency
18 Gy
Radiation dose for precocious puberty
20 Gy
Radiation dose for TSH/FSH/ACTH deficiency
40 Gy
Doxorubicin extravisation
Cold compress, dexrazoxane
Vinblastine extravisation
Warm compress, hyluronidase
Vincristine extravisation
warm compress, hyaluronidase
Alkylating agents
temozolomide, melphalan, ifosfamide, cclophosphamide, thiotepa, carmustine, busulfan, cisplatin, carboplatin
Platinums
Cisplatin, Carboplatin
Platinum SE
Peripheral nueropathy, NV, Nephrotoxicity, myelosuppression, hepatoxicity, hypersenitivity, ototoxicity (cisplat>carbo)
Cisplatin ototoxicity
High frequency sensioneural hearing loss >4,000 hz
Cyclophosphamide nephrotoxicity
water retention with hyponatremia from direct tubular damage not ADH
Ifosfamide nephrotoxicity
proximal tubular fanconi syndrome with glucosuria, phosphaturia, amino aciduria, riscketts, RTA distal tubular damage
Mesna
chelates acrolein
Antidote for ifosfamide neurotoxicity
methylene blue
Late effects for alkylators
Reproduction, pulmonary fibrosis for Busulfan nitrogen mustards, renal dysfunction, ototoxicity, secondary cancers
Antimetabolites
Methotrexate, mercaptopurine, thioguanine, fludarabine, cladribine, clofarabine, nelarabine, cytarabine, gemcitabine, flurorouracil
Antimetabolite SE
myelosuppression, hepatotoxicity, mucositis, NV, neurotoxicity, rash, pulmonary toxicity
HD MTX nephrotoxic
Radiation Recall gemcitabine
Methotrexate neurotoxicity
10-14 day onset
resolves 1-7 days
10-50% recur???
can cause chronic encephalopathy
Cytarabine neurotoxicity
acute cerebellar syndrome
ataxia
nystagmus
dysmetria
dysarthria
3-8 day onset
resolves 1 wk
30% have residual effect
Nelarabine neurotoxicity
solmnolence, seizures
Guillan Barre like syndrome
gradually reversible
Fludarabine neurotoxicity
progressive leukoencephalopathy
can be fatal
delayed onset demyelination
HD methotrexate nephrotoxicity
High output renal failure antidote glucarpidase
Glucarpidase
cleaves circulating Mtx into DAMPA and glutamic acid
Mercaptopurine interaction
Allopurinol
Methotrexate interaction
Aspirin, penicillin, NSAIDs, ciprofloxacin, sulfas, L-Asp (give 24h after MTX)
Topoisomerase
I Topotecan/irinotecan
II Doxorubicin, daunorubicin, idarubicin, etoposide, mitoxantrone, dactinomycin
Topoisomerase SE
NV myelosuppression, mucositis, diarrhea, anthrcyclines - cardiac, hepatic, vesicants, radiation sensitizers (doxo, dactino, dauno, ida) etop infusion reaction
Inrinotecan diarrhea
prodrug metablized to SN-38
Hyperacture <8H - atropine
Acute >8 hours - octreotide
prophy cefixime
Tubulin binding (microtubule inhibitors)
Vinca alkyloids paclitaxel docetaxel erlibulin
Microtubule inhibitor SE
Myelosupression except VCR
Neuropathy
SIADH
Vinblastine - mucositis
Vesicants (warm compress)
Steroids
Dex not bound to transcortin so crosses BBB
Steroid SE
centipedal obesity
growth failure
immunosuppression
myopathy
avascular necrosis
gastric ulcers
pancreatitis
diabetes
psychiatric disorders
hypertension
impaired wound healing
Asparginase
leukemic blasts are deficient in aspargine synthase
Peg-asparginase T1/2 5-7 days
Erwinea T1/2 10-15 hours
Calaspargase T1/2 16 days
Asparginase SE
Hypersensitivity
Coagulopathy
pancreatitis
hepatic toxicity
neurotoxicity
Bleomycin
Chlates metals that bine DNA and produce double stranded breaks
Bleomycin SE
interstitial pneumonitis
hyperpigmentation
hypersensitivity
raynaud
Arsenic Trioxide
apoptosis
SE prolonged QTc
leukocytosis, APL differentiation
Hepatotoxicity
dermatitis
low mag, ca, hyperglycemia
ATRA
differentiation syndrome
chelitis
headache, psuedotumor cerebri
bone and joint pain
hypertriglyceridemia
venous thrombosis
13-cis retinoic acid
skin sensitivity
headache
hypertryglyceridemia
hypercalcemia
epiphyseal changes
pseudotumor cerebri
visual changes
psychiatric disorders
BCR-ABL inhibitors TKIs
Imatinib - NV fatigue dh hepatoxicity hemorrhagic pleural effusions
Dasatinib dh headache hypokalemia poor bone growth pleural and pericardial effusion
nolatinib same with arthralgias, constipation, nasopharyngitis, pyrexia
Axitinib, Pazopanib
VEGF PDGF C-Kit
RCC
Sorafinib
VEGF PDGF c-KIT
HCC
AML FLT3
RCC
ALK inhibitors
Lorlatinib
Large cell anaplasctic lymphoma
NBL
NTRK inihibitors
Larotrectinib
DNA methylation inihibitors
Azacitidine and decitabine
activates tumor suppressor genes silences by hypermethylation
Gemtuzumab
Anti CD33
Brentuxumab
Anti CD30