Side Effects and Warnings Flashcards
What chemotherapy drugs DONT have risk of myelosuppression?
Bleomycin
Vincristine
Asparaginase
Which chemo drugs have the highest risk for nausea and vomiting?
Cisplatin
Cyclophosphamide
Ifosfamide
Doxorubicin
Epirubicin
ICCED
Which chemo drugs have the hightest risk of mucositis?
FLUOROURACIL
Methotrexate
FML I have mucositic
What chemo drugs have the highest risk of diarrhea?
IRINOTECAN
Capecitabine
Fluorouracil
Methotrexate
What chemo has the highest risk of cardiomyopathy?
Anthracyclines (Doxorubicin)
HER2 inhibitors (trastuzumab, pertuzumab)
Fluorouracil
What chemo has the higheset QTc risk?
Arsenic trioxide
Leuprolide
TKI
What chemo has the highest risk for pulmonary fibrosis?
Bleomycin
Busulfan
Carmustine
Lomustine
Blue Car is Low
What chemo has the highest risk for pneumonistis?
Methotrexate
MAbs
What chemo has the highest risk of hepatotoxicity?
Antiandrogens (bicalutamide, flutamide, nilutamide)
Folate antimetabolites
What chemo has the highest risk of nephrotoxicity?
Cisplatin
Methotrexate
What chemo has the highest risk of hemorrhagic cystitis?
Ifofamide
cyclophosphamide (higher doses)
What chemo has the highest risk of neuropathy?
vinca alkaloids (vincristine, vinblastine)
Platinums (cisplatin, oxaliplatin)
Taxanes (Paclitaxel, Docetaxel)
Proteasome inhibitors (Bortezomib)
What cancer agents have the highest risk of thromboembolism?
Aromatase inhibitors (anastrozole)
SERMs (tamoxifen, raloxifene)
Tamoxifen
BW: risk of uterine and endometrial cancer
THROMBOEMBOLIC EVENTS
SE: host flashes, night sweats, vaginal bleeding, vaginal itching, decrease libido, edema, DECREASE bone density
TERATOGENIC!!!!
Prodrug converted by CYP2D6 - use venlafaxine for hot flashes since fluoxetine is a CYP2D6 inhibitor
Raloxifene
BW: risk of uterine and endometrial cancer, THROMBOEMBOLIC EVENTS
SE: hot flashes, vaginal bleeding or itching, decreased libido
Arimidex
Anastrozole
SE: hot flashes, arthralgia/myalgia
Lupron Depot
Leuprolide (GnRH Agonist)
CI: pregnancy
SE: hot flashes, impotence, gynecomastia, bone pain
** used with AI for treatment of breast cancer
**used with antiandrogens initially for prostate cancer
Zoladex
Goserelin
CI: pregnancy
SE: hot flashes, impotence, gynecomastia, bone pain
** used with AI for treatment of breast cancer
**used with antiandrogens initially for prostate cancer
Apalutamide
Antiandrogen 2nd gen
warning: QTc
Degarelix
GnRH Antagonist
Osteoporosis risk
CI: pregnancy
SC inj = hypersensitivity rxns
Flutamide
Antiandrogen 1st gen
BW: hepatotoxicity
SE; hot flashes, gynecomastia
Carmustine
Pulmonary toxicity
Blue Car Pressure Low
Lomustine
Pulmonary toxicity
Blue Car Pressure Low
Cyclophosphamide
Hemorrhagic cystitis **may need to use Mesna at HIGH doses
Nausea and Vomiting
SIADH
Myelosuppression
Ifosfamide
Hemorrhagic cystitis === use Mesna
Nausea and Vomiting
Neurotoxicity
Myleosuppression
Cisplatin
Ototoxicity*
Nephrotoxicity*
CINV
Neuropathy (peripheral)
Myleosuppression
*cumunulative dose related
Carboplatin
Myelosuppression dose related
CINV
Neuropathy (peripheral)
Oxiliplatin
Neuropathy (sensitive to COLD)
QT prolongation
Doxorubicin
Cardiotoxicity
Vesicant
Myleosuppression
RED discoloration of urine and tears
CINV
DO NOT EXCEED 450 - 550 lifetime dose
Irinotecan
Topo 1 (block S phase)
DIARRHEA - use atropine or loperamide
Myelosuppression
Bleomycin
Topo 2 (G2 phase)
NOT myleosuppressive
pulmonary fibrosis
MAX life dose 400 units
**increasesd risk of pulmonary fibrosis when given with G-CSF
Vincristine
Vinca Alkaloids (M phase)
Not myleosuppressive (:
Neuropathy
Vesicant
Constipation
ONLY IV === no intrathecal!!!!!
*major CYP3A4 substrate
Vinblastine
Vinca Alkaloid (M phase)
Bone marrow suppression :(
Vesicant
Neuropathy
*ONLY IV
Paclitaxel
Taxane (M phase)
Neuropathy
Hepatotoxicity
Myleosuppression
hypersensitivity rxn = premedication
Docetaxel
Taxane (M phase)
Neuropathy
Hepatotoxicity
Myleosuppression
hypersensitivity rxn = premedication
Fluorouracil
Pyrimidine analog antimetabolites that block the S phase of cell cycle because it is incorporated into RNA as uracil
BW: increase INR
Hand-foot syndrome
Myelosuppression
Diarrhea!
Mucositis
Capecitabine
Pyrimidine analog antimetabolites that block the S phase of cell cycle because it is incorporated into RNA as uracil
***prodrug of fluorouracil
DPD deficiency increase risk of toxicity!!!!
BW: increase INR
Hand-foot syndrome
Myelosuppression
Diarrhea!
Mucositis
Trexall
Methotrexate
requires leucovirin at high doses > 500 mg/m2
BW: myelosuppression
nephrotoxicity
hepatotoxicity
GI toxicity (mucositis)
TERATOGENICITY
CINV
***use preservative pree formulation for intrathecal administration
** HYDRATION needed to decrease nephrotoxicity
DI: NSAIDs, salicyclates, PPI, beta lactams, salfonamide === all decrease clearance of methotrexate
IV drug is orange-yellow!
Everolimus
mTOR inhibitor
mouth ulcers
peripheral edema
DLD
hypertension
Bortezomib
Peripheral neuropathy
Proteasome inhibitor “zomib”
TrasTUzumab (Herceptin)
HER2 dimerization blocker for breast cancer
Cardiotoxicity
TERATOGENIC
Bevacizumab (Avastin)
VEGF inhibitor
GI peroration and fatal bleeding
Cetuximab
EGFR inhibitor
Acniform rash === indicates better response
Rituximab (Rituxan)
CD20 inhibitor
BW: hep B reactivation
SJS
Imatinib (Gleevec)
TKI oral
For Philadelphia chromosone (BCR-ABL) in CML
QTc prolongation
myleosuppression
fluid retention
Common side effects of TKI “nib”
Hypothyroidism
QTc
Rash === indicative of better response
Hepatici toxicity
Diarrhea
hand-foot syndrome
