Specific Chemo Agents Flashcards
Cyclophosphamide Pharmacology/Metabolism
- Alkylating agent
- Converted to aldophosphoramide and then its active metabolite in the liver (acrolein)
-Acrolein = Bladder toxic
Cyclophosphamide MOA and indications
-MOA: Prevents cell division by cross linking DNA strands
- Cancer
- Non-cancer: Nephrotic syndrome, GPA, SLE
Cyclophosphamide Monitoring
- CBC q 2 wks
- BMP q 2 wks
- LFTs q month
- UA q month
***Hematuria needs to be evaluated very aggressively
Cyclophosphamide ADRs
- May cause sterility
- Severe, potentially fatal hemorrhagic cystitis*
Cisplatin MOA/Indications
- Alkylating agent
- Inhibits DNA synthesis by formation of DNA cross-links
Indications
-Cancer
Cisplatin Drug Monitoring
- BMP –> Renal function***
- Audiography** (baseline and at every subsequent dose)
- LFTs
- CBC
- UA
Cisplatin ADRs
- Nephrotoxicity***
- Ototoxicity***: Tinnitus and SNHL
“Acts like an aminoglycoside in terms of ADRs”
Methotrexate MOA and Indications
- Antimetabolite agent
- MOA: Folate antimetabolite that inhibits DNA synthesis
(look at slide for full paragraph MOA lol)
Indications
- Cancer
- Non-cancer: Autoimmune diseases like RA
Methotrexate unique interactions
- PPIs decrease renal clearance of MTX
- Hold PPIs a couple days before & after high-dose MTX
Methotrexate ADRs
- Stomatitis** (oral mucositis)
- May be slowed with folate supplementation
Methotrexate Special ADRs
- Pulmonary Toxicity**
- Hepatotoxicity**
- Lymphoproliferative cancer
- Nephrotoxicity
- May present with acute or chronic pulmonary symptoms
- Should get CXR prior to initiating MTX treatment
Managing Toxic MTX Levels
- Leucovorin with aggressive IV hydration & alkalization of urine
- Administer glucarpidase for toxic MTX patients with delayed clearance
5-Fluorouracil (5-FU) MOA and Indications
- Antimetabolite
- MOA: Pyrimidine antimetabolite that interferes with DNA synthesis by blocking methylation of deoxyuridylic acid
Indications
- Cancer
- Topically for actinic keratosis or BCC
5-FU ADRs
- Stomatitis/mucositis*
- Enterocolitis
- Hyperpigmentation
Antidote to 5-FU
- Uridine triacetate
- Approved for emergency treatment of a 5-FU OD or severe toxicity
$$$$
Cytarabine MOA and indications
- Antimetabolite
- Inhibition of DNA synthesis
- Incorporates cytosine triphosphate incorporated into DNA
Indications
-Cancer
Cytarabine drug monitoring
- CBC
- CMP
- Serum uric acid
Cytarabine ADRs
- Cytarabine syndrome**: fever, myalgia, bone pain, chest pain, maculopapular rash, conjunctivitis, malaise
- Cerebellar toxicity
Doxorubicin MOA and indications
- Anthracycline ABX
- MOA: Inhibition of DNA/RNA synthesis by intercalation between DNA base pairs by inhibiting topoisomerase
- Powerful iron chelator
Indications
-Cancer
Doxorubicin Monitoring
- CBC
- CMP
- Baseline cardiac evaluation (ECG, MUGA, +/- ECHO***)
Doxorubicin special ADRs
- Cardiotoxicity (HF) ***
- Radiation recall**: Noticed in patients who had prior XRT –> Warmth, erythema, dermatitis
Bleomycin MOA and indications
- Antibiotic
- MOA: Inhibits synthesis of DNA by binding to DNA leading to single and double-strand breaks
Indications: Cancer
Bleomycin Monitoring
- PFTs**
- CMP
- CBC
Bleomycin Special ADRs
- Striae*
- Hyperkeratosis, vesiculation, skin peeling
- Acute or chronic interstitial pneumonitis > pulmonary fibrosis ***
- Febrile rxn
- Myelosuppression
Vinblastine MOA and indications
-Vinca alkaloid
MOA: Binds tubulin & inhibits microtubule formation (disrupting the formation of the mitotic spindle***)
Indications
-Cancer
Vinblastine Monitoring
- CBC
- CMP
- Serum uric acid
Vinblastine ADRs
- SIADH
- Hyperuricemia
- Myelosuppression
Paclitaxel MOA and indications
- Plant alkaloid
- Promotes microtubule assembly by enhancing action of tubulin dimers, with the end result of inhibition of cell replication
Indications
-Cancer
Paclitaxel Monitoring
- CBC
- CMP
- Monitor for hypersensitivity rxn* (monitor VS frequently)
- Continuous cardiac monitoring
Paclitaxel ADRs
- Myelosuppression
- Peripheral neuropathy*
- Arthralgia/myalgia
- Hypersensitivity rxn*
- Rhythm abnormalities
