Treatment of cytotoxic induced SE

Question 1

What can be given to speed recovery from MTX-induced mucositis or myelosuppression?

Answer 1

‘folinic acid rescue’ with folinic acid (given as calcium folinate)

it counteracts the folate-antagonist action of MTX and thus speeds recovery from the above

Question 2

Folinic acid, given as ………. is used to counteract the folate-antagonist action of methotrexate and thus speed recovery from methotrexate-induced mucositis or myelosuppression (‘folinic acid rescue’).

Answer 2

given as calcium folinate

Question 3

What is used in the management of MTX overdose

Answer 3

Folinic acid together with other measures to maintain fluid and electrolyte balance, and to manage possible renal failure.

Question 4

Does folinic acid counteract the abx activity of folate antagonists e.g. trimethoprim

Answer 4

No

Question 5

Using folinic acid + FU together in metastatic colorectal cancer vs using FU alone - what is the advantage?

Answer 5

When folinic acid and fluorouracil are used together in metastatic colorectal cancer the response-rate improves compared to that with fluorouracil alone.

Question 6

When is the calcium salt of levofolinic acid (calcium levofolinate) used instead of calcium folinate

Answer 6

also used for rescue therapy following methotrexate administration, for cases of methotrexate overdose, and for use with fluorouracil for colorectal cancer

Question 7

The dose of calcium levofolinate is generally ….. that of calcium folinate

Answer 7

half

Question 8

What is a common manifestation of urothelial toxicity

Answer 8

Haemorrhagic cystitis

Question 9

Haemorrhagic cystitis is a common manifestation of urothelial toxicity which occurs the following 3

Answer 9

oxazaphosphorines, cyclophosphamide and ifosfamide

Question 10

Haemorrhagic cystitis/urothelial toxicity is caused by which metabolite?

Answer 10

acrolein

Question 11

Haemorrhagic cystitis/urothelial toxicity is caused by the metbaolite acrolein. The following drug reacts specifically with this metabolite in the urinary tract, preventing toxicity

Answer 11

Mesna

Question 12

Mesna is routinely used (preferably PO) in patients receiving the following 3 scenarios

mesna is a drug that reacts with the metabolite acrolein which causes urothelial toxicity*

Answer 12

ifosfamide, and in patients receiving cyclophosphamide by the IV route at a high dose (e.g. more than 2 g) or in those who experienced urothelial toxicity when given cyclophosphamide previously.

Question 13

Why should simultaneous use of radiotherapy be avoided with many cytotoxic abx e.g. anthracyclines?

Answer 13

Many cytotoxic antibiotics act as radiomimetics and simultaneous use of radiotherapy should be avoided because it may markedly increased toxicity

Question 14

Anthracycline abx examples (4)

Answer 14

Daunorubicin, doxorubicin hydrochloride, epirubicin hydrochloride and idarubicin hydrochloride

Question 15

1x anthracycline derivative example

Answer 15

Mitoxantrone i

Question 16

MOA of antimetabolites

Answer 16

Antimetabolites are incorporated into new nuclear material or combine irreversibly with cellular enzymes, preventing normal cellular division.

Question 17

How do alkylating drugs work

Answer 17

They act by damaging DNA, thus interfering with cell replication.

Question 18

not