Vinca Alkaloids

Question 1

What drugs are in the Vinca Alkaloids class?

Answer 1

Drugs in this class are:
- Vincristine
- Vinorelbine
- Vinblastine

Question 2

What is the brand name of Vincristine?

Answer 2

The brand name of this generic drug is:
- Oncovin

Question 3

What is the brand name of Vinorelbine?

Answer 3

The brand name of this generic drug is:
- Navelbine

Question 4

What is the brand name of Vinblastine?

Answer 4

The brand name of this generic drug is:
- Velban

Question 5

What is the generic of name of Oncovin?

Answer 5

The generic name of this brand name drug is:
- Vincristine

Question 6

What is the generic of name of Navelbine?

Answer 6

The generic name of this brand name drug is:
- Vinorelbine

Question 7

What is the generic of name of Velban?

Answer 7

The generic name of this brand name drug is:
- Vinblastine

Question 8

What are the main indications for use of Vincristine?

Answer 8

The main indications of this drug are:
- Acute Lymphoblastic Leukemia
- Non-Hodgkin Lymphoma
- Rhabdomyosarcoma
- Central nervous system tumors
- Chronic lymphocytic leukemia/small lymphocytic leukemia
- Ewing sarcoma
- Hodgkin Lymphoma

Question 9

What are the main indications for use of Vinorelbine?

Answer 9

The main indications of this drug are:
- Hodgkin Lymphoma
- Soft Tissue Sarcoma
- Non-small cell Lung cancer
- Small-cell Lung cancer
- Breast Cancer
- Cervical Cancer
- Ovarian cancer
- Mesothelioma

Question 10

What are the main indications for use of Vinblastine?

Answer 10

The main indications of this drug are:
- Hodgkin Lymphoma
- Soft Tissue Sarcoma
- Testicular cancer
- Kaposi Sarcoma
- Bladder cancer
- Non-small cell Lung cancer

Question 11

What is the class and MOA of Vincristine?

Answer 11

This drug in the following class:
- Vinca Alkaloids

This drug’s MOA is as follows:
- Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Question 12

What is the class and MOA of Vinorelbine?

Answer 12

This drug in the following class:
- Vinca Alkaloids

This drug’s MOA is as follows:
- Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Question 13

What is the class and MOA of Vinblastine?

Answer 13

This drug in the following class:
- Vinca Alkaloids

This drug’s MOA is as follows:
- Binds to tubulin and inhibits microtubule formation stopping cell growth by disrupting the formation of the mitotic spindle. These drugs specifically target the M and S phases of the cell cycle.

Question 14

What is the emetic potential of Vincristine?

Answer 14

The emetic potential of this drug is:
- Minimal

Question 15

What is the emetic potential of Vinorelbine?

Answer 15

The emetic potential of this drug is:
- Minimal

Question 16

What is the emetic potential of Vinblastine?

Answer 16

The emetic potential of this drug is:
- Minimal

Question 17

Describe the emetic potential of the Vinca Alkaloids class.

Answer 17

The emetic potential of this drug class is:
- All are minimal

Question 18

Describe the extravasation risk and management strategies for the Vinca Alkaloids class.

Answer 18

The extravasation risk and management strategies for this drug class are as follows:
- All are vesicants
- If extravasation occurs, stop infusion immediately and gently aspirate extravasated solution (do not flush the line).
- Initiate hyaluronidase antidote and apply warm dry compresses for 20 minutes four times a day for 1-2 days.

Question 19

Describe the general techniques for administration of the Vinca Alkaloids class.

Answer 19

The general techniques for administration of this drug class is described as follows:
- These agents are for IV use only and are FATAL if administered intrathecally
- The Institute for Safe Mediation Practices (ISMP) recommends dispensing vinca alkaloids in a mini-bag (not a syringe) to prevent inadvertent intrathecal administration.
- Vincristine is commonly used in the treatment of adult and pediatric ALL which also includes frequent administration of intrathecal chemotherapy. ISMP has reported 135 fatalities worldwide due to inadvertent intrathecal administration of vincristine.
all of which were dispensed in a syringe.

Question 20

Describe the metabolism of the Vinca Alkaloids class.

Answer 20

The metabolism of this drug is as follows:
- Extensively hepatic metabolism, mostly via CYP3A4

Question 21

What are the notable ADRs of Vincristine?

Answer 21

The notable ADRs of this drug are:
- When used as a single agent, this drug does not typically cause myelosuppression
- Neuropathy (peripheral and autonomic [constipation])

Question 22

What are the notable ADRs of Vinorelbine?

Answer 22

The notable ADRs of this drug are:
- This drug can typically cause cytopenias
- Neuropathy (peripheral and autonomic [constipation])

Question 23

What are the notable ADRs of Vinblastine?

Answer 23

The notable ADRs of this drug are:
- This drug can typically cause cytopenias
- Neuropathy (peripheral and autonomic [constipation])

Question 24

What are the notable/common ADRs of the Vinca Alkaloids class?

Answer 24

The notable/common ADRs of this drug class are:
- When used as a single agent, Vincristine does not typically cause myelosuppression. Vinorelbine and vinblastine however can both cause cytopenias.
- Neuropathy (most common dose limiting side effect of this drug class)

Question 25

Describe the strategy and rationale for management of Neuropathy caused by the Vinca Alkaloids.

Answer 25

The strategy and rationale for management of this condition caused by this drug class are:
- This is the most common dose limiting side effect of this drug class.
- This can not only affect the peripheral nerves (leading to numbness and tingling in the extremities) but it can also affect the autonomic nerves leading to constipation.
- Patients should be on an aggressive bowel regimen while receiving drugs in this class and be evaluated for neuropathy at every visit.
- The presence of peripheral neuropathy may require a dose reduction or omission of the vinca alkaloid.

Question 26

Describe the strategy and rationale for management of hepatic dysfunction when using Vinca Alkaloids.

Answer 26

The strategy and rationale for management of this condition caused by this drug class are:
- All of the vinca alkaloids are hepatically metabolized and require hepatic dose adjustments.
- The only exception is based on clinical judgement if the liver dysfunction is known to be due to the disease.

Question 27

Describe the history of the Vinca Alkaloids.

Answer 27

The history of this drug class is as follows:
- They are derived from the Madagascar periwinkle plant, Vinca rosea.
- This plant was said to be useful in the treatment of diabetes. Attempts to verify the antidiabetic properties of the plants extracts in the 1950’s led instead to the discovery and isolation of vinblastine.
- Scientists first observed vinblastine’s anticancer properties in a lab in 1962 with the observation of regression of lymphocytic leukemia in rats.