Home > Preview
The flashcards below were created by user
on FreezingBlue Flashcards.
Two antimetabolites cause myeolosuppression that can be staved off with the administration of other agents. Which antimetabolites? What other agents? When admin?
- 1. Methotrexate: give leucovorin AFTER mtx to rescue bone marrow and GI mucosa cells
- 2. Pemetrexed: give folic acid & B12 as prophylaxis. Add'l, give steroid to min rash.
Which cytotoxic drugs are vesicants?
- Mechlorethamine (maybe bendamustine, its deriv?): nitr must alk agent
- ALL anthracyc antitum antibios: doxorubicin, daunorubicin, epirubicin, idarubicin, mitoxantrone
- Dactinomycin, mitomycin: some nonanthr antitum antibios
- ALL vinca alk mitotic inhibs: vincristine, vinblastine, vinorelbine
Which cytotoxic drugs are explicitly NON-vesicants?
- Cyclophosphamide, chloreambucil ("safe!"), melphalan: some nitr must alk agents
- Carmustine: nitrosurea alk agent
- Bleomycin: nonanthr antitumor antibio
What drug is the safest nitrogen mustard (alk agent)?
Chlorambucil [leukeran]: a nitr must alk agent
Two purine analog antimetabolites are very similar. What are they, and how do they differ?
- Mercaptopurine and Thioguanine
- Mercaptopurine: extensive hepatic metab by xanthine oxidase, SO decr dose mercapto if taking xanthine oxidase inhibs (allopurinol, fubuxostat). May cause HEPATIC DYSFUNCTION, as (cholestatic jaundice) in 30% pts.
- Thioguanine: DON'T need to decr dose if taking xanth ox inhibs!
Special considerations with Fludarabine [Fludara]?
- = purine analog antimetab
- DON'T give with pentostatin!!
- May cause life-threat hemolytic anemia & SEVERE NEUROLOGIC FX: blind, coma, DEATH
What to worry about with Ifosfamide [Ifex]?
- A nitr must alk agent
- Can cause HEMORRHAGIC CYSTITIS: min w/ concurrent Mesna [Mesnex] therap + extensive hydration.
- Watch out for DEHYDRATION
- DO urinalysis before Qdose: if microscopic hematuria, must postpone dose.
What can happen with a high dose of Cladribine [Leustatin]?
- = purine analog antimetab
- Acute & delayed onset nephrotoxicity
Special considerations with anthracycline antitumor antibiotics? What can be done?
- ALL have potential for acute or delayed cardiotoxicity - Qagent has lifetime cum max
- Can admin IV Dexrazoxane: to decr extravasation rxn; prophylaxis for doxorubicin-assoc cardiomyopathy in pts being treated for breast cancer
What makes Streptozocin [Zanosar] unique?
- A nitrosurea alk agent
- Unique MoA: contains glucose moiety that => selective uptake by pancreatic islet cells, thus
- Unique Use: for metastatic islet cell tumors
- Unique D-L tox: renal damage - assess pre-therap & monitor
- MINIMAL BONE MARROW SUPPRESSION: woot!
How is estramustin [emcyt] different?
- A nit must alk agent
- Chem struct similar to estrogen
- PALLIATIVE (not curative) for metastatic or progressive carcinoma of the prostate
- Can cause thrombosis
There are two purine analog antimetabs that CANNOT be combined. What are they and why not?
- Pentostatin and Fludarabine.
- This combo is CONTRAINDICATED.
- Combo => incr risk of fatal pulmonary toxicity.
There is something special about Cladribine. What is it?
- = a purine analog antimetab.
- Has a unique MoA: inhibits both synthesis & REPAIR of DNA, thus works against both active AND RESTING cells
There are 3 agents that cause very little myelosuppression, making them good candidates for combo therapy. What are they?
- Bleomycin [Blenoxane]: a non-anthracycline antitumor antibiotic
- Streptozocin [Zanosar]: a nitrosurea alk agent
- Vincristine: "bone marrow sparing," a vinca alkaloid mitotic inhibitor
What class of cytotoxic drugs is good for CNS cancers? Why?
Nitrosurea alk agents: b/c can readily cross the BBB
Anthracycline antitumor antibiotics have a unique AE. What is it, and how dose it vary among these agents?
- Harmless coloring of sweat & urine
- Red sweat & urine: doxorubicin, daunorubicin, epirubicin, idarubicin
- Blue-green sweat & urine: mitoxantrone
Epirubicin [Ellence] has a unique AE. What is it?
- = anthracycline antitumor antibiotic
- Irreversible amenorrhea and premature menopause
Which agents are explicitly cell phase SPECIFIC?
- Mitotic inhibitors: b/c act during mitosis
- Antimetabolites: during active phases
- Bleomycin: Nonanthracycline antitum antibios
- Fluorouracil (5-FU): pyrimidine analog antimetab
Which agents are expilicitly cell-cycle NON-specific?
- Alkylating agents
- Platinum Compounds
- Anthracycline antitumor antibiotics
Some agents have been shown to cause secondary cancers. What agents and which cancers?
- Melphalan [Alkeran]: (a nitr must alk agent) leukemia, may be mutagenic
- Teniposide [Vumon]: Type II topoisomerase inhibitors
What to worry about with Cytarabine [Cytosar-U]?
- = a pyrimidine analog antimetab
- High dose: => pulmonary edema; central/periph neurotox
- Liposomal form: can cause chemical arachnoiditis (N/V, HA, fever) - fatal if untreated
What unique AE to worry about with Mitomycin [Mutamycin]?
Hemolytic uremic syndrome: = microangiopathic hemolytic anemia + thrombocytopenia + IRREVERSIBLE renal failure
For which cytotoxic drugs is renal damage the dose-limiting toxicity?
Cisplatin [Platinol AQ]: also myelosuppression, and severe N/V (platinum compounds)
For which cytotoxic drugs is peripheral neuropathy the dose-limiting toxicity?
- Oxaliplatin: numb/ting fingers, toes, around mouth, throat. Warn to cover up, not to touch cold/chilled things.
- Vincristine: by disrupting neurotubules req for axonal transport
- Paclitaxel [Taxol, Abraxane]: with repeated dosing, also BM suppress
For which cytotoxic drugs is oral & GI ulceration or mucositis the dose-limiting toxicity?
- Fluorouracil, 5-FU: ulceration; also myelosuppression (mostly neutropenia), (pyrimidine analog antimetab); also D-L tox can be palmar-plantar (HFS)
- Dactinomycin: mucositis; & myelosuppression (nonanthr antitum antibio)
For which cytotoxic drugs is CNS suppression the dose-limiting toxicity?
Penostatin [Nipent]: purine analog antimetab
For which agents whose dose-limiting toxicity is myelosupression is the time of nadir unusual?
- Carmustine: delayed BM suppress, nadir 4-6 wks after treatment (a nitrosurea alk agent)
- Mitomycin [Mutamycin]: nadirs for neutroP and thrombocytoP 3-4 wks into treatment
For which cytotoxic drugs are pulmonary problems the dose-limiting toxicities?
- Busulfan: pulmonary infiltrates & fibrosis (also myelosuppression)
- Bleomycin [Blenoxane}: lung injury (10% pts) = pulmonitis => pulm fibrosis => death
Drug-resistance is common w/ this class.
Special considerations with Temozolomide [Temodar]?
- PO admin: take on empty stomach; DO NOT crush/chew
- Can cause convulsions
What to worry about with Vinorelbine [Navelbine]?
- Powerful vesicant
- Interstitial pulmonary changes and adult respiratory distress syndrome: w/i 1wk starting treatment; most cases fatal; watch for new onset dyspnea, cough, hypoxia, other s/s lung injury
The only TWO taxoid mitotic inhibitors each have unique and serious AEs. What are the agents and what AEs to watch for?
- Paclitaxel [Taxol, Abraxane]: cardiac - bradycardia, 2nd & 3rd degree heart block, fatal MI; hypersens rxns
- Docetaxel [Taxotere]: Incr risk of DEATH from sepsis w/ liver disease (monitor LFTs); fluid retention if liver dysfunction - edema, cardiac tamponade, dyspnea at rest, pleural effusion, ascites (can decr fluid retention w/ glucocorticoids). Monitor LFTs!!
With which agents REALLY need to worry about neutrophil count and withold if neutrophils fall below certain #?
- Docetaxel [Taxotere]: withold if <1500 (Taxoid mit inhib)
- Topotecan [Hycamtin]: withold if <1500 (Type I top inhib)
- Irinotecan [Camptosar]: withold if <500 or <1500? look up. (Type I top inhib)
What DI to worry about with Capecitabine [Xeloda]?
- = oral prodrug of 5-FU
- Can enhance fx of warfarin - monitor INR, perhaps decr warf