Cytotoxic Agents Drug-by-Drug

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Author:
Anonymous
ID:
7809
Filename:
Cytotoxic Agents Drug-by-Drug
Updated:
2010-02-23 01:24:44
Tags:
Nursing pharmacology cytotoxic agents
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Description:
Drug-by-drug quick MOST IMPORTANT points for each agent
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  1. Cyclophosphamide (nitr must alk agent)
    • Take with food
    • Not a vesicant
  2. Mechlorethamine (nitr must alk agent)
    = Vesicant
  3. Bendamustine (nitr must alk agent)
    Infusion rxn
  4. Estramustine (nitr must alk agent)
    • THROMBOSIS
    • Gyneocomastia
    • Breast tenderness
    • Edema
    • Admin: 1H before or 2H after meal
    • Avoid taking w/ milk or other ca-rich foods or drugs => affects absorption
  5. Chlorambucil (nitr must alk agent)
    • Pulmonary infiltrates/fibrosis
    • Hepatotoxicity
  6. Nitrosureas, generally...
    Cross the BBB!
  7. Carmustine (nitros alk agent)
    • Nadir: 4-6 wks after treatment - do CBC here!
    • Injury: kidney, liver, lungs
  8. Lomustine (nitros alk agent)
    • Delayed BM suppression
    • Potential for pulmonary fibrosis
    • Renal/hepatic toxicity
  9. Streptozocin (nitros alk agent)
    • Unique MoA: glucose moiety => for metastatic islet cell tumors
    • Hypo/Hyperglycemia
    • Minimal BM suppression
    • D-L tox = kidney damage
  10. Busulfan (other alk agent)
    PULMONARY TOXICITY
  11. Temozolomide (other alk agent)
    • Empty stomach
    • Don't crush, open, chew, inhale!
  12. Cisplatin (plat comp)
    • Kidney damage: => extensive hydration + diuretic therap + amifostine
    • Ototoxicity
  13. Carboplatin (plat comp)
    Not special. :(
  14. Oxaliplatin (plat comp)
    Peripheral sensory neuropathy: avoid cold stuff
  15. Methotrexate (FA analog antimetab)
    • Inhibs dihydrofolate reductase: (the enz that converts dihydrofolic acid => tetrahydrofolic acid) - req for activation folic acid => suppress biosynthesis of thymidylate => unable to make DNA => cell kill!
    • BM suppression
    • Oral & GI ulceration (can => DEATH)
    • Pulmonary infiltrates & fibrosis
    • **GIVE leucovorin!!!: rescue marrow and GI mucosa cells
  16. Pemetrexed (FA analog antimetab)
    Give folic acid and B12 prophylaxis: to decr BM and GI tox
  17. Cytarabine (Pyrim analog antimetab)
    • Liposomal form: arachnoiditis
    • Pulmonary edema
    • Central & peripheral neurotox
  18. Fluorouracil, 5-FU (Pyrim analog antimetab)
    Hand & Foot Syndrome
  19. Capecitabine (Pyrim analog antimetab)
    HFS
  20. Mercaptopurine (Pur analog antimetab)
    • Hepatic metab catalyzed by xanthine oxidase: if pt has gout, CANNOT give allopurino or febuxostat (xanth ox inhibs)
    • Heptatic dysfunction: jaundice
  21. Thioguanine (Pur analog antimetab)
    • Similar activity to mercaptopurine
    • Can give w/ allopurinol or febuxostat!
  22. Pentostatin (Pur analog antimetab)
    DON'T prescribe w/ fludarabine! => pulmonary toxicity!
  23. Fludarabine (Pur analog antimetab)
    • DON'T prescribe w/ pentostatin! => pulnoary toxicity!
    • Autoimmune hemolytic anemia
    • Severe neurologic fx
  24. Cladribine (Pur analog antimetab)
    Acute and delayed-onset nephrotoxicity!! (w/ high dose)
  25. Anthracyclines (lumped 2geth. Antitumor antibios)
    • Potential for cardiotoxicity
    • VESICANTS
    • Red sweat urine, except mitoxantrone (blue-green)
    • **Dexrazoxane**: helps prevent extravasation; also admin IV to prevent doxorubicin-assoc cardiomyopathy in pts treated for breast cancer
  26. Epirubicin (anthr antitum antibio)
    Irreversible amenorrhea & premature menopause
  27. Bleomycin (non-anthra antitum antibio)
    • LUNG injury: pneumonitis => severe pulm fibrosis and death
    • Do pulmonary func test @ baseline & after
    • VERY little BM suppression
  28. Mitomycin (non-anthra antitum antibio)
    • Delayed BM suppress (3-4 wks)
    • Irreversible renal failure
    • VESICANT
  29. Vincristine (vinca alk mit inhib)
    • BM sparing!
    • Peripheral neuropathy
    • VESICANT
  30. Vinblastine (vinca alk mit inhib)
    • BM suppression
    • VESICANT
  31. Vinorelbine (vinca alk mit inhib)
    • Interstitial pulm changes
    • Adult resp distress syndrome
    • 50% of pts get neutropenia
  32. Paclitaxel (taxoid mit inhib)
    • 1 w/ solvent, 1 w/o: pt can react to one w/ => give glucocorticoid + antihistamine
    • Cardiotox: brady, 2nd/3rd deg HB, FATAL MI
  33. Docetaxel (taxoid mit inhib)
    • Hypersens/infus rxn: pretreat w/ antihist & glucocort
    • Signif neutropenia: withold if <1500
    • Liver disease? ==> incr risk SEPSIS & FLUID RETENTION (use glucocorticoids)
  34. Topotecan (top I inhib)
    Withold if neutrophils <1500
  35. Irinotecan (top I inhib)
    • DIARRHEA: depends; fluid replace,
    • **Early: ATROPINE
    • **Late: LOPERAMIDE
    • Withold if neutrophils <500
  36. Etoposide (top II inhib)
    Infusion rxn: hypoTN w/ rapid infusion
  37. Teniposide (top II inhib)
    SEVERE hypersens rxn!!: suppress w/ epinephrine

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