Antineoplastic Agents

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Anonymous
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8488
Filename:
Antineoplastic Agents
Updated:
2010-02-28 16:30:46
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Antineoplastic
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Antineoplastic Agents
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  1. Important side effect for Busulfan and Chlorambucil
    • Bone marrow suppression
    • Must have 10-15 day breaks between cycles
  2. What is important about cyclophosphamide and ifosfamide?
    • Both cause hemorrhagic cystitis
    • Ifosfamide must be given with mesna and is not cross resistant with cyclophosphamide
  3. Important info for mechlorethamine
    • given iv push
    • vesicant
  4. General toxicity for all alkylating agents
    bone marrow suppression
  5. 2 important charateristics of carboplatin
    • Must use Calvert's formula: Dose = AUC x (GFR + 25)
    • No N/V
  6. 2 important things abotu Cisplatin
    • always give with about 2 L of fluids
    • N/V
  7. Oxaliplatin?
    dont drink ice before hand
  8. General toxicity of the platinum analogues
    minimal bone marrow suppression -- can be added to drugs that cause suppression
  9. _________ is given orally as a one time dose. Always check its dose.
    General toxicity of ___________ is delayed bone marrown suppression (21-28 days)
    • Lomustine
    • Nitrosoureas (carmustine, lomustine, streptozocin)
  10. Procarbazine interacts with _________ and has a dose limiting toxicity of _____________________
    • MAOIs
    • bone marrow suppression
  11. What are the dose ranges of methotrexate and are are levels checked and folinic acid given?
    • <100mg/m2 = no folinic acid, no level check
    • 100-500 = give folinic acid, no level check
    • > 500 mg/m2 = give folinic acid and level check
  12. When and with what levels of methotrexate is leucovorin given?
    • Started 6-14 hours post MTX dose and given for about 48 hours
    • Leucovorin is given until MTX levels are below 1 x 10 -7 M
  13. What is the DLT of the purine antagonists?
    • (mercaptopurine, thioguanine, cladribine, fludarabine, pentostatin, ect)
    • Bone marrow suppression
  14. What is given with 5-FU and why?
    folinic acid: it causes tigher binding for increased cell kill
  15. Important side effect of 5_FU
    mucostitis and diarrhea
  16. 3 antimetabolites given intrathecally
    MTX, cytarabine, thiotepa
  17. Precautions with intrathecal admin
    • dont use more than 2-3 cc
    • must use normal saline with no preservatives, lactated ringers, elliots b solution
  18. DLT of topoisomerase inhibitors (irinotecan and topotecan)
    • irinotecan: BMS and diarrhea
    • topotecan: BMS
  19. Side effects of the anthracyclins (dauno-, doxorubicin)
    • doxorubicin: hand foot syndrom
    • general: BMS, Cardiac, vesicants, N/V
  20. Important notes for etoposide
    • Hypotension with fast infusion: check BP q 15 minutes, may need to give fluids or epi
    • Prepare properly to avoid precipitation
    • Available PO or IV
  21. Vincristine
    • NO BMS
    • Causes constipation and DLT peripheral neuropathy
  22. Vinblastine
    • BMS
    • No constipation
  23. Doses for IT administration of:

    MTX
    Cytarabine
    Thiotepa
    • MTX: 12-20 mg
    • Cytarabine: 50-100mg
    • Thiotepa: 10-15mg
  24. 3 points for paclitaxel
    • DLT: neurotoxicity
    • give with dexamethasone for 24 hours
    • premed for hypersensitivity rxns
  25. 2 points for docetaxel
    • give dexamethasone for 3 days
    • premedicate for fluid retention and peripheral edema
  26. Common toxicites of taxanes
    • bone marrow suppression
    • mucositis
    • alopecia
    • N/V
  27. Ixabepilone
    • premedicate with H1/H2 anatgonist to avoid hypersensitivity reaction
    • toxicities: neutopenia, fatigue, hand food syndrome, diarrhea, myalgia, stomatitis, sensory neuropathy
  28. Bleomycin - antitumor antibiotics -- 3 points
    • Allergic reaction
    • pulmonary fibrosis
    • No BMS
  29. L-asparaginase, pegasparinginase, asparaginase
    • Little BMS
    • Allergic rxn
  30. Hydroxyurea
    broad area of use -- can administer until we get all results back
  31. LHRH agonists
    • Goserelin, Leuprolide, Triptorelin, Abarelix
    • Bone pain
    • tumor flare
    • hot flashes
  32. Estrogen Receptor modulators
    • N/V
    • bone pain and tumor flare
    • thrombotic events
  33. Aromatse Inhibitors
    • n/v
    • hot flashes
    • tumor flare
    • throboembolism
  34. Estrumustine
    • nitrogen mustard and hormonal
    • n/v
    • diarrhea
    • gynecomastia
    • thromboembolism
  35. other hormonal agents
    • corticosteroids
    • progestins - megestrol
  36. Signal transduction inhibitors
    imatinib, gefitinib, erlotinib, lapatinib

    all have no bone marrow suppression
  37. toxicity fo gefitinib
    • rash
    • acne
    • dry skin
    • fetal harm
  38. imatinib
    • tx for chronic myeloid leukemia
    • fluid retention
  39. erlotinib
    • non-small cell lung cancer
    • interacts with 3a4
  40. lapatinib
    • palmar-plantar erythema -- first sign of toxicity
    • decreases LVEF
    • 3a4 substrate
    • PGP inhibitor
  41. Premedication and infusion recomendations for monoclonal antibodies
    • All are premedicated with APAP + benedryl with or without dexamethasone
    • Start infusion at a slow rate and increase slowly
  42. Traztuzumab
    anitbody against HER/2 on some breast cancer cells
  43. cetuximab
    • binds to egfr
    • severe acne form rash (12% grade 3 or 4)
    • severe infusion reactions
  44. chemoprotectants
    • dexrazoxane
    • amifostine
    • mesna

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