Toxicities

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Anonymous
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8499
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Toxicities
Updated:
2010-02-28 18:06:37
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Toxicities
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Toxicities of Antineoplastics
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  1. 3 common causes of mucositis
    • 5-FU
    • MTX
    • Stem cell transplant conditioning
  2. Given for hematopoietic stem cell tranplants to reduce oral mucositis

    Do not give 24 hours before or after chemo
    Palifermin
  3. Typicall caused by readiation therapy for head and neck cancers or from anit cholinergics
    • xerostima
    • (dry mouth)
  4. tx for xerostima
    • oral rinses
    • saliva subs
    • pilocarpine -- stimulates slivary secretion if residual salivar function
    • amifostine: give prior to radiation (slow IVP over 3 minutes, 15-30 minutes pre radiation) as a protecive agent
  5. Causes of constipation
    • Radiation
    • Neurologic Damage
    • Vinca alkaloids
    • Thalidomide
    • Decreased Mobility
    • other drugs
  6. Causes of diarrhea (6)
    • 1. 5 FU with or without leucovorin
    • 2. Irinotecan
    • 3. MTX
    • 4. Cytarabine
    • 5. GVHD -- diarrhea may be the first sign
    • 6. Radiation therapy
  7. 4 basic tx methods for diarrhea
    • Kapectate or metamucil
    • Opiod agents
    • Somatostatin analogue -- octreotide
    • Immunosuppresion for GVHD
  8. Dose for loperamide
    2 mg after each lose stool or 4 mg load then 2 mg q4 (Max 16mg/day)
  9. dose for diphenoxylate
    2.5 mg/atropine .025: 1-2 tablets q6 or after each lose stool
  10. tx for irinotecan induced diarrhea
    acute: facial flushing, abd cramps, nasal congestion, or diaphoresis -- IV atropine 0.5 mg

    delayed onset: loperamide 4 mg then 2 mg q2 hour until symptom free for 12 hours (4mg q4 hours)
  11. Thrombocytopenic precautions
    • nothing per rectum
    • no IM injections
    • no platelet inhibiting agents
  12. Platelet transfusion guidelines for patients with cancer
    • for leukemia: if less than 10,000 platelets/mcl
    • for solid tumors: if less than 20,000
    • others: < 10,000
  13. ___________is approved for prevention of severe thrombocytopenia in patients undergoing chemo for non myeloid malignancies. May cause ______ ______, peripheral _________, and ______ ___ _______
    • Oprelvekin
    • fluid retention
    • peripheral edema
    • SOB
  14. 4 groups of potential vesicants
    • Daunorubicin, doxorubicin, idarubicin
    • Mechlorethamine
    • Plicamycin
    • Vinblastine, vincristine
  15. Antidote for vincristine, vinblastine, vinorelbine, etoposide, and teniposide
    • hyalurinidase
    • warm compress
  16. Antidote for mechlorethamine
    • DMSO (dimethylsulfoxide)
    • Sodium thiosulfate
  17. Antidote for doxorubicin, daunorubicin, and idarubicin
    • Topical DMSO
    • Cold compress
  18. Antidote for Mitomycin-C
    • DMSO
    • Cold Compress
  19. Cisplatin
    thiosulfate
  20. Causes of Hand foot syndrome, toxic erythema, palmar plantar erythrodysesthesia ro toxic erythema of palms and soles
    • fluorouracil -- prolonged infusions
    • anthracyclins -- more common with liposomal doxarubicin
    • capcitabine -- 60%
    • sorafenib and sunitinib
  21. tx of hand foot syndrom
    • see oncologist
    • decrease dose
  22. Tx of acneform rash from EGFR inhibitors
    • thick alcohol free emollient cream -- lubriderm
    • sun protection all the time

    the rash is actually a sign of response
  23. Tx of rash
    Mild: none or topical hydrocortisone or clindamycin

    Moderate: hydrocortisone or clindamycin or pimecrolimus PLUS doxycycline or minocycline

    Severe: moderate tx PLUS MDP
  24. What should you never give radiation with?
    • MTX
    • Doxorubicin or any anthracycline
    • Bleomycin
  25. What can you give radiation with?
    5 FU
  26. May cause radiation recall rxns
    XRT in the past then capecitebine + taxol
  27. Causes phototoxic rxns
    MTX + 5FU + EGFR
  28. Pretx of asparaginase
    • tylenol and benadryl
    • can happen after 24 hours
    • if symptoms go straight to the ER
  29. tx of bleomycin hypersensitivity
    • rare
    • pretx with tylenol and benadryl
    • take temp q4 hours and call if >101
  30. tx of anthracycline hypersensitivity
    • mostly just local rxns
    • verify if allergic or extravasation
  31. tx of monoclonal antibody hypersensitivity
    • pretx with benadryl and tylenol
    • never infuse less than 30 minutes
    • if reaction: stop infusion, continue with pretx and slower infusion
  32. tx of hypersensitivity with docetaxel
    • pretx with tylenol, dexamethasone, benadryl
    • continue pretx until 3-4 days post infusion
  33. Causes of cardio myopathy (5)
    • anthracyclines
    • mitoxantrone
    • high dose cyclophosphamide and ifosfamide
    • interferon alfa and interleukin
    • trastuzumab
  34. Causes of arrhythmias (5)
    • anthracyclines
    • mitoxantrone
    • high dose cyclophosphamide
    • taxanes (paclitaxel)
    • interleukin 2
  35. Causes of Ischemia (4)
    • 5 FU
    • Interleukin 2
    • Vinca alkaloids
    • Bleomycin, cisplatin, mitomycin c
  36. What are two parameters to monitor with anthracyclines?
    • total dose of doxorubicin should not exceed 450 mg/m2
    • EF < 45% then stop med
  37. Get a _____ _____ if base line LVEF is < 50%. You can also get an endometrial ______. Cardiac toxicity is a function of _______ drug level, so you could change form a _____ dose to a _____ hour ________. Selection of ________ anthracyclines may be beneficial
    • Muga scan
    • biopsy
    • peak
    • bolus
    • 96 hour infusion
    • lipsomal
  38. _________, as cardio protective agent is recommended. Dose with doxorubicin is ______. Give as IV drop ____-_____minutes before doxo or epirubicin. Doxorubicin must be administered within ____ ______ of _________ infusion
    • dexrazoxane
    • 10:1
    • 15-30
    • 30 minutes
    • dexrazoxane
  39. toxicity is much greater when combined wtih cyclophosphamide
    trastuzumab
  40. tx for tumor lysis syndrome
    • IV hydration - at least 100mg/hr
    • urinary alkalinization
    • allopurinol
    • hemodialysis for those with progressive renal dysfunction
  41. 4 agents that cause nephrotoxicity
    • Cisplatin
    • MTX
    • Ifosfamide adn cyclophosphamide
    • Carboplatin
  42. Prevention of nephrotoxicity with cisplatin
    • hydration
    • saline, manitol, maybe loop
    • amifostine
    • premeds: hydration, antiemetic, histamine antagonist, dexamethasone
    • iv sodium thiosulfate: for excessively high doses
  43. nephrotoxicity for MTX
    • monitor for increases greater than 5
    • hydration and alkalinization of urine
  44. Ifosfamide and cyclo nephrotoxicity tx
    • min 2 qts of water/ day
    • watch out for hemmorrhagic cyctitis
    • give mesna with ifosfamide (usually at 60-100% of ifosfamide dose)
    • short infusion of ifosfamide: 20% of ifosfamide dose of mesna at 0, 4, and 8 hours
  45. nephrotoxicity of carboplatin
    • uses AUC
    • typciall 6 but can range from 5-7
  46. common drugs with hepatotoxicity (6)
    • asparaginase
    • carmustine
    • cytarabine
    • mercaptopurine
    • streptozocin
    • high dose etoposide
    • avoid agents if bili is > 5
  47. 4 drugs with pulmonary toxicity
    • bleomycin
    • busulfan: high mortality -- especially look for cough
    • carmustine
    • mitomycin
  48. Cause meningeal irritation
    • intrathecal MTX
    • cytarabine
    • thiotepa
  49. peripheral neuropathies
    • vinca alkaloids
    • cisplatin
    • carboplatin
    • etoposide
    • paclitaxel
    • may treat with gabapentin
  50. cerebellar dysfunction
    • fluorouracil
    • high dose cytarabine
    • asparaginase
  51. combination of toxicities
    • procarbazine: effects of MAOI
    • fludarabine
  52. What should you do if neurotoxicity with ifosfamide?
    • confusion may progress to encephalopathy and death
    • and confusion: bring to ER and give mesna
  53. Possible tx of neurotoxicity
    • gabapentin for most symptoms
    • amifostine -- may decrease the toxicity of cisplatins and taxols
    • vitamin E -- may effective but harmful
  54. drugs that cause male infertility
    • alkylating agents
    • antimetabolites -- very few affects
    • cisplatin based
  55. Female infertility
    • alkylating agents
    • adjuvant chemo
    • MOPP chemo
  56. When are secondary malignancies more common?
    1-17% more common when radiation and alkylating agents are used

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