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13 Cards in this Set

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Cyclophosphamide (Alkylating agent)
-Bladder Toxicity(dose-related, hemorrhagic cystitis)
-SIADH
-Cardiotoxicity with high doses(>= 1800mg/m2/dose)
-Hyperhydration before, during, and following administration (urine output 3mL/kg/hr) + frequent bladder emptying
-Urine dips for blood with each void
-Mesna as chemoprotectant
Ifosfamide (Alkylating agent)
-Bladder toxicity(dose-related, hemorrhagic cystitis)
-Neurotoxicity-lethargy, confusion, cerebellar ataxia, weakness, hallucinations, and seizures
-SIADH-reported less commonly than with cyclophosphamide
-Hyperhydration before, during, and following administration(3mL/kg/hr) + frequent bladder emptying
-Urine dips for blood with each void

-Mesna as chemoprotectant
-Methylene blue can be used for management of encephalopathy
Carboplatin (Alkylating agent)
-NV-less emetogenic than cisplatic
-Nephrotoxicity with electrolyte imbalance(hypomagnesemia, hypocalcemia, hypokalemia)
-Neurotoxicity characterized by peripheral neuropathy-dose-related
-Hypersensitivity reactions characterized by skin rash, urticaria, and pruritus may occur-increased likelihood with number of cycles
-CBC, renal function(BUN, SCr, ins/outs), electrolytes(K, Mg, Ca), audiogram
Cisplatin (Alkylating agent)
NV- HIGHLY EMETOGENIC
-Nephrotoxicity with electrolyte imbalance(hypoMg, hypoCa, hypoK, hypoPO4)
-Ototoxicity(cumulative)-high-frequency hearing loss and tinnitus
SIADH
-Neurotoxicity reactions characterized by skin rash, urticaria, and pruritus may occur-increased likelihood with number of cycles
-Hydration may include Mg, Ca and/or K to decrease acute electrolyte losses
-Mannitol may also be included in IVF to facilitate diuresis
-CBC, renal function(BUN, SCr, ins/outs), electrolytes(K, Mg, Ca), audiogram
Daunorubicin (Antitumor antibiotics)
-Mucositis-continuous infusion > bolus
-Cardiotoxicity-dose-related and cumulative
-Increased risk when exceed 450mg/m2 in adults and 300 mg/m2 in children
-Red/orange tint to secretions(urine, tears, sweat)
-Risk of radiation recall-caution if receiving or have received radiation therapy
-Extravasation-cold compress, dexrazoxane or DMSO
-CBC, renal f(x), liver f(x) tests, cardiac function(baseline and periodically during treatment)

-Dexrazoxane-cardioprotection
Doxorubicin (Antitumor abx)
-Mucositis-continuous infusion > bolus
-Cardiotoxicity-dose-related and cumulative
-Increased risk when exceed 450mg/m2 in adults and 300 mg/m2 in children
-Red/orange tint to secretions(urine, tears, sweat)
-Risk of radiation recall-caution if receiving or have received radiation therapy
-Extravasation-cold compress, dexrazoxane or DMSO
-CBC, renal f(x), liver f(x) tests, cardiac function(baseline and periodically during treatment)

-Dexrazoxane-cardioprotection
Cytarabine (Antimetabolites)
-Neurotoxicity-characterized by cerebellar ataxia,lethargy, and confusion (can occur with IT administration)
-Ara-C syndrome-Characterized by fever, bone pain, myalgia, and macropapular skin rash; steroids are beneficial for management
-Mucositis
-Hand-foot syndrome (desquamation of skin pronounced on palms and soles of feet)
-Conjunctivitis at high doses(> 0.5-1gm/m2)-steroid ophthalmic drops (dexamethasone, hydrocortisone) should be initiated with the first dose and continue on a scheduled basis for at least 24 hours following administration of last dose
-CBC, renal f(x), LFTs
MTX
-Mucositis and diarrhea are common
-Nephrotoxicity - IV hydration with NaHCO3 to ensure excretion; minimize drug interactions(D/C PCNs, Bactrim, NSAIDs, and PPIs)
-May accumulate in fluid collections (ex. pericardial effusions, pleral effusions, etc.)
-CBC, renal f(x), LFTs, drug levels, stool output(drug excreted in feces)

Leucovorin as chemoprotectant
Etoposide (Plant derivatives)
-Hypotension during administration
-Mucositis-continuous infusion > bolus
-allergic reactions
-VS during infusion; stop infusion and administer 10mL/kg bolus if hypotension and resume infusion at slower rate
Vincristine (Plant derivatives)
-Neurotoxicity manifesting as peripheral neurophathy and autonomic dysfunction (jaw pain, constipation, ileus, obstruction)
-SIADH-watch sodium and order urine/serum osmolality
-Extravasation-VESICANT -warm compress
LFTs(bilirubin), stool output
(Vinblastine/Vinorelbine)
-Myelosuppression - severe compared to vincristine
-Neurotoxicity - less frequent compared to vincristine
-Extravasation - VESICANT - warm compress
-CBC, LFTs
Dexamethasone/Prednisone
-Mood swings/ irritability
-Appetite changes; weight gain
-Hyperglycemia
-Increased risk of peptic ulcers - consider H2 blocker or PPI
-Hypo- or hypernatremia
-HTN
-May mask fever
-Immunosuppression
-Skin changes; poor wound healing
-Osteoporosis, osteopenia
-Avascular necrosis
-BG, behavioral changes, assess infection risk
Pegaspargase, L-asparaginase
-Allergic reactions ranging from hivees to anaphylaxis - need Epi-pen at bedside and provide at discharge
-Pancreatitis
-Hyperglycemia
-Decreased serum proteins - decreased albumin, decreased ATIII
-Thrombosis - high index of suspicion for swelling or pain in extremities or respiratory distress
-Vital signs during administration, amylase/lipase, glucose, coagulation studies