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50 Cards in this Set

  • Front
  • Back

Anti-metabolites

Common: myelosuppression, mucositis, alopecia, N/V, tumor lysis syndrome (TLS)

Leucovorin is rescue for prevention of BMS and musositis, caused by which drug?

MTX

MTX ADRs

Stomatitis, mucositis, myelosuppression, chemical arachnoiditis, renally adjusted

mercaptopurine, thioguanine

Myelosuppression, mild N/V/D, stomatitis, cholestatic liver dysfunction (increased bili, +/- transaminases), jaundice

DDI: reduce dose of azathiopurine/6MP by 75% with concomitant use of what?

Allopurinol

Pyrimidine analogues: 5FU, Capecitabine (Xeloda)

Toxicities depend on route, dose, and schedule. Bolus causes myelosuppression. Continuous infusion causes mucositis, diarrhea, HF syndrome

Cytarabine

Toxicities with high dose: conjunctivities, cerebellar dysfunction. Cytarabine syndrome: fever, myalgia, bone and chest pain

Gemcitabine (Gemzar)

Myelosuppression, mild N/V, stomatitis, increased LFTs

Topical 5FU

HF syndrome

Alkylators

Common: myelosuppression, alopecia, mucositis, sterility/infertility/teratogenicity, second malignancies (leukemias, bladder cancer from CTX)

Cyclophosphamide (CTX), Ifosfamide

Hemorrhagic cystitis (caused by metabolite acrolein), highly emetogenic, delayed N/V

Ifosfamide, platinums, busulfan, MTX, cytarabine

Neurotoxicity

Cisplatin

Nephrotoxicity

Cisplatin, HD CTX, carmustine, melphan

N/V (severe and delayed)

Busulfan

Sinusoidal obstruction syndrome of liver, seizures (pretreatment with Keppra). Busulfan tan (hyper-pigmentation of skin), busulfan lung (pulm fibrosis

Platinum alkylators


ie Cisplatin (Platinol), Carboplatin (paraplatin), Oxplatin (eloxatin), is FOLFOX regimen

Myelosuppression, thrombocytopenia (carboplatin's dose limiting toxicity), severe N/V (acute and delayed) with cisplatin)




Hypersensitivity, ototoxicity, nephrotoxicity, neurotoxicity (peripheral neuropathy, loss of taste), DLT of olaliplatin is sensory neuropathy that is aggravated by cold

Procarbazine (matulane)

weak MAOI

Radiation

Xerostomia, dry mouth

High dose MTX, 5-FU

stomatitis, mucositis, esophagitis

Tx for xerostomia

Amifostine (ethyol) prior to RT

Tx for mucositi, stomatitis

rinse with mouthwash

General dosing schedule for MTX

weekly dose, never qd!

Prevention of arachnoiditis from IT MTX or cytarabine

Hydrocortisone 25 mg

risk factors for ifosfamide induced encephalopathy

high dose, bolus dose, low albumin




Tx: methylene blue

Nephrotoxicity

High dose MTX, cisplatin, ifosfamide, Bevacizumab (proteinuria)

Tx for MTX nephrotoxicity

Alkalinization of urine with Na bicarb

DDI with MTX

NSAIDs, probenacid, PPIs, bactrim, sulfonamides, salicylates, phenytoin, vit C, nephrotoxins

Hemorrhagic cystitis prevention and tx

prevention: suprahydration and frequent voiding. Mesna




Tx: bladder irrigation with saline and instillation

Renal dose adjustment

Cisplatin, MTX<carboplatin, cyclophosphamide, bleomycin, etoposide

Hepatic dose adjustment

Vinca alkaloids, anthracyclines, taxanes, gemcitabine, irinotecan, etoposide

Antitumor inhibiitors

Myelosuppression (DLT), N/V (except bleomycin), mucositis, alopecia

Daunorubicin, Doxorubicin, Idarubicin

Cardiac

Bleomycin, mitomycin

Pulmonary

Daunorubicin, dactinomucin, bleomucin

Radiation recall dermatitis

Doxorubicin

Vesicant (extravasation and tissue necrosis), cardiomyopathy. CHF (late onset, chronic)

Cardioprotectant for doxorubicin

Fe chelator dexrazoxane

Cardiotoxicity with biological agents

Bevacizumab, Sunitinib, Trastuzumab, high dose IL-2

No O2 after surgery with what agent?

Bleomycin

Pulm toxicity (lung fibrosis)

Bleomycin (>400 unit or >200 unit/m^2), carmustine, cyclophosphamide, busulfan (busulfan lung), chlorambucil

Peripheral neuropathy

Platinums, taxanes, vincas, anti-myeloma agents (thalidomide, lenalidomide, bortezomib)

Vinca alkaloids

Neurotoxicity (DLT), peripheral neuropathy, exacerbated by cold exposure, neutropenia, constipation (use laxatives)

Taxanes

Neutropenia, neurotoxicity (DLT), hypersensitivity reaction (need premeds), fluid retention

Premeds for Paclitaxel HSR (hypersensitivity reaction)

H1, H2, and corticosteroids (ABCD). A= antiemetic. B= benadryl. C= cimetidine (any H2 blocker). D=Dexamethasone. DON'T use PVC bags!

Docetaxel (Taxotere)

Pleural effusion, fluid retention

Pre-med for fluid retention for Docetaxel

Dexamethasone

Rituximab infusion-related rxn (BBW)

hypotension (cytokine release), bronchospasm, MI, arrhythmias. Premeds: benadryl, famotidine, dexamethasone

Asparaginase (Elspar)

Pancreatitis, hepatotoxicity, decrease clotting factors

Irinotecan

Diarrhea (DLT), treat with loperamide, myelosuppression

Acne, rash

Geftinib, imatinib, erlotinib, cetuximab

Antidote to doxorubicin extravasation (skin)

Dexrazoxane + cold compress