Anesthesia Chemotherapy

Front 1

Renal toxicity can occur after first dose. Have decreased GFRs, electrolyte losses (espec Mag and K)--will see lots of NaCl fluid & diuresis to help.
Peripheral neuropath reversible > 1 yr.

Back 1

Platinating Agents

Front 2

The most severe emotogenic class--60% will have delayed 2-4 day N/V -- will impact fluid and nutrition status.

Back 2

Cisplatin (Platinating agents)

Front 3

As a class, disrupts the metabolic workings of cancer cells (resemble nuclear structural components or inhibit enzymes involved in synthesis of DNA/proteins.)

Back 3

Antimetabolites
(book also calls Nucleic acid synthesis inhibitors)

Front 4

Antimetabolite that is given with reduced folate leucovorin to increase stability and cytotoxicity. Blocks production of thymine nucleotides.

Back 4

Fluorouracil (5-FU)

Front 5

Antimetabolite that is prodrug of 5-FU.

Back 5

Capecitabine

Front 6

Toxicities of 2 drugs: Mucositis/diarrhea which is life threatening, especially in older women. Also myelosupression.

Back 6

Antimetabolites:
Florouracil (5-FU) and Cepecitabine

Front 7

With increased age & high dose you see higher prevalence of renal/hepatic toxicity plus neurotoxicity (is VERY toxic). Also very strong myelosuppression.

Back 7

Antimetabolite:
Cytarabine
2 other that have similar actions, but are less toxic: Gemcitabine, Azacytidine, and Decitabine.

Front 8

Depends on xanthine oxidase for initial oxidation steop. If given with Allopurinol (xanthene oxidase inhibitor) reduce dose or serious toxicity will ensue. Also causes myelosuppression, leukemia and sometimes Chron's disease.

Back 8

Purine Antimetabolites:
6-Mercaptopurine &
6-Thioguanine

Front 9

Side effects:
Myelosuppression to the point of giving prophylactic antibiotics and antivirals until CD4 counts normalize; 15% will see neurotoxicity, mostly somnolence, neuropathy, visual disturbances.

Back 9

Purine Antimetabolites:
Fludarabine, Cladribine, and Pentostatin

Front 10

These drugs block Dihydrofolate Reductase (DHFR) depleating reduced folates so thymidylate and purine synthesis is stopped, thus DNA synthesis is stopped.

Back 10

Antifolates

Front 11

Drug used for >50 years. Possible that malignant cells may have higher amounts of MTX polyglutamated cells which is possibly why MTX has selective effects on malignant vs normal cells.
May require leucovorin "rescue".

Back 11

Antifolate:
Methotrexate

Front 12

A "multi-targeted" antifolate that inhibits 3 pathways.
Severe hematologic toxicity with netropenic sepsis and death reported.
FDA requires co-administration of folic acid and vit B12 with this drug to lower mortality rates.

Back 12

Antifolate:
Pemetrexed

Front 13

Essential for maintaining DNA structure during replication/transcription. They unwind DNA and break a segment; instead of breaking entire molecule, allow replication, then reseal.

Back 13

Topoisomerase Inhibitors (TI)

Front 14

Topoisomerase Inhibitors that are generally well tolerated; myelosuppresion and mucositis at high doses.

Back 14

Etoposide (VP-16)
Teniposide

Front 15

Topoisomerase Inhibitors
Myelosuppression.
20% incidence grade 4 diarrhea with one.
Some low grade fever, mucositis, mild LFT bumps seen.

Back 15

Irinotecan
Topotecan

Front 16

Topoisomerase Inhibitors:
Poison Topo, but also form hydroxy radicals that cleave DNA-effective, but toxic!
Moderate to severe N/V, alopecia & mucositis. Dose limiting myelosuppression.
Most famous for cardiotoxicity.
Heart has few mech to ward of oxidative radical damage.
Acute, chronic, and late onset cardiac damage (up to 20 yrs later).
ST-T wave changes, sinus tachy, PVCs.

Back 16

Doxorubicin
Daunorubicin
Idarubicin
Epirubicin
(Anthracene derivitaves)

Front 17

Topoisomerase Inhibitor
Formulated for reduced toxicities across the board; less radical oxidation.
Intense blue color of drug discolors urine and can tint sclera and skin.

Back 17

Mitoxantrone