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21 Cards in this Set
- Front
- Back
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goal level of MTX with leucovorin
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goal of .1mmolar of MTX after 48h
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administration of leucovorin with MTX
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administered 24h after administration of HD MTX.
dec myelosuprresion and mucositis. |
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hydration protocol with LCV & HDMTX
alkalinization protocal |
NS 100 -125ml/h, 24hrs before MTX dose and 1day after completed...
--monitor UOP alkalinize 6-12 before and 1 day after... -50meQ/ L of NS or po q6h |
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toxicities of MTX
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-myelosupression (DLT)
-mucositis, mild N/V (DLT) -hepatoxicity from chronic low doses...normalizes |
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contraindication of MTX / risk factor
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pleural effusions / ascites where MTX hides in these compartments
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indication / MOA of glucarpidase
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eleminates toxic MTX in pts with reduced renal fxn
-recombinant bacterial enzyme that hydrolyzes folate and antifolates DI: with LCV. must wait 2 hrs |
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glucarpidase warnings and precauations
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anaphylaxis
[MTX] assay interference if w/in 48 hrs continuation and timing of LCV rescue..have to wait 2 hrs |
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MTX DI
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avoid NSAIDs which compete for renal clr
avoid nephrotoxic drugs -delyaed clr of PPI -salicylates, sulfanmides displace MTX |
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how to manage myelosupression in pe-MTX pt
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vitamin B12 1mg IM q3cycles,
folate 1mg po qd rash - dexmethasone 4mg po BID for 3 days before MTX dose |
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pralatrexate / folotyn MOA
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stops thymidine production by complete inhibition of DHFR AND fotylpolygutamyl synthase
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pralatrexate / folotyn BBW and s/e
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myleosupression, mucositis
BBW: TEN esp in pts with ESRD tumor lysis of components causing renal failure |
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praltrexate DDI
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NSAIDs, probenicides
TMP-SMX --all causes delayed renal clr of pralatrexate |
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the purine antagonist dose adjustments
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6MP has adjustments with myelosuprresion, mucositis, renal and hepatic deficinecy
TPMT decifiency concurrent allopurinol use |
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caution with 5FU(pyrimidine antagonist)
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it is a radiosensitizer and can cause more toxicities in anyone with radio chemo...need to dose reduce 5FU
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5FU bolus s/e
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DLT myelosupression, mucositis, diarrhea
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5FU continiuous infusion s/e
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DLT: hand foot syndrome
less myelo, muco, diarrhea |
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capecitabine / xeloda major s/e
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DLT: HF syndrome much more commonly in capecitabine
DLT Diarrhea liver / hyperbilirubinarea myelosupression, alopecia, mucositis |
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DI of capectabine
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warfarin displaces and inc PHT as a 2C9 substrate
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cytarabine / ara-C premedications
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anti-emetic before bc N/D
myelosupression conjunctivitis: tx .1 dexamethason q6h during and for 2-7 days post-completion |
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what is cytarabine syndrome
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fevers
myalgia/arthalgia, bone pain rash |
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gemcitabine summary
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well-tolerated and demonstrated improvment in QOL in pracreatic CA vs no tx
DLT myelosupression flu-like stms |
