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74 Cards in this Set
- Front
- Back
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alkylating agents
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cisplatin, carboplatin, oxaliplatin, cyclophosphamide
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alkylating agents: CCS or CCNS
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CCNS
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Dose limiting toxicity of alkylating agents
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usually myelosuppression or neurotoxicity
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antimetabolites-agents
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MTX, pemetrexed, gemcitabine, 5FU, capecitabine (prodrug of 5FU), cytarabine
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Antimetabolites: CCS or CCNS
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CCS-for S-phase
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Antimitotic agents
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vinblastine, vincristine, vinorelbine, docetaxel, paclitaxel
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antimitotic agents target …
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microtubules
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all drugs that inhibit microtubulin have…
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neurotoxicity
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Topo I inhibitors
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camptothecans: irinotecan and topotecan
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Topo II inhibitors
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etoposide and doxorubicin
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Random Topo inhibitor
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Bleomycin
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Natural products
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daunorubicin, doxorubicin/adriamycin, epirubicin, idarubicin
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Alkylating agents-resistance
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increased glutathione-binds and inactivates before getting to DNA
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antimetabolite resistance
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increased nucleotide synthesis by salvage pathways
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cyclophosphamide DOC for…
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breast cancer and NHL
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Cyclophosphamide dose dependent toxicities
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hemorrhagic cysitis, n/v, myelosuppression, neutropenia
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Cyclophosphamide and hemorrhagic cystitis
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from Acrolein. Hydration is key, at high doses can give Mesna to pts. Always make sure pt is hydrated and they are urinating
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cyclophosphamide toxicity prevention
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antiemetics, hydration (w/wo Mesna), take PO tabs in AM
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Cisplatin is the DOC for
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lung, testicular, ovarian, and head and neck cas
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Cisplatin dose limiting toxcitiy
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renal failure, n/v
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Cisplatin and ototoxicity
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use mannitol as a diuretic with cisplatin to avoid overlapping toxicity
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Cisplatin toxicity prevention
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pre and post hydration with NS containing fluid +/ mg and mannitol, antiemetics
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Avoid ____ with cisplatin
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Al containing needles
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Carbolplatin-Activity
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lun, testicular, OVARIAN, head and neck, endometrial ca
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Carboplatin toxicity
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thrombocytopenia, n/v, myelosuppression
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carboplatin toxicity prevention
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antiemetics
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Gemcitabine DOC for
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pancreatic, SCLC, ovarian ca
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Gemcitabine Toxicity
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myelosuppression, neutropenia, thrombocytopenia, flu-like syndrome (fever, myalgia,rash after 48-72 hrs)
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Gemcitabine toxicity prevention
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antiemetics
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Gemcitabine and flue like syndrome
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rash may respond to topical steroid/fever can be treated with APAP
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5FU/Capecitabine
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mainstay in colorectal cancer
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5-FU Toxicity
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mucositis, diarrhea, myelosuppression, rash, hand foot syndrome
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5-FU bolus
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bone marrow suppression
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5-FU CI
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diarrhea
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Vincristine DOC for
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leukemias and lymphomas
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Dose limiting toxicity for vincristine
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ANS, paralytic ileus (constipation)-monitor
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DO NOT GIVE ____ INTRATHECALLY
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vincristine, vinerlebine
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vinorelbine used in…
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lung and breast ca
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dose limiting toxicity for vinorelbine
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neutropenia
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Vinorelbine-reduce dose when…
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bilirubin is high
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Paclitaxel-DOC for
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lung, breast and ovarian ca
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dose limiting toxicity with paclitaxel
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neutropenia, bone marrow suppression, n/v, anaphylactic rxn
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paclitaxel toxicity prevention
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antiemetics, H2RAs, diphenhydramine 30-60 min prior to infusion and dexameth 20 mg 12, 6, and 1 hr prio to infusion
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Paclitaxel anaphylactic rxn is caused by…
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Cremophor
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Paclitaxel administration
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DO NOT MIX IN PVC BAG-leachs into the soln-may be toxic
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Docetaxel-DOC in
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lung, breast, prostate CA
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do not give docetaxel in pts w/
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bilirubin > ULN or liver enzymes >1.5 x ULN
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Docetaxel toxicity
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bone marrow suppression, n/v, fluid retention
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Docetaxel toxicity prevention
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antiemeitcs, dexameth 8 mg po bid x 3 days to reduce fluid retention and severity of hypersensitivvity rxns
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Irinotecan DOC for
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colon and rectal ca
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Irinotecan toxicity
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neutropenia, n/v, diarrhea
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irinotecan toxicity prevention
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antiemetics, loperamide 4 mg with first loose stool followed by 2 mg po q2hr until diarrhea free for 12 hr
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Etoposide DOC in
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lung ca
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Etoposide toxicity
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myelosuppression
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Doxorubicin activity
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breast ca
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Doxorubicin toxicity
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myelosuppression, cardiac toxicity
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Doxorubicin and cardiac toxicity
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obtain EF prior to tx. Presents with arrhythmias or CHF.
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Doxorubicin cardiac toxicity RF
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total dose, cardiac dz, mediastinal radiation withinin 6 mo
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Cumulative dose of doxorubicin
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not to exceed 550mg/m2
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adjust doxorubicin dose if…
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bilirubin is high
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doxorubicin and sunlight
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photosensitizing
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Bleomycin activity
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testicular ca, germ-cell tumors
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bleomycin toxicity
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pulmonary toxicity-obtain CXR and PFTs prior to and during tx
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bleomycin max lifetime dose
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>400 units-pulmonary fibrosis-monitor for signs of dyspnea
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Rituximab toxicity
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hypersensitivity rxn, infusion rxn-start infusion slwoly and titireate up. P
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Rituximab premeds
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APAP and diphenhydramine (dexameth for RA)
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Trastuzumab place in cancer
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BREAST CANCER-HER2+
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Trastuzumab toxicity
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cardiac-CHF
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cetuximab
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acne-like rash
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cetuximab premed
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antihistamine (topical clindamycin or steroids-even teracyclines used)…rash correlates with benegfit
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beva and htn
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manage with traditional anti-HTN
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Erlotinib-best in…
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NSCLC-asian, nonsmoking women…rash = better response
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sunitinib dosing
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QD 4 wks on, then 2 wks off (soraf is bid, no wks off)
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lenalidomide
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thalidomide analog-dispensing requirements
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