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62 Cards in this Set
- Front
- Back
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Cell Cycle
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- Gap 0 (G0): resting phase..
- Gap 1 (G1): posmitotic phase.. - Synthesis (S): DNA duplicated.. - Gap 2 (G2): premitotic phase.. - Mitosis (M): cell division. |
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Cell-Cycle-Specific Agents |
- Not active in G0 phase.. - Greatest action in divided doses or continuos infusion.. - Plant Alkaloids.. - Antimetabolites. |
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Plant Alkaloids
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Etoposide, Tenoposide..
Paclitaxel, Docetaxel.. Topotecan, Irinotecan.. Vincristine, Vinblastine, Vinorelbine. |
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Antimetabolites
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6-MP..
Thioguanine.. 5 Fluorouracil.. Gemcitabine, Fludarabine, Cladribine, Nelarabine, Clorfarabine, Ara-C.. Hydroxyurea.. MTX. |
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Cell-Cycle-Nonspecific Agents |
- Active in G0 phase.. - Greatest action in bolus.. - Alkylating agents.. - Antitumor antibiotics.. - Hormones, Decadron, Prednisone, Hydrocortisone.. - Miscellaneous: Asparaginas, Retinoids, Imatinib. |
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Alkylating Agents
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Nitrogen mustard..
Cytoxan.. Ifos.. Melphalan.. Lomustine.. Carmustine.. Busulfan.. Procarbazine.. Thiotepa.. Temozolimide.. Dacarbazine.. Cisplatin.. Carboplatin. |
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Common Side Effects of Alkylating Agents
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- Infertility..
- Secondary malignancy. |
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Antitumor Antibiotics
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Dactinomycin..
Bleo, Dauno, Doxo, Idarubicin, Mitoxantrone. |
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Asparaginase (Elspar) |
- IM, I.V., miscellaneous.. - Used in A.L.L induction/ consolidation.. - Acute and delayed anaphylaxis.. - Rare: pancreatitis.. - Observe for at least 60min after each dose.. - Risk for thrombus formation and bleeding. |
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Bleomycin |
- Antitumor antibiotics. Max lifetime dose is 400 units.. - Common: stomatitis, hyperpigmentation of fingernails.. - Occasional: erythema over bony prominences.. - Hypotension, pulmonary fibrosis, high fever 2-6 hours after.. - Give earlier in the day to observe for high fever.. - PFT at baseline, during therapy, and into survivorship.. - No scuba diving.
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Busulfan |
- Alkylating agent, PO, I.V.. - Common: "bronzing" of the skin.. - Occasional: seizures with high dose.. - Premed with anti-seizure meds in patients receiving high dose. |
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Carboplatin |
- Alkylating agent, I.V.. - Hearing loss, GFR needs to be evaluated.. - Secondary leukemia.. - Premed if reacts. |
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Carmustine (BCNU) |
- Alkylating agent, I.V.. - Common: late pulmonary dysfunction.. - Monitor PFT to check for pulmonary fibrosis.. - Avoid extravasation or skin contact.. - Avoid rapid infusion (cause burning or hypotension).. - N/V can occur right away and last for hours to days. |
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Cisplatin |
- Alkylating agent, I.V. - N/V (acute and delayed), #1 emetic-causing drug.. - Hypomagnesaemia.. - Hearing loss. |
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Cisplatin Administration |
- Synergistic with radiation therapy.. - Reacts with Aluminum.. - Premed with antiemetics.. - Maintain UOP at least 2ml/kg/hr. - Mannitol per order. Avoid Lasix (hearing loss).. - Intensifies aminoglycoside toxicity: gentamicin, amikacin, and tobramycin.. - Mg supplement. |
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Clofarabine |
- Antimetabolite, I.V.. - Hepatic and liver toxicities.. - Capillary leak syndrome: fluid retention, weight gain, pulmonary edema, and ascites.. - Monitor for sings of infection and CLS. |
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Cyclophosphamide (Cytoxan) |
- Alkylating agent, I.V., PO.. - Common: sterility.. - Hemorrhagic cystitis, bladder fibrosis.. - SIADH.. - Cardiac toxicity in high dose. |
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Cytoxan Administration |
- Maintain urine specific gravity < 1.010.. - Check urine for blood.. - Start therapy early in the day to protect bladder.. - Encourage urination.. - Pre- and post-hydrate with fluid and mesna. |
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Cytarabine (Ara-C) |
- Antimetabolite, I.V., IM, Sub-Q, IT.. - Conjunctivitis with high dose.. - Occasional: flulike symptoms with fever, diarrhea.. - Rare: encephalopathy, cerebellar dysfunction, pulmonary leak, rash, hepatotoxicity, VOD, pneumonitis.. - With IT: N/V, headache, pleocytosis, fever, learning disabilities, rash, drowsiness, meningismus, convulsions, paresis, ataxia.. |
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Ara-C Administration |
- Steroid eye drops with high dose.. - Neurological test before each high-dose.. - Observe particularly for nystagmus. |
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Daunorubicin and Doxorubicin |
- Antibiotic, I.V.. - Common: subclinical cardiac arrhythmias, pink or red urine.. - Occasional: cardiomyopahty (cumulative and dose dependent).. - Radiation recall. |
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Dauno and Doxo Administration |
- Vesicant.. - Warn family and patient about urine discoloration.. - Cardiac studies: ECHO or multigated angiography.. - Must have acceptable cardiac ejection.. - Keep cumulative dose below 300mg/m2.. - Avoid isometric activity such as weight lifting. |
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Etoposide (VP-16) |
- Plant product (epipodophyllotoxin), I.V., PO.. - Hypotension, secondary malignancy.. - Enhanced damage due to radiation. |
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Etoposide Administration |
- Severe hypotension can occur with rapid infusion.. - Administer over at least 60 minutes.. - Concentration higher than 0.4mg/ml have unpredictable stability.. - Do NOT refrigerate I.V. solution, but PO must be refrigerated.. |
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Hydroxyurea (Hydrea) |
- Antimetabolite, PO.. - Common: myelosupression with rapid drop in WBC count.. - Occasional: N/V, stomatitis, anema.. - Increases fetal Hgb, which may protects SCD patient from crisis.. |
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Hydroxyurea Admin |
- Take on empty stomach.. - Dose often is titrated to WBC count.. - Do not add to acidic or carbonated solutions; alkaline solution is preferred. |
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Ifosfamide |
- Alkylating agent, I.V.. - SIADH.. - Severe hemorrhagic cystitis if not given with mesna.. - Secondary malignancy, bladder fibrosis. |
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Ifosfamide Admin |
- Give with mesna to avoid sever hemorrhagic cystitis.. - Must pre-hydrate 3-6 hours before and 24 hours after dose.. - Must monitor urine specific gravity.. - Fanconi renal failure is more common with history of cisplatin use, prior kidney damage, and greater than 70-100g/m2 cumulative dose.. - May requre Mg, K, and phos suplement. |
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Imatinib (Gleevec) |
- TKI, PO.. - Common: chest pain, fatigue, fever, headache, insomnia, dizziness, depression, rash, pruritis, fluid retention, electrolyte abnormalities, diarrhea, constipation, weight gain, night sweats.. - Rare: CNS hemorrhage, paresthesia, blurred vision, conjuctivitis, nephrotoxicity, flulike symptoms. |
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Imatinib Admin |
- Take at bedtime to avoid N/V.. - Monitor sings of fluid retention.. - Take with food and a large glass of water.. - May dissolve in water or apple juice. |
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Interferon alfa (Inton-A) |
- I.V., IM, Sub-Q.. - Common: flulike symptoms, low blood count, headache, myalgia, rigors, diaphoresis, depression, desquamation, pruritis, abnormal liver function tests.. - Occasional: N/V, hypotension, allergic reaction, arrhythmia, confusion, kidney damage, diarrhea. |
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Interferon alfa Admin |
- Premed with Tylenol.. - CR monitoring during infusion.. - Assess for chest pain or palpitations.. - Assess skin.. - Assess mental status and depression.. - Flulike symptoms usually start 1-2 hours after dose and may last for up to 18 hours. |
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Irinotecan (CPT-11) |
- Plant product, I.V.. - Eearly diarrhea (< 24hours): atropine/diphenoxylate (Lomotil).. - Late onset diarreah (>24 hours): lopramide. |
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Mercaptopurine (6-MP) |
- Antimetabolite, PO.. - Common: myelosuppression.. - Occasional: anorexia, N/V, diarrhea, mucositis.. - Rare: anaphylaxis, urticaria, hepatic fibrosis, hyperbilirubinemia. |
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6-MP Admin |
- Thiopurine S-mehtyl-transferase (TPMT) testing needed if myelosuppression is out of proportion to dose.. - Reduce dose 75% if given with allopurinol.. - Take on empty stomach. |
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Methotrexate (MTX) |
- Antimetabolite, I.V., IM, PO, IT.. - Common: transaminase and bilirubin elevation.. - Rare: leukoencephalopathy, seizures, acute neurotoxicity, osteoporosis, osteonecrosis and soft tissue necrosis, progressive CNS deterioration.
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MTX Admin |
- Patients with effusions may have delayed clearance. Monitor creatinine level.. - Renal impairments enhances toxicity.. - Leucovorin is given as a rescue agent with intermediate to high-dose MTX.. - Hydration with bicarb with high-dose MTX. Monitor urin pH.. - Avoid folic acid.. - Hold Septra, NSAID, and aspirin to avoid delayed clearance.. - Use suncreen. |
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Mitoxantrone |
- Antibiotic, I.V.. - Common: cardiac arrhythmias, N/V, worsening SE due to radiation, bluish-green color to urine.. - Occasional: cardiomyopathy (dose dependent). |
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Mitoxantrone Admin |
- Vesicant.. - Not recommended for patients who received full dose of anthracycline (dauno, doxo, etc.).. - Do not give I.V. push. |
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Nelarabine (ara-G) |
- Antimetabolite, I.V.. - Common: peripheral neuropathy. Similar to VCR.. - Rare: CNS toxicity including drowsiness and Guillain-Barre-like ascending paralysis.. - Prophylactic allopurinol and hyperhydration for patients with large initial tumor burdens. |
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Paclitaxel (Taxol) |
- Plant product, I.V.. - Common: pain, swelling, myelosuppression, diminished or absent deep-tendon reflexes, alopecia, fatigue.. - Occasional: acute anaphylactic reaction, N/V, headache, rash, mucositis, diarrhea, fever, glove and stocking numbness, hyperesthesia with burning sensation, mild-to-severe myalgias, increased triglyceride levels. |
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Paclitaxel Admin |
- Irritant: erythema if extravasated.. - Premed with Benadryl, dexamethasone, and H2 preceptor blocker.. - Avoid bag or tubing containing polyvinyl chloride.. - Use filters. |
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Procarbazine |
- Alkylating agent, PO.. - Hypotension and CNS depression.. - Avoid alcohol, MAOI, and tyramine-rich foods such as aged cheese, wine, bananas, and yogurt. |
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Retinoic acids (Accutane) |
- Miscellaneous, I.V., PO.. - Differentiating agents: causes cells to stop dividing and forces them to mature or change.. - Accutane is used in treating neuroblastoma and APML.. - Photosensitivity.. - Retinoic acid syndrome: capillary leak, fever, respiratory distress, interstitial pulmonary infiltrates, pleural and pericardial effusion. |
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Accutane Admin |
- Take with food.. - Monitor lipid level.. - Avoid sun exposure.. - Keep skin and lips moisturized.. - Monitor nutritional status.. - Saline eye drops as needed.. - Monitor for retinoic acid syndrome, which may occur 1-3 weeks after initiation of therapy.. - Teratogenic and marketed through iPLEDGE. |
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Dasatinib (Spyrcel) |
- Tyrosine kinase inhibitor, PO.. - Common: fluid retention, superfacial edema, headache, fatigue, fever, rash, hypophosphatemia, hypocalcemia, abnormal pain pancytopenia, neutropenia, arthralgia, muscle weakness, neuropathy, pulmonary edema, pleural effusion, cough.. - Occasional: GI bleeding, abnormal liver function tests, increased creatinine, diarrhea. |
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Dasatinib Admin |
- No grapefruit.. - Do not break, chew, or crush tablets.. - May disolve tablets for one dose in 30cc apple or orange juice.. - Discard suspension after 60 minutes. |
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Thalidomide |
- Angiogenesis inhibitor, PO.. - Birth defects.. - Routine pregnancy tests required.. - Take on empty stomach. |
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Thioguanine (6-TG) |
- Antimetabolite, PO.. - Common: myelosuppression.. - Occasional: anorexia, N/V, diarrhea, mucositis.. - Rare: anaphlyaxis, urticaria, hematuria, crystalluria, hepatic fibrosis, hyperbilirubinemia.. - TPMT testing needed if myelosuppression is out of proportion to dose.. - Take on empty stomach. |
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Vincristine (VCR) |
- Plant product, I.V.. - Common: alopecia, loss of deep tendon reflexes.. - Occasional: jaw pain, ptosis, constipation, peripheral neuropathy (walking like a duck).. - Rare: SIADH. |
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VCR Admin |
- Vesicant.. - Refrigerate and protect from light.. - Stool softeners.. - Increase risk for liver toxicity with radiation.. - Fatal if given IT.. - Give through large vein if PIV.. - Infant may have difficulty feeding due to jaw pain.. - Max single dose: 2mg, regardless of BSA or weight. |
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Vesicant |
1. DNA-binding agents: ongoing damage - Anthracyclines most potent.. - Antidote for anthracyclines is Zinecard.. 2. Non-DNA-binding: injury at time of extravasation.. - Vinca.. - Antidote for vinca is hyaluronidase.. 3. Mitoxantrone, Melphalan. |
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How to treat extravasation? |
- Warm pack for: VP-16, Oxaliplatin, Vinblastine, VCR, and Vinorelbine.. - Cold pack for others. |
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Actions and side effects of plant alkaloids
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- Predominantly work in M phase..
- Cause mitotic arrest; stop cell devision.. - Major toxicities:. 1. Neurologic: peripheral neuropathy, jaw pain, constipation, etc.. 2. Reproductive.. 3. Secondary malignancy: Etoposide, related more to leukemias.. |
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Actions and side effects of antimetabloties
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- Work in S phase..
- Inhibit DNA/RNA/protein synthesis.. - Major toxicities: 1. Greater immunosuppression effect.. 2. GI tract. |
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Actions and side effects of alkylating agents
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- Most active in G0 phase..
- Inhibit/ interfere with DNA synthesis.. - Major toxicities: 1. GI tract.. 2. Reproductive: infertility.. 3. Secondary malignancies related more to solid tumor.. 4. Immunosurpression. |
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Actions and side effects of antitumor antibiotics
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- Inhibit DNA synthesis..
- Major toxicities: 1. Cardiac.. 2. Immunosurpression.. 3. GI.. 4. Reproductive. |
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Actions and side effects of hormones
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- For leukemia: anti-cancer effect where they lyse lymphoblasts..
- For solid tumor: anti-nausea effect.. - Major toxicities: 1. Metabolic functions: hyperglycemia, Cushing's.. 2. Bones.. 3. HTN. |
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Biotherapy/ Biologic response modifiers Actions
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- Known as "target therapy"..
- Stimulate the bodies immune system to kill cancer cells.. - 3 major actions: 1. Modifying immune response to tumor.. 2. Act on tumor, suppress growth or kill tumor cells.. 3. Altering bio activities that can directly or indirectly affect malignant cells.. |
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Biologic response modifiers 1: Monoclonal antibodies
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- Campath, CH 14.18, Rituximab.. - Used as diagnostic indicators and provide therapeutic treatment modalities.. - Recognize tumor-associated antigens.. - Cause cell death through interaction with immune response.. - Side effects: hypotension, fever, chills, rash. |
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Biologic response modifiers 2: Cytokines /Lymphokines
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- Interferons, interleukins, growth factors..
- Non-antibody proteins that regulate an immune response.. - Side effects: flu-like syndrome; IL-2 capillary leak syndrome; IL-11 can increase platelet production. |
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Biologic response modifiers 3: Tyrosine kinase inhibitors (TKIs)
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- Imatinib (Gleevec), dasatinib..
- Protein TKI acts as "on-off" switch for signal transduction pathways.. - Imatinib blocks proliferation of the Phili chromosome.. - Side effects: incidence and severity vary from patient, dose, and drug. |
