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72 Cards in this Set

  • Front
  • Back
Name the 3 alkylating agents
Cyclophosphamide
Chlorambucil
Carmustine
What side effect is a particular concern with cyclophosphamide?
Hemorrhagic cystitis (active metabolite acrolein)
What can you do to prevent this?
Give mesna
Maintain adequate hydration
Which drugs are of high emetic potential?
Cisplatin
Mechlorethamine
Streptozotocin
Cyclophosphamide
Carmustine
Dacarbazine
Dactinomycin
What percentage of patients will experience emesis on these medications?
More than 90%
Which agents can cause hepatotoxicity?
Chlorambucil
Etoposide
Vincristine
Paclitaxel
Methotrexate
Name the 3 platinum based agents
What is their mechanism?
Cisplatin
Carboplatin
Oxaliplatin
Crosslink DNA, cause it to break
Name the two topoisomerase inhibitors
How does inhibiting topoisomerase provide therapeutic effect?
Irinotecan
Etoposide
Inhibit DNA replication and repair
Name the 4 anti-mitotic agents

How do they work?
Vincristine
Vinblastine
Paclitaxel
Docetaxel
Name the two anti-metabolite nucleoside agents

How do they work?
Cytarabine
5-Fluorouracil
They are pyrimidine analogs that are incorporated into DNA and cause cell cycle arrest and apoptosis
Name the antimetabolite folic acid antagonist
How does this drug work?
Methotrexate

Inhibits dihydrofolate reductase, synthesis of nucleosides and DNA synthesis
Name the hormonal agents used in cancer therapy
Leuprolide
Tamoxifen
Anastrozole
How does Leuprolide work?
Acts as a GnRH agonist, acting on the pituitary gland - this causes decreased secretion of LH and FSH and therefore decreased estrodial and testosterone
How does anastrozole work?
Inhibits aromatase and the conversion of androgens to estrogens
How does Tamoxifen work?
Estrogen antagonist in the breast
Estrogen agonist in the endometrium
Raloxifene is another serm used to prevent the risk of osteoporosis and breast cancer in post menopausal women. What is its MOA?
Antagonist in the breast and uterine
Agonist in the bone
Name the 2 anthracycline agents

How do these agents work?
Doxorubicin
Daunorubicin

Intercalate DNA - cause reactive oxygen species
Back to alkylating agents
What side effect is a particular concern with carmustine?
Pulmonary Fibrosis
What side effect is of particular concern with Chlorambucil?
Stevens- Johnsons Syndrome
What is a major contraindication of all platinum agents?
Renal insufficiency
Which chemotherapy agents can cause peripheral neuropathy?
Platinum agents (Cisplatin, Carboplatin, Oxaliplatin)
Vincristine
Vinblastine
Paclitaxel
What side effect is of particular concern with cisplatin?
Ototoxicity
Which class of chemotherapy agents is associated with anaphylaxis?
Platinum agents
What side effect is particularly concerning with irinotecan?
Severe, life threatening diarrhea
What side effect is particularly concerning with Vincristine?
Paralytic ileus (secondary to neurologic toxicity) - all patients should be on a prophylactic bowel regimen
What side effects are particularly concerning with Paclitaxel?
Cardiac rhythm abnormalities
Mucositis, stomatitis (Severe)
What side effect is particularly concerning with docetaxel?
Significant fluid retention
What side effect is particularly concerning with cytarabine IV and IT?
IV: Cytarabine syndrome (myalgia, bone pain, rash, conjunctivitis, fever)

IT: Chemical arachnoiditis (N/V, Headache, Fever), Neurotoxicity
Which chemotherapy agents can cause neurotoxicity?
IT Cytarabine
Methotrexate
What are the primary side effects of 5-Fluorouracil?
Hand and foot syndrome (chemotherapy induced acral erythema)
N/V, Diarrhea, Mucositis, Stomatitis
Bone marrow suppression
5-FU (Adrucil) Med Pearl
Leucovorin increases effectiveness and decreases toxcitiy
Which chemotherapy agents are significant for renal toxicity?
Cisplatin
Methotrexate
Which chemotherapy agents can cause stevens-johnson syndrome?
Chlorambucil
Methotrexate
Methotrexate has man primary side effects. Name them (6).
Renal damage
Heptatotoxicity
Neurotoxicity
Bone marrow suppression
Severe diarrhea and ulcerative stomatitis
Stevens-Johnson Syndrome
When do you want to give leucovorin rescure in regards to methotrexate?
24 hours after dosing to limit toxicity - Not concurrently
What are the primary side effects of leuprolide?
Abnormal menses
Exacerbation of endometriosis
Hot flashes/sweats
Decrease bone mineral density
Spinal cord compression
Urinary tract obstruction
Tumor flare
Depression, mood disturbances
***Monitor LH, FSH, testosterone, estrogen levels
What are the primary side effects of anastrazole?
Decreased bone mineral density
Mood disturbances
Hyperlipidemia (monitor lipid panel)
What are the primary side effects of Tamoxifen?
Altered menses
Mood disturbances
Hot flashes
Thromboembolic events
Increased risk of endometrial cancer (annual gynecologic exams)
What is a contraindication to anthracycline therapy?
Pre-existing myocardial insufficiency or arrhythmia
What are the primary side effects of anthracyclines (doxorubicin, daunorubicin)?
Cardiotoxicity
Severe bone marrow suppression
Red coloration of body fluids
What additional side effect is caused by Doxorubicin?
Secondary leukemias
Which chemotherapy agents can cause secondary leukemias?
Chlorambucil
Carmustine
Doxorubicin
***Targeted and Biologic Agents***
Monoclonal Antibodies
EGFR Inhibitors
VEGF Inhibitors
Tyrosine Kinase Inhibitors
Name the 4 Monoclonal antibodies
Alemtuzumab (Campath)
Ibritumomab (Zevalin)
Rituximab (Rituxan)
Tositumumab (Bexxar)
What is the common toxicity between all the monoclonal antibodies?
Infusion-related reactions
What is the solution to this?
Pre-medicate with diphenhydramine and acetaminophen
What toxicity is common to 3 of these medications (and which 3)?
Alemtuzumab
Ibritumomab
Tositumumab
Myelosuppresion
Describe the mechanisms of each of these monoclonal antibodies
Alemtuzumab - targets CD52 on cancer cells promoting cell mediated lysis
Ibritumomab - Attaches to malignant B cell (with radioactive isotope) causing cell death through radiation
Continued
Rituximab - Binds to CD20 and induces apoptosis
Tositumumab - CD20 antibody linked to radioactive isotope
What is each monoclonal antibody used for?
Alemtuzumab (B-cell CLL)
Irbritumomab (CD-20 positive B-cell NHL - Used in combination with rituximab
Rituxumab (CD 20 positive, B-cell NHL, RA)
Tositumumab (CD 20 positive, follicular, NHL refractory to rituximab
EGFR Inhibitors (Cetuximab, Erlotinib, Lapatinib, Trastuzumab)
Which two have infusion related reactions that need pretreatment?
Cetuximab
Trastuzumab
Which can cause a severe rash?
Cetuximab
Erlotinib
Lapatinib
Which agent causes heptatotoxicity and QT prolongation?
Lapatinib
Which agent causes cardiotoxicity and myelosuppression?
Trastuzumab
- Do not use with anthracyclines
What is each EGFR inhibitor used for?
Cetuximab - EGFR positive head, neck or colorectal cancer
Erlotinib - NSCLC, advanced unresectable pancreatic cancer
Lapatinib - Metatstatic breast cancer with HER-2 expression
Trastuzumab - Metastatic breast cancer with HER-2 expression
VEGF Inhibitors (Bevacizumab, Sunitinib, Sorafenib)
What side effect is common between these agents?
Hypertension
Which agent can cause thromboembolic events and bleeding?
Bevacizumab
Which agent can cause heart failure?
Sunitinib
Which agent can cause hand-foot syndrome?
Sorafenib
What is each agent used for?
Bevacizumab (Avastin) - metastatic colorectal cancer, NSCLC, HER-2 negative breast cancer, glioblastoma, metastatic renal cell carcinoma
Sunitinib - Gastrointestinal stromal tumor, Renal cell carcinoma
Sorafenib - Advanced renal cell carcinoma, unresectable hepatocellular carcinoma
Tyrosine Kinase Inhibitors (Dasatinib, Imatinib)
What side effect is common among tyrosine kinase inhibitors?
Fluid retention
What side effect is particular to Dasatinib?
Myelosuppression
What side effect is particular to Imatinib?
Stevens-Johnson Syndrome
Supportive care: What is the use of benodiazepines, aprepitant?
Benzo - anticipatory N/V
Aprepitant - Severe N/V (cisplatin, cyclophosphamide, doxorubicin)
What is given for less severe cases of nausea?
Prochlorperazine
Metoclpramide
When does the lowest concentration of WBC typically occur?
1-2 weeks after chemotherapy administration
What are the values for neutrophils (Normal, Mild, Moderate, Severe)?
3,000-7,000
500-1000
100-500
<100
MOA of ondansetron, aprepitant, metoclopramide, corticosteroids
ondansetron - 5HT3 antagonist
aprepitant - NK1 antagonist
metoclopramide - dopamine antagonist
corticosteroids - potentiate anti-emetic properties of 5HT3 antagonists - can use as single agents in mild cases
Side effects of metoclopramide
Dystonic reactions (EPS)
Sedation
Filgastrim brand name
PEG-Filgastrim brand name
Sargramostim brand name
Neupogen
Neulasta
Leukine
What are some common side effects among the colony stimulating factors?
Bone pain
Hypertension
Hypersensitivity reactions
Difference between Neupogen/Neulasta and Leukine
Neupogen/Neulasta are neutrophil specific
Leukine stimulates all WBCs except lymphocytes