Pharm: Antineoplastic Agents - Toxicities

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TOXICITY: BM SUPP, MUCOSAL TOX, NEUROTOX (N/V,AMS, SEIZURES, PN), EXTRAVASATION FROM INJECTION SITE (VESICENT, ULCERATIONS), PULMONARY TOX, VENO-OCCLUSIVE DZ OF LIVER (TOXIC INJURY TO SINUSOIDAL CAPILLARIES --> OBSTRUCTION OF SMALL HEPATIC VEINS), AMENORRHEA / AZOSPERMIA ; LEUKEMOGENESIS, PREGNANCY: TERATOGENIC!

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; ALKYLATING AGENTS

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TOXICITY: CARDIAC (CHF), HEPATIC VOD, HEMORRHAGIC CYSTITIS, SIADH, IV HYDRATION + MESNA (TO DECR. RISK) CONJUGATES / INACTIVATES ACROLEIN, NEPHROTOX, BLADDER CANCER (+ CLASS TOXICITIES)

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NITROGEN MUSTARDS ; CYCLOPHASPHAMIDE

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TOXICITY: CARDIAC (CHF), HEPATIC VOD, HEMORRHAGIC CYSTITIS, SIADH, IV HYDRATION + MESNA CONJUGATES / INACTIVATES ACROLEIN, NEPHROTOX, BLADDER CANCER (+ CLASS TOXICITIES) (WORSE NEUROTOX, NEPHROTOX, PLATELET SUPPRESSION, UROTHELIAL DAMAGE - USED WITH MESNA TO DECR. RISK)

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; ISOSFAMIDE

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TOXICITY: PN, RENAL TOX, HEARING LOSS

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PLATINUM ANALOGS ; CISPLATIN

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TOXICITY: MYELOSUPPRESSION, RENAL (LESS LIKELY THAN CISPLATIN), PN, HEPATIC VOD

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; CARBOPLATIN

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TOXICITY: NEUROTOX

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; OXALIPLATIN

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TOXICITY: ACUTE: MYELOSUPPRESSION, MUCOSITIS, STOMATITIS, DIARRHEA, RASH (SEVERE), NEUROTOX (HIGH-DOSE - PARALYSIS, PALSY, SEIZURE, COMA) ; NEUROTOX (INTRATHECAL - ARACHNOIDITIS AND OTHER CNS TOX) ; PNEUMONITIS (ANY TIME, ANY DOSAGE) ; DELAYED: NEPHROTOX (PPT IN RENAL TUBULES), HEPATOTOX (CUMULATIVE, PROGRESSIVE), DEMYELINATING ENCEPHALOPATHY (USU. WITH RADIATION / CHEMO) ; IMPAIRED INFERTILITY (DEFECTIVE OOGENESIS OR SPERMATOGENESIS), OPPORTUNISTIC INFECTIONS, SECONDARY LYMPHOMA (CAN USE LEUCOVORIN RESCUE TO "RESCUE" HOST TOXICITY BUT DOES NOT REVERSE NEUROTOX)

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FOLATE ANTAGONISTS ; METHOTREXATE

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TOXICITY: GI TOX (N/V, STOMATITIS, MUCOSITIS, ULCERATIONS THRUOUT GI TRACT, DIARRHEA, MYELOSUPPRESSION (MARKED WITH BOLUS-DOSE REGIMENS), NEUROTOX (CNS), ALOPECIA, HAND-FOOT SYNDROME ** (PALMAR-PLANTAR ERYTHEMA DESQUAMATION, PAIN AND SENSITIVITY TO TOUCH), CORONARY ARTERY VASOSPASM (DURING OR SHORTLY AFTER INFUSION) - ACUTE CHEST PAIN WITH EKG EVIDENCE OF ISCHEMIA

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FLUROPYRIMIDINES ; FLUORORURACIL (5-FU)

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TOXICITY: MYELOSUPPRESSION: ACUTE SEVERE LEUKOPENIA, THROMBOCYTOPENIA, ANEMIA WITH MEGALOBLASTIC CHANGES ; MUCOSITIS (N/V), RASH, ALOPECIA, CEREBELLAR TOXICITY (HIGH DOSE OR INTRATHECAL - ATAXIA, SLURRED SPEECH)***, CEREBRAL TOX (HIGH DOSE OR INTRATHECAL (SEIZURES,COMA)***

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DEOXYCYTIDIDINE ANALOGS ; CYTARABINE (ARA-C)

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TOXICITY: MYELOSUPPRESSION, HEPATOTOX, GI SYMPTOMS, RISK OF INFECTION, INCR. RISK OF TOXICITY IN PT'S WITH TPMT DEFICIENCY

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PURINE ANALOGS ; 6-MERCAPTOPURINE (6-MP)

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TOXICITY: MYELOSUPPRESSION (MAJOR), MUCOSITIS, N/V/D, NEUROTOX (HIGH DOSE - CNS,PN) ; EXTRAVASATION (SEVERE LOCAL VESICANT EFFECTS) ; RADIATION RECALL: SEVERE LOCAL SKIN RXN IN IRRADIATED TISSUE) ; LEUKEMOGENIC (MDS) ; CARDIOMYOPATHY (MOST DISTINCTIVE TOX) - ACUTE: ECG CHANGES, ARRYTHMIA, PERICARDITIS - MYCARDITIS SYNDROME (SEVERE CONDUCTION DISTURBANE AND CHF), MYOCARDITIS ; CHRONIC: CUMULATIVE, IRREVERSIBLE, PROGRESS TO CHF

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; DAUNORUBICIN

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TOXICITY: MYELOSUPPRESSION (MAIN DOSE-LIMITING TOX), LESS NEUROTOX THAN VINCRISTINE ; FATAL IF GIVEN INTRATHECALLY!!

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MICROTUBULE INHIBITORS ; VINBLASTINE (VINKA ALKALOIDS)

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TOXICITY: NEUROTOX (MAIN DOSE-LIMITING TOX), PN, AUTONOMIC NERVOUS SYSTEM DYSFUNCTION, SIADH, LIMITED MYEOSUPPRESSION ; FATAL IF GIVEN INTRATHECALLY!!

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; VINCRISTINE (VINCA ALKALOIDS)

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TOXICITY: MYELOSUPPRESSION WITH NEUTROPENIA (MAJOR) ; PN, GI, HYPERSENSITIVITY RXNS (SERIOUS RXNS, REQUIRE PREMEDICATION)

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; PACLITAXEL (TAXANES)

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TOXICITY: MYELOSUPPRESSION WITH NEUTROPENIA (MAJOR) ; PN, GI, HYPERSENSITIVITY RXNS (SERIOUS RXNS - DOSE-RELATED PROGRESSIVE PERIPHERAL EDEMA, PLEURAL AND PERITONEAL FLUID, AND PULMONARY EDEMA)

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; DOCETAXEL (TAXANES)

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TOXICITY: MYELOSUPPRESSION (DOSE-LIMITING TOX - SIGNIFICANT HEME TOX IN COMBO WITH OTHER AGENTS SUCH AS CISPLATIN) ; SEVERE DIARRHEA (DOSE-LIMITING AND MOST COMMON TOX) ; MUCOSITIS, N/V, ALOPECIA

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TOPOISOMERASE I INHIBITORS ; IRINOTECAN (CAPTOTHECINS)

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TOXICITY: MYELOSUPPRESSION (DOSE-LIMITING TOX), N/V, MUCOSITIS, ALOPECIA, SECONDARY ACUTE LEUKEMIA

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TOPOISOMERASE II INHIBITORS ; ETOPOSIDE (EPIPODOPHYLLOTOXINS)

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TOXICITY: DIARRHEA, NAUSEA, VOMITING (USUALLY EASILY CONTROLLED) ; FLUID RETENTION (MAY LEAD TO EDEMA AND PERI-ORBITAL SWELLING), MYELOSUPPRESSION (DOSE-RELATED, SIGNIFICANT OCCURS INFREQUENTLY, INCIDENCE IS HIGHER IN PT'S WITH ADVANCED CML AND Ph+ ALL) ; RASH (MAY BE MANAGED WITH TOPICAL OR SYSTEMIC GLUCOCORTICOIDS, DOSE REDUCTION, TX INTERRUPTION) ; HEPATOTOX

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BCR-ABL KINASE INHIBITORS ; IMATINIB (GLEEVAC)

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TOXICITY: DIARRHEA, NAUSEA, VOMITING (USUALLY EASILY CONTROLLED) ; FLUID RETENTION (MAY LEAD TO EDEMA AND PERI-ORBITAL SWELLING - MAY CAUSE PLEURAL EFFUSIONS), MYELOSUPPRESSION (DOSE-RELATED, SIGNIFICANT OCCURS INFREQUENTLY, INCIDENCE IS HIGHER IN PT'S WITH ADVANCED CML AND Ph+ ALL) ; RASH (MAY BE MANAGED WITH TOPICAL OR SYSTEMIC GLUCOCORTICOIDS, DOSE REDUCTION, TX INTERRUPTION) ; HEPATOTOX ; PROLONGED QT INTERVAL

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; DASATINIB (SPRYCEL)

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TOXICITY: DIARRHEA, NAUSEA, VOMITING (USUALLY EASILY CONTROLLED) ; FLUID RETENTION (MAY LEAD TO EDEMA AND PERI-ORBITAL SWELLING), MYELOSUPPRESSION (DOSE-RELATED, SIGNIFICANT OCCURS INFREQUENTLY, INCIDENCE IS HIGHER IN PT'S WITH ADVANCED CML AND Ph+ ALL) ; RASH (MAY BE MANAGED WITH TOPICAL OR SYSTEMIC GLUCOCORTICOIDS, DOSE REDUCTION, TX INTERRUPTION) ; HEPATOTOX ; PROLONGED QT INTERVAL

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; NILOTINIB (TASIGNA)

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TOXICITY: DIARRHEA, ACNEIFORM RASH, ANOREXIA, FATIGUE (MC) ; RARE BUT SERIOUS: SJS/TEN, INTERSTITIAL LUNG DISEASE, HEPATIC FAILURE, RENAL FAILURE, GI PERFORATION, ARTERIAL THROMBOSIS, MICROANGIOPATHIC HEMOLYTIC ANEMIA, HAND-FOOT SKIN RXN, CORNEAL PERFORATION/ULCERATION

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EPIDERMAL GROWTH FACTOR INHIBITORS ; ERLOTINIB (TARCEVA)

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TOXICITY: DIARRHEA, ACNEIFORM RASH - SIMILAR TO ERLOTINIB ; ADDITIONALLY: CARDIOPULMONARY ARREST, INTERSTITIAL LUNG DISEASE, HYPOMAGNESEMIA, ANAPHYLACTOID RXN DURING INFUSION

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; CETUXIMAB (ERBITUX)

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TOXICITY: CARDIOMYOPATHY (MOST SERIOUS TOXICITY) - UNDERLYING CARDIAC DISEASE SHOULD BE RULED OUT PRIOR TO STARTING THERAPY ; CLINICAL FOLLOW-UP THEREAFTER ; INFUSION RXNS (FEVER, CHILLS, NAUSEA, DYSPNEA, RASH - TYPICAL OF MONOCLONAL ANTIBODY THERAPY), INTERSTITIAL LUNG DISEASE

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HER2 / NEU INHIBITORS ; TRASTUZUMAB (HERCEPTIN)

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TOXICITY: DIARRHEA AND ACNEIFORM RASH - SIMILAR TO OTHER TYROSINE KINASE INHIBITOR ; HEPATOTOX, PULMONARY TOX, QT PROLONGATION

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; LAPATINIB (TYKERB)

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TOXICITY: SEVERE HEMORRHAGE: GI, PULMONARY (NSCLC PTS), INTRACRANIAL (GLIOBLASTOMA PTS) ; POOR WOUND HEALING / WOULD DEHISCENCE ; HTN ; ARTERIAL THROMBOEMBOLIC EVENTS ; PROTEINURIA (ASYMPTOMATIC) ; GI PERFORATION (MOST FREQUENTLY OBSERVD IN PT'S WITH OVARIAN Ca) ; INFUSION RXNS (UNCOMMON) ; FATIGUE, HYPOTHYROIDISM, DIARRHEA, BONE MARROW SUPPRESSION ; CHF, HAND-FOOT SYNDROME

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ANGIOGENESIS INHIBITORS ; BEVACIZUMAB (AVASTIN)

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TOXICITY: SEVERE HEMORRHAGE: GI, PULMONARY (NSCLC PTS), INTRACRANIAL (GLIOBLASTOMA PTS) ; POOR WOUND HEALING / WOULD DEHISCENCE ; HTN ; ARTERIAL THROMBOEMBOLIC EVENTS ; PROTEINURIA (ASYMPTOMATIC) ; GI PERFORATION (MOST FREQUENTLY OBSERVD IN PT'S WITH OVARIAN Ca) ; INFUSION RXNS (UNCOMMON) ; FATIGUE, HYPOTHYROIDISM, DIARRHEA, BONE MARROW SUPPRESSION ; CHF, HAND-FOOT SYNDROME

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; SUNITINIB (SUTENT)

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TOXICITY: NEUTROPENIA (SEVERE THROMBOCYTOPENIA), HYPOTENSION, QT PROLONGATION, PN, PULMONARY TOX, HYPER-HYPOGLYCEMIA IN PT'S RECEIVING ORAL HYPOGLYCEMIA AGENTS

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PROTEASOME INHIBITOR ; BORTEZOMIB

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TOXICITY: POSSIBLE SEVERE INFUSION RXNS (FIRST-DOSE), SEVERE SKIN RXNS, TUMOR LYSIS SYNDROME, REACTIVATION OF LATENT INFECTION, OPPORTUNISTIC INFECTIONS

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ANTI-CD20 MONOCLONAL ANTIBODY ; RITUXIMAB