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69 Cards in this Set

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Extravasation management:
doxorubicin, idarubicin, daunorubicin, epirubicin
Apply COLD compresses

dexrazoxane 1000mg/m2 over 1-2hr within 6hr. Give 1000mg/m2 on d2 and 500mg/m2 d3. Max BSA=2
Extravasation management:
etoposide, vincristine, vinblastine, vinorelbine
hyaluronidase 150units/mL injected locally. May repeat injections q2-3 hr x 3

Apply WARM compresses 15min q6h x 48h
Extravasation management:
cisplatin, mechlorethamine
sodium thiosulfate: 4ml of 10% solution with 6ml sterile water.
cisplatin= 2ml for each 100mg
mechloreth= 2ml for each 1mg

Apply COLD compresses
Extravasation management:
dactinomycin, melphalan, mitomycin-C, paclitaxel, all other vesicants
Apply COLD compresses

mitomycin: 50% DMSO saturated gauze q6h x 7d
Extravasation management:

irritants
Apply COLD compress for 15 min q6h x 48h
DLT for alkylating agents
myelosuppression
Cytotoxic effects of alkylating agents:
1)inhibition of DNA rep & transcription
2)mispairing of DNA
3)strand breakage
Mesna dosing schema w/ Ifex
20% before Ifex and 20% at 4h and 8h post-Ifex
Renal dysfunction dose modification meds
bleomycin
capecitabine
carboplatin
cisplatin
cyclophosphamide
etoposide
fludarabine
hydroxyurea
ifosfamide
methotrexate
pentostatin
streptozocin
topotecan
Hepatic dysfunction dose modification meds
anthracyclines
docetaxel
etoposide
imatinib
ixabepilone
lapatinib
paclitaxel
thiotepa
vinblastine
vincristine
vinorelbine
Nitrosourea dose limiting toxicity
myelosuppression- DELAYED (nadir approx 4wk)

**very lipophilic- crosses BBB
cisplatin toxicities
nephrotoxicity leading to lypomagnesemia and hypokalemia, myelosuppression, ototoxicity, peripheral neuropathies
carboplatin toxicities
myelosuppression (thrombocytopenia)
oxaliplatin toxicities
peripheral neurotoxicity exacerbated by cold, minimal nephrotoxicity & ototoxicity
anthracycline dose limiting toxicity
myelosuppression (leukopenia), cardiac toxicity
mitoxantrone dose limiting toxicity
leukopenia and cardiac toxicity. Urine may turn blue for 24-48 hr after dose.
topotecan dose limiting toxicity
leukopenia and thrombocytopenia. Also, increased liver enzymes.
irinotecan dose limiting toxicity
diarrhea

may give loperamide 4mg to start, then 2mg q2h
vincristine maximum dose
2mg weekly
vinblastine and vinorelbine dose limiting toxicity
leukopenia and thrombocytopenia
vincristine dose limiting toxicity
neurologic toxicity, constipation, paralytic ileus (paralysis of intestine)
docetaxel- use in severe hepatic impairment?
Contraindicated in severe hepatic impairment. AST/ALT >1.5x ULN or AlkPhos >2.5x ULN
paclitaxel dose limiting toxicity
leukopenia. Also hypersensitivity, peripheral neuropathies, alopecia, mucositis
docetaxel dose limiting toxicity
leukopenia. Also hypersensitivity, peripheral neuropathies, alopecia, peripheral edema
dexamethasone reason it's given pre- and post- docetaxel?
to prevent fluid retention
ixabepilone dose limiting toxicity
leukopenia and peripheral neuropathies. Also, anemia, thromboctyopenia, diarrhea, alopecia
ixabepilone premeds
H1 and H2- no dex needed
antimetabolite mechanism
1) compete for binding sites on enzymes
2) incorporates directly into DNA or RNA
dacarbazine/temozolamide differences
dacarbazine is a prodrug activated in liver. Temozolamide activated at physiological pH.
Dacarbazine has +++ N/V, but temozolamide has +++ myelosuppression. Tem + rad = watch for PCP.
MTX, pemetrexed dose limiting toxicity
leukopenia & thrombocytopenia

Renal tubular necrosis with high dose therapy= vigorous hydration and alkylation of urine to decrease kidney damage
MTX levels increased by (3 methods)
1) highly protein bound drugs
2) NSAIDS that compete for renal excretion
3) Vit C acidifies urine and may increase levels
purine analog (thioguanine, mercaptopurine) dose limiting toxicity
leukopenia & thrombocytopenia
mercaptopurine & allopurinol?
mercaptopurine is metabolized by xanthine oxidase. Significant dose reduction required if given with allopurinol
cytarabine, gemcitabine dose limiting toxicities
leukopenia & thrombocytopenia
high dose cytarabine premeds
allopurinol to prevent TLS and dex eye drops to prevent conjunctivitis
5FU dose limiting toxicities
(bolus) leukopenia & thrombocytopenia
(ci) hand-foot & diarrhea
capecitabine dose limiting toxicity
hand-foot syndrome, diarrhea
azacytadine & decitabine dose limiting toxicity
myelosuppression
gemtuzumab dose limiting toxicity
severe leukopenia
gemtuzumab premeds
Diphenhydramine 50mg PO + APAP 650mg PO and APAP q4h x at least 2 more doses
HER2 grading scale & appropriateness for trastuzumab
scale = 0-3

score of 2-3 = candidate for trastuzumab
erlotinib/ gefitinib interaction w/ warfarin
CYP3A4 substrate = increased warfarin levels= increased INR
imatinib/ dasatinib/ nilotinib dose limiting toxicity
myelosuppression -leukopenia & thrombocytopenia
imatinib / phenytoin interaction
decreased imatinib levels
imatinib/ cimetadine & itraconazole interaction
increase imatinib levels
bortezomib dose limiting toxicity
thrombocytopenia or neuropathies
bleomycin cumulative dose toxicity
pulmonary fibrosis at doses > 400 units
CYP3A inducers
dexamethasone
phenytoin
carbamazepine
phenobarbital
rifampin
st john's wort
CYP3A inhibitors
aprepitant
azole antifungals
macrolides
grapefruit juice
tamoxifen
verapamil
UGT1A1 deficiency
increase of SN-38
DPD deficiency
increase of 5FU
TPMT deficiency
increase of mercaptopurine or thioguanine
MTX inhibits
dihydrofolate reductase (DHFR)
5FU inhibits
thymidylate synthase (TS)
anthracyclines hepatic dose modification-
bilirubin 1.2-3
decrease 50%
bilirubin 3.1-5
decrease 75%
bilirubin >5
omit
imatinib hepatic dose
bilirubin >3x ULN
hold until <1.5x ULN
vinca hepatic dose
bilirubin 1.5-3
50% decrease
bilirubin 3.1-5
omit
docetaxel hepatic-
bilirubin > ULN
omit
AST or ALT >1.5 ULN and
AlkPhos > 2.5 ULN
omit
etoposide- hepatic dosing
bilirubin 1.5-3
50% decrease
bilirubin >3.1
omit
bleomycin renal dosing
CrCl= 30-60, 25%-50% dec
CrCl= 10-30, 25%-50% dec
CrCl <10, 50% dec
capecitabine renal dosing
CrCl= 30-50, 25% dec
CrCl <30, omit
cisplatin renal dosing
use w/caution CrCl <50
cyclophosphamide renal dosing
renal failure = 25% dec
etoposide renal dosing
CrCl = 15-50, dec 25%
fludarabine, hydroxyurea renal dosing
use w/ caution CrCl < 60
ifosfamide renal dosing
CrCl = 10-50, dec 25%
CrCl < 10, dec 50%
MTX renal dosing
approx 80, 25% dec
approx 60, 37% dec
approx 50, 44% dec
< 50, omit
streptozocin renal dosing
renal failure= 50-75% dec
topotecan renal dosing
CrCl 20-39, 50% dec
CrCl < 20, omit