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69 Cards in this Set
- Front
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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 |
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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 |
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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 |
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Extravasation management:
dactinomycin, melphalan, mitomycin-C, paclitaxel, all other vesicants |
Apply COLD compresses
mitomycin: 50% DMSO saturated gauze q6h x 7d |
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Extravasation management:
irritants |
Apply COLD compress for 15 min q6h x 48h
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DLT for alkylating agents
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myelosuppression
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Cytotoxic effects of alkylating agents:
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1)inhibition of DNA rep & transcription
2)mispairing of DNA 3)strand breakage |
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Mesna dosing schema w/ Ifex
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20% before Ifex and 20% at 4h and 8h post-Ifex
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Renal dysfunction dose modification meds
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bleomycin
capecitabine carboplatin cisplatin cyclophosphamide etoposide fludarabine hydroxyurea ifosfamide methotrexate pentostatin streptozocin topotecan |
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Hepatic dysfunction dose modification meds
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anthracyclines
docetaxel etoposide imatinib ixabepilone lapatinib paclitaxel thiotepa vinblastine vincristine vinorelbine |
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Nitrosourea dose limiting toxicity
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myelosuppression- DELAYED (nadir approx 4wk)
**very lipophilic- crosses BBB |
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cisplatin toxicities
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nephrotoxicity leading to lypomagnesemia and hypokalemia, myelosuppression, ototoxicity, peripheral neuropathies
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carboplatin toxicities
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myelosuppression (thrombocytopenia)
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oxaliplatin toxicities
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peripheral neurotoxicity exacerbated by cold, minimal nephrotoxicity & ototoxicity
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anthracycline dose limiting toxicity
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myelosuppression (leukopenia), cardiac toxicity
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mitoxantrone dose limiting toxicity
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leukopenia and cardiac toxicity. Urine may turn blue for 24-48 hr after dose.
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topotecan dose limiting toxicity
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leukopenia and thrombocytopenia. Also, increased liver enzymes.
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irinotecan dose limiting toxicity
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diarrhea
may give loperamide 4mg to start, then 2mg q2h |
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vincristine maximum dose
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2mg weekly
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vinblastine and vinorelbine dose limiting toxicity
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leukopenia and thrombocytopenia
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vincristine dose limiting toxicity
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neurologic toxicity, constipation, paralytic ileus (paralysis of intestine)
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docetaxel- use in severe hepatic impairment?
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Contraindicated in severe hepatic impairment. AST/ALT >1.5x ULN or AlkPhos >2.5x ULN
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paclitaxel dose limiting toxicity
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leukopenia. Also hypersensitivity, peripheral neuropathies, alopecia, mucositis
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docetaxel dose limiting toxicity
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leukopenia. Also hypersensitivity, peripheral neuropathies, alopecia, peripheral edema
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dexamethasone reason it's given pre- and post- docetaxel?
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to prevent fluid retention
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ixabepilone dose limiting toxicity
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leukopenia and peripheral neuropathies. Also, anemia, thromboctyopenia, diarrhea, alopecia
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ixabepilone premeds
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H1 and H2- no dex needed
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antimetabolite mechanism
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1) compete for binding sites on enzymes
2) incorporates directly into DNA or RNA |
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dacarbazine/temozolamide differences
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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. |
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MTX, pemetrexed dose limiting toxicity
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leukopenia & thrombocytopenia
Renal tubular necrosis with high dose therapy= vigorous hydration and alkylation of urine to decrease kidney damage |
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MTX levels increased by (3 methods)
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1) highly protein bound drugs
2) NSAIDS that compete for renal excretion 3) Vit C acidifies urine and may increase levels |
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purine analog (thioguanine, mercaptopurine) dose limiting toxicity
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leukopenia & thrombocytopenia
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mercaptopurine & allopurinol?
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mercaptopurine is metabolized by xanthine oxidase. Significant dose reduction required if given with allopurinol
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cytarabine, gemcitabine dose limiting toxicities
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leukopenia & thrombocytopenia
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high dose cytarabine premeds
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allopurinol to prevent TLS and dex eye drops to prevent conjunctivitis
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5FU dose limiting toxicities
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(bolus) leukopenia & thrombocytopenia
(ci) hand-foot & diarrhea |
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capecitabine dose limiting toxicity
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hand-foot syndrome, diarrhea
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azacytadine & decitabine dose limiting toxicity
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myelosuppression
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gemtuzumab dose limiting toxicity
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severe leukopenia
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gemtuzumab premeds
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Diphenhydramine 50mg PO + APAP 650mg PO and APAP q4h x at least 2 more doses
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HER2 grading scale & appropriateness for trastuzumab
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scale = 0-3
score of 2-3 = candidate for trastuzumab |
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erlotinib/ gefitinib interaction w/ warfarin
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CYP3A4 substrate = increased warfarin levels= increased INR
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imatinib/ dasatinib/ nilotinib dose limiting toxicity
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myelosuppression -leukopenia & thrombocytopenia
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imatinib / phenytoin interaction
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decreased imatinib levels
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imatinib/ cimetadine & itraconazole interaction
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increase imatinib levels
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bortezomib dose limiting toxicity
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thrombocytopenia or neuropathies
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bleomycin cumulative dose toxicity
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pulmonary fibrosis at doses > 400 units
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CYP3A inducers
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dexamethasone
phenytoin carbamazepine phenobarbital rifampin st john's wort |
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CYP3A inhibitors
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aprepitant
azole antifungals macrolides grapefruit juice tamoxifen verapamil |
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UGT1A1 deficiency
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increase of SN-38
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DPD deficiency
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increase of 5FU
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TPMT deficiency
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increase of mercaptopurine or thioguanine
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MTX inhibits
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dihydrofolate reductase (DHFR)
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5FU inhibits
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thymidylate synthase (TS)
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anthracyclines hepatic dose modification-
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bilirubin 1.2-3
decrease 50% bilirubin 3.1-5 decrease 75% bilirubin >5 omit |
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imatinib hepatic dose
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bilirubin >3x ULN
hold until <1.5x ULN |
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vinca hepatic dose
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bilirubin 1.5-3
50% decrease bilirubin 3.1-5 omit |
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docetaxel hepatic-
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bilirubin > ULN
omit AST or ALT >1.5 ULN and AlkPhos > 2.5 ULN omit |
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etoposide- hepatic dosing
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bilirubin 1.5-3
50% decrease bilirubin >3.1 omit |
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bleomycin renal dosing
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CrCl= 30-60, 25%-50% dec
CrCl= 10-30, 25%-50% dec CrCl <10, 50% dec |
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capecitabine renal dosing
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CrCl= 30-50, 25% dec
CrCl <30, omit |
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cisplatin renal dosing
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use w/caution CrCl <50
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cyclophosphamide renal dosing
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renal failure = 25% dec
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etoposide renal dosing
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CrCl = 15-50, dec 25%
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fludarabine, hydroxyurea renal dosing
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use w/ caution CrCl < 60
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ifosfamide renal dosing
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CrCl = 10-50, dec 25%
CrCl < 10, dec 50% |
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MTX renal dosing
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approx 80, 25% dec
approx 60, 37% dec approx 50, 44% dec < 50, omit |
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streptozocin renal dosing
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renal failure= 50-75% dec
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topotecan renal dosing
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CrCl 20-39, 50% dec
CrCl < 20, omit |
