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22 Cards in this Set

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What is a chemotherapy cytoprotectant?
An agent providng protectioin against the toxic effects of chemotherapeutic agents
An ideal protectant is something that is very easy to administer and does not have side effects and does not interfere with the MOA of the chemo.

Dexrazoxane
Leucovorin
Mesna
Ifosfamide is given.
Patient wants to know more about the bladder toxicity.
What is the offending agent?
MOT?
Onset of Toxicity?
Clinical findings?
The ifosfamide is the offending agent.
The mechanism of toxicity is the inactive metabolite acrolein which binds to the bladder lining causing hemorrhagic cystitis
Onset is within days of receiving ifosfamide.
Clinical findings are hematuria
Describe the mechanism of toxicity of Ifosfamide.
Ifosfamide is broken down into active metabolites (nephrotoxin, neurotoxin) and inactive metabolite (acrolein - hemorrhagic cystitis)
What is another agent that can cause hemorrhagic cystitis?
Cyclophosphamide - Incidence is less because it produces acrolein at a lower degree.
What agent is used to prevent bladder toxicity?
What is its MOA?
What is its ROA?
Mesna
Binds to and inactivates acrolein
IV (with ifosfamide) or PO
Don't need to know dose of Mesna
What patients are candidates to receive Mesna?
All Ifosfamide and High Dose Cyclophosphamide patients (don't have to know what a high dose is - she will tell us high or low dose)
List 2 monitoring parameters that you would assess while the patient is on this regimen?
Urinary voiding, urinalysis, I/Os
Renal Function
CBC
What agent causes heart toxicity?
What is the MOA?
What is the onset of toxicity?
Doxorubicin (Anthracycline antibiotic)
This agent forms iron-dependent oxygen free radicals due to anthracycline-iron complexes
The myocardium is more susceptible to this due to lower levels of defensive enzymes capable of detoxifying these radicals.
Early onset - within hours to days (EKG changes - arrhythmmias, qt prolongation, transient/reversible, self limiting once patient is off medication)
Late onset - several years post administration (Heart Failure)
What is the lifetime doxorubicin dose?
450-550 mg/m^2
What are the 4 risk factors for cardiac toxicity?
Total cumulative dose
Cardiovascular disease
Combination cardiotoxic therapy (Probably don't want to give Doxorubicin (an anthracycline) with Herceptin - Breast cancer)
Age > 65 years or Pediatrics
What imaging study should be used to monitor heart function?
ECHO - To find out LVEF (>50 % is normal)
If you are below this, you probably wouldn't be receiving an anthracycline antibiotic
What clinical finding would you expect to find in a patient who experience heart toxicity?
Sign of reduced LVEF based on imaging studies
SOB
Tachycardia, Tachypnea
Fluid Retention/Edema
Poor perfusion
What pharmacologic agent is used to prevent cardiac toxicity?
Dexrazoxane
What is its MOA?
What is the ROA?
Potent intracellular chelating agent that interferes with iron-mediated free radicals

IV 30 min prior to doxorubicin administration
Who is a candidate for dexrazoxane?
Can consider for use in adult patients approaching a Doxorubicin lifetime dose > 300 mg/m^2

FDA approved in women with metastatic breast cancer approaching a Doxorubicin lifetime dose > 300 mg/m^2 (Goal cannot be to cure cancer, just to manage. You will never rid them of all their tumors)

This is very controversial. It is not very well used. The guidelines only suggest using it in the above scenario's. It may inhibit the anti-tumor effect of anthracycline's.
What do you want to monitor for when a person is on Dexrazoxane?
Cardiac function (LVEF)
CBC
LFT's (Metabolized via liver)
What agent causes kidney toxicity?
What is the mechanism of action?
Cisplatin

Direct tubular damage t othe nephron
What is the onset of toxicity?
Is this reversible?
Acute - hours to days
Chronic - weeks

Sometimes reversible if you give them aggressive hydration/electrolytes
Sometimes it is not reversible however.
The other major nephrotoxic chemotherapy agent.
What is its mechanism of toxicity?
Methotrexate - Can cause acute kidney injury - acute damage to the proximal tubule and also due to its metabolites that precipitate in the kidney and cause obstruction.
What clinical findings would you expect to find in a patient who experienced kidney toxicity?
Increased SCr
Electrolyte abnormalities
I/Os - Decreased urine output
What supportive care agent must be included in a patient taking cisplatin or methotrexate to minimize the risk of kidney toxicity?
Normal Saline Hydration
What lab parameters should you monitor while a patient is on one of these regimens?
SCr
K
Mg