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18 Cards in this Set

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Methotrexate can cause renal toxicity, but if we keep the urine _____ during therapy, it can be largely avoided.
>8.0 (sufficiently alkaline, essentially)
High doses of cytarabine (anything over 1g/m^2) can cause diff side effects like:
cerebellar dysfunction
tear-duct dysfunction --> conjunctivitis
Methotrexate has a _____ dose range. _____ does require rescue with ______ and urine ______.
Huge.
high
leucovorin, alkalinization
When leucovorin is used to rescue, which cells are you rescuing? What does this mean re: timing?

There is a _____ between starting methotrexate and starting leucovorin.
all cells, tumor and normal.

That to get a therapeutic kill ratio, our timing has to be good.

delay
Should you guess based on half-life how long we should provide leucovorin?

When should we stop leurovorin?
no. Other factors are affecting methotrexate clearance.

when we physically see (in real time, not guessing) when the mtx lvls have lowered to safe.
What can alter MTX clearance?

The _____ pocket of fluid, the ____ the delay in MTX clearance.
NSAIDS

renal function decrease

third-spacing: finds small pockets of fluid, and just sits in there.... "depot effect" it won't necessarily be causing bad effects in there, but we should be aware that it may be leaking out.
- key point: just draw the levels to know when to stop.
- bigger, longer
Renal toxicity
Mucositis
Myelosupression
Infectious complications

- all possible side effects of?
MTX
What are 5 causative agents of renal toxicity?
**Cisplatin** - top of the list
Interleukin 2
HD Methotrexate
Mitomycin
Nitrosoureas
Which platinum-based compound can cause cross-linked DNA of kidney tubules?

Clinical effects?

How can this be prevented?
Cisplatin.

Mg, K wasting
decreased GFR
acute/chronic renal failure

hydration w/ normal saline
mannitol
prophylactic Mg
Bladder toxicity: hemorrhagic cystic is seen with which drug(s)?

How does this happen?

How can this be prevented?
cyclophosphamide
Ifosfamide
- sometimes HD methotrexate

direct toxicity, acrolein metabolite

hydration, mesna, bladder irrigation.
After 2-3 doses of ______ patients are at increased risk of what complication?

What percentage of this damage is reversible?
cerebellar toxicity, 70% reversible.
Ifosfamide can cause what type of CNS complications?

Vinca alkaloids?

Taxanes?
reversible encephalopathy

neuropathies in fingers, toes, loss of DTRs

does limiting paresthesias w/ stocking/glove distribution.
Ototoxicity is seen with....
Sx?
Cisplatin.

Loss of hearing in high frequency ranges
Acute Tinnitus, chronic hearing loss
Irreversible
Classic presentation for ______-caused cardiac toxicity is CHF-like stuff.
Anthracycline.
What is dexrazoxane?
chemoprotectant that might help lower free radical damage/heart damage.
________ based incidence of cardiac dysfunction is highly dependent on prior or concurrent doxorubicin exposure.
Trastuzumab (Herceptin)
TPMT is the major inactivation of which chemo agent?
Inactivation mut would mean what re: dosing?
Heterozygous? Homozygous?
6-MP

have to give someone less to avoid toxicity.

Both are reduced, but homozygous is waaaAAaay reduced. (90% dose reduction)
Are pharmacogenetics helpful in 6-MP treatment?
yes.