Flashcards in 00 Chemotherapy Deck (93):
What is the generic name of Cytoxan?
Cyclophosphamide (Alkylating agent)
What are the ADRs associated with Cytoxan (Cyclophosphamide)?
DLT: Myelosuppression. High dose: cardiotoxicity, hemorrhagic cystitis
What is a common class side effect/warning with alkylating agents?
What is the generic name of Ifex?
Ifosfamide (Alkylating agent)
What can be used to prevent hemorrhagic cystitis (with ifosfamide and cyclophosphamide)?
Hyper-hydration with NS to flush out ACROLEIN. The use of Mesna (Mesnex), continue a few hours after end of chemo
What is the generic name of Busulfex?
Busulfan (Alkylating agent)
What is a unique side effect of Busulfan?
"Busulfan tan", "Busulfan lung", seizures
What should be used with high dose Busulfan?
Antiepileptic prophylaxis (commonly with Keppra)
What is the generic name of Trexall, Rheumatrax?
What are some common side effects with Methotrexate?
Myelosuppression, hepatotoxic, nephrotoxic
What are the contraindications to MTX use?
Severe renal/hepatic dysfunction. Pregnancy (Category X)
What are some more common DDIs with MTX to keep an eye out for?
NSAID/Probenecid (increases [MTX] by competing for renal clearance)
What is one way to increase the excretion of MTX?
Urine alkalinization with NaHCO3 can increase renal clearance (especially w/ high dose)
What can be used for MTX-induced myelosuppression?
Leucovorin, start 24 hours after MTX administration
What is the generic name of Voraxaze?
Glucarpidase (used for MTX toxicity)
What is the generic name of Alimta?
What needs to be done before starting Alimta (Premetrexed)?
Daily folic acid and Q9 weeks of Vitamin B12 starting 1 week prior to reduce heme/GI toxicities
What is the generic name of Adrucil?
What are the side effects associated with 5-FU?
Myelosuppression (Bolus > IV), Hand-foot syndrome (IV > bolus), Diarrhea/mucositis (IV > Bolus)
What is the generic name of Xeloda?
Capecitabine (oral pro-drug of 5-FU)
How do the side effects of Xeloda compare to 5-FU?
Similar, except more GI SEs (diarrhea, N/V, mucositis)
What is the generic name of Kepivance?
Palifermin (IV drug to help manage Mucositis)
What is the generic name of Gemzar?
What is the generic name of Ara-C?
What are some toxicities with Ara-C (Cytarabine) to look out for?
High dose: Cerebullar toxicity (trouble walking straight, sitting up, writing), Conjuntivitis, N/V/mucositis
How is Purinethol (Mercaptopurine) metabolized?
By Xanthine oxidase (w/ allopurinol decrease dose by 50-75%)
What are the boxed warnings for Taxanes?
Myelosuppression, Hypersensitivity (w/i 2-3 mins, pre-med w/ steroids, H1RA, H2RA)
What is the generic name of Taxol?
Paclitaxel (Taxane) - contains Cremophor in formulation, this causes the hypersensitivity reactions
What is the generic name of Abraxane?
Paclitaxel Albumin-bound (Taxane) - no need for premeds, doesn't contain Cremophor
What is the generic name of Taxotere?
Docetaxel (Taxane) - Contains Polysorbate 80 instead of Cremophor, still causes hypersensitivity reactions
How does Paclitaxel compare to Albumin-bound Paclitaxel?
Paclitaxel has more hypersensitivity reactions and neutropenia, but albumin bound paclitaxel has more neuropathy
Whats important to remember about the Vinca Alkaloids?
Lethal if given intrathecally - Vesicant
How do the side effects of Vincristine and Vinblastine compare?
Vincristine causes more Neurotoxicity (peripheral and central) which causes constipation. Vinblastine causes more Myelosuppression
What is the generic name of Camptosar?
Irinotecan (Topoisomerase Inhibitor)
What is the DLT of Camptosar (Irinotecan)?
"I ran to the can": SEVERE diarrhea
What genetic test can help with Irinotecan?
UGT1A1 mutation increases toxicity
What pre-med if often given before Irinotecan?
Atropine to help with diarrhea. Once symptoms occur, other agents can be used (Loperamide, Lomitil, Octreotide)
What is the generic name of Toposar?
Etoposide (Topoisomerase II inhibitor)
What is a common ADR with Etoposide?
Infusion-related reaction (contains Polysorbate 80)
What is a warning associated with Cisplatin?
Nephrotoxicity!!! Anaphylaxis, Ototoxicity
What are the ADRs associated with Cisplatin?
N/V (acute and delayed). Myelosuppression
What can be done to help with the severe N/V caused by Cisplatin?
Antiemetics for highly emetogenic therapy (eg., Aprepitant + 5HT3 antagonist + Steroid)
What is the DLT with Paraplatin (Carboplatin)?
How do the toxicities of Carboplatin and Cisplatin compare?
Carboplatin has less Nephrotoxicity but greater Myelosuppression
What is the major ADR seen with Eloxatin (Oxaliplatin)?
Peripheral neuropathy (exacerbated by cold temperature)
What is a common class side effect of Anthracyclines?
Cardiotoxicity (max cumulative dose for all agents ~500mg/m2), vesicants, myelosuppression, cause urine to be red
What is the generic name of Adriamycin?
What is the generic name of Doxil?
Liposomal Doxorubicin (slightly less cardiotoxicity than Doxorubicin, but more HFS and stomatitis)
What is the generic name of Cerubidine?
What is the generic name of Zinecard?
Dexrazoxane (free-radical scavenger) - used to help prevent cardiotoxicity caused by anthracyclines
What is the generic name of Totect?
Dexrazoxane - indicated for the treatment of anthracycline-induced extravasation
What are some warnings with the use of Blenoxane (Bleomycin)?
Pulmonary fibrosis (esp. > 400 units), oxygen treatment (> 25%) can increase pulmonary toxicity
What are some warnings with the use of Nolvadex (Tamoxifen)?
(Anti-estrogen: SERM): Stroke, PE, uterine malignancy
What is a common ADR seen with anti-estrogen type chemotherapy treatments?
Menopausal symptoms (hot flashes), fluid retention, tumor flare, osteoporosis
What is the generic name of Arimidex?
Anastrozole (selective aromatase inhibitor): osteoporosis risk > than with Tamoxifen
What is the generic name of Gleevec?
Imatinib mesylate (TKI)
What are the ADRs associated with Gleevec (Imatinib mesylate)?
Myelosuppression. Fluid retention (CHF, LVEF)
What is the generic name of Tarceva?
What are the ADRs associated with Tarceva (Erlotinib)?
Acneiform rash, Diarrhea
What is the generic name of Nexavar?
What is the generic name of Sutent?
How do the ADRs of Sorafenib and Sunitinib compare?
Sunitinib has more HTN and stomatitis, but less HFS. Sorafenib also causes diarrhea
What is the generic name of Rituxan?
What are the warnings associated with Rituxan?
1st dose infusion reaction. PML
What is the generic name of Herceptin?
What are the warnings associated with Herceptin?
Cardiotoxicity. Pulmonary toxicity. Infusion-related reaction
What is the generic name of Erbitux?
What is the generic name of Avastin?
What are the warnings associated with Avastin?
Wound dehiscence (be careful if patients needs surgery)
What is the class warning for Immunomodulator Antiangiogenesis drugs?
Thromboembolism, recommend patients be on an anti-coagulant. Required to be in REMS program
What are the Immunomodulator Antiangiogenesis drugs?
Thalomid (Thalidomide), Revlimid (Lenalidomide)
What is the generic name of Velcade?
Bortezomib (Protease inhibitor)
What is a common ADR with Velcade (Bortezomib)?
What cancer type is Hydroxyurea (Hydrea) used for?
Heme, Solid tumors (also for SICKLE CELL)
What is the generic name of Torisel?
Temsirolimus (mTOR kinase inhibitor: only chemo for kidney cancer)
What is the generic name of Afinitor?
Everolimus (mTOR kinase inhibitor: also used for GVHD prophylaxis)
What is the generic name of Zofran?
Ondansetron (5HT3 Receptor Antagonist)
What is the generic name of Kytril?
Granisetron (5HT3 Receptor Antagonist)
What is the generic name of Sancuso?
Granisetron Patch (5HT3 Receptor Antagonist)
What is the generic name of Anzemet?
Dolasetron (5HT3 Receptor Antagonist) - least potent
What is the generic name of Aloxi?
Palonosetron (5HT3 Receptor Antagonist) - most potent
What is a common side effect of the 5HT3 receptor antagonists?
Constipation, QT prolongation
Which chemotherapy drugs have high emetic risk?
Cisplatin, Cyclophosphamide (these are the most common)
Which chemotherapy drugs have delayed onset of emesis?
Cisplatin, Carboplatin, Cyclophosphamide, and Doxorubicin
What is the generic name of Emend?
Aprepitant (NK-1 Receptor Antagonist)
How is Emend (Aprepitant) dosed?
3 days only! PO: 125mg day 1, 80mg day 2 and 3. OR given IV 150mg and nothing day 2 and 3
What is the generic name of Decadron?
How is Decadron (Dexamethasone) dosed?
With Aprepitant: 12mg day 1, 8mg day 2-4
W/o Aprepitant: 10-20mg day 1, 8mg day 2-4
What is the generic name of Reglan?
What is a side effect to look out for with Reglan (Metoclopramide)?
How are anti-emetic drugs usually dosed for a highly emetogenic chemotherapy regimen?
Day 1: Dexamethasone + Aprepitant (or Olanzapine) + 5HT3 antagonist (Palonosetron preferred). Day 2-3: Dexamethasone + Aprepitant (or Olanzapine). Day 4: Dexamethasone (+ Olanzapine)
How are anti-emetic drugs usually dosed for a moderately emetogenic chemotherapy regimen?
Day 1: Dexamethasone + 5HT3 antagonist. Days 2-4: Dexamethasone