Agent Specific Supportive Care Flashcards
(54 cards)
What drugs are alkylating agents?
cyclophosphamide/ifosfamide
What is the enzyme that metabolizes cyclophosphamide?
CYP3A4 and CYP2B6
What are the toxicities associated with Cyclophosphamide?
- interstitial pneumonia
- SIADH
- myelosuppression (dose limiting toxicity)
- nausea/vomiting
- alopecia
- amenorrhea/infertility
- cardiotoxicity
- secondary malignancies (bladder cancer or leukemia)
- hemorrhagic cystitis (ifosfamide>cyclophosphamide)
What are the toxicities associated with Ifosfamide?
- CNS toxicity/encephalopathy
- nephrotoxicity
- myelosuppression (dose limiting toxicity)
- nausea/vomiting
- alopecia
- amenorrhea/infertility
- cardiotoxicity
- secondary malignancies (bladder cancer or leukemia)
- hemorrhagic cystitis
What are the symptoms of hemorrhagic cystitis?
hematuria, dysuria, frequency
What are the monitoring parameters to assess hemorrhagic cystitis?
daily urine analysis
What is the preventative treatment for hemorrhagic cystitis?
hydration, mesna
What is the treatment for hemorrhagic cystitis?
continuous bladder irrigation
What are the symptoms of encephalopathy?
somnolence, confusion, hallucinations, psychosis
What is the treatment of encephalopathy?
methylene blue 50mg IV q6h
What drugs are alkylating-like agents/platinum agents?
- cisplatin
- carboplatin
- oxaliplatin
What are the common uses of Cisplatin?
bladder, cervical, head and neck, lung, ovarian, testicular cancer
What are the toxicities associated with Cisplatin?
- severe nausea/vomiting
- severe nephrotoxicity (dose limiting toxicity)
- neuropathy
- ototoxicity
- mild myelosuppression (anemia)
How is nephrotoxicity addressed associated with Cisplatin?
- may be reversible
- pre/post hydration +/- diuresis
- avoid dehydration associated with N/V
- replace potassium and magnesium
What are the toxicities associated with Carboplatin?
- myelosuppression (dose limiting toxicity)
- nephrotoxicity
- ototoxicity
- N/V
- hypersensitivity
What are the toxicities are associated with oxaliplatin?
- neuropathy (dose limiting toxicity)
- mild/moderate myelosuppression
- N/V
What drugs are antifolate agents?
aka antimetabolites
- methotrexate
- pemetrexed
- pralatrexate
What drugs are pyrimidine analogs?
aka antimetabolites
- fluorouracil (5-FU)
- capecitabine
- cytarabine
- gemcitabine
What drugs are prine analogs?
- 6-mercaptopurine
- 6-thioguanine
- clabribine
- pentostatin
- clofarabine
- fludarabine
- nelarabine
What is the mechanism of action of methotrexate?
inhibits dihydrofolate reductase which limits the avaliability of reduced folates for purine synthesis
What is the toxicity associated with methotrexate?
- myelosuppression (dose limiting toxicity)
- mucositis (dose limiting toxicity)
- hepatotoxicity/nephrotoxicity
accumulation in ascites/pleural effusion
What drugs should be discontinued with methotrexate use?
- penicillins
- aspirin
- probenecib
- NSAIDs
What is the use of Leucovorin?
repletes reduced folate stores from methotrexate therapy- allowing large doses to be administered and is REQUIRED for high dose methotrexate therapy (~1+g/m2), generally continued until methotrexate levels < 0.05-1 umol/L
What is the use of Glucarpidase?
reduces methotrexate level >97% within 15 minutes (not to be administered within 2 hours of leucovorin)
