Clinical Aspects of Chemotherapy Drugs - DM

Question 1

Nitrogen Mustard MOA

Answer 1

alkylating agent

Question 2

Cyclophosphamide SE

& interactions

Answer 2

• hemoragic cystitis due to acrolein *
• myelosupression (nadir 10 - 14 d) *
• cardiomyopathy
• secondary malignancies (leukemia)

CYP 2B6, 2C9, 3A4

(Nitrogen mustard)

Question 3

Cyclophosphamide Pearls

Answer 3

• hydration
• mesna (prevents hemorrhagic cystitis - acrolein)
• watch urine output, blood in urine, pain c urination

Question 4

Mechlorethamine, Procarbazine SE

Answer 4

• myelosuppression
• N/V
• vesicant - Na thiosulfate / bicarb neutralizes
• secondary malignancies / infertility (highly mutagenic)

(nitrogen mustard)

Question 5

Mechlorethamine & Procarbazine Pearls

Answer 5

• CI with live vaccines

- Procarbazine = mild MAO inhibitor

Question 6

Platinum Analogues

Answer 6

Cisplatin & Carbaplatin PLATIN

• oxaliplatin

(alkylating agents)

Question 7

Platinum Analogues

& which is more likely to cause

Answer 7

N/V - Cis
myelosuppression - carbo
nephrotoxicity - cis (hydration & furosemide/mannitol)
neuropathy - cis
ototox - cis (will interact with other ototox meds)

Question 8

Oxaliplatin SE

Answer 8

• neuropathy
• N/V/D
• mucositis, stomatitis

Question 9

Neuropathy signs

Answer 9

paresthesias
cold sensitivity
pharyngolaryngeal dysesthias

Question 10

Oxaliplatin Pearls

Answer 10

• avoid cold temp for up to 5 days

- chronic neuropathies

Question 11

Dacarbazine SE

Answer 11

• alopecia
• LFT elevation
• myelosuppression
• N/V

Question 12

Dacarbazine Pearls

Answer 12

oral version available = temozolomide

Question 13

Pemetrexed SE & interactions

Answer 13

• mucositis / stomatitis
• myelosuppression
• rash
• neuropathy

drugs impairing renal function (NSAIDs)

START folic acid & vitamin B12 supplementation before & continue after

Question 14

5-fluorouracil + leucovorin SE

& interaction

Answer 14

• myelosuppression
• mucositis
• diarrhea

WARFARIN (monitor INR)
DPD

Question 15

What type of patients do we need to watch for with antimetabolites - folate? Why?

Answer 15

Dihydropyrimidine Dehydrogenase (DPD) deficiency
- poor metabolism, more toxicity

Question 16

Why do we add leucovorin?

Answer 16

increases efficacy (can actually be more toxic in combo)

Question 17

Carpecitabine SE & interactions

Answer 17

• diarrhea
• thrombocytopenia / neutropenia
• hand/foot syndrome

DPD deficiency
inhibits 2C9

Question 18

Mercaptopurine, Thioguanine SE

Answer 18

• myelosuppression
• rash
• diarrhea
• hepatotoxicity

TMPT enzyme deficiency –> incr. toxicity

Question 19

What do we do if pt is on allopurinol?

Answer 19

stop allopurinol

allopurinol inhibit xanthine oxidase, which breaks down mercaptopurine

Question 20

Fludarabine SE

Answer 20

• neurotoxicity
• severe hemolytic anemia
• myelosuppression - severe

Question 21

Fludarbine Pearls

Answer 21

consider PCP prophylaxis

helps combat the myelosuppression

Question 22

What deficiency do we worry about with purine analogues?

Answer 22

TMPT (thiopurine methyltransferase) enzyme deficiency

it increases toxicity

Question 23

Cytarabine SE

Answer 23

• cerebellar toxicity
• corneal toxicities (prednisolone eye drops for prophylaxis)
• hand / food syndrome

Question 24

hand/foot syndrome grade

Answer 24

1: painless, no impairment
2: painful, cracking, numbness, activity is impaired
3: strong pain, blistering, self-sufficiency at risk!

Question 25

Gemcitabine SE

Answer 25

- strong radiosensitizer | - rash

Question 26

What drugs are antimicrotubules?

Answer 26

paclitaxel & docetaxel TAXANES

Question 27

Taxanes SE & interactions

Answer 27

- hypersensitivity to cremophor vehicle in taxol (CI) - peripheral neuropathy - fluid retention (decetaxel) - CYP 2C8, 3A4 - additive neuropathy

Question 28

taxane pearls

Answer 28

anaphylaxis risk - prophylaxis: steroid, H1 or H2 blocker 30 mins prior - tx: diphenhydramine, epinephrine, steroids) - abraxane: less chance for anaphylaxis docetaxel = less neuropathy, more neutropenia (than paclitaxel) - docetaxel fluid retention prophylaxis: dexamethasone

Question 29

Vincristine & Vinblastine SE

Answer 29

- peripheral neuropathy / neurotox - constipation - vesicant - hypersensitivity

Question 30

Vincristine & Vinblastine Pearls

Answer 30

- test for hypersensitivity - avoid high [O2] - no intrathecal use!

Question 31

topotecan & irinotecan SE

Answer 31

- severe diarrhea | - severe myelosuppression

Question 32

does topotecan or irinotecan have more active metabolite?

Answer 32

irinotecan --> SN 38

Question 33

anthracycline SE

Answer 33

- cardiotox, myopathy, HF - arrhythmias - vesicant - doxorubicin cummulative dose > 550 mg/m2 or 450 mg/m2 (monitor EF baseline & after 250-300 mg/m2) - epirubicin cumulative dose of 935 mg/m2

Question 34

anthracyclines CI

Answer 34

cumulative doses & cardiac function

Question 35

anthracycline pearls

Answer 35

- liposomal doxorubicin is NOT interchangeable - discolored body fluids - central catheters performed due to extravasation risk!

Question 36

Daunorubicin & Idarubicin SE

Answer 36

- cardiotox - vesicant - alopecia - myelosuppression - discoloration of body fluids

Question 37

Etoposide SE

Answer 37

- alopecia - myelosuppression - mucositis / stomatitis - secondary malignancies - diarrhea CYP enzyme metabolized

Question 38

What should we watch for with etoposide formulation?

Answer 38

IV must be run SLOWLY or risk HoTN

Question 39

Bleomycin SE

Answer 39

- pulm tox - alopecia - hypersensitivity - increased LFTs

Question 40

Bleomycin Pearls

Answer 40

- test dose for hypersensitivity | - avoid high inhaled [O2]

Question 41

L-asparagine, Pegasaraginase SE

Answer 41

- hypersensitivity | - life-threatening coagulopathies

Question 42

hormonal SE

Answer 42

- osteoporosis - menopause - hot flashes - heart disease - sexual characteristics - libido - blood clotting - wt gain

Question 43

Trastuzumab SE

Answer 43

- cardiomyopathy - hypersensitivity - infusion reactions - rash - diarrhea

Question 44

Trastuzumab interactions

Answer 44

- incr. cardiomyopathy with anthracyclines, cyclophosphamide

Question 45

Trastuzumab pearls

Answer 45

- used in combo with other agents (HER2 positive) | - monitor EF

Question 46

Lapatinib SE

Answer 46

- diarrhea - dyspepsia - rash - cardiac effects

Question 47

Lapatinib interactions

Answer 47

CYP 3A4, 2C8, PGPi

Question 48

Lapatinib pearls

Answer 48

- metastatic cancer | - combo with other agents metastatic

Question 49

Gefitinib & Erlotinib SE

Answer 49

- rash - diarrhea - interstitial lung disease

Question 50

Cetuximab & Panitumumab

Answer 50

...pts with wild-type (non-mutated) KRAS respond to tx

Question 51

Cetuximab & Panitumumab SE

Answer 51

- rash - diarrhea - interstitial lung disease - infusion related rxn (less with panitumumab)

Question 52

Bevacizumab AE

Answer 52

- bleed risk! | - HTN

Question 53

Bevacizumab CI/caution

Answer 53

- serious wound - thrombotic risk - CHF - CNS metastasis - current anticoag - recent surgery

Question 54

Ofatumumab & Rituximab SE

Answer 54

- HoTN - bronchospasm - angioedema - cytopenias - tumor lysis syndrome can premedicate with APAP, diphenhydramine, steroids

Question 55

Imatinib, Dasatinib, Nilotinib SE

Answer 55

- edema - N - muscle cramps - rash - myelosuppression - increased LFTs - QT prolonging

Question 56

Imatinib, Dasatinib, Nilotinib monitoring

Answer 56

- hematologic response - CBC - cytogenic response - Ph+ cells - molecular response - BCL-ABL transcripts

Question 57

What are Imatinib, dasatinib, and nilotinib known as? * what is their MOA

Answer 57

magic bullet target philadelphia chromosome BCR-ABL TKi (CML)