Cytotoxic Drugs

Question 1

Example of an alkylating agent

Answer 1

Cyclophosphamide

Question 2

Main side effects associated with alkylating agents

Answer 2

Urothelial toxicity (Tx Mensa)
Increased risk of permanent male sterility

Question 3

Example of an anthracycline

Answer 3

Doxorubicin
- all end in ‘RUBUCIN’

Question 4

Main side effects associated with anthracyclines

Answer 4

RED urine (rubicins = red)
Cardiotoxic side effects (accumulative, test LVEF)

Question 5

What can be used to reduced cumulative cardio toxicity associated with anthracyclines?

Answer 5

Dexrazoxane
- iron chelater

Question 6

Example of an Antimetabolite

Answer 6

Methotrexate
Fluorouracil

Question 7

Main side effects associated with antimetabolites

Answer 7

Oral mucositis and myelosupression

Question 8

Example of cytotoxic antibiotics

Answer 8

Bleomycin

Question 9

Main side effect associated with bleomycin

Answer 9

Pulmonary fibrosis and toxicity

Question 10

Example of platinum compounds

Answer 10

Carboplatin
Cisplatin
Oxaliplatin

Question 11

Example of a Taxane

Answer 11

Docetaxel

Question 12

Main side effects associated with taxanes

Answer 12

• Hypersensitivity reactions- can be premeditated with corticosteroids and antihistamines

Question 13

Example of a vinca alkaloid

Answer 13

Vincristine
Vinblastine

Question 14

How are vinca alkaloids given?

Answer 14

IV administration ONLY
- intrathecal administration = FATAL

Question 15

What can be associated with cytotoxic drugs when given IV?

Answer 15

Extravastion of IV drugs
- leading to severe local tissue necrosis due to leakage of the cytotoxins

Question 16

which cytotoxic drugs are associated with oral mucositis (sore mouth)?
- FAM

Answer 16

Flurouricil
Methotrexate
Anthracyclines (Doxorubicin)
- prevent with good oral hygiene

Question 17

What is tumour lysis syndrome?

Answer 17

Occurs due to the rapid destruction of malignant cells
- cancer cells break down and release their contents into the bloodstream faster than the body can eliminate them

Question 18

What can tumour lysis syndrome cause?

Answer 18

HYPER- k, Ph and uricaemia
HYPOcalcaemia
- this can lead to Renal damage and arrhythmias

Question 19

How can Hyperuricaemia be treated?

Answer 19

Allopurinol or Febuxostat

Question 20

Which type of cancer is Hyperuricaemia most likely in?
- think LL

Answer 20

Lymphoma and leukaemia
- TX aLLopurinol (two L’s)

Question 21

When is allopurinol given to prevent Hyperuricaemia in those at risk of TLS

Answer 21

24 hours prior to treatment
- along side hydration

Question 22

When is Febuxostat given to prevent Hyperuricaemia

Answer 22

2 days BEFORE treatment

Question 23

which cytotoxic drug causes bone marrow suppression?
- Which DO NOT cause it?

Answer 23

ALL
- except vincristine and bleomycin

Question 24

What do you do if the patient’s bone marrow has NOT recovered before next treatment?

Answer 24

REDUCE the dose

Question 25

how to treat neutropenic fever occuring immediately after cytotoxic drug treatment?

Answer 25

Broad spec ABX

Question 26

which drug can cause blood in urine (urothelial toxicity)? - how is it treated?

Answer 26

Cyclophosphamide (alkylating agent) - MESNA

Question 27

What can be given to avoid myelosupression with methotrexate treatment?

Answer 27

Folinic acid

Question 28

which chemotherapies have a high risk of nausea and vomiting?

Answer 28

Cisplatin and high dose cyclophosphamide

Question 29

what can be given to prevent acute nausea and vomiting due to chemotherapy - occurring within 24 hours of treatment)

Answer 29

Low risk: dexamethasone or lorazepam High risk: Ondansetron + dexamethasone + Aprepitant

Question 30

what can be given to prevent delayed nausea and vomiting Due to chemotherapy - occuring 24 hours after treatment

Answer 30

Moderate: dexamethasone + ondansetron High: dexamethasone + Aprepitant

Question 31

what can be given to prevent anticipatory nausea and vomiting associated with chemotherapy - occurring before treatment?

Answer 31

Lorazepam