CYTOTOXIC DRUGS examples

Question 1

Anthracyclines examples

Answer 1

• Daunorubicin
• Doxorubicin
• Epirubicin
• Idarubicin

Question 2

Anthracyclines: SE

Answer 2

• rubi-red urine
• cardio toxic
• Dehydration/diarrhoea

Question 3

Anthracyclines: formulations

Answer 3

• Formulations not interchangeable (conventional, liposomal, pegylated liposomal)
• Liposomal → reduced cardiotoxicity but causes painful macular skin eruptions

Question 4

What is important safety information regarding Doxorubicin

Answer 4

• Hand-foot syndrome (painful reddening skin eruptions)
• Treat by cooling hands or feet and avoid using gloves and socks

Question 5

Alkylating agents - examples

Answer 5

• Cyclophosphamide
• Ifosfamide
• Melphalan
• Bendamustine

Question 6

Alkylating agents - side effects

Answer 6

• Urothelial toxicity
• Increased risk of permanent male sterility

Question 7

Cyclophosphamide - SE

Answer 7

• cardiotoxicity (high doses)
• cystitis
• pigmentation in nails
• anorexia, weight loss

Question 8

Antimetabolites - examples

Answer 8

• Cytarabine
• Fluorouracil
• Methotrexate
• Mercaptopurine

Question 9

Methotrexate - MOA

Answer 9

It inhibits the enzyme dihydrofolate reductase

Question 10

Methotrexate - SE

Answer 10

1. Bone marrow suppression
2. Renal/hepatic impairment
3. Respiratory problems
4. Ulcerative stomatitis

Question 11

Methotrexate - monitoring

Answer 11

1. FBC
   - Repeated every 1-2 weeks until stable
   - Then every 2-3 months
2. Renal function
   - Repeated every 1-2 weeks until stable
   - Then every 2-3 months
3. Liver function
   - Repeated every 1-2 weeks
   - Then every 2-3 months

Question 12

How often is
Methotrexate administered?

Answer 12

WEEKLY
It the patient is taking it orally, then should take it ONCE a
week, on the same day i.e. every mondays

Question 13

What is the max
Methotrexate dose?

Answer 13

20-30mg a WEEK
Methotrexate 10mg every day is an overdose!!

Question 14

Why is Folic acid used?

Answer 14

• Folic acid reduces the side effects of Methotrexate
• Folic acid decreases mucosal (e.g. oral mucositis) and Gl side-effects (E.g. ulcerative stomatitis

Question 15

How often does Folic acid need to be administered? And what strength?

Answer 15

5mg of Folic acid ONCE a week
To be taken on a different day to Methotrexate

Question 16

What is the difference between Folic acid and Folinic acid?

Answer 16

• They both reduce the side effects of Methotrexate
• However, Folic acid is more common in practice community as it is an oral preparation
• Folinic acid is given IV, and can also be used for acute toxicity and overdose of Methotrexate

Question 17

Which medication should Methotrexate
NOT be taken with?

Answer 17

1. Trimethoprim
2. NSAIDS, aspirin
3. Penicillins
4. PPIs

Question 18

Doxorubicine - SE

Answer 18

• dehydration
• diarrhoea
• cardiomyopathy

Question 19

Cytotoxic Antibiotics

Answer 19

Bleomycin
Mitomycin
Platinum Compounds: Carboplatin Cisplatin Oxaliplatin.

Question 20

Cytotoxic Antibiotics - side effects

Answer 20

• Progressive pulmonary fibrosis
• Pulmonary toxicity

Question 21

Taxanes - examples

Answer 21

Cabazitaxel
Docetaxel
Paclitaxel

Question 22

Taxanes - side effects

Answer 22

• Hypersensitivity reactions → premedicate with corticosteroids and antihistamines
• Monitor cardiac output
• Monitor for signs and symptoms of pneumonitis and sepsis

Question 23

Paclitaxel

Answer 23

Arrythmias

Question 24

Vinca Alkaloids - examples

Answer 24

Vinblastine
Vincristine
Vindesine

Question 25

Vinca Alkaloids - side effects

Answer 25

* Bronchospasm * Neurotoxicity - neuropathy, motor weakness, myalgia

Question 26

What are the signs of neurotoxicity with Vincristine?

Answer 26

- Neuralgia - Jaw pain - Burning sensation - Muscle spasm

Question 27

What should Vinca alkaloids NOT be administered by?

Answer 27

INTRATHECALLY It can ONLY be given as INTRAVENOUSLY (IV)

Question 28

which chemotherapy agent is NOT associated with bone marrow suppression

Answer 28

vincristine bleomycin