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Name an alkylating agent.
Cyclophosphamide (Cytoxan)
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What is the alkylating agent MOA?
forms strong covalent bonds with DNA inhibiting replication and causing bond breaks and cell death
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Common SE for Cyclophosphamide?
- leucopenia
- N/V
- alopecia
- diarrhea
- mucositis
- amenorrhea
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Adverse/Rare SE Cyclophosphamide?
- hemorrhagic cystitis
- sterility
- secondary malignancies
- SIADH
- cardiac necrosis
- renal tubular necrosis
- skin rash
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Which antineoplastic should be taken early in the day if taken orally?
cyclophosphamide
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Which antineoplastic requires patient to drink 3-4 Liters of water after an IV injection?
cyclophosphamide
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Which antineoplastic needs mesna uroprotection to prevent hemorrhagic cystitis?
cyclophosphamide
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What other drugs does cyclophosphamide have an effect on?
- warfarin
- succinylcholine
- vaccines
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Name an anthracycline.
Doxorubicin (Adriamycin)
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Which antineoplastic is known for the risk of cardiotoxicity?
Doxorubicin
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Which antineoplastic is a vesicant and can cause severe skin necrosis if extravasation occurs?
Doxorubicin
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Which antineoplastic is only an IV?
Doxorubicin
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What is the anthracycline MOA?
inhibits DNA and RNA synthesis by intercalation of DNA base pairs and inhibition of DNA repair by topoisomerase
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T/F: anthracyclines can be used to treat non-malignant diseases.
false
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What are the most notable side effects for alkylating agents?
- bone marrow suppression
- nausea
- hemorrhagic cystitis
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T/F: alkylating agents can be used to treat both malignant and non-malignant diseases.
true
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What are the adverse/rare SE of Doxorubicin?
- acute and delayed cardiotoxicity
- sterility
- secondary malignancy
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What other drugs can Doxorubicin affect?
- digoxin
- phenytoin
- radiation
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What drugs could have an affect on Doxorubicin?
- cyclosporine
- paclitaxel
- trastuzumab (could increase cardiotox)
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No live virus vaccines should be given during therapy with which drugs?
- Doxorubicin
- Capecitabine
- Cytarabine
- 5-fluorouracil
- Gemcitabine
- Mercaptopurine
- Methotrexate
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Which drug could darken the urine for 24-48 hours?
doxorubicin
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You should watch for fever, malaise, sore mouth or throat, pain or swelling near injection site when taking this drug?
doxorubicin
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Patients should have ejection fraction measured before starting therapy with this drug?
doxorubicin
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Which antineoplastics are similar in structure to naturally occurring compounds?
antimetabolites
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What is the MOA of antimetabolites?
kill tumor cells by inhibiting DNA synthesis by a specific mechanism or they incorporate themselves into DNA, causing apoptosis
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Rare/Adverse SE of Capecitabine?
- chest pain
- venous thrombosis
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What drug can enhance the toxic effect of Capecitabine?
leucovorin
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What drug can Capecitabine have an adverse effect on ?
phenytoin
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Which drug should the sunlight be avoided and wear sunscreen with?
Capecitabine
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T/F: Capecitabine needs to be taken with food.
true
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T/F: Capecitabine can be taken within two hours of an antacid.
false
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Which drug can cause a painful rash on the hands and feet?
capecitabine
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Rare/adverse SE of cytarabine?
- chest pain
- tumor lysis syndrome
- neurotoxicity
- coma
- rash
- skin desquamation
- ocular toxicity (eye)
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T/F: cytarabine does not have any major drug interactions.
true
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Changes in mental status may occur during therapy with which drug?
cytarabine
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What drug requires aggressive water intake and antiemetic therapy?
cytarabine
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Which drug requires steroid eye drops to prevent ocular toxicity?
cytarabine
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Which drug comes in a topical cream or solution dosage form?
5-fluorouracil
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Most common rare/adverse SE of 5-fluorouracil?
chest pain
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What other drugs can 5-fluorouracil have an affect on?
- carvedilol
- natalizumab
- phenytoin
- warfarin
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Which drug should you not take alcohol with?
5-fluorouracil
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Should you avoid sunlight if you are taking 5-fluorouracil?
yes
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Which drug can cause severe diarrhea and mucositis?
5-fluorouracil
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If you have a genetic deficiency of dihydropyrimidine dehydrogenase, which drug might cause you to have increased systemic toxicities?
5-fluorouracil
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-
What drug class is capecitabine?
antimetabolite
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What drug class is cytarabine?
antimetabolite
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What drug class is 5-fluorouracil?
antimetabolite
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What drug class is gemcitabine?
antimetabolite
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What drug class is mercaptopurine?
antimetabolite
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What drug class is methotrexate?
antimetabolite
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What drug class is doxorubicin?
anthracycline
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What drug class is cyclophosphamide?
alkylating agent
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What drug class is carboplatin?
platinum compound
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What drug class is cisplatin?
platinum compound
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What drug class is Imatinib?
targeted therapy
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What drug class is Rituximab?
targeted therapy
-
What drug class is Trastuzumab?
targeted therapy
-
What drug class is Docetaxel?
taxane
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What drug class is paclitaxel?
taxane
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What are rare/adverse SE of gemcitabine?
-
What other drugs can gemcitabine effect?
- bleomycin
- fluorouracil
- warfarin
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Which drug can cause severe flu-like symptoms to occur?
gemcitabine
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Need to watch for fever, bleeding and bruising if you are taking ___?
- gemcitabine
- mercaptopurine
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Which drug can increase the toxicity of radiation if given concurrently with radiation?
gemcitabine
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Thrombocytopenia is common with use of this antimetabolite?
gemcitabine
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Mercaptopurine
purinethol
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Rare/adverse SE of mercaptopurine?
-
Which drug can increase mercaptopurine levels?
allopurinol
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What other drug can mercaptopurine have an effect on?
warfarin
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Which antimetabolite should be taken on an empty stomach and is used to treat Crohn's?
mercaptopurine
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Which drug has been associated with writing prescriptions with sixfold overdosage?
- mercaptopurine
- (do not write 6-MP!!)
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Which antimetabolite should be taken in the evening to lower the risk of relapse?
mercaptopurine
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Which drug can be tested for risk of toxicity using TPMT genotyping?
mercaptopurine
-
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Which drug can be used for an ectopic pregnancy?
methotrexate
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What are the rare/adverse SE for methotrexate?
- renal failure
- arachnoiditis
- encephalopathy (with IT administration)
- sterility
- hepatotoxicity
- demylenating encephalopathy
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What other drug can methotrexate have an adverse effect on?
cyclosporine
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What other drugs could affect methotrexate (a lot)?
- cipro
- cyclosporine
- NSAIDs
- penicillin
- PPIs
- salicylates
- sulfonamides
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T/F: prolonged exposure to sunlight should be avoided when taking methotrexate.
true
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Which antimetabolite should not be administered with radiation therapy?
methotrexate
-
When giving an IT injection of this drug, a preservative-free solution needs to be used?
methotrexate
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Leukovorin must be given when using high doses of this drug to prevent severe life-threatening myelosuppressionand mucositis?
methotrexate
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Avoid this drug in patients with third spacing like ascites or effusions?
methotrexate
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Which agents are cell cycle nonspecific agents that are directly toxic to DNA by causing strand breaks to form?
platinum compounds
-
What is the MOA of the platinum compounds?
form strong covalent bonds with DNA inhibiting replication and causing cell death
-
Carboplatin
Paraplatin-AQ
-
-
-
-
-
-
-
What are adverse/rare SE of carboplatin?
-
Which drug class should you avoid taking with carboplatin (or cisplatin too)?
aminoglycosides because will increase risk of ototoxicity (gentamicin)
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Which drug should you absolutely not take if you are pregnant or breastfeeding?
-
This platinum compound can cause severe N/V?
-
This platinum compound should be taken with plenty of fluids after chemo therapy?
-
Hypersensitivity risk increases after 6+ treatments with this drug?
carboplatin
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What is the most common adverse SE of cisplatin?
ototoxic
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For which drug should you verify any dose written for over 100 mg/m2?
cisplatin
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Ototoxicity is more common in children than adults with this drug?
cisplatin
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This platinum compound is highly emetogenic?
cisplatin
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IV hydration should be given before and after _____ therapy?
cisplatin
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While on this drug, potassium and magnesium levels especially should be monitored?
cisplatin
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Renal function should be assessed before giving this drug?
cisplatin
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What other drugs can affect cisplatin?
- aminoglycosides
- amifostine
- taxanes
-
What other drugs can cisplatin have effects on?
-
Mannitol or furosemide can be given with this drug to reduce nephrotoxicity?
cisplatin
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This class kills tumors by targeting abnormal genetic signaling proteins specific to the cancer and many are used in combo with other cytotoxic drugs?
targeted therapy
-
What is the MOA of Imatinib?
inhibits tyrosine kinase needed for cell proliferation and targets the Philadelphia fusion gene
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What is the MOA of Rituximab and Trastuzumab?
they are monoclonal antibodies that target CD-20 antigen on B-cells and the HER2/neu oncogene, respectively
-
What are the adverse SE of Imatinib?
- hepatotoxicity
- heart failure
- severe bullous dermatologic reactions
- hemorrhage
-
What drugs can affect Imatinib?
- azole antifungals
- lansoprazole
-
What other drugs can Imatinib effect?
- carbamazepine
- digoxin
- codeine
- colchicine
- fentanyl
- cyclosporine
- fludarabine
- simvastatin
- tamoxifen
- tramadol
- warfarin
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Which drug has the common side effect of fluid retention or edema?
Imatinib
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What drug has a common side effect of infusion reaction?
Rituximab
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Which drug is recommended to be pretreated with benadryl and APAP?
Rituximab
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Which drug can reactivate serious infections like Hepatitis B?
Rituximab
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Patient should report shortness of breath, chest tightness, fever or chills during treatment with this drug?
Rituximab
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What other drug can Rituximab have an effect on?
antihypertensives
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What are the rare/adverse SE of Rituximab?
- severe or fatal mucocutaneous reactions
- lichenoid dermatitis
- paraneoplastic pemphigus
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- anaphylaxis
- bowel obstruction and perforation
- progressive multifocal leukoencephalophathy
-
Which drug is used to treat early stage and metastatic breast cancer?
trastuzumab
-
What are rare/adverse SE of trastuzumab?
- cardiotoxicity
- pulmonary toxicity
-
Which two drugs are known well for their cardiotoxic effects?
-
T/F: patient should have ejection fraction measured before starting therapy with trastuzumab.
true
-
Patients treated with trastuzumab should report immediately what symptoms?
- shortness of breath
- chest pain
- fever
- chills
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What other drugs can trastuzumab effect?
- anthracyclines
- myelosuppressive chemo
-
Which drug class is known for its bone marrow suppression and peripheral neuropathies?
taxanes
-
What is the MOA of taxanes?
stabilize the microtubule bundles by promoting assembly and preventing depolymerization, thereby inhibiting cell replication
-
What are the rare SE for Docetaxel?
- skin desquamation
- hypersensitivity
- oncolysis
-
You should report any fever or infection to Dr. with what drug?
docetaxel
-
Which drug must you premedicate with a corticosteroid to reduce fluid retention?
docetaxel
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T/F: taxanes should be given before platinums when given together to limit toxicity.
true
-
What are the rare SE for paclitaxel?
- hypersensitivity
- skin rashes
-
You can experience bradycardia if you are taking which drug?
paclitaxel
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Infection and peripheral neuropathies can be seen with prolonged use of this drug?
paclitaxel
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____ is a radiosensitizer and will increase effect and toxicity of radiation therapy?
paclitaxel
-
Monitor blood pressure regularly while infusing this drug?
paclitaxel
-
Severe bone marrow suppression is possible when taking this drug?
paclitaxel
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Premedicate with corticosteroid, benadryl, H2 blocker (histamine) to prevent hypersensitivity with which drug?
paclitaxel
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Which drug class will cause tissue necrosis if extavasation occurs?
taxanes
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