Pharm II (chemo 1e)

most commonly seen with anthracyclines, taxanes and some alkylating agents

occurs 3 weeks after first cycle

- avoid concurrent toxins - vary drugs

worse in young than elderly

• most commonly seen with platinum, anthracyclines, IV nitrogen mustard derived alkylators
• main cause of prematurely discontinuing chemo

• •Prevention:
• 1. light meals
• 2. amnesics
• 3. multiple drugs

1. HT-3 inhibitors eg. Ondansetron

2. anti-histaminics eg.prochlorperazine

3. anti- dopamines eg. Metoclopromide

4. minor tranquilizers eg. Lorazepam

5. steroids eg. Dexamethasone

6. THC

• most important side effect because it is the biggest cause of treatment related deaths.
• - white count decreases by 7-10 days
• - red cells decrease by approximately 1 % per day

associated with severe mucositis--> infection

Report Fever and Chills ASAP!!!! (chance of neutrppenia and sepsis). If it persists think Fungal infection.

• 1. granulocyte colony stimulating factor
• 2. erythropoietin
• 3. megakaryocyte growth factor

-most commonly seen with antimetabolites, occurs at time of nadir ( lowest) blood counts.

-painful leading to dysphagia and diarrhea resulting in electrolyte disturbance and malnutrition

-associated with yeast infection

extravasation is biggest concern particularly with IV alkylators, naturally occurring products

• antimetabolites -->discoloration
• nail changes--> taxanes
• “hand-foot” syndrome --> infusional chemo and capecitabine

acneiform rashes--> EGFR inhibitors and steroids (may be a good sign)

• Most commonly seen with:
• - vinca alkaloids
• - taxanes
• - platinum

Sensory may recover, Motor will not

• Most Commonly seen with:
• - anthracyclines
• free-radical mediated
• prevented with cardioprotective agent
• eg. dexrazoxane

• - 5-FU ( and capecitabine)
• - high dose cyclophosphamide

• Most commonly seen with:
• - cis-platinum
• Proximal tubular toxin
• Prevent with hydration, amifostine
• - mitomycin-c
• can cause TTP with renal failure
• free radical mediated
• - cyclophosphamide (or ifosfamide)
• acrolein mediated hemorhagic cystitis
• may be prevented with MESNA

• Most commonly seen wth:
• - Bleomycin
• free radical intermediate that interacts with heme asociated iron in pulmonary interstitium
• - Gemcitabine
• - Busulfan

• Most commonly seen with:
• - all alkylators
• - anthracyclines
• Presentation:
• - myelodysplasia
• - myelofibrosis
• - leukemia
• - (TTP)

• 1. CNS----“chemo brain” Memory loss
• 2. FATIGUE
• 3. CHRONIC PAIN
• 4.hallmarks of AGING---osteoporosis, loss of muscle mass with decrease grip strength and gait speed.
• 5. SECONDARY MALIGNANCIES
• -leukemia, Lymphoma, lung cancer, bladder cancer

ALL agents carry increased risk of adverse outcomes in 1st trimester. (Methotrexate used to induce abortion)

Patients in 2nd and 3rd trimesters can be treated with most regimens except ANTIMETABOLITES

• Cancer is thrombogenic
• Certain anti-hormonal agents are also thrombogenic especially tamoxifen

Cancer has negative impact on libido, also causes N/V/D and fatigue

• Most commonly seen with anti-hormonal agents
• - LHRH agonists
• - androgen and estrogen receptor blockade
• - estrogen synthesis inhibitors

• 1. corticosteroids
• 2. aromatase inhibitors (decrease circulating
• estrogen)
• 3. LHRH agonists (decrease circulating androgens and estrogen)
• 4. most chemo agents to certain degree
• ____________________________
• 1. Aromatase inhibitors
• 2. Adjuvant chemo

Cessation of ovulation and azoospermia, often seen with alkylators and topoisomerase inhibitors

• 1. anti-inflamatories
• -Cause mucosal disruption and bleeding risk
• 2. anti-infectives
• - increased risk of fungal infections
• 3. anti-gout medication
• - may inhibit pro-drug activation (Allopurinol and 5-FU)
• - may increase drug effect (Colchicine and vincas)
• (Allopurinol and 6-MP)

• 4. diuretics
• - increase risk of renal dysfunction
• 5. anti-convulsants
• -increase metabolism and thus decrease efficacy
• 6. anti-coagulants
• -leading to increased bleeding