-
Important side effect for Busulfan and Chlorambucil
- Bone marrow suppression
- Must have 10-15 day breaks between cycles
-
What is important about cyclophosphamide and ifosfamide?
- Both cause hemorrhagic cystitis
- Ifosfamide must be given with mesna and is not cross resistant with cyclophosphamide
-
Important info for mechlorethamine
-
General toxicity for all alkylating agents
bone marrow suppression
-
2 important charateristics of carboplatin
- Must use Calvert's formula: Dose = AUC x (GFR + 25)
- No N/V
-
2 important things abotu Cisplatin
- always give with about 2 L of fluids
- N/V
-
Oxaliplatin?
dont drink ice before hand
-
General toxicity of the platinum analogues
minimal bone marrow suppression -- can be added to drugs that cause suppression
-
_________ is given orally as a one time dose. Always check its dose.
General toxicity of ___________ is delayed bone marrown suppression (21-28 days)
- Lomustine
- Nitrosoureas (carmustine, lomustine, streptozocin)
-
Procarbazine interacts with _________ and has a dose limiting toxicity of _____________________
- MAOIs
- bone marrow suppression
-
What are the dose ranges of methotrexate and are are levels checked and folinic acid given?
- <100mg/m2 = no folinic acid, no level check
- 100-500 = give folinic acid, no level check
- > 500 mg/m2 = give folinic acid and level check
-
When and with what levels of methotrexate is leucovorin given?
- Started 6-14 hours post MTX dose and given for about 48 hours
- Leucovorin is given until MTX levels are below 1 x 10 -7 M
-
What is the DLT of the purine antagonists?
- (mercaptopurine, thioguanine, cladribine, fludarabine, pentostatin, ect)
- Bone marrow suppression
-
What is given with 5-FU and why?
folinic acid: it causes tigher binding for increased cell kill
-
Important side effect of 5_FU
mucostitis and diarrhea
-
3 antimetabolites given intrathecally
MTX, cytarabine, thiotepa
-
Precautions with intrathecal admin
- dont use more than 2-3 cc
- must use normal saline with no preservatives, lactated ringers, elliots b solution
-
DLT of topoisomerase inhibitors (irinotecan and topotecan)
- irinotecan: BMS and diarrhea
- topotecan: BMS
-
Side effects of the anthracyclins (dauno-, doxorubicin)
- doxorubicin: hand foot syndrom
- general: BMS, Cardiac, vesicants, N/V
-
Important notes for etoposide
- Hypotension with fast infusion: check BP q 15 minutes, may need to give fluids or epi
- Prepare properly to avoid precipitation
- Available PO or IV
-
Vincristine
- NO BMS
- Causes constipation and DLT peripheral neuropathy
-
-
Doses for IT administration of:
MTX
Cytarabine
Thiotepa
- MTX: 12-20 mg
- Cytarabine: 50-100mg
- Thiotepa: 10-15mg
-
3 points for paclitaxel
- DLT: neurotoxicity
- give with dexamethasone for 24 hours
- premed for hypersensitivity rxns
-
2 points for docetaxel
- give dexamethasone for 3 days
- premedicate for fluid retention and peripheral edema
-
Common toxicites of taxanes
- bone marrow suppression
- mucositis
- alopecia
- N/V
-
Ixabepilone
- premedicate with H1/H2 anatgonist to avoid hypersensitivity reaction
- toxicities: neutopenia, fatigue, hand food syndrome, diarrhea, myalgia, stomatitis, sensory neuropathy
-
Bleomycin - antitumor antibiotics -- 3 points
- Allergic reaction
- pulmonary fibrosis
- No BMS
-
L-asparaginase, pegasparinginase, asparaginase
-
Hydroxyurea
broad area of use -- can administer until we get all results back
-
LHRH agonists
- Goserelin, Leuprolide, Triptorelin, Abarelix
- Bone pain
- tumor flare
- hot flashes
-
Estrogen Receptor modulators
- N/V
- bone pain and tumor flare
- thrombotic events
-
Aromatse Inhibitors
- n/v
- hot flashes
- tumor flare
- throboembolism
-
Estrumustine
- nitrogen mustard and hormonal
- n/v
- diarrhea
- gynecomastia
- thromboembolism
-
other hormonal agents
- corticosteroids
- progestins - megestrol
-
Signal transduction inhibitors
imatinib, gefitinib, erlotinib, lapatinib
all have no bone marrow suppression
-
toxicity fo gefitinib
- rash
- acne
- dry skin
- fetal harm
-
imatinib
- tx for chronic myeloid leukemia
- fluid retention
-
erlotinib
- non-small cell lung cancer
- interacts with 3a4
-
lapatinib
- palmar-plantar erythema -- first sign of toxicity
- decreases LVEF
- 3a4 substrate
- PGP inhibitor
-
Premedication and infusion recomendations for monoclonal antibodies
- All are premedicated with APAP + benedryl with or without dexamethasone
- Start infusion at a slow rate and increase slowly
-
Traztuzumab
anitbody against HER/2 on some breast cancer cells
-
cetuximab
- binds to egfr
- severe acne form rash (12% grade 3 or 4)
- severe infusion reactions
-
chemoprotectants
- dexrazoxane
- amifostine
- mesna
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