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Flashcards in Chemo Part 2 Deck (13)
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1
Q

What drug do men use with breast cancer?

When are AI’s more effective in breast cancer?

What are your SERMS and what are their side effects?

A

Tamoxifen.

Post menopausal women.

Tamoxifen(Soltamox), Fulvestrant(Faslodex). Venlafaxine for hot flashes and Raloxifene is used for prophylaxis not treatment. DVT/PE, menopausal symptoms, hot flashes, flushing, edema, weight gain, hypertension, mood changes, amenorrhea, vaginal bleeding/discharge.

2
Q

What are your aromatase inhibitors and their side effects?

How early do you need to discontinue Raloxifene(evista) prior to immobilization?

Can you take Aromatase inhibitors with tamoxifen or estrogen pills?

A

Anastrozole (Arimidex), Letrozole (Femara), Exemestane (Aromasin). Higher risk of osteoporosis, Higher risk of CVD. Edema, DVT/PE, bone pain, osteo, menopausal symptoms, hot flashes, arthralgia/myalgia, lethargy/fatigue, N/V, rash, hepatotoxicity, hypertension, dyslipidemia.

72 hours.

NO

3
Q

What are your GnRH agonists and how do they work?

What are the GnRH side effects?

What are the side effects of your GnRH antagonists?

A

Leuprolide(Lupron Depot), Goserelin(Zoladex). Also known as LHRH agonists, they can cause tumor flare, to prevent tumor flare anti androgens are given for several weeks in conjunction of GnRH agonists.

Osteoporosis risk, tumor risk. Hot flashes, impotence, gynecomastia, peripheral edema, bone pain, injection site pain, QT prolongation, dyslipidemia, hyperglycemia

This is Degarelix. Osteoporosis risk, do not cause tumor flare. Hypersensitivity reactions.

4
Q

What are your 1st generation antiandrogens and when can they be used?

What is your 2nd generation antiandrogen?

What is the BSA formula?

A

Bicalutamide (Casodex), only in combo with GnRH agonists.

Enzalutamide (xtandi)

square root of Ht(cm) x wt(kg)/3600.

5
Q

What are your alkylating agents?

What unique concerns happen with cyclophosphamide and ifosfamide?

Which alkylating agent turns pink when decomposed?

A

Cyclophosphamide, Ifosfamide, Carmustine, Bendamustine, Busulfan, Melphalan.

Hemorrhagic cystitis, Mesna given to help.

Dacarbazine.

6
Q

What are the warnings of the alkylating agents?

What are the cisplatin unique toxicities and side effects?

What’s special to know about carboplatin and oxaliplatin?

A

Hemorrhagic cystitis, pulmonary toxicity with busulfan.

Nephro and ototoxicity, Amifostine helps prevent nephrotoxicity, highly emetogenic. Anaphylactic like reactions and risk increased with repeated exposure. Peripheral neuropathy.

Carboplatin is dosed using the Calvert formula. Oxaliplatin is acute sensory neuropathy and can be exacerbated by exposure to cold. Similar side effects to cisplatin except for renal, oto, and highly emetogenic.

7
Q

What is the lifetime max dose of doxorubicin and what drug is chemoprotectant for it?

What are unique concerns and side effects of doxorubicin?

What rare side effect to know about danorubicin and cytarabine liposomal and doxorubicin liposomal?

A

450-550 mg/m2. Dexrazoxane(Zinecard). Totect is for antidote of extravasation.

Vesicants, Red urine, do not exceed 450-550 mg/m2, KNOW TOTECT VS ZINECARD. N/V. Myocardial toxicity, vesicant, myelosuppresion.

Hand-foot syndrome.

8
Q

What to know about Vincristine and Vinblastine?

What color does Mitoxantrone turn your urine?

What are the taxanes and what phase do they inhibit?

A

Vincristine is capped at 2mg/dose. NEVER give intrathecal. Vincristine in a small IV big(a piggyback) rather than a syringe. Vincristine liposomal is NOT interchangeable.

Blue urine

Paclitaxel, Docetaxel, Cabazitaxel, Paclitaxel albumin bound. They inhibit microtubules during M phase.

9
Q

What are the taxanes side effects?

What to know about irinotecan and how does it work?

What are the topoisomerase 2 inhibitors and what to know about it?

A

Docetaxel can cause severe fluid retention. Severe hypersensitivity reactions except Abraxane. Use NON-PVC bag and tubing except abraxane.

Inhibits topoisomerase 1 during S phase. Acute cholinergic symptoms(diarrhea treated with atropine), delayed diarrhea(loperamide). Diarrhea early and late.

Inhibit G2 phase. Etoposide capsules (VePesid) refrigerate capsules. Etoposide IV can cause infusion related hypotension, IV preparation use non PVC IV bag and tubing due to leaching. Prepare solution to a concentration of <0.4 mg/mL to avoid precipitation due to water solubility.

10
Q

What to know about 5-FU?

What to know about Capecitabine (Xeloda)?

What to know about Methotrexate?

A

S phasee worker. Leucovorin given to increase efficacy. Pharmacogenomics: DPD deficiency increases risk of severe toxicity.

Oral prodrug of fluorouracil. Pharmacogenomics DPD deficiency increases risk of severe toxicity.

S Phase. Leucovorin rescue must be given. Intrathecal is preservative free ONLY. Given weekly. Levoleucovorin ( Fusilev). Hydration and IV sodium bicarb given to alkalinize the urine and decreased nephrotoxicity, watch for hepatotoxicity and myelosuppression. Drug interactions are NSAIDs and salicylates.

11
Q

What is Pemetrexed?

What to know about Tretinoin AKA All-trans retinoic acid?

What to know about Arsenic Trioxide?

A

Alimta.

Pregnancy safety issue. RA-APL differentiation syndrome BBW.

QT prolongation. RA-APL differentiation syndrome.

12
Q

What to know about Asparaginase and Pegaspargase?

What to know about Bleomycin?

What are the mTOR inhibitors?

A

Pegylated less frequent dosing and less allergic reactions. Hypersensitivity reactions, prolonged prothrombin time (PT/INR).

Not myelosuppressive, Max lifetime dose of 400 units due to pulmonary toxicity risk. Pulmonary fibrosis and hypersensitivity reaction.

Everolimus, Zortress for transplant. Side effects are dyslipidemia, rash, stomatitis, interstitial lung disease. Use non-PVC bag and tubing for Temsirolimus. Dyslipidemia, hyperglycemia, myelosuppression, interstitial lung disease.

13
Q

What drugs are your immunomodulators and boxed warnings?

What are your proteasome inhibitors?

What to know about bortezomib?

A

Lenalidomide (Revlimid), Pomalidomide, Thalidomide (Thalomid). Severe birth defects and fetal risk/pregnancy.

Bortezomib, Carfilzomib.

acyclovir and valacyclovir can be used to prevent herpes reactivation. Peripheral neuropathy is the same side effect for Bortezomib and Carfilzomib.

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