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Therapy - Oncology > Drug Toxicities > Flashcards

Drug Toxicities Flashcards

1
Q

Cell-Cycle Specific Agents

A

Antimetabolites, Vinca Alkaloids, Taxanes, Etoposide, Irinotecan/Topotecan

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2
Q

Cell-Cycle Nonspecific Agents

A

Anthracyclines, Platinums, Alkylating Agents, Dacarbazine, Nitrosureas

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3
Q

Antimetabolites

A

MTX, cytarabine, 5-FU, gemcitabine, fludarabine, 6-MP, hydroxyurea

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4
Q

Vinca alkaloids

A

Vincristine, vinblastine, vinorelbine

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5
Q

Taxanes

A

Paclitaxel, docetaxel

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6
Q

Anthracyclines

A

Doxorubicin, daunorubicin, idarubicin, epirubicin

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7
Q

Platinums

A

Cisplatin, carboplatin, oxaliplatin

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8
Q

Alkylating Agents

A

Cyclophosphamide, ifosfamide, melphalan, busulfan, chlorambucil

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9
Q

EGFR TKI’s

A

Erlotinib, gefitinib

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10
Q

BCR/ABL TKI’s

A

Imatinib, dasatinib, nilotinib

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11
Q

VEGF TKI’s

A

Sorafenib, sunitinib

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12
Q

EGFR/HER2 TKI

A

Lapatinib

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13
Q

Alkylating Agents Class toxicities

A

myelosuppressive, cytotoxic, mutagenic & carcinogenic (cause secondary leukemias), teratogenic

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14
Q

Cyclophosphamide Toxicity

A

Hemorrhagic cystitis

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15
Q

Premed for cyclophosphamide

A

IV fluids

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16
Q

Ifosfamide Toxicity

A

Hemorrhagic cystitis

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17
Q

Premed for ifosfamide

A

IV fluids & Mesna

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18
Q

Cisplatin toxicities

A

SEVERE N/V, nephrotoxicity, ototoxicity, peripheral neuropathies, electrolyte abnormalities

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19
Q

Premed for cisplatin nephrotoxicity

A

1 L hydration with NS before & after dose

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20
Q

Premed for cisplatin electrolyte abnormalities

A

20 mEq K & 8 mEq Mg (prevent hypokalemia & hypomagnesemia)

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21
Q

Carboplatin toxicity

A

Bone marrow suppression (thrombocytopenia), less of other toxicities compared to cisplatin

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22
Q

Oxaliplatin toxicity

A

Myelosuppression, peripheral neuropathies

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23
Q

Which medication toxicity includes a neuropathy that is exacerbated by cold temperatures?

A

Oxaliplatin

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24
Q

Anthracycline Class toxicities

A

Myelosuppression, cardiotoxicity, vesicant (causes tissue necrosis upon extravasation)

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25
Q

Mitoxantrone Toxicities

A

Myelosuppression. Doesn’t produce free radicals so less cardiotoxicity & less risk of necrosis following extravasation than the anthracyclines

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26
Q

Taxane Class Toxicities

A

Myelosuppression, neuropathies

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27
Q

Paclitaxel Toxicities

A

Hypersensitivity reactions due to cremophor vehicle. Special “taxol” tubing required for infusion (DHEP free)

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28
Q

Premeds for Paclitaxel Toxicity

A

Dexamethasone, Diphenhydramine, & H2RA to prevent hypersensitivity rxn due to cremophor vehicle

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29
Q

Docetaxel Toxicities

A

Edema, hypersensitivity reactions

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30
Q

Premed for Docetaxel Toxicity

A

8 mg dexamethasone BID x 3 days to prevent edema

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31
Q

Vinca alkaloids Class toxicity

A

FATAL if given intrathecally, peripheral neuropathies

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32
Q

Vinblastine & vinorelbine toxicity

A

Bone marrow suppression

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33
Q

Cytarabine toxicities (standard doses)

A

Myelosuppression, mucositis

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34
Q

Cytarabine toxicities (high dose 1 - 3 g/m2)

A

Cerebellar toxicity, chemical conjunctivitis

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35
Q

Premed for high dose cytarabine toxicity

A

Corticosteroid eye drops continuing 48 - 72 hours after last dose

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36
Q

5-FU & capecitabine toxicities

A

Diarrhea, mucositis, palmar-plantar erythrodysesthesia (hand-foot syndrome)

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37
Q

6-MP drug interactions

A

interactions with xanthine oxidase inhibitors (allopurinol)

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38
Q

Enzyme deficiency that causes 6-MP toxicities

A

TPMT (thiopurine methyltransferase)

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39
Q

Purine analog drug

A

Fludarabine

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40
Q

Toxicity of purine analogs

A

Prolonged lymphopenia

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41
Q

Premed for fludarabine

A

TMP/SMX 1 tab M, W, F (PCP prophylaxis)

Acyclovir/valacyclovir (HSV, VZV prophylaxis)

42
Q

MTX toxicities

A

myelosuppression, mucositis, LFT elevations, acute renal failure

43
Q

Premed for MTX

A

Hydration & alkalization of the urine (use sodium bicarb) can minimize/prevent acute renal failure

44
Q

Concurrent med with high dose MTX

A

Leucovorin required for cell rescue

45
Q

Irinotecan toxicities

A

Myelosuppression, diarrhea

46
Q

This drug has an active metabolite (SN-38)

A

Irinotecan

47
Q

TX of irinotecan-induced early onset diarrhea

A

Atropine 0.25 - 1 mg IV

48
Q

TX of irinotecan-induced late onset diarrhea

A

Loperamide 4 mg, then 2 mg q 2 hrs until no bowel movements for 12 hours. May exceed 16 mg (max dose for OTC use). Do not use for more than 48 consecutive hours.

49
Q

Topotecan toxicity

A

Myelosuppression

50
Q

Etoposide toxicities

A

Myelosuppression, secondary leukemias

51
Q

Drugs that cause secondary leukemias?

A

Alkylating agents, anthracyclines, etoposide

52
Q

Drug that causes pulmonary fibrosis?

A

Bleomycin

53
Q

Unique toxicities of high-dose cytarabine?

A

Cerebellar toxicity & chemical conjunctivitis

54
Q

Which drug MUST be given with mesna?

A

Ifosfamide

55
Q

What should be done prior to the administration of cisplatin?

A

1 L of NS followed by an additional liter after administration

56
Q

Which agent can cause hypersensitivity rxns secondary to the cremophor vehicle necessary for dilution & IV administration?

A

Paclitaxel

57
Q

A new drug called ixabepilone has recently been approved for breast cancer. It works as a microtubule inhibitor. What unique side effect would you expect from this newer agent?

A

Peripheral neuropathy

58
Q

Which of the following would you expect to be more effective if given as a continuous infusion over 24 hours vs. IV bolus of 30 min?

A

Cytarabine (the antimetabolites)

59
Q

Which agent can cause hemorrhagic cystitis due to the metabolite acrolein?

A

Cyclophosphamide & ifosfamide

60
Q

A patient receiving an infusion of chemotherapy begins complaining of flushing, sweating, abdominal cramps, and an urgent need to use the restroom while the drug is being administered. What agent is this patient receiving?

A

Irinotecan

61
Q

Which agent causes peripheral neuropathy exacerbated by cold temperatures?

A

Oxaliplatin

62
Q

Which agent requires the pharmacist to dispense with an auxiliary label “Fatal if given intrathecally”?

A

Vincristine, vinorelbine, vinblastine

63
Q

What must be done prior to the 1st infusion of daunorubicin?

A

MUGA scan to assess LVEF

64
Q

Which of the following medications requires PCP prophylaxis for months after administration?

A

Fludarabine (the purine analogs)

65
Q

The lipophilicity of which drug makes it useful for treating CNS malignancies?

A

Lomustine (the nitrosureas)

66
Q

What is the dose-limiting toxicity of vincristine?

A

Peripheral neuropathy

67
Q

Pemetrexed toxicities

A

Bone marrow suppression, cutaneous reactions

68
Q

Premed for Pemetrexed

A

Prevention of bone marrow suppression: folic acid (0.4 - 1 mg PO QD) & Vitamin B12 supplementation (1 mg IM q 3 cycles)

69
Q

Erlotinib toxicities

A

Rash, acne, diarrhea

70
Q

Cetuximab toxicity

A

Rash (good sign; means the drug is working)

71
Q

Bevacizumab toxicities

A

Hemorrhage, HTN, proteinuria, thrombosis, impaired wound healing

72
Q

Crizotinib toxicities

A

Visual disturbances, N/V, diarrhea/constipation, hypogonadism (post-marketing surveillance new toxicity)

73
Q

Trastuzumab toxicities

A

Infusion reactions (fever, chills), Heart failure (decreased LVEF) - needs a MUGA prior to use

74
Q

Liposomal doxorubicin toxicities

A

Cumulative cardiotoxicity (less cardiotoxic than conventional doxorubicin), hand-foot syndrome (dose-limiting effect), myelosuppression (less than with conventional doxorubicin)

75
Q

Tamoxifen AE’s

A

Hot flashes/flushing, nausea, thromboembolism, endometrial cancer, vaginal discharge

76
Q

Aromatase inhibitor toxicities

A

Hot flashes, arthralgias, myalgias, possible loss of BMD

77
Q

Lapatinib toxicities

A

Hand-foot syndrome, rash, diarrhea, fatigue, elevated LFT’s (boxed warning for hepatotoxicity), decreased ejection fraction (reversible)

78
Q

Everolimus toxicities

A

Immunosuppression, infection, myelosuppression, diarrhea, mucositis, impaired wound healing, increased cholesterol, glucose, & triglycerides

79
Q

Denosumab toxicities

A

Hypocalcemia, ONJ

80
Q

Abiraterone toxicities

A

Mineralocorticoid excess (HTN, hypokalemia, edema), adrenal insufficiency, hepatotoxicity (monitor LFT’s). Given with prednisone.

81
Q

Sunitinib & sorafenib toxicities

A

Hand-foot syndrome (mainly with sorafenib), rash/desquamation, diarrhea, mild myelosuppression, HTN, hypothyroidism, decreased LVEF/HF (only with sunitinib)

82
Q

Ipilimumab boxed warnings for immune-mediated AE’s

A

Enterocolitis, hepatitis, dermatitis

83
Q

Premed for ipilimumab

A

High dose corticosteroids to lessen AE’s

84
Q

Vemurafenib toxicities

A

Cutaneous SCC occurs in 25%, photosensitivity, LFT monitoring required

85
Q

Asparaginase toxicities

A

Hypersensitivity rxns: fever, arthralgias, hypotension, anaphylaxis
Pancreatitis, abdominal cramps
Coagulopathies (bleeding & clots - clots more common)

86
Q

This drug has NO myelosuppression

A

Asparaginase

87
Q

Imatinib toxicities

A

Diarrhea, N/V, abdominal pain, edema/fluid retention, rash, fatigue, musculoskeletal symptoms, elevated LFT’s, myelosuppression

88
Q

Dasatinib toxicities

A

Similar to imatinib but add pleural effusion

89
Q

Dasatinib Drug Interactions

A

PPI’s (requires acidic environment for absorption)

90
Q

Nilotinib toxicities

A

Similar to imatinib but add QT prolongation (monitor K, Mg, EKG)

91
Q

AE’s of thalidomide/lenalidomide

A

Peripheral neuropathies, somnolence, neutropenia, thrombosis, teratogenic

92
Q

Bortezomib toxicities

A

Sensory neuropathy, herpes virus reactivation, green tea/vitamin C interaction

93
Q

Calcineurin inhibitors toxicities

A

Nephrotoxicity, HTN, hyperlipidemia, hyperglycemia, hypertriglyceridemia

94
Q

Tacrolimus unique toxicities (in addition to other calcineurin inhibitor toxicities)

A

HA (dose-dependent), electrolyte abnormalities (hyperkalemia, hypomagnesemia, hypophosphatemia)

95
Q

Main side effect of mycophenolate mofetil

A

Diarrhea (peak-dependent; dose-limiting)

96
Q

IL-2 inhibitor drugs

A

Daclizumab & basiliximab

97
Q

IL-2 inhibitor MOA

A

Immediate immunosuppression

98
Q

Alemtuzumab toxicities

A

Prolonged immunosuppression after just one dose (less predictable than IL-2 inhibitors); infusion reactions, pancytopenias, viral infections

99
Q

Premed for alemtuzumab viral prophylaxis

A

TMZ/SMX (PCP prophylaxis)

Famciclovir (HSV, HVZ prophylaxis)

100
Q

Premed for alemtuzumab infusion reactions

A

APAP, diphenhydramine, & corticosteroid

Therapy - Oncology (1 decks)

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