Fitz - Managing Complications

Question 1

HL regimen

Answer 1

ABVD - Doxorubicin, Bleomycin, Vinblastine, Dacarbazine

Question 2

Type of activity in the ABVD regimen

Answer 2

Doxorubicin - Intercalating Agent
Bleomycin - antibiotic
Vinblastine - Antimitotic, destabilizer of microtubules
Dacarbazine - alkylating

Question 3

Type of clearance in the ABVD regimen

Answer 3

Doxorubicin - hepatic
Bleomycin - renal
Vinblastine - CYP3A4/5
Dacarbazine - hepatic

Question 4

Toxicity of ABVD regimen

Answer 4

Doxorubicin - cardiomyopathy
Bleomycin - pulmonary fibrosis
Vinblastine - neuropathy
Dacarbazine - marrow suppression

Question 5

NHL regimen

Answer 5

CHOP - 
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

Question 6

NHL regimen activity

Answer 6

Cyclophosphamide - alkylating (N mustard)
Doxorubicin - intercalating
Vincristine - antimitotic, destabilizer of microtubules
Prednisone - CS

Question 7

NHL Clearance

Answer 7

Cyclophosphamide - CYP3A4/5; CYP2D6 prodrug
Doxorubicin - hepatic
Vincristine - CYP3A4/5
Prednisone - 100% bioavailable

Question 8

NHL toxicity

Answer 8

Cyclophosphamide - acrolein (hemorrhagic cystitis)
Doxorubicin - Cardiomyopathy
Vincristine - neuropathy, constipation
Prendisone - hyperglycemia/osteopenia

Question 9

Antiemetic classes best used for acute cytotoxic emesis

Answer 9

1. 5HT3 receptor antagonists (~setron –> vagal afferent and area postrema)
2. D-2 R antagonist - METOCLOPRAMIDE

Question 10

Antiemetic classes best used for delayed cytotoxic emesis - caused by what drug?

Answer 10

1. NK1 R antagonists (in vagal afferent and area postrema) - APREPITANT
   Caused by cisplatin

Question 11

dronabinol

Answer 11

Cannabinoid receptor agonist - used if refractory to other agents

Question 12

leucovorin used for what?

Answer 12

with HDMTX, to replenish folate pool in normal cells - bypasses DHFR

Question 13

MESNA used for what? Give when?

Answer 13

hemorrhagic cystitis caused by acrolein (cyclophosphamide/CHOP or Ifosfamide).

Give prophylactically.

Question 14

Amifostine used for what?

Answer 14

Nephrotoxicity associated with cisplatin.

Question 15

Five of the worse CINV drugs

Answer 15

1. CARmustine (nitrosourea)
2. DACARbazine (alkylating agent)
3. MECHlorethamine (nitrogen mustard)
4. CYCLophophamide (nitrogen mustard)
5. Cisplatin