Traditional Cytotoxic Chemotherapy: CELL CYCLE NONSPECIFIC

Aklylating agent moa

cross linking DNA strands; inhibits DNA and protien synthesis

Cell cycle nonspecific agents

alkylating agents, anthracyclines, platinum based compounds

Alklyating agents; list

cyclophosphamide, ifosfamide, busulfan, carmustine

cyclophosphamide/ifosfamide; safety concerns

hemorrhagic cystitis due to toxic metabolic acrolein in bladder

cyclophosphamide/ifosfamide; monitoring

hematuria, urinalysis for RBC, urinary tract symptoms

cyclophosphamide/ifosfamide; prevention of tox

hydration

mesna with ALL ifosfamide and doses >1g/m2 of cyclophoshamide

cyclophosphamide/ifosfamide; management of tox

bladder irragation with normal saline

ifosfamide; safety concerns

neurotox (encephalopathy and cerebellar dysfunction)

ifosfamide; monitoring

s/sx of neurotox

ifosfamide; prevention/treatment of tox

methylene blue

ifosfamide generic

Ifex

busulfan generic

Buslfex, myleran

busulfan; safety concerns

pulmonary toxicity (pulmonary fibrosis) and seizures

busulfan; monitoring

s/sx pulm tox, PFTs, s/sx seizures

busulfan; treatment of tox

supportive care (oxygen-pulm tox, antiseizure meds for seizure prevention/treatment)

carmustine generic

biCNS, gliadel wafer

carmustine; safety concerns

neurotoxicity (seiures, cerebral edema), pulmonary toxicity (pulmonary fibrosis)

carmustine; which form has higher incidence of neurotoxicity

wafer implant

carmustine; management of tox

supportive care (oxygen-pulm tox, antiseizure meds for seizure prevention/treatment)

platinum based compounds moa

alkylating agents; also crosslink DNA, interfing with DNA synthessis and cell replication, leading to cell death

platinum based compounds

cisplatin, carboplaitn, oxaliplatin

which platinum agent has the greatest incidence of nephrotoxicity and otoxocitiy

cisplatin

carboplatin generic

paraplatin

platinum agents; safety concerns

hypersensitivity

nephrotoxicty

ototoxicity

peripheral neuropathy

oxaliplatin; additional safety concern

acute sensory neuropathy excerbated by COLD

platinum-based compounds; monitoring for nephrotoxicity

Renal funciton (BUN, SCr, intake/output), electolytes (Mg, K, Na, Ca)

platinum-based compounds; management for nephrotoxicity

prevention; hydration, amifostine/ethyol with cisplatin, limit cisplatin dose to less than 100mg/m2 per cycle

amifostine/ethyol moa

chemoprotectant; used to reduce cumulative renal toxicity of cisplatin

platinum-based compounds; monitoring for ototoxicity

s/sx of hearing loss or tinnitus; audiogram at baseline

platinum-based compounds; management for ototocicity

avoid concomittant ototoxic medication (AMG)

oxaliplatin; monitoring for cold neuropathy

acute sensory neuroapthy; abnromal senseation in hands, feet perioral area or thraot, jaw spasms, chest pressure

oxaliplatin; prevention for cold neuropathy

avoid cold exposure; cold temps, consumption of cold food/beverages

atnhracycline moa

intercalaction into DNA, inhibtion of topoisomerase II and creastion of oxygen free radicals that damage cells

doxorubicin generic

adriamycin

doxorubicin; safety concerns

cardioxicity (heart failure and cardiomyopathy), red discoloration of body fluids)

doxorubicin; monitoring

LVEF, s/sx of HFD

doxorubicin; prevention of tox

limit total lifetime cumulative dose to 450-500mg/m2

dexrazoxane in patients at doses above 300mg/m2

mitoxantrone- what?

anthracenedione, related to anthracycline

mitoxantrone safety concerns

blue disoloration of sclera and bodily fluids

anthracyclines

doxorubicin, daunorubicin, epirubicin, idarubicin