onc meds

Cell Cycle Nonspecific (3 classes)

• Alkylating agents

• Anthracyclines

• Platinum compounds

All Awesome Pharmacists

S-Phase (2 classes)

• Antimetabolites

• Topo I inhibitors

AT the S-phase, the DNA replicATes

G2 phase (2 drugs)

• Etoposide

• Bleomycin

M phase (2 classes)

• Taxanes

• Vinca alkaloids

ALKYLATING AGENTS (4)

• Cyclophosphamide

• Ifosfamide

• Busulfan

• Carmustine

Hemorrhagic cystitis is caused y the toxic metabolite ______

acrolein

What chemoprotectant is given with all ifosfamide and high cyclophosphamide doses (>1 g/m2)?

MESNA

PLATINUM ANALOGS (3)

• Cisplatin

• Carboplatin

• Oxaliplatin

Platinum based safety concerns (4)

• Hypersensitivity rxn

• Nephrotoxicity (prevent with hydration, amifostine chemoprotectant, and limit dose to <100 mg/m2 per cycle)

• Ototoxicity

• Peripheral neuropathy

What specific adverse effect does oxaliplatin have?

Acute neuropathy exacerated by cold

ANTHRACYCLINES (1)

• Doxorubicin

Doxorubicin safety concerns (2)

• Cardiotoxicity (LVEF)

• Red discoloration

Doxorubicin

A. Red discoloration of body fluids

B. Blue discoloration of body fluids

A. Red discoloration of body fluids

Mitoxantrone

A. Red discoloration of body fluids

B. Blue discoloration of body fluids

B. Blue discoloration of body fluids

How to prevent doxorubicin induced cardiotoxicity? (4)

• Limit total lifetime cumulative dose to 450-550 mg/m2

• Consider dexrazoxane chemoprotectant when cumulative dose ≥ 300

• Monitor LVEF with ECHO before and after treatment

TOPO I INHIBITOR

• Irinotecan

How to prevent & treat diarrhea with irinotecan?

• Symptomatic care, hydration, replete lights

• PPX: acute diarrhea - atropine

• TX: acute diarrhea - atropine

- Delayed diarrhea: loperamide

TOPO II INHIBITOR (1)

• Etoposide

VINCA ALKALOID (2)

• Vincristine

• Vinblastine

- VinCristine causes more CNS tox

- VinBlastine causes more Bone marrow suppression

Vincristine safety concerns (3)

• Peripheral neuropathy - limit single doses to 2 mg

• Autonomic neuropathy (constipation)

• Paralysis & death if given intrathecally - prepare in small IV piggyback bags with label

What medication can cause paralysis & death if given intrathecally?

Vincristine

TAXANES (2)

• Paclitaxel

• Docetaxel

Taxanes safety concerns (2)

• Peripheral neuropathy

• Hypersensitivity reactions - premedication

What taxane can cause severe fluid retention?

Docetaxel

PYRIMIDINE ANALOG ANTIMETABOLITES (2)

• Fluorouracil

• Capecitabine

Pyrimidine analog safety concerns

• Hand-foot syndrome (PPE)

• Diarrhea

• Mucositis

• Increased risk of DPD deficiency - antidote is uridine triacetate

• Significantly increase INR

What is the antidote for pyrimidine analog antimetabolite DPD deficiency?

Uridine Triacetate

Hand foot syndrome management (5)

• Use EMOLLIENTS (aquaphor, urea cream, etc)

• Limit friction & pressure

• Avoid heat exposure

• Cold compresses to provide temporary relief

• Topical steroids & pain meds if needed

FOLATE ANTIMETABOLITES (1)

• Methotrexate

Methotrexate safety concerns

• Nephrotoxicity with high doses ≥500

• GI toxicity (diarrhea, mucositis)

How to PPX & TX methotrexate induced nephrotoxicity?

• PPX: leucovorin rescue

- hydration with IV sodium bicarb to alkalinze the urine

- avoid NSAIDs, salicylates

• TX: antidote - glucarpidase which rapidly lowers MTX levels

What can glucarpidase be used for?

Treatment of methotrexate induced nephrotoxicity

Leucovorin rescue is required for doses ≥ ____ to reduce toxicities

500

VITAMIN B9 (folate) name

LEUCOVORIN

Oral mucositis management (5)

• Good oral hygiene (soft toothbrush)

• Ice chips

• Freq rinsing with bland rinses (sodium bicarb)

• TX with viscous lidocaine 2%, magic mouthwash

• Thrush TX: nystatin oral suspension, clotrimazole troches

Arsenic trioxide main safety concern (1)

QT prolongation

Bleomycin safety concerns (2)

• Pulmonary toxicity - lifetime cumulative dose to 400 units

• Hypersensitivity reactions

Bortezomib safety concern (1)

• Herpes reactivation

With what medication do you need 2 negative pregnancy before treatment?

Thalidomide

Anthracylines extravasation

A. cold compress + dexrazoxane

B. warm compress + hyaluronidase

A. cold compress + dexrazoxane

Vinca alkaloids extravasation

A. cold compress + dexrazoxane

B. warm compress + hyaluronidase

B. warm compress + hyaluronidase

RITUXIMAB (target & safety)

• Target: CD20

• Safety: Hep B reactivation

CETUXIMAB (target & safety)

• Target: EGFR gene

• Safety: acneiform rash

TRASTUZUMAB (target & safety)

• Target: HER2 overexpression

• Safety: cardiotoxicity (monitor LVEF)

BEVACIZUMAB

• VEGF inhibitor

• Safety: impaired wound healing, thromboembolic events (HTN), bleeding, GI perforation

Bevacizumab should NOT be used for ____ days before or after surgery

28

PEMBROLIZUMAB

• PD-1 inhibitor

• Safety: immune mediated toxicities

IPILIUMUMAB

• CTLA-4 inhibitors

• Safety: immune mediated toxicities

IMATINIB (target & safety)

• Target: BCR-AL fusion gene

• Safety: fluid retention, QT prolongation

Tyrosine Kinase Inhibitor