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Which anti-cancer may cause <color orange>M</color>yelosuppression
<color orange>M</color>ucositis
Pulmonary Fibrosis?

<color orange>MTX</color>

Which anti-neoplastic agent causes <color orange>M</color>ucositis & Hand-Foot Syndrome

<color orange>5-FU</color>

What can be used to tx Hand-Foot syndrome caused by 5-FU?

pyridoxine (Vit B6)

What can be used for mucositis caused by 5-FU?

ice chips

What can be used to treat MTX toxicity?

"Leucovorin Rescue" after 24 hrs

What can be used to ↑ 5-FU conc?

leucovorin

<color purple>C</color>NS-Neurotox, visual & personality Δ; Give steriods paralysis & alopecia

<color purple>Cytarabine</color>

cytarabine

(Ara-C)

Anti-metabolite: Pyrimidine Analog
* C = pyrimidine (C & T)

Which anti-cancer drugs req chest x-ray (CXR) & may cause pulmonary fibrosis.

Think <color blue>BlungB</color>

Busulfan
Bleomycin

Which anti-cancer agent can cause hyperpigmentation / Δ in nail bed & pulmonary fibrosis?

Think <color blue>BlungB</color>

Bleomycin

damages the pancreas resulting in IDDM (dose-limiting)

<color brown>Streptozocin</color>

What is streptozocin used to treat?

Treatment of metastatic islet cell carcinoma of the <color brown>pancreas</color>

Which anti-neoplastic agent causes
nephrotoxicity
hepatotoxicity
pulmonary fibrosis

<color green>carmustine</color>

Which drugs are used to treat ↑Ca++ of malignancy?

plicamycin
mitomycin

Which anti-neoplastic agent may cause hemolytic cystitis "dose-limiting"

<color pink>cyclophosphamide</color>

What can be used to pre-treat hemorrhagic cystitis caused by cyclophosphamide?

mesna
prehydrate

what are the metabolites to cyclophosphamide?

<color pink><b>acrolein</b></color>
4-aldophosphamide
4-hydroperoxycyclophosphamide
& nor-nitrogen mustard

Which anti-neoplastic agent causes altered mental status (psychosis)

Think <color pink> C </color> w/ cyclophosphamide that causes hemorrhagic cystitis

<color pink>ifosphamide</color>

peripheral neuropathy "dose-limiting"

<color grey>Vin<color red>c</color>ristine / Vin<color blue>b</color>lastine/Vinorelbine</color>

Vin<color red>C</color>ristine
<color red>C</color>NS
<color red>C</color>onstipation
causes <color red>SIADH</color>

Vin<color blue>B</color>lastine
<color blue>B</color>lood dyscrasia
<color blue>B</color>one Marrow Suppression

Which anti-neoplastic agent causes ↑ LFTs, cholinergic early/late onset of diarrhea

<color brown>irinotecan</color>

What can be used to treate early onset of diarrhrea caused by irinotecan?

atropine 1 mg

What can be used to tx late onset of diarrhea caused by irinotecan?

loperamide [no real max]

which onset of diarrhea, early or late, caused by irinotecan can be lethal?

late

Which anti-cancer medications are nephrotoxic?

Remember <color green>green Cs</color> on chemo Man near the kidneys - 2 platins + carmustine

<color green>cisplatin
carboplatin</color> (less nephortox than cisplatin)
<color green>carmustine</color>

What agent is used to reduce the incidence of moderate-to-severe xerostomia in patients undergoing postoperative radiation treatment for head and neck cancer, where the radiation port includes a substantial portion of the parotid glands?

What agents is used as pre-tx when a pt is on platinum anti-neoplastic agents?

amifostine

also hydrate pts

* amifostine is also used reduce the cumulative renal toxicity associated with repeated administration of cisplatin

Which agents causes cardiotoxicity (CHF)
- cause cardiomegaly → irreversible CHF

Liposomal forms = less toxic

<color red>daunorubicin
doxorubicin</color>

What can be used for pre-treatment to prevent cardiotoxicity caused by daunorubicin & doxorubicin?

or what cardioprotective drug can be given with daunorubicin & doxorubicin?

dexrazoxane (Zine<u>card</u>)

* <u>card</u>ioprotective

What chemo agents cause <color orange>alopecia</color>?

Think VIP CTC

Vinorelbine
Ifosfamide
Paclitaxel

Cyclophasphamide
Topatecan
Cytarabine

Which anti-neoplastic agent causes
OTOtoxicity
neurotoxicity
nephrotoxicity
light sensitivity
↓ electrolytes

Remember the C in the chemo man head

<color purple>cisplatin</color>

What is the BBW for Xeloda?

Severe DDI capecitabine + coumadin = ↑↑↑ INR & PT [Hand-Foot Syndrome]

Which chemo agent are red in color?

daunorubicin (also causes red-pink urine = normal)

doxorubicin

Which chemo agent causes Blue-green coloration: May cause urine, saliva, tears, and sweat to turn blue-green for 24 hours postinfusion; whites of eyes may have blue-green tinge?

<color blue>mitoxantrone</color>

What is the life time does of doxorubicin?

450 - 500 mg/m2

daunorubicin citrate (liposomal)

(DaunoXome)

Antineoplastic Agent: Anthracycline

daunorubicin <u>HCl</u>

(Cerubidine) ← inj [pwd & soln]

Antineoplastic Agent: Anthracycline

What is the lifetime dose of daunorubicin?

550 mg/m2

* has a higher cumulative lifetime dose than doxorubicin

doxorubicin

(Adriamycin, Doxil [liposomal]) ← both = inj

Antineoplastic Agent: Anthracycline

(Doxil)

doxorubicin liposomal

Antineoplastic Agent: Anthracycline

(Adriamycin)

doxorubicin

Antineoplastic Agent: Anthracycline

(Cerubidine)

daunorubicin <u>HCl</u>

Antineoplastic Agent: Anthracycline

(DaunoXome)

daunorubicin <u>citrate</u> (liposomal)

Antineoplastic Agent: Anthracycline

bleomycin

(Blenoxane)

Antineoplastic, Abx

(Blenoxane)

bleomycin

Antineoplastic, Abx

Which anti-neoplastic agent has a BBW for pulmonary fibrosis?

bleomycin

* busulfan, MTX, Carmustine != BBW but does cause

Which agent can cause interstitial pneumonitis (AE)?

bleomycin

Mitomycin is used for treatment of __________

adenocarcinoma of stomach/pancreas (treats hypyercalcemia caused by malignancy)

mitoxantrone

(Novantrone®)

Antineoplastic Agent: Anthracenedione

(Novantrone®)

<color blue>mitoxantrone</color>

Antineoplastic Agent: Anthracenedione

busulfan

(Myleran [tabs], Busulfex [inj])

Antineoplastic Agent: Alkylating Agent

Which anti-cancer agent has a BBW for bone marrow suppression?

busulfan

carboplatin

* Vinblastine causes bone marrow suppression

Both busulfan & bleomycin may cause pulmonary fibrosis but what is the difference?

busulfan (alkylating agent)
- ↑ uric acid (pt often placed on allopurinol)
- S/Sx = SOB
- BBW = bone marrow suppression
- PO & IV

bleomycin (antineoplastic, abx)
- BBW = pulmonary fibrosis
- inj only

(Myleran)

busulfan tabs

Antineoplastic Agent: Alkylating Agent

Which anti-neoplastic platinum agent is a better choice of drug in pts w/ kidney dysfcn?

carboplatin

cisplatin has BBW for renal toxicity

Both carboplatin & cisplatin are
available IV,
may cause nephrotox,
BBW = anaphylactic & experienced MD,
tx ovarian cancer & has off-label use w/ head & neck cancer, what is the difference?

carboplatin
- ototox = reversible
- BBW = vomiting, bone marrow suppression
- causes N/V if pre-tx w/ emetogenic

cisplatin
- ototox = permanent
- BBW = ototox, renal tox, med safety (max dose/cycle)
- requires tx of N/V b/f tx b/c it's a potent emotogenic drug
- neurotoxicity, light sensitivity, ↓ eletrolytes

Which agents are anti-neoplastic, platinum analog?

carbo<u>platin</u>
cis<u>platin</u>
oxali<u>platin</u> (Eloxatin)

Which anti-neoplastic, platinum analog has a BBW for ototoxicity, renal toxicity, anaphylaxis, max dose per cycle, experience physician?

cisplatin

* ALL platinum analog has BBW for anaphylaxis

amifostine

(Ethyol)

Adjuvant, Chemoprotective Agent (Cytoprotective); Antidote

(Ethyol)

amifostine

Adjuvant, Chemoprotective Agent (Cytoprotective); Antidote

What is the MOA of mesna?

Remember mesna is used to pre-tx pts taking cyclophasphamide to prevent hemorrhagic cystitis

MOA = binds to acrolein (cyclophosphamide metabolite)

Which anti-cancer drug may cause pulmonary fibrosis?

The B drugs

Bleomycin & busulfan
MTX
carmustine

* note docetaxel causes pulmonary <u>edema</u>

Which anti-cancer drugs on the chemo man has neurotoxicity?

Remember the 2 <color purple>C</color> as the ears

Cytarabine & cisplatin

What kind of tubing should be avoided w/ paclitaxel?

PVC

What should we worry abt when a pt is on paclitaxel & what should we do?

hypersensitivty rxn

Pre-tx w/ anti-emetic, benadryl, cimetadine & dexamethasone 8 mg BID x 5 days

<color red>Avoid</color> PVC tubing

What SE are seen with docetaxel?

fluid retention & pulmonary edema

What is used for pre-tx for pts on docetaxel?

dexamethasone 8 mg BID x 5 days

* same as paclitaxel

What are some pt education for pts on anti-cancer meds?

- maintain hydration (2 - 3 L/day)
- maintain nutrition (eat sm freq meals to ↓ N/V)
- Notify MD if persistent cough, sore throat, fever, sores on mucous membranes
- freq oral care (good hygiene)
- wear sunscreen

capecitabine

(Xeloda)

Anti-neoplastic Agent: Antimetabolite (Pyrimidine analog)

Which anti-neoplastic agents are pyrimidine analogs?

capecitabine
cytarabine

Which anti-neoplastic drugs may cause Hand-Foot Syndrome?

5-FU
capecitabine

Which anti-neoplastic agent causes red-pink urine?

daunorubicin

dexrazoxane

(Zinecard)

Cardioprotective use in pre-tx of daunorubicin & doxorubicin

(Zinecard)

dexrazoxane

Cardioprotective use in pre-tx of daunorubicin & doxorubicin

(Xeloda)

capecitabine

Anti-neoplastic Agent: Antimetabolite (Pyrimidine analog)

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