52 terms

Onco - drug, toxicity and antidote

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Nitrogen Mustard, Mechlorethamine
nausea, vomiting, CNS, myelosuppression, hepatotoxicty, 2nd malignancy, infertility, extravasation (1/6M sodium thiosulfate)
Cyclophosphamide
chance of hemorrhagic cystitis (MESNA), MS, IS, N, V, alopecia, rarely pneumonitis, HD - SIADH, cardiotoxicity, N, V. 2nd malignancies
Ifosfamide
hemorrhagic cystitis (MESNA required!), encephalopathy (Methylene Blue), MS, IS, N, V, alopecia, rarely pneumonitis, HD - SIADH, cardiotoxicity, N, V. 2nd malignancies
Chlorambucil
myelosuppression - delayed and prolonged, infertility, rarely neuropathy and pneumonitis, 2nd malignancies - AML
Busulfan
Myelosuppression - delayed and prolonged, pulmonary fibrosis, hyperpigmentation, gynecomastia, mucositis and infertility, HD - venooclussive disease of the liver
Melphalan, I-PAM
in BMT - GI toxicity becomes dose limiting, myelosuppression, mucositis, infertility
Thiotepa
in BMT - mucositis, cutaneous toxicity, severe thrombocytopenia, myelosuppression, n,v
Cisplatin
SEVERE nausea and vomiting, nephrotoxicity, neurotoxicity, ototoxicity, moderate vesicant, dose related moderate myelosuppression
Carboplatin
myelotoxicity, higher doses - renal dysfunction, neurotoxicity
Oxaliplatin
dose limiting cumulative peripheral neuropathy precipitated by cold, low rates of nephrotoxicity and ototoxicity, moderate myelosuppression
Mitomycin C
delayed myelsuppression (3-8)w, GI toxicity, hemolytic uremic syndrome
Altretamine / Hexamethlymelamine
25% have neurotoxicity (mood changes, depression, psychosis, peripheral neuropathy), n,v, myelosuppression, flu-like symptoms, rash, increased LFT's
Carmustine
pulmonary fibrosis (50% of pts with a cumulative dose of >1500mg/mm^2), myelosuppression (delayed 4w), n,v, mucositis, CNS toxicity
Streptozocin
dose limiting nephrotoxicity. severe nausea and vomiting
Dacarbazine
myelosuppression, nausea and vomiting
Temozolamide
myelosuppression, nausea and vomiting
Procarbazine
dose limiting myelosuppression, GI upset, CNS, 2nd malignancies are more common
Bendamustine
n,v, bone marrow suppression, infusion rxns
Methotrexate
mucositis, myelosuppression, diarrhea, HD renal dysfunction, liver toxicity and rare pneumonitis
5-fluorouracil
dose related bone marrow suppression, CNS toxicity (chemo brain), stomatitis, diarrhea, cutaneous toxicity. Continuous infusion - less myelosuppression but more severe diarrhea, mucositis and hand-foot syndrome. Bolus dosing - myelosuppression is dose limiting
Floxuridine
dose limiting hepatic toxicity, myelosuppression and hand foot syndrome
Capcetibine
hand-foot syndrome
Cytosine Arabinoside
severe nausea and vomiting, bone marrow suppression, diarrhea, stomatitis, HD - conjunctivitis, CNS toxicity (forbrain, ataxia, nystagmus, fine motor skills)
Gemcitabine
myelosuppression, flu-like syndrome
6-mercaptopurine
myelosuppression, diarrhea, stomatitis, liver toxicity
Fludarabine Monophosphate
higher doses - severe neurotoxicity, myelosuppression and GI toxicity
Pentostatin / 2'deoxycoformycin
n,v myelosuppression, conjunctivitis. HD - neurologic and renal toxicity
Cladribine / 2-Chlorodeoxyadenosine
moderate myelosuppression, HD - severe neurologic and renal toxicity
Clofarabine
dose limiting - myelosuppression, immunosuppression, flu like syndrome, neurotoxicity and nephrotoxicity
Decitabine
myelosuppression, n,v, diarrhea, flu like symptoms, laboratory abnormalities (hyperglycemia, hypomagnesemia, hypokalemia, increased LFT's)
5-azacitidine
myelosuppression, n, v, neurotoxicity, laboratory abnormalities
Hydroxyurea
myelosuppression (within DAYs), megaloblastic anemia, rash, radiation recall
Nelarabine
dose limiting CNS toxicity, myelosuppression, n, v, <40% will have some CNS toxicity(somnolence, HA, peripheral neuropathy, seizures, coma)
Bleomycin
pulmonary fibrosis (>300units), alopecia, mucositis is the acute dose limiting toxicity, fever, allergic rxns, cutaneous toxicity
Doxorubicin
cardiotoxicity (cumulative dosing >450-550mg/mm^2 intermittently or 800mg/mm^2 weekly / continuous infusions), myelosuppression, mucositis, alopecia, n,v radiation recall, red urine (not a toxicity but patients need to know)
Daunorubicin
cardiotoxicity (>450-550mg/mm^2 intermittently or 800mg/mm^2 weekly / continuous infusions (Dexrazoxane)), myelosuppression, mucositis, alopecia, n,v radiation recall,
Idarubicin
cardiotoxicity (>150mg/mm^2 intermittently (Dexrazoxane)), myelosuppression, mucositis, alopecia, n,v radiation recall,
Epirubicin
cardiotoxicity (>900mg/mm^2 intermittently (Dexrazoxane)), myelosuppression, mucositis, alopecia, n,v radiation recall,
Mitoxantrone
risk of cardiotoxicity is lower than doxorubicin, myelosuppression, milder nausea, v, mucositis, alopecia, moderate vesicant
Dactinomycin-D / Actinomycin D
myelosuppression, n,v, skin tocicity, mucositis, diarrhea, constitutional symptoms
Vincristine / Liposomal Vincristine
neurotoxicity (foot drop syndrome, peripheral neuropathies, paralytic ileus (>2mg single dose)), mod/severe vesicant,
Vinblastine
myelosuppression, neurologic tox is less common than with vincristine and associated with chronic usage
Vinorelbine
leukopenia and neurotoxicity
Paclitaxel
hypersensitivity rxn, myelosuppression, peripheral neuropathy, alopecia, mucositis
Docetaxel
infusion related rxns, myelosuppression, neurotoxicity
Cabazitaxel
hypersensitivity / infusion rxn
Ixabepilone
neutropenia, peripheral neuropathy, arthralgias, alopecia
Eribulin
significant myelosuppression, neurologic tox is less common than with vincristine
Estramustine
painful gynecomastia, cardiovascular complications, thromboembolism, decreased libido/ED, n,v
Etoposide, VP-16
secondary malignancies, myelosuppression, mucositis, alopecia
Topotecan
diarrhea, myelosuppression, alopecia
Irinotecan
diarrhea (early - anticholinergics (atropine), late - loperimide), myelosuppression
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