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Oncology Drugs ALL

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sgthuan's version from 2017-07-11 13:28

Cell cycle non-specific agents - Alkylating Agents, Platinum

genericbrandDrug Classclinical pearls
cyclophosphamideCytoxanalkylating agentsHemorrhagic cystitis --> adequate hydration & **** Mesna, BBW myelosuppression, hemorrhagic cystitis
ifosfamideIfexalkylating agentshemorrhagic cystitis --> adequate hydration & Mesna, BBW myelosuppression, hemorrhagic cystitis, neurotoxicity
carmustineBiCNUalkylating agentsuse NON-PVC bag and tubing, BBW myelosuppression, pulmonary toxicity
dacarbazineDTIC-Domealkylating agents*** protect from light --> decomposed drug turns PINK, BBW myelosuppression, hepatic necrosis
procarbazineMatulanealkylating agentsMAOI, avoid food/drug interaction
bendamustineBendeka, Treandaalkylating agentshepatotoxicity
busulfanMyleran, Busulfexalkylating agentspulmonary toxicity
lomustineCeeNU, Gleostinealkylating agents*** ONLY 1 dose q6w --> death if overdose, pulmonary toxicity
melphalanAlkeran, Evomelaalkylating agents
temozolomideTemodaralkylating agents
cisplatinPlatinolplatinum-based*** Nephrotoxicity - use chemoprotectant "AMIFOSTINE" (Ethyol), ototoxicity --> MAX doses <100mg/m2/cycle, **** highest Emetogenic, BBW anaphylactic-like reactions, SE peripheral neuropathy, N/V
carboplatinParaplatinplatinum-based*** Myelosuppression, Calvert formula - total dose = target AUC x (GFR + 25) with AUC from 2-8 mg/mLxmin
oxaliplatinEloxatinplatinum-based** acute sensory neuropathy --> can be exacerbated by exposure to "cold"
doxorubicinAdriamycinanthracyclinespotent vesicant, red urine DISCOLORATION, BBW myocardial toxicity --> MAX lifetime 450-550mg/m2, vesicant, myelosuppression, **** dexrazoxane (Totect) for extravasation & (Zinecard) for cardioprotection
doxorubicin liposomalDoxil, Lipodox50anthracyclinesNOT a vesicant, red urine DISCOLORATION, BBW myocardial toxicity, myelosuppression, SE hand-foot syndrome
daunorubicinCerubidineanthracyclinesmyocardial toxicity
epirubicinEllenceanthracyclinesmyocardial toxicity
idarubicinIdamycinanthracyclinesmyocardial toxicity
valrubicinValstaranthracyclinesmyocardial toxicity, used for bladder instillation ONLY
mitoxantroneNovantroneanthracenedione related to anthracyclinesvesicant like, *** blue urine DISCOLORATION, BBW myocardial toxicity, myelosuppression
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Cell cycle specific

genericBrandclassdrug pearls
vincristineVincasar PFSvinca alkaloids - M phaseBBW potent vesicant --> warm compress & hyaluronidase, FOR IV ONLY, SE peripheral sensory neuropathy (paresthesias), autonomic neuropathy - gastroparesis & *** CONSTIPATION --> capped at 2mg/dose, **** NOT MYELOSUPPRESSION
vinblastineVelbanvinca alkaloids - M phasemyelosuppression, BBW potent vesicant --> warm compress & hyaluronidase, FOR IV ONLY, SE peripheral sensory neuropathy (paresthesias), autonomic neuropathy - gastroparesis & constipation
vincristine liposomalMarqibovinca alkaloids - M phasenot interchangeable with vincristine
paclitaxelTaxoltaxanes - M phaseBBW **** severe infusion-related hypersensitivity reactions (due to solvent system) --> premed with benadryl & corticosteroid & H2RA, myelosuppression, SE peripheral sensory neuropathy (parethesias), myalgias, arthralgias, *** use non-PVC bag and tubing
docetaxelTaxotere, Docefeztaxanes - M phaseBBW **** severe infusion-related hypersensitivity reactions (due to solvent system) --> premed with corticosteroid, myelosuppression, SE peripheral sensory neuropathy (parethesias), myalgias, arthralgias, *** severe Fluid Retention - edema, pleural effusion
paclitaxel albumin-boundAbraxanetaxanes - M phase*** NO premed required (no solvent system)
irinotecanCamptosartopoisomerate I inhibitor - S phaseBBW myelosuppression, diarrhea (early and late), SE acute cholinergic symptoms - flushing, sweating, cramps, diarrhea --> atropine, delayed diarrhea --> loperamide, *** homozygous for UGT1A1*28 --> increased risk for neutropenia & diarrhea, *** MUCOSITIS
topotecanHycamtintopoisomerate I inhibitor - S phaseBBW myelosuppression, use ONLY ANC>1,500 & platelet > 100,000, SE N/V/D, abdominal pain
etoposide IVToposartopoisomerate II inhibitor - G2 phaseBBW myelosuppression, *** infusion rate-related hypotension --> infuse over 30-60m, use non-PVC IV bag and tubing, *** MAX concentration 0.4mg/ml due to precipitation
etoposide phosphateEtopophostopoisomerate II inhibitor - G2 phaseBBW myelosuppression, *** do NOT have MAX concentration of 0.4mg/ml
etoposide capsulesVePesidtopoisomerate II inhibitor - G2 phase**** refrigerated capsule, IV to PO is 1 to 2 (50% bioavailability)
fluorouracil 5-FUAdrucilpyrimidine analog antimetabolites - S phase*** given with LEUCOVORIN to increase efficacy, *** DPD deficiency increase risk of toxicity --> give antidote Vistogard, SE hand-foot syndrome, cardiotoxicity, *** DIARRHEA, MUCOSITIS
capecitabineXelodapyrimidine analog antimetabolites - S phaseprodrug for 5-FU, BBW significant increased INR, CI severe renal impairment CrCl<30, *** DPD deficiency increase risk of toxicity --> give antidote Vistogard, SE hand-foot syndrome, cardiotoxicity, *** DIARRHEA, MUCOCITIS
cytarabine conventionalCytosarpyrimidine analog antimetabolites - S phaseBBW myelosuppression, hepatotoxicity, GI toxicity, SE pulmonary toxicity, neurotoxicity - encephalopathy, hand-foot syndrome, *** conjunctivitis --> corticosteroid eye drops
cytarabine liposomalDepoCytpyrimidine analog antimetabolites - S phasefor intrathecal administration, BBW myelosuppression, hepatotoxicity, GI toxicity, SE pulmonary toxicity, encephalopathy, hand-foot syndrome, conjunctivitis
gemcitabineGemzapyrimidine analog antimetabolites - S phaseSE myelosuppression, flu-like symptoms, hepatotoxicity, pulmonary toxicity
methotrexateTrexall, Otrexup, Rasuvo, Rheumatrexfolate antimetabolites - S phasehigh dose >500mg/m2 requires LEUCOVORIN, levoleucovorin is dosed at 1/2 the dose, *** hydration & IV NaHCO3 must be given to alkalinize the urine & nephrotoxicity, ** DDI - NSAIDs, aspirin, beta-lactam, PPI, sulfonamide abx, probenecid --> decreased clearance, SE nephrotoxicity, hepatotoxicity, hand-foot syndome, *** MUCOSITIS
pemetrexedAlimtafolate antimetabolites - S phaseto decrease risk of SE --> give folate and vitamin B12, SE nephrotoxicity, hepatotoxicity, dermatologic
pralatrexateFolotynfolate antimetabolites - S phaseto decrease risk of SE --> give folate and vitamin B12, SE nephrotoxicity, hepatotoxicity
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Miscellaneous

genericBrandclassdrug pearls
arsenic trioxideTrisenox
asparaginaseErwinazeNO myelosuppression
bleomycinnoneNO myelosuppression, *** Pulmonary toxicity --> MAX lifetime dose 400 units
mitomycinMutamycinvesicant --> antidote dimethyl sulfoxide DMSO and cool compresses, *** blue IV --> make the urine turn BLUE
lenalidomineRevlimidimmunomodulators, severe birth defect, REMS
pomalidomidePomalystimmunomodulators, severe birth defect, REMS
thalidomideThalomidimmunomodulators, severe birth defect, REMS
hydroxyureaDroxia, HydreaDMARDfor sickle cell anemia, *** ONLY use if > 3 mod-severe pain crisis in one year, **** hazardous & TERATOGENIC
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