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Oncology Intro Meds

Gundrum Day 1

Trastuzumab dosing Weight based
Carboplatin dosing Calvert Formula
Methotrexate Antifolate, Antimetabolite
Pemetrexed Antifolate, Antimetabolite
5-Fluoruracil Antipyrimidine, Antimetabolite
Capecitabine Antipyrimidine, Antimetabolite
Cytaraine Antipyrimidine, Antimetabolite
Gemcitabine Antipyrimidine, Antimetabolite
6-MP Antipurine, Antimetabolite
Fludarabine Antipurine, Antimetabolite
Cladribine Antipurine, Antimetabolite
Clofarabine Antipurine, Antimetabolite
Hydroxyurea Antimetabolite
Vincristine Vinca Alkaloid, Antimicrotubule
Vinblastine Vinca Alkaloid, Antimicrotubule
Vinorelbine Vinca Alkaloid, Antimicrotubule
Paclitaxel Taxane, Anitmicrotubule
Docetaxel Taxane, Antimicrotubule
Irinotecan Camptothecan, Topoisomerase I inhibitor
Topotecan Camptothecan, Topoisomerase I inhibitor
Etoposide Epipodophyllotoxin, Topoisomerase II Inhibitor
Cell Cycle Specific Classes Antimetabolites, Antimicrotubules, Topoisomerase I Inhibitors, Topoisomerase II Inhibitors, Hormonal Agents, mTORs
Antimetabolite subclasses Antifolates, Antipyrimidines, Antipurines,
Antimicrotubule subclasses Vinca Alkaloids, Taxanes
Topoisomerase I Inhibitor Subclasses Camptothecans
Topoisomerase II Inhibitor Subclasses Epipodophyllotoxin
Hormonal Agents subclasses SERMS, Aromatase Inhibitors, LHRH agonists, Antiandrogens
Tamoxifen SERM, Hormonal Agent
Raloxifene SERM, Hormonal Agent
Letrozole Aromatase Inhibitor, Hormonal Agent
Anastrazole Aromatase Inhibitor, Hormonal Agent
Exemestane Aromatase Inhibitor, Hormonal Agent
Everolimus mTOR inhibitor
Temsirolimus mTOR inhibitor
Blemoycin Cell cycle specific
L-asparaginase Cell cycle specific
Peg-asparagase Cell cycle specific
Erwinia asparaginase Cell cycle specific
Cell Cycle non-specific Classes Alkylating agents, anthracyclines, tyrosine kinase inhibitors, monoclonal antibodies, hormonal agents, immunomodulators, proteasome inhibitors
Alkylating Agent Subclasses Nitrogen Mustard, Platinums
Chlorambucil Nitrogen Mustard, Alkylating agent
Cyclophosphamide Nitrogen Mustard, Alkylating agent
Ifosfamide Nitrogen Mustard, Alkylating agent
Cisplatain Platinum, Alkylating agent
Carboplatin Platinum, Alkylating agent
Oxaliplatin Platinum, Alkylating agent
Daunorubicin Anthracycline
Doxorubicin Anthracycline
Idarubicin Anthracycline
Epirubicin Anthracycline
Imatinib Tyrosine Kinase Inhbitor
Dasatinib Tyrosine Kinase Inhbitor
Nilotinib Tyrosine Kinase Inhbitor
Bosutinib Tyrosine Kinase Inhbitor
Erlotinib Tyrosine Kinase Inhbitor
Rituximab Monoclonal Antibody
Bevacizumab Monoclonal Antibody
Cetuximab Monoclonal Antibody
Trastuzumab Monoclonal Antibody
Leuprolide LHRH agonist, hormonal agent
Goserelin LHRH agonist, hormonal agent
Bicalutamide Antiandrogen, hormonal agent
Flutamide Antiandrogen, hormonal agent
Nilutamide Antiandrogen, hormonal agent
Thalidomide Immunomodulator
Lenalidomide Immunomodulator
Bortezomib Proteasome Inhibitor
Carfilzomib Proteasome Inhibitor
-trex- Antifolates
-bine antipyrimidine, antipuriness (excet 5-FU, 6-MP)
Vin- Vinca Alkaolid
-taxel taxanes
-otecan Topoisomerase I inhibitors
-oposide topoisomerase II Inhibitors
-fen- SERMS
-ozole Aromatase Inhibitors (except Exemastane)
-olimus mTOR Inhibitors
-platain platinums
-rubicin anthracyclines
-tinib Tyronse kinase inhbitors
-mab monoclonal antibodies
-amide antiandrogens
-lidomide immunomodulators
-zomib proteaseome inhibitors
antimetabolites MOA similar in structure to nucleotides, disrupts the replication of DNA, RNA and nucleic acids; S phase
Antifolates MOA inhibits DHFR, S phase
Methotrexate DIs NSAIDS, PPIs, Penicillins
Methotrexate Clinical pearls -high dose MTX requires leucovorin resucue + NaHCO3 to maintain urine pH > 7
Pemetrexed Clinical pearls -supplement with folic acid 400 mcg PO daily and vitamin B 12 1000 mcg IM every 9 weeks to prevent myelosuppression -premedicate with dexamethasone 4 mg PO BID the day before, day of and day after treatment fo avoid rash
Leucovorin Indications -folate rescue with high dose methotrexate -stabilizes FdUMP binding when used with 5-Fluorouracil
5-Fluorouracil MOA: continuous infusion FdUMP binds to/inactivates thymidylate synthase
5-Fluorouracil MOA: Bolus Incorporates into DNA /RNA as a flase nucleotides and interferes with function
5-Fluorouracil Drug interactions Strong CYP2C9 inhibitor- increased warfarin effect
Cytarabine MOA inhibits DNA polymerase (inhibits DNA elongation)
Cytarabine Adverse Effects High-dose = cellbeullar toxicity, conjunctivitis
Cytarabine Clinical pearls -corticosteroids may help with flu-like symptoms -steroids eye drops should be administered during high-dose administration to avoid conjunctivitis
Gemcitabine MOA inhibits DNA polymerase (inhibits DNA elongation), Inhibits DNA synthesis/repair
Gemcitabine Clinical pearls -rash may respond to topical steroids, fevers may respond to acetaminophen
Purines MOA incorporates into DNA as a false purine and stops DNA synthesis
6-MP drug interactions allopurinol increases toxicity, 6-MP reduces anticoagulant effects of warfarin
Fludarabine Adverse effects tumor lysis syndrome, pulmonary toxicity, peripheral neuropathis, altered mental status
Fludarabine Clinical pearls Prophylaxis required for PCP and HSV infections
Cladribine Clinical pearls requires prophylaxis against PCP
Clofarabine adverse effects elevated LFTs, nausea/vomiting, tumor lysis syndrome
Hydroxyurea Clinical pearls Can be used to decreased WBC counts rapidly to prevent adverse effects of leukocyotosis
Vinca Alkaloids MOA Destabilize microtubule assembly, M phase
Taxanes MOA Stabilize microtubule assembly, M phase
Vincristine DLT Peripheral neuropathies, constipation
Vinca Alkaloids Clinical Pearls lethal if administered intrathecally
Paclitaxel Clinical Pearls Contains CREMOPHOR which leads to hypersensitivity reactions. Pre-medicate with dexamethasone, diphenhydramine and ranitidine to decrease hypersensitivity reactions
Docetaxel clinical Pearls Contains POLYSORBATE 80 (less hypersensitivity); Give Dexamethasone day before, day of and day after administration to decrease fluid retention
Topoisomerase I inhibitors MOA active during the S phase, single strand breaks
Topoisomerase II Inhibitors MOA active during the G2 phase, double strand breaks
Irinotecan DLT diarrhea
Acute diarrhea <12 hours after administration, treated with atropine
Delayed diarrhea >12 hours after administration, treated with loperamide
Active metabolize of irinoteccan SN-38
Etoposide Adverse Effects secondary malignancies
Bleomycin DLT pulmonary toxicity, requires pulmonary function test
L-asparaginase, Peg-asparagase and Erwinia asparaginase ADRs Pancreatitis
Peg-asparagase is derived from E Coli
Erwinia asparaginase is derived from Erwinia Chrysanthemi
Chlorambucil ADRs secondary malignancies
Cyclophosphamide ADRs hemorrhagic cystitis
Cyclophosphamide Clinical Pearls -Hydration needed to prevent hemorrhagic cystitis -Mesna may be requried with high-dose regimens
Ifosfamide ADR hemorrhagic cystitis
Ifosfamide Clinial Pearls -Hydration needed to prevent hemorrhagic cystitis -Mesna always given to prevent hemorrhagic cystitis -methylene blue may be given for CNS toxicities
Cisplatin Clinical Pears Highly emetogenic
Calavert Formula Dose (mg) = Target AUC x (CrCl + 25)
Oxaliplatin DLT peripheral neuropathies exacerbated by cold
Anthracyclines ADRs cardiac toxicity, LVEF monitoring, maximum lifetime doses
mAb soure: -o- Murine, 100% mouse
mAb soure: -xi- chimeric 67% human
mAb soure: -zu- humanized 90% human
mAb soure: -u- human 100% human
monoclonal antibodies DLT infusion-related reactions
Rituximab Clinical Pears -reactivation of hep B can occur -Premedicate with APAP and diphenhydramine
Trastuzumab ADRS Cardiac toxicity, dosed as mg/kg
Cetuximab MOA binds to epidermal growth factor receptor-1, premedicate with diphenhydramate
Cetiximab ADR Rash
Bevacizumab MOA Binds to VGEF ligand
Tyrosine Kinase Inhibitors MOA inhibits BCR-ABL tyrosine kinase
Imatinib ADRs -CHF
Nilotinib counseling points -take twice daily, hyperglycemia
mTOR MOA targets mTOR, which is a molecule that is required for multiple interacellular signaling pathways, G1 phase
Temsirolimus Clinical Pearls requires diphenhydramine pemedication
Bortezomib MOA Reversible inhibition of 26S proteasome, leading to accumulation of cellular debris
Carfilzomib MOA Irreversible inhibition of 20s proteasome, leading to accumulation of cellular debris
DLT: Diarrhea, hand-foot syndrome, mucositis Continuous infusion 5-FU, Capectabine
DLT: peripheral neuropathies, constipation Vincristine
DLT: diarrhea Irinotecan
DLT: pulmonary toxicitiy Bleomycin
DLT: hypersensitivity reations Asparaginase
DLT: N/V Cisplatin
DLT: Peripheral neuropathies exacerbated by cold Oxaliplatin
DLT: Infusion-related reactions Monocolonal antibodies
DLT: peripheral neuropathies, myelosuppression Bortezomib, Cafilzomib
Rifampin CYP3A4 inducer
CBZ CYPEA4 inducer
phenytoin CYP3A4 inducer
phenobarbital CYP3A4 inducer
St. John's Wort CYP3A4 inducer
Azole Antifungals CYP3A4 inhbitor
Calcium Channel Blockers CYP3A4 inhbitor
Amiodarone CYP3A4 inhbitor
SSRIs CYP3A4 inhbitor
Cyclosporine CYP3A4 inhbitor
Tacrolimus CYP3A4 inhbitor
Aprepitant CYP3A4 inhbitor
Grapefruit CYP3A4 inhbitor
Asparaginase Cell Cycle G1
Bleomycin Cell Cycle G2
Created by: Bmiller01



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