Antineoplastic Agents

Question 0

Antimetabolites

Answer 0

Methotrexate (Rheumatrex, Trexall)
Flouracil (5-FU, Adrucil, Carac, efudex

• Adverse effects include GI complaints, stomatitis, bone marrow suppression, alopecia, hepatotoxicity, neurotoxicity, hypersensitivity reactions, anaphylaxis.
• Highly toxic to rapidly dividing normal tissues.
• Monitor blood counts.
• Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
• With Methotrexate administration, Leucovorin is given to decrease the toxic effects of Methotrexate (Leucovorin Rescue Therapy). Leucovorin can be fatal for the patient receiving Methotrexate if not given in the right dose at the right time.

Question 1

Alkylating agents

Answer 1

Nitrogen Mustards
Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan,
Neosar) Bendamustine (Treanda)
Nitrosoureas
Carmustine (BiCNU, Gliadel)
Miscellaneous Alkylating Agents
Oxaliplatin (Eloxatin) Cisplatin (Platinol) Carboplatin (Paraplatin)

• Bone marrow suppression (neutropenia, anemia, thrombocytopenia) is the primary dose-limiting adverse effect.
• Adverse effects include Alopecia, severe GI complaints, anorexia, Stevens-Johnson syndrome, neurotoxicity, nephrotoxicity, ototoxicity, hypersensitivity reactions, hemorrhagic cystitis, anaphylaxis.
• Monitor I&O and increase fluids to decrease renal irritation.
• Monitor blood counts.

Question 2

Anti tumor antibiotics

Answer 2

Bleomycin (Blenoxane) Doxorubicin (Adriamycin, Rubex)

• Bone marrow suppression (neutropenia, anemia, thrombocytopenia) is the primary dose-limiting adverse effect.
• Most are vesicants except Bleomycin, monitor IV site closely.
• Cardiotoxicity associated with many of the agents in this class.
• Adverse effects include severe GI complaints, stomatitis, alopecia, pulmonary and cardiac toxicities, hypersensitivity reactions, anaphylaxis.
• Monitor blood counts.
• Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
• EKG indicated prior to therapy and at regular intervals

Question 3

Hormones

Answer 3

Dexamethasone (Decadron)
Medroxyprogesterone (Provera,Depo-Provera)
Megestrol (Megace)
Prednisone (Deltasone) Testosterone (Andro, Histerone)

• These agents are not cytotoxic and produce few severe adverse effects.
• Adverse effects are related to the type of hormone or hormone antagonist used and include Weight gain, insomnia, nervousness, hot flashes, GI complaints, thrombophlebitis, osteoporosis, hepatotoxicity, sexual dysfunction, anaphlylaxis

Question 4

Hormone antagonists

Answer 4

Leuprolide (Eligard, Lupron, Viadur)
Raloxifene (Evista) Tamoxifen (Nolvadex) Anastrozole (Arimidex)

• These agents are not cytotoxic and produce few severe adverse effects.
• Adverse effects are related to the type of hormone or hormone antagonist used and include Weight gain, insomnia, nervousness, hot flashes, GI complaints, thrombophlebitis, osteoporosis, hepatotoxicity, sexual dysfunction, anaphlylaxis

Question 5

Plant alkaloids

Answer 5

Vincristine (Oncovin)
Vinblastine (Velban)
Paclitaxel (Taxol)

• Adverse effects include bone marrow suppression, numbness and tingling, ataxia, severe GI complaints, alopecia, anorexia, stomatitis, nephrotoxicity, pulmonary and cardiac toxicities, joint and bone pain, hypersensitivity reactions, anaphylaxis.
• Neurotoxicity is associated with plant alkaloids, including decrease in muscle strength, loss of deep tendon reflexes, motor instability, numbness, tingling. May be irreversible.
• Monitor blood counts.
• Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).

Question 6

BRMs

Answer 6

Interferon Alfa-2
Epoetin Alfa -procrit
Proleukin

• Adverse effects include flu-like symptoms, malaise, fatigue, asthenia, GI complaints, hypotension, tachycardia, thrombocytopenia, oliguria, anuria, hepatotoxicity, suicide ideation, cardiac arrest.
• Monitor blood counts. Imperative to monitor H & H with Procrit therapy, target hemoglobin should not exceed 12g/dl with Procrit therapy.
• Monitor I&O, encourage fluids and keep well hydrated (at least 2000ml/day).
• Monitor ALT and AST.