What 3 things do you need to know about the administration of anthracyclines?
1) They’re vesicants.
2) Cumulative lifetime maximum dose
3) Reduce dose if pt gets radiation
What do you monitor for with anthracyclines?
- EKG/Echo
* Changes in urine/tears color
Side effects of anthracyclines?
- GI; mucositis
- Cardiac
- Early/low nadir
- Alopecia
Emetic potential of anthracyclines?
High
What is the cardiac protectant drug for anthracyclines and how soon do you administer it prior to giving the anthracycline?
Dexrozoxane (30 minutes prior)
What are 2 things to know about the administration of Cisplatin?
2) IV fluids with magnesium and mannitol
What 4 things do you monitor with Cisplatin?
- Check UOP q1-2 hours.
- Hearing tests
- Creatinine
- Creatinine clearance or iothalamate tests (iothalamate coming out of favor)
What organs are affected most by Cisplatin?
Kidneys and ears (high-pitched hearing loss)
What is the emetic potential of Cisplatin?
VERY HIGH!!!
What PRN medications might you give with Cisplatin?
Mannitol and Lasix PRN if UOP falls
What are 2 administration things to know about cyclophosphamide (cytoxan)?
- Always given with IVF
2. Mesna for higher doses
What do you monitor for with cytox?
Dip urine q void
What are side effects of cytox?
- Hemorrhagic cystitis
- Cardiac if high dose
- Kidneys
- SIADH
What is the emetic potential of cytox?
Moderate
What is hemorrhagic cystitis?
A biproduct of cytox (acrolein) irritates the bladder wall
What secondary cancer does cyclophosphamide put you at risk for?
Bladder cancer
What do you need to know about the administration of cytarabine (ARA-C)?
It has variable doses and variable forms.
What other medication is given with ARA-C?
Eye drops:
• Prophylactic NS with high dose
• Tx steroid drops if conjunctivitis
What are the side effects of cytarabine?
- Chemical conjunctivitis
- High fevers/flu symptoms
- Hand/foot syndrome
- Neuro toxicities (seizures, fine motor)
What is the emetic potential of ARA-C?
- Low to moderate
* High if given IT (give zofran)
Patients that get ARA-C are at increased risk for getting ___, because ____. Therefore AML patients get ____ when they spike a fever.
- Strep viridins
- strep V lives in the gut wall and ARA-C messes with the gut wall
- Cefepime
What do you need to know about the administration/preparation of etoposide?
- It needs minimal dilution for stability.
* Undiluted it’s very unstable.
What do you need to monitor for with etoposide?
Hypotension: check BP before and mid-dose and slow the infusion if low BP.
What is the emetic potential of etoposide?
Low to moderate
