Miscellaneous AGENTS

Question 1

bortezomib

Answer 1

Velcade

• proteasome inhibitor
• reversibly inhibits chymotrypsin-like activity at 26S proteasome
• inhibiting leads to activation of signaling cascades, cell-cycle arrest, and apoptosis
• give antiviral to prevent herpes reactivation (zoster & simplex)
• SC administration has less neuropathy than IV administration

:: CONTRAINDICATIONS ::
: hypersensitivity to boron or mannitol
** DO NOT GIVE INTRATHECAL = FATAL **

:: SIDE EFFECTS ::
: peripheral neuropathy
: thrombocytopenia, neutropenia

Question 2

mitomycin

Answer 2

Mutamycin
- free radical formation and alkylator

• *VESICANT**
• do NOT extravasate
• antidote = DMSO + cool compresses
• IV solutions are hazy blue
• can turn urine blue-green

:: BOXED WARNING::
: bone marrow suppression

Question 3

bleomycin

Answer 3

• intercalating agent
• blocking topoisomerase II

:: BOXED WARNING::
: pulmonary fibrosis - increased risk when given with filgrastim, separate administration

• test dose due to anaphylactoid reactions
• pre-medicate with APAP to reduce fever/chills
• not myelosuppressive
• PULMONARY TOX RISK = maximum lifetime dose of 400 units