methotrexate/leucovorin/ irinotecan/topotecan
how long do you have to wait before giving leucovorin after methotrexate
what other drug that inactivates methotrexate must you space out from leucovorin
24-48 hr after methotrexate doses >100mg/m2
glucarpidase inactivates methotrexate
- must wait 2 hours from leucovorin
what is a caution with pemetrexed due to the way it is cleared
renal insufficiency
inhibitors of 3A subfamily
when preparing paclitaxel, what is a special consideration due to the solvent cremophor EL
use non-PVC tubing, bag, and use in-line filter during admin.
what are some side effects of docetaxel
mucositis, incr. liver enzymes, dermatologic rxns, hypotension, nail changes, fluid retention(corticosteroids for hypersensitivity will help this)
irinotecan is most active in what kind of environment (basic or acidic); what should be the diluent
active in acidic
diluent; D5W
how should etoposide be prepared
non PVC tubing
is concentration dependent; incr. concentration--> shorter stability
T/F are vinorelbine, vinblastine, and vincristine all vesicants?
True
- all vesicants and will cause neurologic toxicities (rare in vinblastine tho)
what are other side effects common with paclitaxel
peripheral neuropathy
alopecia (complete hair loss)
myalgias
cardiac (bradycardia, heart block, Vtach)
side effect seen with ixabepilone
neuropathy; dose limiting
what drugs could be affected with methotrexate due to the effects on renal function
what are other drug interactions with methotrexate
NSAIDS and aspirin decrease elimination by effects on renal function
- protein bound drugs, cisplatin, Bactrim
what medication would you give with pemetrexed therapy to prevent/improve rash
dexamethasone 4mg BIDX 3 days (begin 1 day print to tx)
false; it is, dose limiting
vincristine is NOT myelosuppressive
give diphenhydramine, h2 blocker, and corticosteroid
happens from solvent-cremophor EL
what are the similar side effects/considerations that both paclitaxel, cabazitaxel and docetaxel share
use non-PVC tubing and bags
premeditate for rxns
monitor BP
3A4 metabolism
**carbazitaxel: do not use in hepatic impairment**
irinotecan has an early and delayed onset of diarrhea:
what would you give for early onset and what would you give for delayed
early; atropine IV (cholinergic diarrhea)
delayed; loperamide (secretory diarrhea)
etoposide has similar side effects and monitoring to docetaxel and paclitaxel. what does this include?
CYP3A4 interactions
- hypotension
- allergic rxns
can also cause secondary leukemias
myelosuppresion (DLT)
what is a dose limiting toxicity of vincristine
neurotoxicity
what is abraxane (how is it different from paclitaxel)
- think side effect profile
nano-particle albumin bound paclitaxel
- less allergic rxns(no cremophor EL in formulation)
- similar side effects; more sensory neuropathy
looks like milk lol
ixabepilone has similar considerations with docetaxel and paclitaxel. what is one additional consideration that was not mentioned with the other two medications
use DEHP free tubing/bags
only stable for 6 hrs
only use LR!!
similar
- CYP3A4
- premeditate with H1,H2, steroid
- dose adjust with liver impairment
what is a common side effect of topotecan that will require approx. 50% of pts to get a blood transfusion
anemia
what vitamins would you give with pemetrexed treatment
what does this decrease?
vitamin B12 and folate
- decreases hematologic side effects, mucostitis, and diarrhea
start 1 wk before, and continue throughout therapy
a pt is to be started on vincristine for their ALL and the prescribers are trying to figure out the best way to administer this drug. The med. student suggests that intrathecally might be the best route to take because they said so. what should you recommend
do not give vincristine intrathecally
what drug class would you want to use with caution while on paclitaxel
3A4 drugs (phenytoin, phenobarbital)
rarely a vesicant
what should not be added in the tubing of eribulin mesylate
dextrose
prolongs QT interval
*loves saline*