Chemotherapy drugs and toxicities

• even generalists should know these concepts

• anthracyclines cause cardiac toxicity

• cisplatin and microtubule inhibitors cause neuropathy, resulting in weakness and autonomic dysfunction, including constipation

• cisplatin can cause kidney failure

• 5’FU, Doxil, EGFR inhibitors cause nasty skin rashes

• bleomycin can cause horrible pulmonary fibrosis

• alkylators are mutagenic and can cause sterility—consider sperm banking

Dosing of chemotherapy

• calculation is based on body surface area or weight of the patient

• adjust for renal and/or hepatic function

• bone marrow reserve

• concurrent medical problems and treatment—is the patient on statins?

• performance status and age of patient

• goals—palliative vs. curative

Minimizing toxicity

• monitor patient, labs, specific organ functions

• adjust dosing according to patient’s physiology and previous toxicity

• hydration, particularly for protecting the kidneys

• antiemetics

• hematopoietic growth factors to boost white cells and red cells (treatment to boost platelets doesn’t work that well right now)

• prophylactic antibiotics

• specific protective agents

Category: Pharmacology Notes