Rituxan

Infusions must be given in hospital or clinic since they can be fatal!

(there are A LOT of side effects associated with rituximab)

Severe infusion reactions occur with rituximab normally when, and what should be given prior to rituximab infusions?

Severe reactions typically occur during the first infusion with time to onset of 30 - 120 minutes. Administer diphenhydramine and APAP prior to infusion

Iodine 131 induces cellular damage by the formation of free radicals in the target and neighboring cells

Cytokine release syndrome is associated with tositumomoab thus pretreat with what to decrease its occurance?

What kind of protective medication needs to be given prior to tositumomab?

TMP/SMZ and famciclovir for a minimum of 2 months or until CD4 counts are > 200 cells/liter

Nephrotoxicity - vigorous hydration and sometimes mannitol used to avoid renal failure; electrolyte wasting requiring magnesium and potassium supplementation. Amifostine (Ethyol) may also be used prophylactically.

Vesication occurs when extravasated, treat with injections of hyaluronidase and moderate heat

How are vinca alkaloids administered?

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IV only; Do not administer intrathecally - fatal

Which of the purine analogs undergo extensive first pass metabolism in the liver by xanthine oxidase. And how does allopurinol hinder this?

6-mercaptopurine (6-MP). Allopurinol inhibits its first metabolism thus resulting in a raise in 6-MP bioavailability by 400 to 500%.

The dose of 6-MP should be increased or decreased when given concomitantly with allopurinol?

trimethoprim-sulfamethoxazole prophylaxis against Pneumocytsis jiroveci

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When 5-FU is given for chemo, what should also be given to increase efficacy?

prodrug of 5-FU, it's taken PO with meals

Capecitabine increases INR up to 91% due to 2C9 inhibition; required decreased warfarin dosage/INR monitoring

Restore normal function to genes (DNA) that are critical for differentiation and proliferation

Taxanes inhibit microtubule function and angiogenesis (dyfunctional microtubule bundling)

Pre-treat with:

dexamethasone

diphenhydramine

H2-blocker

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Pretreatment with:

dexamethasone 8mg BID x 3 days starting the day prior to docetaxel

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What significant drug interaction do all tyrosine kinase inhibitors have?

all the TKIs have significant drug interactions with the CYP 450 system especially 3A4

Tyrosine Kinase inhibitos respod better to what type of lung cancer?

which populations have higher incidence of K-ras wild type genetics?

K-ras wild type in Asians and light smokers or non-smokers

QT-prolongation: monitor ECG, avoid concurrent QT prolonging agents, keep Mg⁺ and K⁺ within normal range