PHCL 4020: Chemotherapy: Test Bank |Verified Practice
Questions with A+ Answers | Final Exam Guide FOR 2025/2026
(the most recent quizzes)
Cell cycle nonspecific agents - Alkylating agents
Anthracyclines
Platinum Compounds
All Awesome Pharmacists
MOA of alkylating agents - Work by *cross-linking DNA strands* which *inhibits DNA and
protein synthesis* and results in cell death
Examples of alkylating agents - - *Cyclophosphamide and Ifosfamide*
- *Busulfan*
- *Carmustine*
Other drugs in class: bendamustine, dacarbazine, lomustine, mechlorethamine, melphalan,
mitomycin, procarbazine, temozolamide
Safety concerns for cyclophosphamide and ifosfamide - *Hemorrhagic cystitis* caused by
*toxic metabolite acrolein* which concentrates in the bladder
Safety concerns for ifosfamide - *Hemorrhagic cystitis* caused by *toxic metabolite
acrolein* which concentrates in the bladder
Neurotoxicity, including encephalopathy and cerebellar dysfunction
Monitoring of *Hemorrhagic cystitis* with cyclophosphamide - *Hematuria*, urinalysis (for
RBCs), lower urinary tract symptoms (ex: urinary urgency, *dysuria*, incomplete bladder
emptying)
Prevention of hemorrhagic cystitis in cyclophosphamide and ifosfamide - 1. Adequate
*hydration*
,2. *Mesna* (a chemoprotectant) with *all ifosfamide doses* and *high doses* of
*cyclophosphamide* (ex: >1 g/m2)
Treatment of hemorrhagic cystitis in cyclophosphamide and ifosfamide - Bladder irrigation
with normal saline
When to give Mesna for prevention of hemorrhagic cystitis - Give with *all ifosfamide doses*
and *high doses* (>1 g/m2) of *cyclophosphamide*
Monitoring for ifosfamide (neurotoxicity specifically) - S/S of neurotoxicity like confusion,
incoordination, imbalance
Prevention and treatment of ifosfamide neurotoxicity - Methylene blue
Busulfan safety concerns - *Pulmonary toxicity* (ex: pulmonary fibrosis) and seizures
Monitoring recommended for Busulfan *Pulmonary toxicity* and *seizures* - S/S of
pulmonary toxicity (ex: dyspnea, cough) and pulmonary function tests
S/S of seizures (ex: tonic-clonic movements, lack of awareness)
Treatment of pulmonary toxicity in Busulfan and carmustine - Symptomatic care (ex: oxygen)
Prevention/treatment of seizures in Busulfan and carmustine - Antiseizure medication (ex:
Keppra)
Safety concerns with carmustine - *Neurotoxicity* (ex: *seizures*, cerebral edema) -->
particularly with the wafer implant
*Pulmonary toxicity* (ex: pulmonary fibrosis)
Monitoring with carmustine *seizures and pulmonary toxicity* - S/s of seizures, headache
S/S of pulmonary toxicity, pulmonary function tests
MOA of platinum-based compounds - alkylating agents that *cross link DNA*, interfering
with *DNA synthesis* and cell replication, which results in cell death
Platinum-based compounds - *Cisplatin*
Carboplatin
, Oxaliplatin
Safety concerns with platinum-based compounds (*cisplatin*, etc) - *Hypersensitivity
reactions, nephrotoxicity, ototoxicity, peripheral neuropathy*
Safety concerns specifically with oxaliplatin - *acute* sensory neuropathy *exacerbated by
the cold*
Monitoring for platinum-based compounds (*cisplatin*, etc) for *HSR, nephrotoxicity,
ototoxicity, peripheral neuropathy* - S/s of *anaphylaxis* (dyspnea, angioedema, urticaria),
vital signs (BP, HR)
*Renal function* (ex: BUN, SCr, intake/output), electrolytes (ex: Mg, K, Na, Ca)
S/S of *hearing loss* or *tinnitus*, *audiogram* at baseline
S/S of neuropathy (ex: *extremity numbness, paresthesia, pain*)
Monitoring for oxaliplatin *acute sensory neuropathy* - S/S of acute sensory neuropathy ->
ex: *abnormal sensations* (in hands, feet, perioral area, or throat), jaw spasm, chest pressure
Treatment of hypersensitivity reactions in platinum-based compounds (*cisplatin*, etc) -
Symptomatic care (ex: oxygen, bronchodilators, systemic steroids)
Prevention of nephrotoxicity in platinum-based compounds (*cisplatin*, etc) - Adequate
*hydration*
*Amifostine (Ethyol)*, a chemoprotectant that reduces cumulative renal toxicity with
*cisplatin*
*Limit cisplatin dose per cycle to <100 mg/m2*
Amifostine - a chemoprotectant that reduces cumulative renal toxicity with cisplatin
Mesna - *Mesna* (a chemoprotectant) with *all ifosfamide doses* and *high doses* of
*cyclophosphamide* (ex: >1 g/m2)
Questions with A+ Answers | Final Exam Guide FOR 2025/2026
(the most recent quizzes)
Cell cycle nonspecific agents - Alkylating agents
Anthracyclines
Platinum Compounds
All Awesome Pharmacists
MOA of alkylating agents - Work by *cross-linking DNA strands* which *inhibits DNA and
protein synthesis* and results in cell death
Examples of alkylating agents - - *Cyclophosphamide and Ifosfamide*
- *Busulfan*
- *Carmustine*
Other drugs in class: bendamustine, dacarbazine, lomustine, mechlorethamine, melphalan,
mitomycin, procarbazine, temozolamide
Safety concerns for cyclophosphamide and ifosfamide - *Hemorrhagic cystitis* caused by
*toxic metabolite acrolein* which concentrates in the bladder
Safety concerns for ifosfamide - *Hemorrhagic cystitis* caused by *toxic metabolite
acrolein* which concentrates in the bladder
Neurotoxicity, including encephalopathy and cerebellar dysfunction
Monitoring of *Hemorrhagic cystitis* with cyclophosphamide - *Hematuria*, urinalysis (for
RBCs), lower urinary tract symptoms (ex: urinary urgency, *dysuria*, incomplete bladder
emptying)
Prevention of hemorrhagic cystitis in cyclophosphamide and ifosfamide - 1. Adequate
*hydration*
,2. *Mesna* (a chemoprotectant) with *all ifosfamide doses* and *high doses* of
*cyclophosphamide* (ex: >1 g/m2)
Treatment of hemorrhagic cystitis in cyclophosphamide and ifosfamide - Bladder irrigation
with normal saline
When to give Mesna for prevention of hemorrhagic cystitis - Give with *all ifosfamide doses*
and *high doses* (>1 g/m2) of *cyclophosphamide*
Monitoring for ifosfamide (neurotoxicity specifically) - S/S of neurotoxicity like confusion,
incoordination, imbalance
Prevention and treatment of ifosfamide neurotoxicity - Methylene blue
Busulfan safety concerns - *Pulmonary toxicity* (ex: pulmonary fibrosis) and seizures
Monitoring recommended for Busulfan *Pulmonary toxicity* and *seizures* - S/S of
pulmonary toxicity (ex: dyspnea, cough) and pulmonary function tests
S/S of seizures (ex: tonic-clonic movements, lack of awareness)
Treatment of pulmonary toxicity in Busulfan and carmustine - Symptomatic care (ex: oxygen)
Prevention/treatment of seizures in Busulfan and carmustine - Antiseizure medication (ex:
Keppra)
Safety concerns with carmustine - *Neurotoxicity* (ex: *seizures*, cerebral edema) -->
particularly with the wafer implant
*Pulmonary toxicity* (ex: pulmonary fibrosis)
Monitoring with carmustine *seizures and pulmonary toxicity* - S/s of seizures, headache
S/S of pulmonary toxicity, pulmonary function tests
MOA of platinum-based compounds - alkylating agents that *cross link DNA*, interfering
with *DNA synthesis* and cell replication, which results in cell death
Platinum-based compounds - *Cisplatin*
Carboplatin
, Oxaliplatin
Safety concerns with platinum-based compounds (*cisplatin*, etc) - *Hypersensitivity
reactions, nephrotoxicity, ototoxicity, peripheral neuropathy*
Safety concerns specifically with oxaliplatin - *acute* sensory neuropathy *exacerbated by
the cold*
Monitoring for platinum-based compounds (*cisplatin*, etc) for *HSR, nephrotoxicity,
ototoxicity, peripheral neuropathy* - S/s of *anaphylaxis* (dyspnea, angioedema, urticaria),
vital signs (BP, HR)
*Renal function* (ex: BUN, SCr, intake/output), electrolytes (ex: Mg, K, Na, Ca)
S/S of *hearing loss* or *tinnitus*, *audiogram* at baseline
S/S of neuropathy (ex: *extremity numbness, paresthesia, pain*)
Monitoring for oxaliplatin *acute sensory neuropathy* - S/S of acute sensory neuropathy ->
ex: *abnormal sensations* (in hands, feet, perioral area, or throat), jaw spasm, chest pressure
Treatment of hypersensitivity reactions in platinum-based compounds (*cisplatin*, etc) -
Symptomatic care (ex: oxygen, bronchodilators, systemic steroids)
Prevention of nephrotoxicity in platinum-based compounds (*cisplatin*, etc) - Adequate
*hydration*
*Amifostine (Ethyol)*, a chemoprotectant that reduces cumulative renal toxicity with
*cisplatin*
*Limit cisplatin dose per cycle to <100 mg/m2*
Amifostine - a chemoprotectant that reduces cumulative renal toxicity with cisplatin
Mesna - *Mesna* (a chemoprotectant) with *all ifosfamide doses* and *high doses* of
*cyclophosphamide* (ex: >1 g/m2)
