A patient is started on Cisplatin for a malignancy. Which one of the following can be used to decrease the toxicity profile of this drug?
A. Leucovorin
B. Dexrazoxane
C. Vitamin E
D. Saline infusion
E. Dosage adjustment
cisplatin s/e nausea and vommitig, nephrotoxicity , n v can corrected by giving ondasteron, nephrotoxicity can be corrected by hydration and diuresis i.e ans ddd saline infusion
DDDD agree,
If we give fluids, we are going to increase diuresis therefore med elimination. Can be use as well manitol..
Hydration is not the mechanism by which saline decreases toxicity guys.
.
let someone come up with the right mechanism.
The clinical use of cisplatin is hampered by nephrotoxicity,
expressed by a reduction in glomerular filtration rate in
proportion to the repeated cycles of cisplatin chemotherapy.
ESCP SIG Cancer Care recommendations on the prevention
of cisplatin nephrotoxicity
Before administration
(1) Estimate GFR or CrCl using aMDRD or Cockcroft“Gault
formula, respectively
(2) Ensure euvolemia is present
Dosage
Adjust cisplatin dosage according to the patient™s renal function
Administration
Administer the platinum slowly
Hydration
(1) Use a saline solution infusion that produces a brisk diuresis.
(2) Urine flow should be maintained at 3“4 l/24 h the preceding day
and for the next 2“3 days.
(3) Do not use diuretics, neither mannitol nor furosemide.
(4) There are no data for patients who already are on diuretics, for
another concomitant disease such as hypertension.
After administration
(1) When feasible, determine serum creatinine 3“5 days after
completion of the course.
(2) Monitor magnesium levels routinely and supplement when
necessary.
(3) Avoid co-administration of nephrotoxic drugs (aminoglycosides,
non-steroidal antiinflammatory drugs, iodinated contrast media,
zoledronate, etc.).
(4) Re-evaluate renal function before the next course.
lets talk of our bible- the UW..
UW says Cisplatin toxicity on Renal Tubules is reduced with saline infusion cuz high chloride ion concentration in the tubules keep the drug in inactive form. It's not just the hydration status like for Acyclovir.