1. How is cyclophosphamide activated?

By metabolism in the liver and then generates phosphoramide mustard and acrolein

2. What is the mechanism of action of cyclophosphamides?

phosphoramide mustard attaches to DNA and kills cells

3. What are the indications for Cyclophosphamide?

used to treat a variety of cancers including breast and Burkitt's lymphoma, used to treat non-cancer diseases involving rapid cell division, such as intractable rheumatoid arthritis

4. What are the limiting toxicities of Cyclophosphamide?

BM and hemmorhagic cystitis (leads to fibrosis of the bladder and bloody urine)

5. What are the contraindications for Cyclophosphamide?

liver disease due to metabolized in the liver

6. When should cyclophosphamide be given?

give it to the patient early in the morning for frequent urination -- to prevent the toxic effects of acrolein build up in the bladder

7. What are the effects of Acrolein on the bladder?

acrolein accumulates in and attacks the bladder creating blood in the urine

8. What are important precautions to take when administering cyclophosphamide?

make sure the patient is adequately hydrated to avoid the build up of toxic levels of acrolein

9. What are the pharmacokinetics of Carmustine?

crosses the BBB and used to treat brain tumors, given through IV

10. What are the major adverse effects of Carmustine?

delayed hematopoietic depression, renal toxicity and pulmonary fibrosis