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Gentamicin enhances toxicity risk
31%
76/242
Cardiotoxicity
7%
17/242
Hemorrhagic cystitis
23%
55/242
Myelosuppression
33%
79/242
Addition of mesna decreases drug toxicity
5%
11/242
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Based on the information provided in the vignette, the patient has transitional cell carcinoma of the bladder. He is started on cisplatin-based chemotherapy. Cisplatin is associated with nephrotoxicity, ototoxicity, and peripheral neuropathy. Adverse effects of gentamicin, an aminoglycoside, include nephrotoxicity and otoxicity. One would expect an enhanced toxicity risk when taken together. Platinum analogs include cisplatin and carboplatin. Cisplatin-based chemotherapy can be used in a variety of cancers, such as testicular, bladder, and ovarian cancers. Cisplatin is believed to cross-link DNA in order to inhibit DNA synthesis. This medication is mostly excreted by the kidneys, and can cause peripheral neuritis, acoustic nerve damage, and damage the kidneys. Recall that aminoglycosides are associated with nephrotoxicity, otoxociticty, neuromuscular blockade, and has teratogenic properties. Due to their overlapping toxicity, this could explain the potentiated risk of nephrotoxicity and otoxicity a patient may have if taking by both drugs. Incorrect Answers: Answer 2: Cardiotoxicity is more associated with Doxorubicin and Trastuzumab. Answer 3: Hemorrhagic cystitis is associated with Cyclophosphamide. Answer 4: 6-mercaptopurine, 5-fluorouracil, and methotrexate is more associated with myelosuppresion. Answer 5: Addition of mesna is used to reduce the risk of hemorrhagic cystitis secondary to Cyclophosphamide treatment. Amifostine is a free radical scavenger used to decrease the risk of nephrotoxicity from cisplatin and carboplatin.
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