Pharmacology cheat sheet

Corticosteroids

Dexamethasone (Decadron), Prednisone (Deltasone), Methylprednisolone (Solu-Medrol)

Suppress inflammatory mediators via glucocorticoid receptors — control vasogenic edema around brain/spine tumors; also antiemetics and taxane premedication.

Hyperglycemia, insomnia, appetite gain, immunosuppression, bone loss. Never stop abruptly — always taper.

Antiemetics

Ondansetron (Zofran), Palonosetron (Aloxi), Aprepitant (Emend), Metoclopramide (Reglan), Lorazepam (Ativan)

5-HT3 blockers act on gut and brainstem vomiting centers; NK1 blockers raise the emesis threshold; benzodiazepines cover anticipatory nausea.

Headache, constipation, QT prolongation (ondansetron), restlessness (metoclopramide). Give BEFORE treatment.

Pain medications (analgesics)

Morphine (MS Contin), Oxycodone (OxyContin), Fentanyl patch (Duragesic), Gabapentin (Neurontin)

WHO pain ladder: non-opioids → weak → strong opioids binding mu-receptors; gabapentin covers neuropathic pain; RT is an analgesic for bone pain.

Constipation (bowel regimen from day one), sedation, respiratory depression. No heat over fentanyl patches.

GI support agents

Loperamide (Imodium), Senna (Senokot), Docusate (Colace), Omeprazole (Prilosec), Nystatin (Mycostatin)

Slow gut motility (loperamide), stimulate it (senna), soften stool (docusate), suppress acid (omeprazole), treat oral thrush topically (nystatin).

Ileus if constipation unmanaged. Avoid loperamide masking diarrhea in febrile neutropenia.

Antibiotics & antimicrobials

TMP-SMX (Bactrim), Levofloxacin (Levaquin), Cefepime (Maxipime), Fluconazole (Diflucan), Acyclovir (Zovirax)

Prophylaxis against PJP and herpes during immunosuppression; empiric broad-spectrum IV coverage for febrile neutropenia.

Rash (sulfa), tendon rupture (fluoroquinolones), QT prolongation, nephrotoxicity (acyclovir — hydrate).

Growth factors

Filgrastim (Neupogen), Pegfilgrastim (Neulasta), Epoetin alfa (Epogen, Procrit)

Stimulate marrow progenitors to rebuild neutrophils (G-CSF) or red cells (ESAs), preventing febrile neutropenia and treatment delays.

Bone pain, injection reactions, hypertension and thrombosis risk with ESAs. Not within 14 days of chemo (pegfilgrastim).

Bone-modifying agents

Zoledronic acid (Zometa), Pamidronate (Aredia), Denosumab (Xgeva)

Block osteoclast-mediated resorption (bisphosphonates bind bone; denosumab blocks RANKL) to prevent skeletal events in bone metastases.

Osteonecrosis of the jaw (dental clearance first), hypocalcemia, kidney injury (check creatinine), flu-like post-infusion symptoms.

Rescue & protective agents

Mesna (Mesnex), Leucovorin (Wellcovorin), Amifostine (Ethyol), Dexrazoxane (Zinecard), Palifermin (Kepivance)

Mesna neutralizes bladder-toxic acrolein; leucovorin restores folate metabolism after methotrexate; amifostine scavenges radicals in normal tissue; dexrazoxane protects the heart.

Hypotension with amifostine (give slowly, monitor BP), nausea, allergy. Timing is critical for leucovorin rescue.

Immunotherapy (checkpoint inhibitors)

Pembrolizumab (Keytruda), Nivolumab (Opdivo), Atezolizumab (Tecentriq), Ipilimumab (Yervoy)

Block PD-1/PD-L1 or CTLA-4 brakes on T cells — not chemotherapy, but increasingly combined with radiation.

Immune-related adverse events: pneumonitis, colitis, hepatitis, thyroiditis — managed with corticosteroids.

Targeted therapy

Trastuzumab (Herceptin), Bevacizumab (Avastin), Erlotinib (Tarceva), Imatinib (Gleevec)

Antibodies or TKIs against specific drivers (HER2, VEGF, EGFR, BCR-ABL); biomarker testing selects patients.

Trastuzumab: cardiotoxicity. Bevacizumab: bleeding, poor wound healing. EGFR TKIs: rash, diarrhea.

Hormonal (endocrine) therapy

Tamoxifen (Nolvadex), Anastrozole (Arimidex), ADT (leuprolide/Lupron)

ER modulation, aromatase inhibition, or GnRH down-regulation for hormone-driven breast and prostate cancers (ADT pairs with prostate RT).

Hot flashes, VTE risk (tamoxifen), bone loss (AIs, ADT), fatigue and metabolic risk (ADT).