478 Obstetrics and Gynecology Board Review •••
❍ What is the mechanism of action of paclitaxel?
Paclitaxel binds and stabilizes intracellular microtubules, leading to abnormal spindle formations that lead to its
cytotoxic effect.
❍ Serum albumin levels may be predictive of what toxicity associated with ifosfamide?
Central nervous system toxicity may occur with serum albumin levels <3.0 mg/dL due to production of
chloroacetaldehyde metabolite.
❍ What is the most common secondary malignancy associated with the use of chemotherapy?
Acute nonlymphocytic leukemia.
❍ What antibiotics should be used initially in a febrile neutropenic patient?
For low-risk patients with febrile neutropenia, empiric treatment with oral ciprofloxacin and amoxicillin-clavulanate
is safe and effective. High-risk patients require monotherapy with an antipseudomonal beta-lactam agent such as
Cefepime, meropenem, imipenem-cilastatin, or piperacillin-tazobactam.
❍ How should chemotherapy-induced mucositis be treated?
Topical solutions containing viscous xylocaine, antacids, and antifungals may be used along with adequate pain relief.
❍ What is the dose-limiting toxicity of paclitaxel?
Peripheral neuropathy.
❍ Describe steroid premedication for administration of paclitaxel versus docetaxel.
Dexamethasone 20 mg is given orally the night before and the morning of paclitaxel administration to prevent
hypersensitivity reaction.
Dexamethasone 8 mg is given orally bid for 3 to 5 days starting 24 hours prior to docetaxel administration to
prevent fluid retention.
❍ What is the best way to avoid cisplatin-induced renal toxicity?
Aggressive pretreatment hydration.
❍ What is the growth fraction of a tumor?
The number of cells actively involved in cell division.
❍ Methotrexate is specific for what phase of the cell cycle?
S phase.
❍ The chemotherapeutic combination with the most documented activity against recurrent squamous cell
carcinoma of the cervix is?
Cisplatin and paclitaxel
❍ The use of chemotherapy concurrently with radiation for primary therapy of cervical cancer is termed?
Radiosensitization.