A 5-year-old boy with leukemia is treated with chemotherapy that includes ifosfamide. 48 hours after treatment, he presents with painless gross hematuria. What agent could have been given to prevent this side effect?
A.Allopurinol
B.Mesna
C.Misoprostol
D.Pralidoxime (2-PAM)
E.Thiosulfate
Explanation:
Alkylating chemotherapy agents such as ifosfamide and cyclophosphamide may degrade to the metabolite acrolein, which can damage the bladder, producing the symptoms described.
Mesna binds to acrolein and prevents it from causing this damage.
Allopurinol inhibits xanthine oxidase and may reduce the probability of developing urate kidney stones. Kidney stones would present with pain.
Misoprostol (PGE1) is used to prevent the development of ulcers in patients taking NSAIDs long term.
Pralidoxime is used to reverse the phosphorylation of acetylcholinesterase in patients that have been exposed to pesticides or nerve gasses.
Thiosulfate scavenges cyanide ions in patients with cyanide poisoning.