A 16-year-old on multi-agent chemotherapy for osteosarcoma receives doxorubicin as part of every cycle. Which monitoring strategy and cumulative dose ceiling guide safe administration?

• A Baseline and serial echocardiography, ceiling of 450 to 550 mg/m2 ✓
• B Serial audiometry, ceiling of 200 mg/m2
• C Weekly serum creatinine, ceiling of 300 mg/m2
• D Serial pulmonary function tests, ceiling of 400 mg/m2

Explanation

Doxorubicin causes dose-dependent, largely irreversible cardiomyopathy through free radical injury to cardiac myocytes. Risk rises sharply beyond a cumulative dose of about 450 to 550 mg/m2, so left ventricular function is assessed by echocardiography or MUGA scan before therapy and periodically during it. Audiometry monitors cisplatin ototoxicity, creatinine tracks cisplatin nephrotoxicity, and pulmonary function testing relates to bleomycin, none of which applies to anthracycline surveillance.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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