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Hematology RC Editable > Drugs > Flashcards

Drugs Flashcards

1
Q

Eltrombopag

A

For ITP: 50mg PO daily and titrate to plt>50

For severe AA in triple IST
150mg daily

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2
Q

Avatrombopag

A

20mg PO daily, titrate to plt >50
If liver disease for pre-op, 40-60mg PO daily x5 days, finish ~8d prior to the surgery or procedure

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3
Q

Romiplostim

A

1mcg/kg SC/IV weekly, titrate to plt>50
Max 10mcg/kg/week

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4
Q

Rituximab for ITP, WAIHA [off label], TTP [with plex]

A

375mg/m2 weekly x4

*1g q14d x2 doses more for autoimmune [can be later lines of rx or off label though]
- RA, myasthenia, MS, pemphigus, mixed cryoglobulinemia, neuromyelitis optica, IgG4 disease, dermatomyositis/polymyositis

Either dosing in some renal: minimal change disease, membranous nephropathy, lupus nephritis, GPA, MPA, EGPA

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5
Q

Gemtuzumab target

A

CD-33

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6
Q

Inotuzumab target

A

CD-22

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7
Q

Rituximab target

A

CD-20

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8
Q

Blinatumumab drug target

A

Bispecific antibody
Anti-CD19 and anti-CD3

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9
Q

Alemtuzumab

A

CD52

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10
Q

Rituximab Risks

A

Infusion reactions
serum sickness
Hypogammaglobulinemia
Infection risk
Hep B reactivation, strongyloides
Cardiac arrhythmia
Progressive Multifocal Leukoencephalopathy [PML] from JC virus reactivation

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11
Q

Steroid Side effects

A

Insomnia
Mood issues
HTN
hyperglycemia
Osteoporosis
Infection risk
PJP
Weight gain, fluid retention

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12
Q

Fostamatinib

A

Syk inhibitor [spleen tyrosine kinase]
100mg PO BID -> 150mg BID
S/E: HTN, diarrhea

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13
Q

Anticoag in HIT

A

Argatroban: for HIT, HITT, HIT with PCI
- hepatic clearance, adjust if liver issues to 0.5-1.2 mcg/kg/min
- no adjustment for renal (ARgat, Alright for Renal)
Dose: 1-2mcg/kg/min drip, adjust to PTT

Bivalirudin: for HIT needing PCI
Dose: 0.15 mg/kg/h drip, adjust to PTT.
Lower if renal/liver issues

Danaparoid: for pregnant
IV or subcut. Renal clearance, longer half-life
Dose: 2250 units IV bolus, then 400/300/200 units per hour
Use danaparoid anti-Xa level to monitor
If subcut, dont need to monitor

Fondaparinux: easy
- long half life, not in renal disease [renally cleared], ok in pregnancy
- 5-10mg subcut daily [weight based]

DOACs: not approved for acute HIT [lack of controlled trial data, but clinical experience present] but can be used with pt discussion
- Dose: same as treatment of VTE
- Issue: Has peaks and troughs… Apix BID maybe more stable levels, but Riva has been used more. Dabig not without parenteral first.
- if life threatening thrombosis prob not
- no PTT confounding

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14
Q

Tranexamic acid risks

A

Contraindication: hematuria. Risk ureteral clots and obstructive uropathy
Caution in recent/active VTE or atherosclerotic disease
Headache
Abdominal discomfort

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15
Q

TXA MOA

A

Lysine analog, prevents plasminogen from binding lysine residue on fibrin strands -> prevents fibrinolysis

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16
Q

UFH heparin issues

A

IV, mostly inpatient
unpredictable, AT level, heparin resistance
Bleeding
Osteoporosis with prolonged use

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17
Q

LMWH pros/cons

A

Osteoporosis in long use
renal clearance, careful if CrCl<30
Still small risk of HIT
Can try Protamine if bleed

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18
Q

Fondaparinux pros/cons

A

Long half life, renally cleared
CI if CrCl<30
Caution if CrCl<50
No reversal
OK in HIT

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19
Q

Direct Thrombin inhibitors

A

Argatroban, Bivalirudin
Short half lives = drip. Monitor with PTT
Bival off label for HIT

Dabigatran is oral, not for HIT.

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20
Q

Danaparoid

A

Indirect Xa inhibitor, IV or subcut
Adjust for renal dysfunction, renally cleared
VTE proph, off label for HIT

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21
Q

Risks of Splenectomy

A

Surgical and anesthetic risks
Infection with encapsulated organisms: strep pneumonia, meningococcal, HIB
Post splenectomy sepsis: 3.2%, 1.4% mortality
Need vaccinations. If can’t vaccinate in time, give PCN proph
Thrombosis
Small risk of pulmonary HTN

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22
Q

ATG side effects

What proph?

A

Infusion reactions: fever, rigours, rash, hypotension, hypertension, third spacing

Serum sickness = fever, rash, joint pain, malaise, B symptoms

Pre-meds: Benadryl, tylenol
Prednisone 1mg/kg x10d then taper rapidly [for serum sickness proph]

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23
Q

Triple IST for severe AA or very severe AA

A

horse ATG [ATGAM] 40mg/kg IV daily x4days [inpatient]

CsA 10 mg/kg/d split BID,. target trough 200-350, 6-12 months then slow taper

Eltrombopag, 150mg daily [75mg daily if east asian or liver disease]. 6 months then taper or stop.

Response 10-12 weeks

24
Q

CsA side effects

A

Hair growth, gingival hyperplasia, renal insufficiency, HTN, neurotoxicity [PRES, sz, PML], magnesium wasting

25
Q

IFN side effects

A

fatigue, myalgias, influenza like symptoms, mood change, suicidality, optic changes, autoimmunity, neuropathy
Less with pegylated IFN
Not teratogenic, ok in pregnancy`

IFN= influenza-like, fatigue, Neuro (eyes, neuropathy, mood)

26
Q

Ruxolitinib Side effects

A

Myelosuppression [esp MF], weight gain, high cholesterol, increased skin cancers, increased infections like Zoster

27
Q

In ALL: want proph, but what type cannot be used concurrently with Vincristine?

A

Potent Azoles: Posa and Vori
Increase neurotoxicity with Vincristine

Often use Micafungin, then fluconazole later in therapy

28
Q

Drug induced ITP

A

drug-Ab complex = heparin
Hapten = penicillin, cephalosporin
Ab binds drug adsorbed on platelet = quinine
BM suppression = valproate

Abx: B lactam, TMPSMX, vanco
anti-epileptic or antipsychotic: valproate, carbamazepine
GP2b3a - platelet clumping and thrombocytopenia within hours

29
Q

Caplacizumab dose/duration

A

11mg subcut x30d

30
Q

Eculizumab dosing/frequency

A

aHUS
900mg weekly x4, then 1.2g q2weeks

PNH
600mg qweekly x4, then 900mg q2 weeks

31
Q

Ravulizumab dosing/loading/frequency

A

aHUS or PNH [treatment by weight]
60-100kg: 2700mg load, then 3300mg 2 weeks later and then every 8 weeks

32
Q

Drug induced neutropenia

A

anti-thyroids
antibiotics
anti convulsants
other: Clozapine, Ritux, Sulfasalazine, Deferiprone, Levimasole in drugs

33
Q

What is 7+3?

A

7 days of Cytarabine 200mg/m2/d over 24h infusion for 7 days
3 days of anthracycline:
- Daunorubicin 60-90mg/m2 daily
- Idarubicin 12mg/m2 daily

34
Q

What is FLAG-Ida?

A

Fludarabine 30mg/m2 D1-5
Cytarabine 2g/m2 over 4h D1-5 [high dose]
G-CSF 300mcg daily D1-5
Idarubicin 10mg/m2 D1-3

35
Q

GO dosing
AML
APL

A

in AML: ALFA 0701 trial, add GO to 7+3 in low/int risk
GO 3mg/m2 days 1/3/7. Other option is higher dose on D1
Low risk: 5y OS 77% vs 55%
Int risk: 5y OS 40% vs 35%

in APL: add in higher risk to ATRA/ATO
9mg/m2 on day 1

36
Q

Midostaurin dosing

A

RATIFY trial, ITD or TKD [ITD is the inferior/worse one, in 2/3 of FLT3]

Dose: 50mg PO BID days 8-21 of 28d cycle
Watch for QTC

37
Q

Gilteritinib dose

A

120mg PO daily
Approved for R/R FLT3 positive
Is type 1 inhibitor like midostaurin, so works on ITD and TKD

Newer trial [MORPHO], in FLT3+ with MRD+ before transplant, benefit of post-transplant Gilteritinib maintenance

38
Q

Special drugs:
Oral or IV/subcut:

Aza
Ven
IDH1
IDH2
Glasdegib
Midostaurin
Gilteritib
GO
Menin inhibitors

A

Aza: Subcut or PO [Onureg]
Venetoclax: PO
IDH1: PO
IDH2: PO
Glasdegib: PO
Midostaurin: PO
Gilteritib: PO
Quizartinib: type 2 inh of FLT3-ITD only
Gemtuzumab Ozogamicin: IV
Menin inhibitors: Revumenib PO, Zeftomenib PO

39
Q

Lococo protocol
Induction:
Consolidation:

A

For low risk APL [WBC<10]

INDUCTION:

ATRA: 45mg/m2/d PO split BID
ATO: 0.15mg/kg/d IV
–Continue until CR with hematologic recovery
– if WBC goes >10 give HU
– maybe DS proph prednisone 0.5mg/kg/d

Consolidation [7 cycles of 28d]
ATRA: 45mg/m2/d for 15/28d cycle
ATO: 0.15mg/kg/d for Mon-Fri (5 doses/wk), 4 weeks on/4 weeks off

40
Q

APML4
Induction
Consolidation

A

ATRA: 45mg/m2/d split BID, D1-36
ATO: 0.15mg/kg/d D9-36
Idarubicin: 12mg/m2 D2/4/6/8
DS proph: Pred 1mg/kg daily D1-10

Alternative: GO + ATRA/ATO

Consolidation varies

41
Q

Treatment of HLH
Dex
Etoposide

A

Dex 10mg BID
Etoposide 150mg/m2 IV
- 2x/wk for 2 weeks
- 1x/wk for 6 weeks
- every 2 weeks after if needed

*if not cancer HLH, there is max cumulative dose of etoposide, 2-3g/m2 [~13-20 doses]
Is a topoisomerase II inhibitor

42
Q

t-AML latencies for:
1. Alkylators or RT?
2. Topoisomerase inh?

How many TP53 mutated?

A
  1. Alkylators: 5-10 years, monsoonal karyotypes [5,7,27], TP53
  2. TopoII: 1-5 years, MLL/KMT2A or RUNX1

TP53 mutations in 30-40%

CHIP predisposes to therapy associated myeloid neoplasm if have CHIP and get Chemotherapy

43
Q

Blina Dosing? Drug class?
Trials/Indications

Side effects?

A

9mcg over 24h D1-7, then 28mcg over 24h D8-28

BiTE for CD19/CD3. Not good for bulky, but gets MRD negative well

  1. BLAST: Ph- B-ALL if MRD+ after initial therapy [not overt relapse]
  2. TOWER: in R/R Ph- B-ALL, better than standard chemo
  3. In Ph+ B-ALL: in older for decreased intensity regimens, for MRD+ after therapy, for R/R

Side effects: Neurotoxicity, CRS

44
Q

Meds in ABVD
Who can drop the Bleo?
Which trial?
Neutropenia -> do they get feb neut? G-csf proph?

A
45
Q

What was the ESCHELON 1 trial?

A
46
Q

Side effects of Brentuximab?
MOA of Brentuximab?
What proph do they need?

A
47
Q

What is escBEACOPP
Outcomes and risks

A
48
Q

What is BrECADD?

A
49
Q

Nivo-AVD: who to use it in?

A
50
Q

Bleomycin lung toxicity:
Risk factors?
Mortality?
Treatment?

A
51
Q

What is AETHERA trial

A
52
Q

What long term monitoring after HL therapy?
RT related? In general?

A
53
Q

Examples of, Side effects, proph:
PIs
IMIDs
anti-CD38 ab

A

PIs:
Bortezomib, Carfilz, Ixazomib
s/e: neuropathy, VZV, low plt, N/V/D, rash, fatigue
proph: valtrex

IMIDs:
Len, Thal, Pomalidomide
s/e: thromboemb, cytopenias, rash, fatigue, diarrhea, 2nd malignancies
proph: ASA or LMWH or ?DOAC. depends on other RFs for thrombosis

Anti-CD38 Ab:
Dara, Isatuximab, Elotuzumab
s/e: infusion/injection site reaction, hypogammaglobulinemia, infections, shingles
proph: Valtrex, +/- IVIG

54
Q

Types of myeloma CAR-Ts

A

Idecel [KARMMA]
Ciltacel [CARtitude] prob better

S/e: CRS, ICANs, hypogammaglobulinemia, infection
Less grade 3+ CRS than B-ALL or NHL CAR-T though. Grade 1/2 still ~60-75%

Valtrex, PJP proph
Revaccinate after

55
Q

Myeloma bispecifics, targets, and side effects?

A

anti-BCMA
Teclistimab [majesTIC]
Elrenatamab

anti-GPRC5D
Talquetamab [monumenTAL]

s/e: CRS, hypogammaglobulinemia is common, often need IVIG, infections.

Valtrex proph, maybe PJP proph
Revaccinate after

Hematology RC Editable (28 decks)

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