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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

Adriamycin=doxo
Bleo
Vinblastine
Dacarbazine

Drop bleo if PET2 is negative, per RATHL
Omit bleo if BLI, underlying lung or renal disease, drop in DLCO or pulm symptoms from treatment, age >70

45
Q

What was the ESCHELON 1 trial?

A

Phase 3
Advanced stage cHL
Brentuximab-AVD vs ABVD
5y mPFS 82 vs 75%

46
Q

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

A

Peripheral neuropathy 30% >gr2
Most over 60 got neutropenia gr3+
Feb neut 20%
More infection/hospitalization

Anti-cd30 drug antibody conjugate, with MMAE

Use G-CSF proph!

47
Q

What is escBEACOPP
Outcomes and risks

A

Bleo
Etop
Doxo
Cyclo
Vincristine
Procarbazine-> dacarbazine
Pred

With escalating doses based on tolerance

For young and high risk patients

HD15: Better control than ABVD but more early and late toxicities, more infertility, more secondary malignancies

HD18: neg PET2 -> 4 cycles ok

48
Q

What is BrECADD?

A

HD21 trial
Brentuximab
Etop
Cyclo
Doxo
Dacarbazine
Dex

Vs esc beacopp
Advanced stage cHL

better 3y PFS 94.9 vs 92.4
Benefit across all subgroups, especially benefit in low IPI

Less AE, less TRMB, less TRM

PET2 guided 4 vs 6 cycles

Better tolerability, less fertility issues

49
Q

Nivo-AVD: who to use it in?

A

SWOG S1826

Nivo-AVD vs BV-AVD in advanced stage cHL

2y PFS 92 vs 83%
Less TRM, better tolerability, much less neuropathy. Less feb neut in older but still present in both

More hyper/hypo thyroid. Risk other immune related adverse effects

50
Q

Bleomycin lung toxicity:
Risk factors?
Mortality?
Treatment?

A

10% get it, 1% die
RFs: age >70, higher cumulative dose, renal disease, underlying lung disease

Dry cough, SOB
CT changes: fibrosis, diffuse alveolar danc damage, NSIP, BOOP, organizing pneumonia
PFT: DLCO decreases first

RX:
Stop Bleo
Steroids: pred 1mg/kg or pulse
Oxygen to 89-92% (NOT high fiO2 doses)
CT to monitor
Potentially Abx if infection
2nd line: NAC, imatinib, anti-TNF infliximab

51
Q

What is AETHERA trial

A

BV maintenance after auto in high risk pts

High risk:
Primary Refractory
Early relapse <1y
Extranodal disease at relapse

52
Q

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

A

Relapse
Secondary malignancy
Cardiac toxicity: cardiomyopathy or CVD
Neuropathy (BV)
Pulmonary (Bleo)

H&P, labs, CXR

RT: breast cancer screen (8-10y after chest RT or age 40), lung cancer, TSH if neck RT, CRC screen early if abdo/pelvic RT

Bone density
Dental
Cataract
Psychosocial

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 (magnetisMM-3)

anti-GPRC5D
Talquetamab [monumenTAL]

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

Valtrex proph, maybe PJP proph
Revaccinate after
Maybe CMV monitoring

56
Q

Aza dosing

Mono therapy

With Ven

A

75mg/m2 subcutaneous x7d

Cycle 3+ can increase to 100mg/m2 if no response so far and tolerating well without cytopenias

With Ven
75mg/m2 dose
Ven 100->200->400mg day 1/2/3
Ven 20->50->70mg if on Posa

57
Q

Polatuzumab MOA
Use?

A

ADC CD79a and MMAE
neuropathy, cytopenias

DLBCL
Pola-R-CHP (1L DLBCL or HGBL)
- POLARIX trial vs RCHOP, better PFS
- IPI2+
Pola-BR (RR DLBCL

Hematology RC Editable (28 decks)

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