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Cancer Medicines > Hematologic Malignancies > Flashcards

Hematologic Malignancies Flashcards

Recognize medications used for different hematologic malignancies, and their side effect profiles

1
Q

Vincristine

A

Indications
ALL: Induction and Maintenance: monthly (+ prednisone)

Non-Hodgkin Lymphoma (“Oncovin”)

Do NOT give intrathecally

  • *Adverse Events**:
  • peripheral neuropathy
  • neurotoxicity
  • constipation and paralytic ileus
  • vesicant
  • *Monitoring Requirements**
  • clinical neurotox history
  • bowel regimen
  • central line preferred

DDIs:
CYP3A4 and P-GP substrate

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2
Q

cytarabine

A

Indications
ALL: Induction & consolidation

AML: Induction (7+3) and consolidation (high dose)

  • *Adverse Events**
  • Bone marrow Suppression
  • Rash on hands and feet
  • conjunctivitis
  • neurotox (speech and movements)
    • Monitoring Requirements **
  • twice a day showers to help rash (wash drug off!)
  • steroid eye drops up until 48 hours after end of chemo
  • monitor for cerebellar toxicity (especially if patient is >50 yo, on high dose, or CrCl<60 mL)

Notes
Liposomal dauno rubicin/cytarabine (Vyxeos) available for secondary AML

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3
Q

Tyrosine Kinase Inhibitors

A

Indications
Ph-positive ALL (first line)

Imatinib (1st gen)

Dasatinib/nilotinib/bosutinib (2nd gen)

Ponatinib (3rd gen)

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4
Q

Tyrosine Kinase Inhibitors

A

Indications
Ph-positive ALL (first line)

Imatinib (1st gen)

Dasatinib/nilotinib/bosutinib (2nd gen)

Ponatinib (3rd gen)
for T315I mutation

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5
Q

Imatinib

A
  • GI intolerance
  • Edema
  • Rash (loss of skin pigmentation))
  • chronic fatigue

CYP enzyme inducer

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6
Q

Dasatinib

A

BBW: QT Prolongation
- pleural effusions

  • *Monitoring Parameters**
  • for pleural effusions if cardiac troubles

*CONTRAINDICATIONS**
with PPIs and H2RAs

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7
Q

Nilotinib

A

BBW: QT prolongation

- increased lipase
hyperglycemia
- increased bilirubin
- hypophosphatemia
- sudden cardiac death
-peripheral arterial occlusive dx
  • *Monitoring Parameters**
  • baseline electrolyets
  • QTc

CONTRAINDICATIONS
PPIs and H2RAs

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8
Q

Bosutinib

A

N/V/D
Rash

caution with H2RAs and PPIs

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9
Q

Ponatinib

A

BBW: vascular occlusion. (REMS)

  • severe hepatotoxicity
  • rash
  • dry skin
  • abdominal pain and pancreatitis
  • fluid retention
  • *Monitoring Parameters**
  • lipase
  • routine LFTs
  • caution with comorbid conditions
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10
Q

Daunorubicin

A

Indication
AML Induction

ALL induction

  • *BBWs**
  • Vesicant
  • Bone Marrow Suppression
  • Cardiomyopathy
  • Hepatic Impairment (adjust)
  • Renal Impairment (adjust)
  • *Monitoring Parameters**
  • for CHF
  • LFTs
  • CrCl
  • Redness at injection site
  • CBC w/diff

Note
Also part of Vyxeos (liposomal) with cytarabine)

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11
Q

Venetoclax

A
  • *Indications**
  • refractory CLL
  • AML induction (if pt >75yo)
    • Adverse Effects **
  • increased risk TLS (titrate up slowly)
  • neutropenia
  • skin rash
  • fatigue
  • N/V/D
  • Increased LFTs
  • *Monitoring Parameters**
  • platelets
  • LFTs

DDIs:
- shouldn’t be used with strong CYP3A inhibitors/inducers

MOA:
Small molecular inhibitor

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12
Q

Cyclophosphamide

A
  • *Indications**
  • CLL
  • Non-Hodgkin Lymphoma (R-CHOP)
  • HSCT conditioning
  • *Adverse Events**
  • myelosuppression (low WBCs)
  • hemorrhagic cystitis (need to administer with pre and post hydration, maybe furosemide or Mesna [with HSCT])
  • hepatotoxicity (VOD)
  • cardiotoxicity (HF, arrhythmias)

Monitoring Parameters
- CBC (may need G-CSF)
- dose adjust renal
dose adjust hepatic

MOA: alkylating agent

  • *DDIs**
  • requires CYP3A4 activation, stop all inhibitors 7 days prior to dose
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13
Q

pegasparaginase

A 
**Indications**
ALL Induction (+/- TKI)
  • *Adverse Events**
  • Hypersensitivity Reaction (can premedicate in future if not too severe a reaction)
  • Pancreatitis
  • Hepatotox
  • Coagulopathies
  • *Monitoring Parameters**
  • lipase
  • LFTs
  • clotting factors?
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14
Q

Rituximab

A
  • *Indications**
  • Non-Hodgkin Lymphoma (R-CHOP)
  • CLL
**Adverse Events**
BBW: SJS
- Infusion Reaction (within 30 - 120 minutes; so premedicate with ASA or antihistamines)
- TLS
- Hep B reactivation
  • *Monitoring Parameters**
  • watch for rash
  • watch for infusion rxn
  • TLS panel
  • LFTs (for Hep B)
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15
Q

Ibrutinib

A

Indications
refractory CLL

  • *Adverse Events**
  • Lymphocytosis (lots of lymphocytes in the blood)
  • bleeding
  • new afib
  • hypertension
  • *Monitoring Parameters**
  • watch for bleeding
  • BP
  • watch for afib

DDIs:
with CYP3A inducers/inhibitors

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16
Q

Idelalisib

A
  • *Indications**
  • refractory CLL
  • *Adverse Events**
  • hepatotox
  • diarrhea
  • pneumonitis
  • colitis
  • *Monitoring Parameters**
  • LFTs (dose reduce if >5x ULN)

DDIs:
with CYP3A inducers/inhibitors

17
Q

Decitabine

A
  • *Indications**
  • AML Induction (> 60 yo)
  • *Adverse Events**

Monitoring Parameters

Cancer Medicines (9 decks)

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