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Hematology > Malignant Heme Pharm > Flashcards

Malignant Heme Pharm Flashcards

1
Q

What is Post Remission therapy ?

A

Short Term intense chemotherapy with Cytarabine based regimens.

High dose chemotherapy or chemoradiotherapy with autologous bone marrow rescue.

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2
Q

What is cytarabine ?

A

It is a pyrimidine anti-metabolite activated by kinases to ARA-CTP which inhibits the S phase of the cell cycle.

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3
Q

What are the black box warnings of Arsenic Trioxide ?

A

AV block, QT prolongation, electrolyte imbalance

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4
Q

What is differentiation syndrome ?

A

Fever, Dyspnea, weight gain, pulmonary infiltrates, pleural or pericardial effusions +/- Leukocytosis.

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5
Q

What would you use to treat Acute Promyelocytic Leukemia ?

A

ATRA and Arsenic trioxide. for standard treatment

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6
Q

What is the childhood treatment of APL ?

A

ATRA + Anthracycline + Cytarabine

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7
Q

What is the remission and consolidation therapy for APL ?

A

ARTA in conjunction with standard dose cytarabine and daunorubicin or idarubicin + ARTA without cytarabine

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8
Q

What is the mantenance therapy for APL ?

A

ATRA + 6-ercaptopurine + Methotrexate

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9
Q

What does Arsenic Trioxide do ?

A

Degrades PML-RAR-Alpha fusion protein.

Cardiovascular Toxicities

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10
Q

What is the remission induction therapy for ALL ?

A

Prednisone + Vincristine + Anthracycline

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11
Q

What is the consolidation therapy for ALL ?

A

Methotrexate + Mercaptopurine

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12
Q

What is the CNS Prophylaxis therapy for ALL; sometimes with irradiation

A

IT Methotrexate + Mercaptopurine

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13
Q

What is so great about Imatinib ?

A

It is an oral inhibitor of BCR-ABL tyrosine kinase. The adverse effects induces hepatic enzyme elevation and pancytopenia.

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14
Q

How would you treat the acute phase of CML ?

A

Due to the short durability classic chemotherapy is utilized

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15
Q

When you use Imitinab to treat CML ?

A

In the chronic phase this is the first line of treatment

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16
Q

If the binding site for Imitinab has been mutated what drug would you use next ?

A

Desatinib and Nimotinib

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17
Q

What are the common treatment regimens for CLL ?

A

Fludarabine + Cyclophosphoamide

Fludarabine + Rutiximab

Fludarabine + Rutiximab + Cyclophosphoamide

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18
Q

How would you treat hairy cell leukemia ?

A

Purine analoges show the best response rate. Cladribine + INF Alfa-2b, Pentostatin

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19
Q

What are the anti-neoplastic actions of Interferons ?

A

They will prolonge all the phases of the cell cycle. and induce cellular differentiation

20
Q

What would you use to treat AML ? (post remission)

A

ARA-C - pyrimidine analog
Thioguanine - purine analog
Donorubicin- Free radical generator (Cardiotoxicity)
**All three are myelosupressive

21
Q

What is metranomic dosing ?

A

Daily administration of lower doses of anti-hematologic malignancy drugs. By administering the drug more frequently you can avoid the proliferative effect some drugs exhibit at low concentrations
**It will circumvent hormesis.

22
Q

What is Gemtuzomab ?

A

It is an Anti-CD33 antibody. This will be on cells of myleoid origin. The receptor Ab complex is internalized and releases Calechimycin which induces DNA stand breakage. Accelerated approval for AML relapse.

23
Q

What is a problem with Gemtuzomab

A

Initial phase acute toxicity with 10% venoocclusive disease.

24
Q

Why did we learn about Gemtuzumab ?

A

It carries an antitumor drug to tumor cells with CD-33. It is a monoclonal Ab carrier of a Chemo drug.

25
Q

What does Alemtuzumab do in CLL ?

A

Orphan Drug that binds to CD-52 on mature Lymphocytes, monocytes, and Lymphoid cells. Induces a similar effect to rituximab.

26
Q

Bendamustin in CLL ?

A

It is both an anti-metabolite and an an Alkylating agent. It causes DNA cross linking and very durable dsDNA single and double strand breakage. This drug is less susceptible to resistance.

27
Q

How are interferons used to treat hematologic malignancies ?

A
  1. They exhibit a direst antiproliferative effect on the tumor.
  2. Activate the host immune system against the tumor cell (Cytotoxic T and NK cells)
  3. Stimulate anti-proliferative cytokines
28
Q

What is the most common treatment of Hogkin Lymphoma ?

A

Antracycline ( Doxirubicin ) Mitotic Spindel Inhibitor ( Vincristine ) Alkylating (Cyclophosphoamide ) or Bleomycin. Carbazine Drug and a corticosteroid.

29
Q

What is the dose limiting toxicity of alkylating drugs ?

A

Myelosupression. Other classes of agents dont show this uniform response.

30
Q

Can advanced Hodgkin disease be cured ?

A

Yes they can be treated with high dose therapy. 60-70% of patients can be cured with combination chemo. If the patient relapses they can rarely be cured with salvage therapy. High dose therapy with Autologous SCT.

31
Q

What are the adverse effects of high dose therapy ?

A

They destroy stem cells which will have to be replaced after high dose therapy.

32
Q

How do you treat Non-HL

A

COMP therapy. When they express CD-20 you can also employ rituximab

33
Q

What are the concerns when treating Non-HL ?

A

Sterility from pelvic irridation using high dose cyclophosphoamide, secondary malignancies, and left ventricular dysfunction.

34
Q

What are the two anti-CD20 antibodies

A

Tositumomab
Ibritumomab
They will not bind to non-lymphoid tissue and have a high incidence of hematologic malignancy.

35
Q

How do you treat Burkitt Lymphoma ?

A

Cyclical Regimen of Cyclophosphoamide + methotrexate, Vincristine and Doxorubicin, and possibly cytarabine

36
Q

During Pregnancy Chemo ?

A

Class X drugs are Teratogenic will cause death in utero. Other drugs can just cause organ malformation.

37
Q

What are the adverse effects of Arsenic Trioxide ?

A

Acute Promyeloctic differentiation syndrome, AV block, cardiac arrhythimas, leukocytosis

38
Q

What are the adverse effects of ATRA ?

A

Acute Promyelocytic Leukemia Differentiation syndrome and Leukocytosis

39
Q

What are the adverse effects of Bleomycin ?

A

Pulmonary Fibrosis, Boobs on cancer man, and Idiosyncratic reaction ( fever )

40
Q

What are the adverse effects of carboplatin ?

A

Anemia and Infection

41
Q

What are the adverse effects of chlorambucil ?

A

Bone Marrow suppression, secondary malignancy, pregnancy and infertility

42
Q

What are the adverse effects of Cladiribine ?

A

Marrow supression and neurotoxicity

43
Q

What are the adverse effects of Ifosamide ?

A

Coma and hemorrhagic cystitis

44
Q

What are the adverse effects of Doxorubicin, Danuribicin, and Idiorubicin ?

A

These Anthracyclines generate free radicals and inhibit Topo-2. they can cause heart disease and extravasational necrosis. d

45
Q

What are the adverse effects of Interferon alpha ?

A

Contraindicated with autoimmune disease. Cause depression and suicidal thoughts.

46
Q

What are the adverse effects of methotrexate ?

A

Ascites, Diahrrhea, exfolative dermititis, pulmonary disease, fibrosis, renal imparment, and tumor lysis syndrome.

47
Q

What are the adverse effects of vinblastine and vincristine ?

A

Fatal Neuropathic Toxicity

Hematology (12 decks)

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