Other hematologic pharmacotherapies Flashcards
Epogen is considered a _____
Colony Stimulating Factor (CSF)
Erythropoietin (Epogen) MOA
Stimulates erythroid progenitor (Proerythroblast) division and
differentiation, stimulating erythropoiesis
Erythropoietin (Epogen) Indications
○ Anemia of Chronic Kidney Disease
○ HIV-Associated Anemia
○ Chemotherapy-Related Anemia
○ To reduce need for surgery-associated transfusion
Erythropoietin (Epogen) contraindications
○ Hypersensitivity to mammal-derived proteins/albumin
○ Neonates or infants - benzyl alcohol forms
○ Uncontrolled hypertension
○ Caution if cardiovascular disease, CABG surgery, or stroke
Erythropoietin (Epogen) side effects
○ Nausea, vomiting
○ Hypertension
○ Cough
○ Pruritus
○ Rash
○ Headache
○ Arthralgias
○ Fatigue
○ Edema
Erythropoietin (Epogen) Adverse reactions
○ Thromboembolism
○ Myocardial Infarction
○ Stroke
○ CHF Exacerbation
○ Seizures
○ Severe hypertension
○ Pure Red Cell Aplasia
Erythropoietin (Epogen) BBWs
○ Increased mortality and serious cardiovascular events, MI, stroke,
VTE when target Hgb is greater than 11 g/dL in CKD patients
○ Increased mortality and/or tumor progression in cancer patients.
Use only in chemo-related anemia when cancer cure is not
anticipated
○ Increased incidence of thromboembolic events in surgical
patients. If need to give, consider concomitant DVT prophylaxis
Erythropoietin (Epogen) Follow up
○ Check BP, Ferritin, and TIBC at baseline, then periodically
○ Check Hgb weekly and adjust PRN until stable, then check Hgb
monthly
○ Benefits probably outweigh unexpected risk during
pregnancy/lactation
____ is considered a Granulocyte Colony Stimulating
Factor (G-CSF)
Neupogen
Filgrastim (Neupogen) MOA
Binds to receptors on
hematopoietic stem cells,
influencing and increasing the
production of neutrophils
Filgrastim (Neupogen) indications
○ Post-Chemotherapy Neutropenia-induced myelosuppression
○ Post-Bone Marrow Transplant Neutropenia
○ Peripheral Blood Progenitor Cell (PBPC) Mobilization
○ Severe, chronic Neutropenia (congenital or idiopathic)
○ Hematopoietic Syndrome of Radiation - counter the myelosuppressive
radiation
○ AIDS-Associated Neutropenia
Filgrastim (Neupogen) contraindications
○ Hypersensitivity to E. coli proteins
○ If within 24 hours of chemotherapy or radiation treatment
○ Caution if sickle cell disease, myelodysplasia, or myeloid cancer
Filgrastim (Neupogen) adverse reactions
○ Splenic rupture
○ Acute Respiratory Distress
Syndrome (ARDS)
○ Thrombocytopenia
○ Anaphylaxis
○ Glomerulonephritis
○ AML or Myelodysplastic
Syndrome occurring in patients
with congenital neutropenia
Filgrastim (Neupogen) follow up
○ For post-chemotherapy, post-BMT, and post-radiation neutropenia
patients, CBC with diff 3 times per week
○ For severe, chronic neutropenia patients, CBC with diff 2 times per week
for first 4 weeks, then monthly for 1st year, then every 3 months
thereafter
■ Also, bone marrow evaluation annually if congenital neutropenia
○ Benefits likely outweigh risks during pregnancy; Risk of fetal harm is low
based on human data
○ Lactation safety is unknown, caution advised. Consider avoiding
breastfeeding till >3 days after DC
_____ is considered an Colony Stimulating Factor (CSF)
Leukine
Sargramostim (Leukine) MOA
Stimulates proliferation and
differentiation of
granulocytes and
macrophages
Sargramostim (Leukine) indications
○ Post-Chemotherapy Neutropenia-induced myelosuppression
○ Post-Bone Marrow Transplant Neutropenia
○ Peripheral Blood Progenitor Cell (PBPC) Mobilization
○ Severe or Chronic Neutropenia (congenital or idiopathic)
○ Hematopoietic Syndrome of Radiation
○ AIDS-Associated Neutropenia
Sargramostim (Leukine) contraindications
○ If circulation of Leukemic Myeloid blasts is greater than 10%
○ Concurrent chemotherapy or radiation therapy w/in 24 hours
○ Caution if pericardial effusion, arrhythmias, or CHF
○ Potential for antibody development against the drug
Sargramostim (Leukine) side effects
○ Abdominal pain (89%)
○ Diarrhea (89%)
○ Fever (81%)
Sargramostim (Leukine) adverse reactions
○ Severe asthenia
○ Pleural effusion
○ Pericardial effusion
Sargramostim (Leukine) follow up
○ Monitor respiratory status during and right after infusion
○ Check CBC with diff at baseline and then 2 times per week
○ BUN/Creatinine should be checked at least every other week if
the patient has renal impairment
○ LFTs should be checked at least every other week if the patient
has hepatic impairment
What is the “Caution: Benzyl Alcohol” about?
● Some manufacturers of Epogen and Leukine have used Benzyl Alcohol as a
preservative
● The low dose seems to be harmless to adults, but is known to be harmful to
neonates – Benzyl Alcohol Toxicity
● Caution/contraindications for Epogen and Leukine
○ If the vial contains Benzyl Alcohol as a
preservative, the medication should not be
administered to infants, pregnant women, or
breastfeeding mothers