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Heme/Onc/BMT > Pharmacology/Conditioning Regimens > Flashcards

Pharmacology/Conditioning Regimens Flashcards

1
Q

Abatacept

A

biological agent, interferes with T-cell activation

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2
Q

Eculizumab

A

immunosuppressive drug, can treat TMA

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3
Q

Rituximab

A

Targets CD20+ B cell malignancies; due to infusion reactions (common s/e), use premeds then start at slow rate and titrate up; also screen for HBV

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4
Q

Autologous Car T cell therapy

A

Genetically modifying T-cells to fight cancerous cells; alter genes inside T-cells by adding chimeric antigen receptor (CAR) that will help T-cells attach to specific cancer cell antigen (ex: CD19 antigen in certain lymphomas and leukemias)

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5
Q

KYMRIAH

A

CAR-T cell medication used to treat B-cell leukemia, using bodies own T-cells, modifying them, and then re-implanting them to fight cancerous cells

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6
Q

Tacrolimus

A

Immunosuppressive drug/calcineurin inhibitor that works against helper T-cells, preventing production of IL-2

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7
Q

Campath

A

Also known as alemtuzumab - commonly causes hypersensitivity reaction
May cause rigors - so have Demerol on hand

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8
Q

Ursodiol

A

VOD ppx

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9
Q

Cyclophosphamide common s/e

A
  1. n/v
  2. Hemorrhagic cystitis due to acrolein as byproduct of cytoxan
  3. SIADH - b/c Cytoxan can be toxic to renal collecting tubulues and anti-diuretic hormone activity
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10
Q

Cytoxan management (2, think ppx)

A
  1. MESNA
  2. Hyper hydration (using fluid containing at least 0.45% NaCl. Achieve urine specific gravity ≤ 1.010 prior to start of cyclophosphamide)
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11
Q

Cyclophosphamide adverse effects (4)

A
  1. n/v
  2. Hemorrhagic cystitis due to acrolein as byproduct of cytoxan
  3. SIADH - b/c Cytoxan can be toxic to renal collecting tubulues and anti-diuretic hormone activity
  4. cardiotoxicity
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12
Q

Busulfan and pharmacokinetics

A

type of chemotherapy; pharmacokinetics are very important, always get busulfan levels to monitor for steady stead
If too high - risk of VOD
If too low - won’t kill cancer cells // or risk for engraftment failure

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13
Q

Carboplatin, cisplatin (platins) monitoring (3)

A
  1. Ototoxic, need baseline audiogram
  2. Highly emetogenic, but can be delayed n/v
  3. Kidneys - very nephrotoxic
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14
Q

Etoposide monitoring (2)

A
  1. hypersensitivy rxns b/c it contains preservative

2. hypotension - monitor BPs (if hypotensive, stop infusion, give bolus, then restart at 1/2 rate)

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15
Q

Targeted AUC range for non-myeloablative busulfan dosing

A

600-750

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16
Q

Busulfan infusion

A

Always starts with saline, not Bu, and ends with NS flush so that drug level reflects entire dose infused
*Stop clock should be involved for Bu kinetcs

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17
Q

Common toxicities of Busulfan (7)

A
  1. N/v - give IVF and anti-emetics
  2. Mucositis
  3. Seizures (ppx with anticonvulsant, usually Ativan)
  4. Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
  5. Skin changes: bronzing and darkening of skin - temporary
  6. Hepatotoxicity
  7. Intersitial Pneumonia
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18
Q

Busulfan seizure prophylaxis

A

Anti-convulsant, usually Ativan, give during Bu administration and 48h after; if it is a sickle cell patient, use Keppra (30mg/kg)

19
Q

Busulfan and hepatotoxicity (4: risk factors, management, ppx, treatment)

A
  1. Risk factors: Fe overload, abnormal LFTs, previous chemo, previous abdominal radiotherapy
  2. Monitor: weight, LFTs, I&Os, abd circumference, liver size
  3. Prophylaxis: Ursodiol/Actigall
  4. Treatment: defibrotide to treat VOD
20
Q

Common toxicities of Busulfan (7)

A
  1. N/v - give IVF and anti-emetics
  2. Mucositis
  3. Seizures (ppx with anticonvulsant, usually Ativan)
  4. Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
  5. Skin changes: bronzing and darkening of skin - temporary
  6. Hepatotoxicity
  7. Intersitial Pneumonia
21
Q

Melphalan

A

Chemotherapy drug that crosses BBB so good for CNS tumors, also good for multiple myeloma
Has decreased risk of VOD because it is metabolized in blood stream and not liver

22
Q

Common toxicities of Melphalan (6)

A
  1. N/v
  2. Mucositosis - common
  3. Myelosuppression
  4. Hypersensitivity reactions - monitor during infusions*
  5. Hepatotoxicity
  6. Pulmonary fibrosis (rare)
23
Q

Common toxicities of Busulfan (7)

A
  1. N/v - give IVF and anti-emetics
  2. Mucositis
  3. Seizures (ppx with anticonvulsant, usually Ativan)
  4. Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
  5. Skin changes: bronzing and darkening of skin - temporary
  6. Hepatotoxicity – VOD RISK***
  7. Intersitial Pneumonia
24
Q

Melphalan stability

A

Stable in 0.9% NaCl for 90 minutes at room temperature, meaning 90 min from pharmacy dispensing - ensure it will not expire during infusion

25
Q

Thiotepa

A

Type of chemotherapy that crosses BBB so good for brain tumors

26
Q

Common toxicities of Thiotepa (4)

A
  1. N/v
  2. Mucositis - may be severe
  3. Myelosuppression
  4. Skin changes - b/c it is excreted in skin and can cause burns, nursing does bed baths every 8h at start of infusion through 24h after - hyperpigmentation may occur for several weeks but will fade
27
Q

Common toxicities of Carboplatin (7)

A
  1. Nephrotoxic - watch creatinine level closely and give fluids (make sure 12h urine creatinine is good, and dose using Calvert Formula, monitor serum electrolytes)
  2. N/v
  3. Hepatotoxicity - monitor LFTs
  4. Peripheral neuropathy - damage to nerves outside brain and spinal cord, usually resulting in weakness and numbness, common in hands & feet
  5. Allergic rxns (skin rash, urticaria, pruritis, bronchospasm, etc)
  6. Ototoxicity - need to do baseline audiogram before and after
28
Q

Common toxicities of Carboplatin (6)

A
  1. Nephrotoxic - watch creatinine level closely and give fluids (make sure 12h urine creatinine is good, and dose using Calvert Formula, monitor serum electrolytes)
  2. N/v
  3. Hepatotoxicity - monitor LFTs
  4. Peripheral neuropathy - damage to nerves outside brain and spinal cord, usually resulting in weakness and numbness, common in hands & feet
  5. Allergic rxns (skin rash, urticaria, pruritis, bronchospasm, etc)
  6. Ototoxicity - need to do baseline audiogram before and after
29
Q

Common toxicities of Etoposide (7)

A
  1. Hypotension - if occurs, then stop infusion, once it resolves restart at 1/2 rate; may also give bolus fluids
  2. N/v
  3. Myelosuppresion
  4. Mucositis
  5. Hepatotoxicity
  6. Peripheral neuropathy
  7. Hypersensitivity rxn
30
Q

How to prevent etoposide hypersensitivity rxn

A

NEVER INFUSE VOLUME IN LESS THAN 1 HOUR AND NEVER DILUTE INCORRECTLY
Monitor V/S

31
Q

Biological agents and four types

A

Agents that can target specific things to gain anti-cancer effects, may be administered before or after transplant

  1. Rituximab - targets CD20+ B cell malignancies
  2. Campath - targets CD52
  3. Atgam - targets T cells
  4. Thymboglobulin (ATG) - targets T cells
32
Q

Biological agents and four types

A

Agents that can target specific things to gain anti-cancer effects, may be administered before or after transplant

  1. Rituximab - targets CD20+ B cell malignancies
  2. Campath - targets CD52
  3. Atgam (ATG) - targets T cells
  4. Thymboglobulin - targets T cells
33
Q

ATG

A
  1. Targets T cells
  2. Use as an inducing agent to produce lymphopenia, causing longterm suppression of T cells and immune dysfunction
  3. Can commonly cause hypersensitivity reactions, also need to have Demerol as emergency med
34
Q

Cyclosporine

A

immunosuppressive drug that works against helper T-cells, preventing production of IL-2 via calcineurin inhibition
Used for induction & maintenance immunosuppression
IV much more potent than PO (increased risk for nephro and neurotoxicity)
Monitor nephrotoxicity closely - watch Cr, K, Mg

35
Q

Side effect profile of immunsuppressive drugs (such as Tacro, Cyclo) (5)

A
  1. Reversible alopecia
  2. Nephrotoxic - monitor Cr closely
  3. Glucose intolerance
  4. N/V/D
  5. Infection
36
Q

Florinef

A

(fludrocortisone) used to regulate high K levels; decreases potassium levels in the blood

37
Q

MMF/Cellcept

A

Immunosuppressive drug that slows proliferative pathway of B&T cells; unique b/c it lacks cardio and nephrotoxicities

38
Q

Monoclonal antibodies and 3 types

A

Target against specific immunoreactive cells by recognizing cell-surface antigens

  1. Alemtuzemab
  2. Daclizumab
  3. Infliximab
39
Q

Bactrim ppx - when to use, and dose

A

Use it daily from first day of conditioning to day -2, then restart once ANC >500 x 2 consecutive days
5mg/kg max: 160mg, three times weekly

40
Q

HSV ppx, Acyclovir - when to use

A

Begin on first day of conditioning through ANC >500 x 3 days post-nadir
Do not need to give if both donor & recipient are (-)

41
Q

Fungal ppx

A

Micafungin IV starting on day 0

Switch to fluconazole when ready for PO/discharge

42
Q

cytarabine common side effect

A

chemotherapy agent that may cause conjunctivitis - give steroid drops

43
Q

Hydroxyurea

A

Type of chemo agent used to treat leukemias

44
Q

Allopurinol

A

Used to reduce uric acid (waste product found in blood when body breaks down purines - can increase in blood when cancer cells die) in cancer patients

Heme/Onc/BMT (4 decks)

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