Pharmacology/Conditioning Regimens Flashcards
Abatacept
biological agent, interferes with T-cell activation
Eculizumab
immunosuppressive drug, can treat TMA
Rituximab
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
Autologous Car T cell therapy
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)
KYMRIAH
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
Tacrolimus
Immunosuppressive drug/calcineurin inhibitor that works against helper T-cells, preventing production of IL-2
Campath
Also known as alemtuzumab - commonly causes hypersensitivity reaction
May cause rigors - so have Demerol on hand
Ursodiol
VOD ppx
Cyclophosphamide common s/e
- n/v
- Hemorrhagic cystitis due to acrolein as byproduct of cytoxan
- SIADH - b/c Cytoxan can be toxic to renal collecting tubulues and anti-diuretic hormone activity
Cytoxan management (2, think ppx)
- MESNA
- Hyper hydration (using fluid containing at least 0.45% NaCl. Achieve urine specific gravity ≤ 1.010 prior to start of cyclophosphamide)
Cyclophosphamide adverse effects (4)
- n/v
- Hemorrhagic cystitis due to acrolein as byproduct of cytoxan
- SIADH - b/c Cytoxan can be toxic to renal collecting tubulues and anti-diuretic hormone activity
- cardiotoxicity
Busulfan and pharmacokinetics
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
Carboplatin, cisplatin (platins) monitoring (3)
- Ototoxic, need baseline audiogram
- Highly emetogenic, but can be delayed n/v
- Kidneys - very nephrotoxic
Etoposide monitoring (2)
- hypersensitivy rxns b/c it contains preservative
2. hypotension - monitor BPs (if hypotensive, stop infusion, give bolus, then restart at 1/2 rate)
Targeted AUC range for non-myeloablative busulfan dosing
600-750
Busulfan infusion
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
Common toxicities of Busulfan (7)
- N/v - give IVF and anti-emetics
- Mucositis
- Seizures (ppx with anticonvulsant, usually Ativan)
- Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
- Skin changes: bronzing and darkening of skin - temporary
- Hepatotoxicity
- Intersitial Pneumonia
Busulfan seizure prophylaxis
Anti-convulsant, usually Ativan, give during Bu administration and 48h after; if it is a sickle cell patient, use Keppra (30mg/kg)
Busulfan and hepatotoxicity (4: risk factors, management, ppx, treatment)
- Risk factors: Fe overload, abnormal LFTs, previous chemo, previous abdominal radiotherapy
- Monitor: weight, LFTs, I&Os, abd circumference, liver size
- Prophylaxis: Ursodiol/Actigall
- Treatment: defibrotide to treat VOD
Common toxicities of Busulfan (7)
- N/v - give IVF and anti-emetics
- Mucositis
- Seizures (ppx with anticonvulsant, usually Ativan)
- Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
- Skin changes: bronzing and darkening of skin - temporary
- Hepatotoxicity
- Intersitial Pneumonia
Melphalan
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
Common toxicities of Melphalan (6)
- N/v
- Mucositosis - common
- Myelosuppression
- Hypersensitivity reactions - monitor during infusions*
- Hepatotoxicity
- Pulmonary fibrosis (rare)
Common toxicities of Busulfan (7)
- N/v - give IVF and anti-emetics
- Mucositis
- Seizures (ppx with anticonvulsant, usually Ativan)
- Myelosuppressive (decreased BMT activity - fewer WBC, RBC and platelets)
- Skin changes: bronzing and darkening of skin - temporary
- Hepatotoxicity – VOD RISK***
- Intersitial Pneumonia
Melphalan stability
Stable in 0.9% NaCl for 90 minutes at room temperature, meaning 90 min from pharmacy dispensing - ensure it will not expire during infusion
Thiotepa
Type of chemotherapy that crosses BBB so good for brain tumors
Common toxicities of Thiotepa (4)
- N/v
- Mucositis - may be severe
- Myelosuppression
- 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
Common toxicities of Carboplatin (7)
- Nephrotoxic - watch creatinine level closely and give fluids (make sure 12h urine creatinine is good, and dose using Calvert Formula, monitor serum electrolytes)
- N/v
- Hepatotoxicity - monitor LFTs
- Peripheral neuropathy - damage to nerves outside brain and spinal cord, usually resulting in weakness and numbness, common in hands & feet
- Allergic rxns (skin rash, urticaria, pruritis, bronchospasm, etc)
- Ototoxicity - need to do baseline audiogram before and after
Common toxicities of Carboplatin (6)
- Nephrotoxic - watch creatinine level closely and give fluids (make sure 12h urine creatinine is good, and dose using Calvert Formula, monitor serum electrolytes)
- N/v
- Hepatotoxicity - monitor LFTs
- Peripheral neuropathy - damage to nerves outside brain and spinal cord, usually resulting in weakness and numbness, common in hands & feet
- Allergic rxns (skin rash, urticaria, pruritis, bronchospasm, etc)
- Ototoxicity - need to do baseline audiogram before and after
Common toxicities of Etoposide (7)
- Hypotension - if occurs, then stop infusion, once it resolves restart at 1/2 rate; may also give bolus fluids
- N/v
- Myelosuppresion
- Mucositis
- Hepatotoxicity
- Peripheral neuropathy
- Hypersensitivity rxn
How to prevent etoposide hypersensitivity rxn
NEVER INFUSE VOLUME IN LESS THAN 1 HOUR AND NEVER DILUTE INCORRECTLY
Monitor V/S
Biological agents and four types
Agents that can target specific things to gain anti-cancer effects, may be administered before or after transplant
- Rituximab - targets CD20+ B cell malignancies
- Campath - targets CD52
- Atgam - targets T cells
- Thymboglobulin (ATG) - targets T cells
Biological agents and four types
Agents that can target specific things to gain anti-cancer effects, may be administered before or after transplant
- Rituximab - targets CD20+ B cell malignancies
- Campath - targets CD52
- Atgam (ATG) - targets T cells
- Thymboglobulin - targets T cells
ATG
- Targets T cells
- Use as an inducing agent to produce lymphopenia, causing longterm suppression of T cells and immune dysfunction
- Can commonly cause hypersensitivity reactions, also need to have Demerol as emergency med
Cyclosporine
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
Side effect profile of immunsuppressive drugs (such as Tacro, Cyclo) (5)
- Reversible alopecia
- Nephrotoxic - monitor Cr closely
- Glucose intolerance
- N/V/D
- Infection
Florinef
(fludrocortisone) used to regulate high K levels; decreases potassium levels in the blood
MMF/Cellcept
Immunosuppressive drug that slows proliferative pathway of B&T cells; unique b/c it lacks cardio and nephrotoxicities
Monoclonal antibodies and 3 types
Target against specific immunoreactive cells by recognizing cell-surface antigens
- Alemtuzemab
- Daclizumab
- Infliximab
Bactrim ppx - when to use, and dose
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
HSV ppx, Acyclovir - when to use
Begin on first day of conditioning through ANC >500 x 3 days post-nadir
Do not need to give if both donor & recipient are (-)
Fungal ppx
Micafungin IV starting on day 0
Switch to fluconazole when ready for PO/discharge
cytarabine common side effect
chemotherapy agent that may cause conjunctivitis - give steroid drops
Hydroxyurea
Type of chemo agent used to treat leukemias
Allopurinol
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
