Purine Antagonists

Question 1

What drugs are in the Purine Antagonist class?

Answer 1

Drugs in this class are:
- 6-Mercatopurine (6-MP)
- Fludarabine
- Cladribine
- Clofarabine
- Nelarabine
- Pentostatin
- Thioguanine

Question 2

What is the brand name of 6Mercatopurine (6MP)?

Answer 2

The brand name of this generic drug is:
- Purixan

Question 3

What is the brand name of Fludarabine?

Answer 3

The brand name of this generic drug is:
- Fludara

Question 4

What is the brand name of Cladribine?

Answer 4

The brand name of this generic drug is:
- Mavenclad
- Leustatin

Question 5

What is the brand name of Clofarabine?

Answer 5

The brand name of this generic drug is:
- Clolar
- Clofarex

Question 6

What is the brand name of Nelarabine?

Answer 6

The brand name of this generic drug is:
- Arranon

Question 7

What is the brand name of Pentostatin?

Answer 7

The brand name of this generic drug is:
- Nipent

Question 8

What is the brand name of Thioguanine?

Answer 8

The brand name of this generic drug is:
- Nipent

Question 9

What is the generic of name of Purixan?

Answer 9

The generic name of this brand name drug is:
- 6Mercatopurine

Question 10

What is the generic of name of Fludara?

Answer 10

The generic name of this brand name drug is:
- Fludarabine

Question 11

What is the generic of name of Mavenclad?

Answer 11

The generic name of this brand name drug is:
- Cladribine

Question 12

What is the generic of name of Clolar?

Answer 12

The generic name of this brand name drug is:
- Clofarabine

Question 13

What is the generic of name of Arranon?

Answer 13

The generic name of this brand name drug is:
- Nelarabine

Question 14

What is the generic of name of Nipent?

Answer 14

The generic name of this brand name drug is:
- Pentostatin

Question 15

What is the generic of name of Nipent?

Answer 15

The generic name of this brand name drug is:
- Thioguanine

Question 16

What are the main indications for use of 6Mercatopurine?

Answer 16

The main indications of this drug are:
- ALL

Question 17

What are the main indications for use of Fludarabine?

Answer 17

The main indications of this drug are:
- CLL
- AML
- HSCT
- Non-Hodkin Lymphoma

Question 18

What are the main/common indications of the Purine Antagonist class?

Answer 18

The main/common indications of this drug class are:
- Leukemias with Fludarabine
- Non-Hodgkin Lymphoma with 6MP

Question 19

What is the class and MOA of 6Mercaptopurine?

Answer 19

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 20

What is the class and MOA of Fludarabine?

Answer 20

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 21

What is the class and MOA of Cladribine?

Answer 21

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 22

What is the class and MOA of Clofarabine?

Answer 22

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 23

What is the class and MOA of Nelarabine?

Answer 23

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 24

What is the class and MOA of Pentostatin?

Answer 24

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 25

What is the class and MOA of Thioguanine?

Answer 25

This drug in the following class:
- Purine Antagonist

This drug’s MOA is as follows:
- Purine antagonists inhibit DNA and RNA synthesis by acting as false metabolite.
- The anti-metabolite is incorporated into DNA and RNA eventually inhibiting the ir synthesis.
- They are specific for the S phase of the cell cycle.

Question 26

What is the emetic potential of 6Mercatopurine?

Answer 26

The emetic potential of this drug is:
- Minimal to Low

Question 27

What is the emetic potential of Fludarabine?

Answer 27

The emetic potential of this drug is:
- Minimal

Question 28

Describe the emetic potential of the Purine Antagonist class.

Answer 28

The emetic potential of this drug class is:
- Minimal to Low except for Clofarabine (Moderate)

Question 29

What drugs in the Purine Antagonist class have a high emetic potential?

Answer 29

Drugs in the class with a high emetic potential are:
- None, N/A

Question 30

What drugs in the Purine Antagonist class have a moderate emetic potential?

Answer 30

Drugs in the class with a moderate emetic potential are:
- Clofarabine

Question 31

What drugs in the Purine Antagonist class have a low emetic potential?

Answer 31

Drugs in the class with a low emetic potential are:
- All are Minimal to Low except for:
- Fludarabine and Cladribine (Minimal)
- Clofarabine (Moderate)

Question 32

What drugs in the Purine Antagonist class have a minimal emetic potential?

Answer 32

Drugs in the class with a minimal emetic potential are:
- Fludarabine
- Cladribine
- All the rest are “Minimal to Low” except for Clofarabine (Moderate)

Question 33

Describe the extravasation risk and management strategies for the Purine Antagonist class.

Answer 33

The extravasation risk and management strategies for this drug class are as follows:
- None, N/A

Question 34

Describe the metabolism of 6Mercaptopurine.

Answer 34

The metabolism of this drug is as follows:
- Total body clearance of the principal metabolite correlates with creatinine clearance

Question 35

Describe the metabolism of Fludarabine.

Answer 35

The metabolism of this drug is as follows:
- Renal impairment may result in slower elimination of parent drug and metabolite, and a greater cumulative effect

Question 36

What are the clinical pearls of 6Mercaptopurine?

Answer 36

The clinical pearls of this drug are as follows:
- Doses for ALL are typically titrated to maintain an ANC between 500-1500 cells/mcL. Methods of dose titration will vary per protocol but typically involve adjusting doses every 4-8 weeks.
- In patients intolerant to this drug (abnormally low CBC unresponsive to dose reduction, severe bone marrow toxicities, or repeated myelosuppressive episodes), consider genotyping of NUDT15 and TPMT.
- NUDT15 and TPMT genotyping or phenotyping may assist in identifying patients at risk for developing toxicity and those who may needs empiric dose reductions due to decreased metabolism of 6-MP.