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Oncology Exam 2
Smith Medications for Thrombocytopenia (C)
| Term | Definition |
|---|---|
| Thrombocytopenia is a condition where ________ levels dropped. Sx include? | platelet; bleeding, bruising on skin |
| What are our Thrombopoietin Receptor Agonsits? | -Ethrombopag -Romiplostim -Avatrombopag |
| Where are the receptors of our Trombopoietin Receptor agonists? | immature platelets; by agonizing those receptors, they stimulate those immature platelets to continue differentiating/maturing/proliferating |
| Thrombopoietin Receptors agonists are used to? | Stimulate production of megakaryocytes and platelets in the marrow by activating the TPO receptor • FDA-approved for immune thrombocytopenia (ITP), chronic hepatitis C–associated thrombocytopenia, severe aplastic anemia, and chronic liver disease–associated thrombocytopenia • Being evaluated for other conditions where platelet levels are low |
| ITP (immune thrombocytopenia) is a autoimmune condition where the pt’s immune system is making antibodies against _______ | platelets; *so pts own body is killing off their platelet cells |
| Eltrombopag is a small-molecule, non-peptide thrombopoietin-receptor agonists. MOA? Indication? Dose? | MOA: Mechanism: thrombopoietin receptor agonist; induces proliferation and differentiation of megakaryocytes; Indication: ITP after failure with corticosteroids, immunoglobulins, or splenectomy Dose: usually 50mg PO Q day, but patients of East Asian ancestry or with moderate to severe hepatic insufficiency, start with 25mg Q day |
| AE of Eltrombopag are? DI are? | – Common: anemia, nausea, pyrexia, cough, fatigue, headache, and diarrhea – Serious: hemorrhage, thrombosis, ascites, drug-induced disorder of liver, liver failure, portal vein thrombosis, encephalopathy, cataracts; DI: Ca2+, antacids, Ca2+ rich foods (will bind up drug and you won’t get as much drug BA -possible risk to developing fetus and nursing infants |
| Serious AE of hemorrhage, thrombosis, ascites, drug-induced disorder of liver, liver failure, portal vein thrombosis, encephalopathy, cataracts are see in all ____ ________ _______ ______ | 3 Thrombopoietin Receptor agonists |
| Romiplostim is an? MOA? | an Fc-peptide fusion protein (peptibody): four copies of a small peptide grafted onto an immunoglobulin scaffold; -MOA: thrombopoietin receptor agonist; induces proliferation and differentiation of megakaryocytes -Indication: ITP after failure with corticosteroids, immunoglobulins, or splenectomy; -Given SQ, once weekly |
| AE of Romiplostim? | Common: headache, dizziness, insomnia, myalgia, arthralgia, extremity pain, abdominal pain, dyspepsia, and paresthesia – Serious: Acute myeloid leukemia, hemorrhage, increased reticulin in bone marrow, portal vein thrombosis -possible risk to developing fetus and nursing infants |
| Difference of Romiplostim to Eltrombopag is? | its structure, its a fusion protein, contains 4 short peptides that are able to agonize the receptor bound to the heavy chain of an antibody (Fc) |
| Avatrombopag similar to Eltrombopag in that it’s a small molecule, non-peptide receptor agonist. Difference is that it binds to a different site on the thrombopoietin receptor—> | its not competing with a pt’s own thrombopoietin; binding to different site on the receptor and perhaps has different PK compared to the other 2 TRA. |
| MOA of Avatrombopag is? | – thrombopoietin receptor agonist; induces proliferation and differentiation of megakaryocytes – does not compete with TPO for binding to the TPO receptor and has an additive effect with TPO on platelet production |
| Indication of Avatrombopag is? Administration is ____ | ITP after failure with corticosteroids, immunoglobulins, or splenectomy; PO |
| AE of Avatrombopag is? | – Common: pyrexia, abdominal pain, nausea, headache, fatigue, contusion, epistaxis, upper respiratory infection, arthralgia, gingival bleeding, petechiae, nasopharyngitis, and peripheral edema – Serious: Portal vein thrombosis (Chronic liver disease, 0.4% ), Thrombosis • Possible risk to developing fetu and nursing infants • Take with food |
| Another medication we can use for thrombocytopenia is Rituximab which is a ? MOA? Indication? | Chimeric IgG1 monoclonal antibody against the cluster of differentiation 20 (CD20) expressed on mature B cells and B-cell lymphomas; MOA: kills B cells possibly through complement-dependent cytotoxicity and antibody-dependent cellular cytotoxicity -Indication: For treating ITP: by targeting B-cells as described above, there is a reduction in the number of cells that product antibodies, including those that attach to platelets |
| Primary adverse effect of Rituximab is? | – Immunosuppression due to targeting of normal mature B cells – Hypersensitivity related to chimeric nature of the monoclonal antibody |
| Two other agents for the tx of thrombocytopenia are? | Intravenous immune Globulin (IVIG) and Rho (D) immune globulin (Anti-D immune globulin) |
| Intravenous immune globulin (IVIG) is a drug that can be used in immune thrombocytopenia purpura (ITP) is an autoimmune disease resulting in destruction of platelets. IVIG is derived from? | human plasma; contains a mixture of antibodies; Indication: used to treat many diseases, including ITP (We have found that if we give IVIG, which is a blood product that contains a mixture of antibodies, we are providing the pt with some antibodies that are binding to the Fc receptors on macrophages (means they immune system is blocked and can’t chew up platelets) |
| MOA of Itravenous immune globulin (IVIG) is? | – not fully understood – antibodies in the IVIG saturate Fc receptors on immune cells, preventing them from recognizing auto-antibody-coated platelets and destroying them |
| AE of Intravenous immune globulin include? | rash, chills, headaches, shortness of breath, or hypotension; premedication used to prevent this |
| Rho (D) immune globulin (anti-D immune globulin) is derived from? | human plasma where donors were exposed to the D antigen *targets RBC that are (+) for the D antigen |
| Indication of Rho (D) immune globulin (anti-D immune globulin) is? | – managing Rh-negative pregnancies – treating immune thrombocytopenic purpura (ITP) in RhoD positive patients |
| MOA of Rho (D) immune globulin (anti-D immune globulin) is? AE? | – MOA not entirely understood – Possible mechanism: After administration of anti-D immune globulin, the anti-D coated red blood cells saturate the Fc receptor sites on macrophages in the reticuloendothelial system of the spleen. This results in preferential destruction of those red blood cells. This may spare the destruction of antibody-coated platelets; AE: possible severe vascular hemolysis |
| D antigen is something that can cause _______ ______ and baby is A+ or B+, AB+, O+, that + means that babies’ RBC are expressing the D antigen. | pregnancy loss *women who carry a fetus that is (+) for the D antigen, they will be given anti-D immune globulin b/c they are trying to stop the mother’s immune system from making antibodies that will then cross over the placenta and attack the fetus’ RBC |
| We can only use Rho (D) immune globulin (anti-D immune globulin) in ITP pts that are? | already D (+); so we have a limited # of people that can use anti-D immune globulin for treating their ITP |
| Smith recap on Rho (D) immmune globulin: | we use this product in pts that are already expressing the antigens on the RBC, the antibodies in the product find those D antigens, get the immune system going after those RBC and not after the platelets |
Created by:
Xander635
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