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#OTILT #IDtwitter #oncopharm
What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔
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🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨
What factors do you have to consider while treating a cancer pt with a malignant pleural effusion and concurrent infection? 🤔
1/
🚨Cancer pts are at risk for MPE➡️consequence of metastatic involvement of the primary tumor in the pleura💨
💡Lung, breast, and lymphoma are the most common causes💡
Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)
Exudative=malignant OR infection
One of the criteria is a serum protein ratio >0.5
Query of the pleural fluid with the use of the Lights criteria will help to determine the etiology (transudative or exudative)
Exudative=malignant OR infection
One of the criteria is a serum protein ratio >0.5
Since both MPE & infectious effusions🦠contain↗️↗️protein
🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯
🛑Avoid highly protein bound abx (Ex: daptomycin, ceftriaxone, ertapenem)➡️can get sequestered in the pleural fluid& have↘️systemic distribution & ↘️the ability to treat a bacteremia if present 😳🤯
Abiraterone 💊 is an oral antiandrogen approved for metastatic hormone sensitive and castrate resistant prostate cancer
Why does abieraterone have to be coadministered with prednisone? 🤔 What if a patient wishes to avoid steroid therapy? 🤯
#oncopharm #pharmpearl
Why does abieraterone have to be coadministered with prednisone? 🤔 What if a patient wishes to avoid steroid therapy? 🤯
#oncopharm #pharmpearl
Abiraterone is a CYP17 inhibitor that suppresses downstream non-gonadal androgen synthesis
As a consequence➡️ reflex↗️↗️ ACTH production leads to excess in mineralocorticoids
Early trials WITHOUT pred▶️pts developed severe hypertension, hypokalemia and edema 2/2 ↗️ aldosterone
As a consequence➡️ reflex↗️↗️ ACTH production leads to excess in mineralocorticoids
Early trials WITHOUT pred▶️pts developed severe hypertension, hypokalemia and edema 2/2 ↗️ aldosterone
To suppress the reflex activation of the HPA axis & diminish symptoms of mineralocorticoid excess▶️coadministration with prednisone is required
If a pt is reluctant to taking long term pred▶️try Epleronone ✅ Mineralocorticoid receptor antagonist- blocks🛑 aldosterone!
If a pt is reluctant to taking long term pred▶️try Epleronone ✅ Mineralocorticoid receptor antagonist- blocks🛑 aldosterone!
Ever wonder how the BCG (Bacillus Calmette–Guérin) vaccine works against bladder cancer?🤔
BCG vaccine➡️approved for the tx of bladder cancer in 1990⌛️
✅Main intravesical agent shown to⬇️risk of progression of non-muscle invasive to muscle-invasive disease (>platinum chemo!)🤯
BCG vaccine➡️approved for the tx of bladder cancer in 1990⌛️
✅Main intravesical agent shown to⬇️risk of progression of non-muscle invasive to muscle-invasive disease (>platinum chemo!)🤯
So, how does a vaccine for MYCOBACTERIUM work for bladder cancer!?🤨(dont worry, I was making the same confused face you are! Let me explain it to you!)
BCG=attenuated live strain of Mycobacterium🦠 bovis (which interestingly is related to the bacteria that causes tuberculosis)
BCG=attenuated live strain of Mycobacterium🦠 bovis (which interestingly is related to the bacteria that causes tuberculosis)
It is administered by DIRECT instillation into the bladder and the mycobacterium outer membrane binds to a substance (Fibronectin) that is ALSO found within the urothelium.
Today I verified an order for clozapine for the very first time of my entire first year of being a pharmacist😳
Here are 5 clinical pearls I learned today about the use of clozapine for schizophrenia, important for new residents & interns to learn about this therapy! #pharmpearl
Here are 5 clinical pearls I learned today about the use of clozapine for schizophrenia, important for new residents & interns to learn about this therapy! #pharmpearl
1⃣ Clozapine➡️second-generation, atypical antipsychotic➡️HIGHLY effective for treatment resistant schizophrenia
Unlike other antipsychotics➡️clozapine⬇️incidence of EPS or tardive dyskinesia➡️beneficial agent for pts who experience this debilitating ADE from other agents
Unlike other antipsychotics➡️clozapine⬇️incidence of EPS or tardive dyskinesia➡️beneficial agent for pts who experience this debilitating ADE from other agents
So why if it is so effective is it reserved after failure of 2⃣adequate trials of other antipsychotics? 🤔
Clozapines use in clinical practice is limited due to its significant adverse effects and judicious monitoring required on treatment...see below...
Clozapines use in clinical practice is limited due to its significant adverse effects and judicious monitoring required on treatment...see below...
