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Chapter 96. Chronic Leukemias and Multiple Myeloma

Student Questions

A first-line treatment for a newly diagnosed Ph positive chronic phase CML includes which of the following?

A. Nilotinib

B. Ibrutinib

C. Omacetaxine

D. Ponatinib

Answer: A

Option A: Correct. Nilotinib, dasatinib, and imatinib are BCR-ABL tyrosine kinase inhibitors used in the first-line treatment for chronic phase CML.

Option B: Incorrect. Ibrutinib is used in the treatment of chronic lymphocytic leukemia.

Option C: Incorrect. Omacetaxine is used after failure of a tyrosine kinase inhibitor. It is not used as a first-line agent.

Option D: Incorrect. Ponatinib is used after failing two or more tyrosine kinase inhibitors and in those patients with the T315I mutation.

Patient counseling points for dasatinib include:

A. Avoiding iron preparations

B. Avoiding proton pump inhibitors

C. Discussing hand-foot syndrome

D. Discussing peripheral neuropathy

Answer: B

Option A: Incorrect. There is not a drug interaction with iron preparations.

Option B: Correct. Coadministration with a proton pump inhibitor can result in decrease absorption of dasatinib.

Option C: Incorrect. Hand-foot syndrome is not a commonly reported adverse effect.

Option D: Incorrect. Peripheral neuropathy is not a commonly reported adverse effect.

MP is a 54-year-old female with newly diagnosed chronic phase CML. Current medications include ferrous sulfate for anemia, naproxen for arthritis, esomeprazole for peptic ulcer disease, hyoscyamine for irritable bowel and levofloxacin for a urinary tract infection. Which drug–drug interaction may warrant concern?

A. Ferrous sulfate and dasatinib

B. Levofloxacin and nilotinib

C. Esomeprazole and imatinib

D. Hyoscyamine and ponatinib

Answer: B

Option A: Incorrect. There is not a drug–drug interaction with ferrous sulfate and dasatinib.

Option B: Correct. The combination of levofloxacin and nilotinib may prolong the QT interval. Clinician should determine length and frequency of levofloxacin use for urinary tract infections.

Option C: Incorrect. There is not a drug–drug interaction with esomeprazole and imatinib.

Option D: Incorrect. There is not a drug–drug interaction with hyoscyamine and ponatinib.

SC is a 32-year-old male ...

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