Summary of "Day 2 Anticancer Drug Dose Calculations Short Course | Dr. Pravallika Vutukuru"

Main Ideas and Concepts

Chemotherapy Dose Calculation:
The video focuses on calculating doses of anticancer drugs, specifically Doxorubicin (Adriamycin) and Cyclophosphamide, based on a hypothetical patient case. The importance of understanding drug concentrations and volumes needed for administration is emphasized.
Body Surface Area (BSA) Considerations:
BSA is a critical factor in chemotherapy dosing, particularly for patients who are obese or underweight. For patients with a BSA greater than 2 m², a cap of 2 m² is often applied to avoid toxicity.
Special Cases in Dosing:
Dosing adjustments for patients with amputations are discussed, with specific percentages of body surface area to be deducted based on the amputated part. The video also addresses how to handle dosing for patients with renal impairment and how to calculate creatinine clearance.
Pharmacokinetics and Dosing:
Introduction to pharmacokinetic-based dosing, particularly for Carboplatin, which is individualized based on the area under the curve (AUC) and glomerular filtration rate (GFR). The significance of understanding renal function and its impact on drug dosing is highlighted.
Fixed vs. Weight-Based Dosing:
Fixed dosing is primarily used for oral anticancer therapies with a broader therapeutic index, while weight-based dosing is used for drugs with linear pharmacokinetics. The video discusses the rationale behind using fixed doses and the implications for patient adherence to medication.
Organ Function Assessment:
The necessity of assessing organ function (renal and hepatic) before administering chemotherapy to avoid excessive toxicity. Adjustments to dosing based on organ function tests and the importance of monitoring parameters are discussed.
Genotype-Based Dosing:
The concept of genetic testing to identify patients at risk for adverse drug reactions is introduced, specifically in relation to enzyme polymorphisms affecting drug metabolism.

Methodology and Instructions

Dose Calculation Steps:
- Determine the patient's BSA and apply any necessary caps (e.g., cap at 2 m² for high BSA).
- Calculate the required volume of drug based on concentration and desired dose.
- Adjust doses for special populations (e.g., amputees, obese patients).
- For pharmacokinetic dosing (e.g., Carboplatin), use the formula:
  Total Carboplatin Dose = Target AUC × GFR + 25
Creatinine Clearance Calculation:
Use the Cockcroft-Gault formula for estimating creatinine clearance based on age, weight, and serum creatinine.
Adjusting for Organ Function:
Monitor liver and kidney functions and adjust doses accordingly based on established guidelines for specific drugs.
Genotype Testing:
Consider genetic testing for patients who show adverse reactions to drugs, particularly those with known polymorphisms affecting drug metabolism.