21 Therapeutic Modalities in Hematology Flashcards
Irreversibly binds COX-1 and COX-2
Aspirin
Antiplatelet drugs
Aspirin
Thienopyridines
Dipyridamole
Abeiximab, eptifibatide, tirofiban
Inhibit ADP-induced platelet aggregation
SE: bleeding
Thienopyridines
Prodrugs that require metabolic activation by the hepatic cytochrome P450 enzyme system
Clopidogrel
Prasugrel
Indication of thienopyridines
Oral, Prasugrel for patients undergoing stenting
Inhibits PDE, increases cAMP, reduce Ca ions leading to inhibition of activation
SE: vasodilation
Dipyridamole
GpIIb/IIIa inhibitor
SE thrombocytopenia, bleeding
Abeiximab, eptifibatide, tirofiban
Administration of Abeiximab, eptifibatide, tirofiban
IV bolus then infusion
Fab fragment of a humanized murine monoclonal AB directed against the activated form of GpIIb/IIIa
Binds to the activated receptor with high affinity and blocks the binding of adhesive molecules
Abciximab
Cyclic heptatide that bind GpIIb/IIIa because it incorporates the KGD motif
Eptifibatide
Anonpeptidic tyrosine derivative that acts as an RGD mimetic
Tirofiban
Anticoagulant drugs
Heparin Low molecular weight heparin Fondaparinux Lepirudin, argatroban, bivalrudin Vitamin K antagonist (warfarin)
Activates antithrombin III
IV or SC, monitored via PTT
SE: Bleeding, thrombocytopenia
Heparin
Activates antithrombin III
SC or IV, high bioavailability, monitored by anti FXa levels
SE: bleeding
Low risk of thrombocytopenia
Low molecular weight heparin (enoxaparin)
Synthetic analogue of ATIII activating sequence Binds and activates antithrombin III SC, high bioavailability SE: bleeding Does not cause HIT
Fondaparinux
Direct thrombin inhibitor
IV infusion, monitored via PTT
SE: bleeding
Lepirudin
Argatroban
Bivalirudin
Inhibits carboxylation of vitamin K dependent clotting factors
Oral, metabolized by CYP450 system, narrow therapeutic window, monitored by INR and PT
SE: Bleeding, skin necrosis, embryopathy
Warfarin
Drugs that attack diseases more precisely via specific unique pathways and cell surface markers
Targeted therapy
Targeted therapy drugs
Gemtuzumab + ozogamicin
Denileukin + diptheria toxin
Ibritumomab + 90Y
Anti CD33 + calicheamicin
For AML
Gemtuzumab + ozogamicin
Anti-IL2 + protein synthesis inhibitor
For cutaneous T-cell lymphoma
Denileukin + Diptheria toxin
Anti-CD20 + ionizing radiation
Refractory B-cell lymphoma
Ibritumomab + 90Y
Replace an abnormal but non-malignant lymphohematopoietic with one from a normal donor
Replace a malignant hematopoietic system with one from a normal donor
Hematopoietic stem cell transplant
2 types of hematopoietic stem cell transplant
Allogeneic bone marrow transplant
Autologous bone marrow transplant
From another member of the same species
Allogeneic bone marrow transplant
Type of transplant that makes use of a person’s own stem cells for treatment
Can be used for lymphoma-related diseases
Can’t be used for aplastic anemia or thalassemia
Autologous bone marrow transplant
Large needle is connected to a large machine and centrifuges the blood that comes in the machine and it just gets the stem cells
The other components of blood are returned to the patient
Apheresis
Frequent complication of allogeneic stem cell transplantation, in which lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host
Graft-versus-host disease
Provides immediate correction of deficient cellular and soluble blood components
Transfusion therapy
To treat fibrinogen deficiencies
Cryoprecipitate
To treat or prevent bleeding due to low platelet levels
To correct functional platelet problems
Concentrate of platet
To correct a deficiency in coagulation factors or to treat shock due to plasma loss from burns or massive bleeding
Fresh frozen plams
To increase the amount of RBC after trauma or surgery or to treat severe anemia
RBC
Storage period; RBC FFP Plasma concentrate Cryoprecipitate
42 days (ref) or 10y (freezer)
1y (freezer)
5 days (RT)
1y (freezer)
Never requested unless for emergencies
Fresh whole blood
Oxygen carrying capacity + volume expansion
No viable platelets, degraded coagulation factors
Immunogenic due to presence of plasma
For exchange transfusion in neonates
Whole Blood
Fibrinogen and FVII and vWF
Cryoprecipitate
Decreased fibrinogen, FII, FVII, FIX, X
No large multimers of vWF
Plasma exchange in thrombotic thrombocytopenic purpura
Cryosupernatant
This is performed before the transfusion of red cells
Donor red cells are mixed mixed with the patient serum
Cross matching
Usually due to ABO incompatibility
Hypotension, tachycardia, fever, chills, hemoglobinuria
Acute hemolytic transfusion reaction
Due to sensitization from previous reaction
Delayed hemolytic transfusion reaction
Most frequent reaction to transfusion
Chilled, rigors, increase in temperature by 1 deg
Antibodies against donor leukocytes
Febrile nonhemolytic transfusion reaction
Treatment for FNHTR
Use of leukodepleted products
Due to presence of plasma proteins
Allergic transfusion reactions
Treatment for allergic transfusion reactions
Premedicate with antihistamines
T-lymphocytes from donor attack the immunodeficient host
Graft versus host disease
Most common cause of transfusion related mortalities
Signs of acute lung injury after transfusion of plasma
Transfusion related acute lung injury
Volume expansion due to transfusion
Transfusion associated circulatory overload
