BIIC Pharmacology Lecture 9_Myeloid Proliferative Disorders Flashcards
How does Polycythemia vera (PV) present?
Palent usually presents with erythrocytosis in combinalon with leukocytosis, thrombocytosis or splenomegaly.
What is the:
MOA:
Indication:
ADR:
Considerations:
For Heparin and Enoxaparin
MOA: Activates the protease Anti-thrombin III, which inactivates thrombin and Factor X
Indication: Anticoagulant therapy, thromboembolic disorders
ADR: heparin induced thrombocytopenia (auto immune activation and distruction of platelets)
Considerations: Heparin effectively catalyzes the inactivation of both Thrombin and Factor Xa while Enoxaparin only inactivates Factor Xa.
NOTE: Heparin $$$
What drug reverses heparin?
Protamine sulfate
What is the:
MOA:
Indication:
ADR:
Considerations:
For the Factor Xa Inhibitors (Rivaroxaban, Apixaban)
MOA: Inhibitor of Factor Xa
Indication: treatment or prophylaxis deep venous thrombosis
ADR: hemorrhage
Considerations: Andexanet alfa approved as reversal agent in 2018
What is the:
MOA:
Indication:
ADR:
Considerations:
Of the anti coagulant Warfarin?
MOA: Inhibits liver Vitamin K Reductase. This reduces vitamin k which is needed to synthesis factors II, VIII, IX, and X
Indication: immune thrombocytopenic purpura, different types of lymphomas and leukemias, graft-verses-host disease
ADR: Hemorage
Considerations: Monitor PT and INR, avoid foods in Vitamin K
What is the:
MOA:
Indication:
ADR:
Considerations:
Of the Xanthine Oxidase Inhibitor Allopurinol
MOA: Inhibits xanthine oxidase, the enzyme that converts hypoxanthine to xanthine and xanthine to uric acid
Indication :Increased uric acid levels
ADR: agranulocytosis, aplastic anemia
Considerations: Concomitant use with of allopurinol with didanosine should be avoided.
What is the:
MOA:
Indication:
ADR:
Of the Tyrosine Kinase Inhibitor Ruxolitinib
MOA: seleclvely inhibits JAK1 and JAK2
Indication: Polycythemia Vera, Myelofibrosis
ADR: Increases the risk of Herpes zoster, hepatitis infections
What is the:
MOA:
Indication:
ADR:
Of Pegylated interferon-alpha
MOA:Enhance host immune system to increase activated T lymphocytes, natural killer cells, and macrophages
Indication: Polycythemia Vera, Essetial Thrombocytosis
ADR: Nothing significant
What is the:
MOA:
Indication:
ADR:
Considerations:
Of Hydroxyurea
MOA:Inhibits ribonucleotide reductase and inhibits DNA synthesis
Indication: Sickle cell anemia, Essential Thrombocythemia, Polycythemia Vera
ADR: May cause severe myelosuppression.
Considerations: Reduces platelet count
What causes Primary Myelofibrosis (PMF) and how does it present clinically?
It is caused by a mutation in JAK2 that makes JAK2 more active. It presents with night sweats, fatigue and weight loss in men 60 and older. It is a diagnosis of exclusion
What is the main treatment for PMF?
Glucocorticoids and/or low-dose thalidomide
What is the:
MOA:
Indication:
ADR:
Considerations:
Of the Glucocorticoids Prednisone and Methylprednisolone
MOA: Anti-inflammatory corticosteroids with potent Glucocorticoid and weak mineralcorticoid activity.
Indication: primary myelofibrosis (in this case)
ADR: Lots of them, and they are terrible. (osteopenia,
osteoporosis, adrenal insufficiency avascular necrosis, weight gain)
Considerations: Can cause tendon rupture, particularly when taken with fluoroquinolones.
What is the:
MOA:
Indication:
ADR:
Of the immunomodulator thalidomide
MOA: Thalidomide exhibits immunomodulatory and antiangiogenic characteristics
Indication: Primary Myelofibrosis
ADR: Can cause sever birth defects
What is the:
MOA:
Indication:
ADR:
Considerations:
Of Anagrelide
MOA:phosphodiesterase-3 enzyme (PDE-3) inhibitor that inhibits platelet aggregation and causes a dose-related reduction in platelet production
Indication: thrombocytosis secondary to myeloproliferative disorders
ADR: Prolonged QT interval,
hemorrhage
Considerations: report cardiovascular symptoms to doctor
