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PT: Hematology & Pulmonary > Drug Induced Blood Disorders > Flashcards

Drug Induced Blood Disorders Flashcards

1
Q

Aplastic anemia mechanisms

A
  • direct dose dependent toxicity
  • idiosyncratic
  • immune mediated
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2
Q

What is the most common type of aplastic anemia?

A

Immune mediated (overproduction of cytokines)

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3
Q

What drugs can cause aplastic anemia?

A

Carbamazepine

Phenytoin

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4
Q

What are examples of direct dose dependent toxicity aplastic anemai?

A

Chemotherapy/radiation

Pgp

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5
Q

Symptoms of neutropenia

A

Infection

Fever

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6
Q

Symptoms of thrombocytopenia

A

Bruising

Bleeding

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7
Q

Main three symptoms of aplastic anemia

A
  • anemia
  • neutropenia
  • thrombocytopenia
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8
Q

Aplastic anemia affect what type of cells?

A

Pluripotent stem cells (RBC, WBC, platelets)

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9
Q

Who is at risk for aplastic anemia?

A

Young

Old

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10
Q

What is the mortality rate of aplastic anemia?

A

50%

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11
Q

T/F the higher the dose, the worse aplastic anemia is

A

True

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12
Q

How do you diagnose aplastic anemia?

A

Bone marrow biopsy

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13
Q

Aplastic anemia treatment

A
  • remove drug
  • supportive care (antibiotic/antifungal)
  • bone marrow transplant
  • immunosuppressive therapy
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14
Q

What is the treatment of choice for 20 years and younger for aplastic anemia?

A

Bone marrow transplant

Possibly 45 and younger

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15
Q

What are the immunosuppresive therapy that can be done in aplastic anemia?

A
  • antithymocyte globulin
  • cyclosporine
  • corticosteroids
  • G-CSF
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16
Q

Carbamazepine causes what blood induced disorder?

A

Aplastic anemia

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17
Q

Phenytoin causes what blood induced disorder?

A

Aplastic anemia

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18
Q

Agranulocytosis affects what cells?

A

WBC

Granulocytes (eosinophils, NTs, basophils)

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19
Q

When do you see drug induced agranulocytosis?

A

1-2 weeks after exposure

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20
Q

Risk factors of agranulocytosis

A

Female

Increasing age

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21
Q

Mechanisms of agranulocytosis

A

Direct toxic effect

Immune mediated

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22
Q

Symptoms of agranulocytosis

A

Fever, infection, chills

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23
Q

Drugs that can cause agranulocytosis

A
  • methimazole

- clozapine

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24
Q

Methimazole can cause what drug induced disorder?

A

Agranulocytosis

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25
Clozapine can cause what drug induced disorder?
Agranulocytosis
26
T/f clozapine is dose dependent
False! | Independent
27
When are you more likely to see clozapine induced agranulocytosis?
First 3 months
28
Hemolytic anemia affect what cells?
RBCs
29
Mechanisms of hemolytic anemia
- immune mediated | - metabolic (G6PD deficiency)
30
How do you diagnose hemolytic anemia?
Coombs test or DAT (direct antiglobulin test)
31
What drugs can cause hemolytic anemia?
- penicillin - cephalosporin - rifampin - methyldopa
32
Penicillin can cause what drug induced blood disorder?
Hemolytic anemia
33
Cephalosporin can cause what drug induced blood disorder?
Hemolytic anemia
34
Rifampin can cause what drug induced blood disorder?
Hemolytic anemia
35
Methyldopa can cause what drug induced blood disorder?
Hemolytic anemia (autoantibodies)
36
T/F Hispanics are more likely to have G6PD
false! | African americans
37
Treatment of hemolytic anemia
Remove drug Supportive care Severe: GC
38
What cells are affected in thrombocytopenia?
Platelets
39
Platelet count for thromobocytopenia
<100,000 or >50% reduction
40
Non drug causes of thrombocytopenia
Alcoholism Post viral infection Lupus
41
Symptoms of thrombocytopenia
Bruising Bleeding Thrombosis (HIT)
42
Drugs that can cause throbomocytopenia
- heparin | - glycoprotein IIb/IIIa inhibitors
43
Heparin can cause what drug induced blood disorder?
Thrombocytopenia
44
Glycoprotein IIb/IIIa inhibitors can cause what drug induced blood disorder?
Thrombocytopenia
45
HIT
Heparin induced throbmocytopenia
46
Which type of HIT would you see in the first few days?
Type I
47
Which type of HIT is reversible?
Type I
48
Which HIT has higher platelet count?
Type I
49
Which HIT typically has no clinical consequence?
Type I
50
Which HIT has a direct effect on platelet activation?
Type I
51
Which HIT would you see 5-10 days after?
Type II
52
Which HIT is a white clot syndrome?
Type II
53
Which HIT has a lower platelet count?
Type II
54
Which HIT is at risk in unfractionated heparin, surgical patients and females?
Type II
55
Which type of HIT can cause thrombosis?
Type II
56
Thrombosis
Release of procoagulants and endothelial cell activation
57
What is the clinical diagnosis for type II HIT?
Thrombosis
58
Treatment of type II HIT
- Stop all forms of heparin - need another anticoagulant - NO WARFARIN - NOT PLATELETS
59
T/f you can give someone with type II HIT warfarin
False! | Needs to be stably anticoagulated and platelet count >150,000
60
T/f do not give someone with type II HIT platelets
True
61
Prevention of HIT
Shortest course of heparin Low MW heparin Early warfarin initiation
62
Treatment of thrombocytopenia
Removal of drug
63
What are 2 direct thrombin inhibitors you can use in type II HIT?
Bivalrudin | Agatroban
64
T/f epifibatide and tirofiban drug induced thrombocytopenia is immediate
True
65
T/f abciximab induced thrombocytopenia is immediate reaction
Immediate AND delayed
66
T/f all 3 types of glycoprotein inhibitors are typically given with heparin
True!

PT: Hematology & Pulmonary (8 decks)

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