Drugs

Question 1

Xa reversal agent

Answer 1

Andexxa (recombinant Xa, very expensive)

Question 2

Dabigatran reversal agent

Answer 2

Idarucizumab

Question 3

Xa inhibitors

Answer 3

rivaroxaban, apixaban, betrixaban and edoxaban

Question 4

warfarin onset

Answer 4

48 to 72 hours

Question 5

how does heparin work

Answer 5

by activating antithrombin III, which blocks thrombin from clotting blood.

Question 6

use of LMWH

Answer 6

does not require monitoring of the APTT coagulation parameter and has fewer side effects.

Question 7

why are NOACs better than warfarn

Answer 7

relatively short half life + rapid onset

Question 8

inherited thrombophilias

Answer 8

Lupus anticoagulant 
Prothrombin gene mutation
Protein S
Factor V Leiden
Antithrombin 3 deficiency
Protein C
APS

Question 9

Lovenox class

Answer 9

LMWH

Question 10

LMWH drugs

Answer 10

dalteparin, fondaparinux, enoxaparin

Question 11

fondaparinux trade name

Answer 11

Arixtra

Question 12

direct thrombin inhibitors

Answer 12

argatroban, dabigatran

Question 13

acquired VTE conditions

Answer 13

antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria (PNH), disseminated intravascular coagulation (DIC)

Question 14

NOAC encompasses

Answer 14

Direct thrombin inhibitors + Xa inhibitors

Question 15

cryoprecipitate

Answer 15

• FFP that is centrifuged, then you collect precipitate.
• fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor (VWF), and fibronectin derived from one unit of Fresh Frozen Plasma (FFP).
• Cryoprecipitate (cryo) contains a concentrated subset of FFP components including fibrinogen, factor VIII coagulant, vonWillebrand factor, and factor XIII. Cryo IS NOT just a concentrate of FFP. In fact, a unit of cryo contains only 40-50% of the coag factors found in a unit of FFP, but those factors are more concentrated in the cryo.

Question 16

cryoprecipitate uses

Answer 16

hypofibrinogenemia, vonWillebrand disease, and in situations calling for a “fibrin glue.”

Question 17

FFP clinical use

Answer 17

MULTIPLE factor deficiencies and active BLEEDING.

Question 18

How does irradiation work for blood transfusions?

Answer 18

Irradiation is needed to destroy all living leukocytes (white blood cells), particularly lymphocytes that could cause transfusion associated graft versus host disease (TAGVD).

Question 19

leukocyte reduction

Answer 19

Red blood cell and platelet units may be filtered to remove most of the leukocytes (white blood cells). This may reduce the risk for febrile transfusion reactions, may help prevent alloimmunizaton to MHC (HLA) donor antigens, and help reduce the risk for cytomegalovirus (CMV) infection.

Question 20

washed RBCs

Answer 20

A unit of packed red blood cells (PRBCs) is washed to reduce plasma proteins. This reduces the risk for allergic transfusion reactions. Washing reduces immunoglobulins, such as anti-IgA that could cause anaphylactic transfusion reactions in persons with selective IgA deficiency.

Question 21

Use of flow cytometry

Answer 21

evaluate for clonal populations of cells

Question 22

What is a mixing study?

Answer 22

Test performed on blood plasma of patients or test subjects to distinguish factor deficiencies from factor inhibitors, such as lupus anticoagulant, or specific factor inhibitors, such as antibodies directed against factor VIII. The purpose is to determine the cause of prolongation of PT, Partial Thromboplastin Time, or sometimes of thrombin time (TT).

Question 23

how a mixing study works

Answer 23

If the problem is a simple factor deficiency, mixing the patient plasma 1:1 with plasma that contains 100% of the normal factor level results in a level ≥50% in the mixture (say the patient has an activity of 0%; the average of 100% + 0% = 50%).[3] The PT or PTT will be normal (the mixing study shows correction). Correction with mixing indicates factor deficiency; failure to correct indicates an inhibitor.

Question 24

colony stimulating factor medications + caveat

Answer 24

• GCSF
• Neupogen, Granix and Zarxio and trade names for G-CSF
• Can’t get neulasta inpatient, only granix

Question 25

jadenu

Answer 25

deferasirox (treatment for iron overload)

Question 26

function of PD-1

Answer 26

This receptor is generally responsible for preventing the immune system from attacking the body's own tissues; it is a so-called immune checkpoint.

Question 27

pembrolizumab mechanism

Answer 27

Blocks PD-1 located on lymphocytes. This receptor is generally responsible for preventing the immune system from attacking the body's own tissues; it is a so-called immune checkpoint.

Question 28

pembrolizumab trade name

Answer 28

keytruda

Question 29

anastrozole trade name

Answer 29

arimidex

Question 30

prolia generic name + use

Answer 30

- denosumab | - It can treat osteoporosis and hypercalcemia.

Question 31

source of stem cells for nonmalignant HCT and why

Answer 31

Bone marrow - Contains a lower dose of T cells and confers a lower risk of graft-versus-host disease (GVHD).

Question 32

cyclophosphamide trade name

Answer 32

cytoxin

Question 33

cyclophosphamide chemo mechanism

Answer 33

crosslinking leading to apoptosis

Question 34

adeno tumor markers

Answer 34

1) PD-L1 2) ROS-1 3) EGFR 4) ALK 5) BRAF 6) KRAS

Question 35

TXA mechanism

Answer 35

antifibrinolytic

Question 36

TXA use

Answer 36

heavy vaginal bleeding | vWF

Question 37

blast crises in CML defined as any of the following...

Answer 37

≥20 percent peripheral blood or bone marrow blasts [3] ●Large foci or clusters of blasts on the bone marrow biopsy [4] ●Presence of extramedullary blastic infiltrates (eg, myeloid sarcoma also known as granulocytic sarcoma or chloroma)

Question 38

AI's

Answer 38

There are 3: exemestine anastrozole lestrozole

Question 39

tumors that metastasize to bone

Answer 39

prostate, breasts, lungs, thyroid, and kidneys

Question 40

xgeva generic name

Answer 40

denosumab

Question 41

capecitabine mechanism

Answer 41

metabolised to 5-FU which in turn is a thymidylate synthase inhibitor

Question 42

HER2 directed drugs

Answer 42

trastuzumab, pertuzumabm lapatinib

Question 43

perjeta generic name

Answer 43

pertuzumab

Question 44

paclitaxel mechanism

Answer 44

microtubule inhibition

Question 45

medication approved for breast cancer BRCA patients

Answer 45

olaparib

Question 46

preferred endocrine therapy for postmenopausal women

Answer 46

aromatase inhibitor (AI) rather than tamoxifen.

Question 47

NOAC with lowest GI bleed risk

Answer 47

eliquis

Question 48

when NOAC's can be restarted following bleed

Answer 48

2 weeks following resolution of bleed

Question 49

sorafenib

Answer 49

protein kinase inhibitor

Question 50

TKI's approved for CML

Answer 50

imatinib, dasatinib, and nilotinib

Question 51

vitamin k dependent clotting factors

Answer 51

II, VII, IX, and X.

Question 52

Primary cisplatin contraindication

Answer 52

CKD

Question 53

DOAC contraindications

Answer 53

1) elevated INR because of liver disease 2) severe renal impairment (CrCl <30) 3) BMI >40

Question 54

risk of XRT to chest

Answer 54

CAD and LV dysfunction

Question 55

difference in coverage between zosyn and cefepime

Answer 55

lose anaerobe coverage

Question 56

pradaxa generic name

Answer 56

dabigatran

Question 57

pradaxa problem

Answer 57

``` pH sensitive (problem with PPI's), which causes decreased GI absorption. Try to avoid using it. ```

Question 58

interactions with NOACs

Answer 58

cyp450

Question 59

intracranial hemorrhage and AC

Answer 59

NOACs as a class better than warfarin, but apixaban

Question 60

GI bleed and AC

Answer 60

apixaban has less GI bleed risk, but other NOACs have the same or possibly slightly higher risk of GI bleed

Question 61

AC and fall risk

Answer 61

It's overblown, there've been studies looking in it, and there's no significantly increased risk. Intracranial bleeds are rare and intracranial bleeds related to falls are even more rare.

Question 62

definition of anemia in men and women

Answer 62

below 12 Hgb in women, 13.5 in men

Question 63

therapeutic Xa level on heparin ggt

Answer 63

UH: 0.3-0.7 IU/mL