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hema Flashcards

0
Q

enoxaparin,

A

Low-molecular-weight heparin
act on factor Xa
better bioavailability and 2-4times longer half life
administered subcutaneously without monitering, not easily reversed

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1
Q

Heparin

A

cofactor for the activation of antithrombin, decrease thrombin, and decrease factor Xa.short half-life.
use for immediate anticoagulation for pulmonary embolism, acute coronary syndrome, MI, DVT. Used during pregnancy(does not cross placenta) follow PTT!!!!!!!!!!
TOX :HIT, reverse by protamine sulfate

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2
Q

dalteparin

A

Low-molecular-weight heparin
act on factor Xa
better bioavailability and 2-4times longer half life
administered subcutaneously without monitering, not easily reversed

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3
Q

heparin-induced thrombocytopenia

A

development of IgG antibodies against heparin bound to PLT factor 4 (PF4). Antibody-heparin-PF4 complex activates PLT–>thrombosis and thrombocytopenia

nonimmune: 1-2days, thrombocytopenia moderate to mild
immune: HITT, 4-14 days, thrombocytopenia

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4
Q

Lepirudin

A

derivatives of hirudin, anticoagulant used by leeches
inhibit thrombin
used as an alternative to heparin for anticoagulating pt with HIT

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5
Q

bivalirudin

A

derivatives of hirudin, anticoagulant used by leeches
inhibit thrombin
used as an alternative to heparin for anticoagulating pt with HIT

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6
Q

Warfarin

coumadin

A

involves synthesis and gamma-carboxylation of vit K-dependent factor II, VII, IX, X and protein C and S. FOLLOW PT/ INR
cytochrome P450. long half life.
use in chronic anticoagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation)
NOT used in pregnancy!!!! tox: bleeding, teratogenic, skin/tissue necrosis,drug interaction. reversal use Vit K

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7
Q

streptokinase

A

causes thrombolysis through formation of plasmin by forming activator complex with plasminogen to cleave arginine-valine bond

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8
Q

argastroban

A

PT, PTT decrease

no antidote/ careful in patient with liver disease.

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9
Q

alteplase

tPA

A

thrombolytics: aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots.
increase PT and PTT, no change in PC
Use in early MI, early ischemic stroke, direst htombolysis of severe pulmonary embolism
TOX: bleeding, CI in pt with active bleeding and his of surgery, HTN
treat with aminocaproic acid

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10
Q

aminocaproic acid

A

inhibitor of fibrinolysis
antidote for thrombolytics
can also use tranexamic acid or fresh frozen plasma

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11
Q

aspirin

ASA

A

irreversibly inhibits COX-1 and COX-2 by acetylation,serine
PLT cannot synthesis new enzyme, effect lasts until new PLT produced
increase bleeding time & decrease TXA2 and PG. no effect on PT and PTT.
use: antipyretic, analgesic, antii-nflammatory, anti-PLT
TOX: GI, tinnitus, renal failure, reye’s, resp alka, meta acid

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12
Q

clopidogrel

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in prophylaxis acute coronary syndrome; prevention of AS following recent myocardial infarction.

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13
Q

ticlopidine

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in coronary stenting, decrease incidence or recurrence of thrombotic stroke.
TOX: Neutropenia, agranulocytosis, TTP, aplastic anemia

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14
Q

prasugrel

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in acute coronary syndrome; coronary stenting, decrease incidence or recurrence of thrombotic stroke.

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15
Q

ticagrelor

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in acute coronary syndrome; coronary stenting, decrease incidence or recurrence of thrombotic stroke

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16
Q

cilostazol

A

phosphodiesterase III inhibitor; increase cAMP in PLT, thus inhibiting PLT aggreagtion; vasodilator.
Use:intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (with aspirin), angina prophylaxis
TOX: nausea, headache, facial flushing, hypotension, abdominal pain

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17
Q

dipyridamole

A

phosphodiesterase III inhibitor; increase cAMP in PLT, thus inhibiting PLT aggreagtion; vasodilator.
Use:intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (with aspirin), angina prophylaxis
TOX: nausea, headache, facial flushing, hypotension, abdominal pain

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18
Q

abciximab

A

monoclonal antibody Fab fragment.
bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty, use with heparin sometimes
TOX: bleeding, thrombocytopenia

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19
Q

eptifibatide

A

bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty
TOX: bleeding, thrombocytopenia

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20
Q

tirofiban

A

bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty
TOX: bleeding, thrombocytopenia

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21
Q

methotrexate

A

folic acid analog that inhibits dihydrofolate reductase–> decrease dTMP–>decrease DNA and protein synthesis.
use: leukemias, lymphoma, choriocarcinoma, sarcoma
non-neoplastic: abortion, ectopic pregnancy, RA, psoriasis.
TOX: myelosuppression, which is reversible with leucovorin
macrovesicular fatty change to liver, mucositis, teratogenic

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22
Q

5-FU

A

pyrimidine analog bioactivated to 5-F-dUmp, which covalently complexes folic acid.
inhibits thymidylate synthase–>decrease dTMP->decrease DNA and protein synthesis
Use in colon cancer, basal cell carcinoma,
tox: photosensitivity, myesupression, not reversible by leucovorin, rescue with thymidine

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23
Q

cytarabine

arabinofuranosyl

A

pyrimidine analog–> inhibition of DNA polymerase
use in leukemias, lymphomas
tox: leukopenia, thrombocytopenia, megaloblastic anemia

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24
Q

6-MP

mercaptopurine

A

purine (thiol) analogs–>decrease de novo purine synthesis. activated by HGPRT
leukemia
TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol

25
Q

azathioprine

A

purine (thiol) analogs–>decrease de novo purine synthesis. activated by HGPRT
leukemia
TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol

26
Q

6-TG

thioguanine

A

purine (thiol) analogs–>decrease de novo purine synthesis. activated by HGPRT
leukemia
TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol

27
Q

cladribine

A

purine analog,
use in hairy cell leukemia,
resistant to adenosine deaminase

28
Q

dactinomycin

A

intercalates in DNA
use in Wilm’s tumor, Ewing’s sarcoma, rhabdomyosarcoma, childhood tumors
tox; myelosuppression

29
Q

doxorubicin

adriamycin

A

generate free radicals
noncovalently intercalate in DNA–>breaks in DNA–>decrease replication
use in: soild tumors, leukemias, lymphomas
TOX: cardiotoxicity (dilated cardiomyopathy)”use dexrazoxane”, myelosuppression, alopecia. tissue following extravasation

30
Q

dauorubicin

A

generate free radicals
noncovalently intercalate in DNA–>breaks in DNA–>decrease replication
use in: soild tumors, leukemias, lymphomas
TOX: cardiotoxicity (dilated cardiomyopathy)”use dexrazoxane”, myelosuppression, alopecia. tissue following extravasation

31
Q

dexrazozane

A

iron chelation agents

prevent cardiotoxicity in doxorubicin and daunorubin

32
Q

Bleomycin

A

induces free radical formation, which causes breaks in DNA strands
use in testicular cancer, Hodgkin’s lymphoma
TOX: pulmonary fibrosis, skin changes, minimal myelosuppression.

33
Q

cyclophosphamide

A

covalently X-linked(interstrand) DNA at guanine N-7. require bioactivation by liver
use in solitumor, leukemia, lymphomas and some brain cancers
tox: myelosuppression;
hemorrhagic cystitis, partially prevented with mesna

34
Q

mesna

A

thiol group of mesna binds toxic metabolite in cyclophosphamide

35
Q

ifosfamide

A

covalently X-linked(interstrand) DNA at guanine N-7. require bioactivation by liver
use in solitumor, leukemia, lymphomas and some brain cancers
tox: myelosuppression;
hemorrhagic cystitis, partially prevented with mesna

36
Q

carmustine

A

nitrosoureas: requires bioactivation. cross BBB–>CNS
brain tumors (glioblastoma multiforme)
TOX: CNS toxicity (dizziness, ataxia)

37
Q

lomustine

A

nitrosoureas: requires bioactivation. cross BBB–>CNS
brain tumors (glioblastoma multiforme)
TOX: CNS toxicity (dizziness, ataxia)

38
Q

semustine

A

nitrosoureas: requires bioactivation. cross BBB–>CNS
brain tumors (glioblastoma multiforme)
TOX: CNS toxicity (dizziness, ataxia)

39
Q

streptozocin

A

nitrosoureas: requires bioactivation. cross BBB–>CNS
brain tumors (glioblastoma multiforme)
TOX: CNS toxicity (dizziness, ataxia)

40
Q

busulfan

A

alkaylates DNA
CML, also use to ablate pt bone marrow before transplant
pulmonary fibrosis
hyperpigmentation

41
Q

vincristine

A

alkaloids bind to tubulin in M phase and block polymerization of microtubule so that mitotic spindle cannot form
use in solid tumor, leukemia, lymphoma
neurotoxicity: areflexia, peripheral neuritis
paralytic ileus

42
Q

vinblastine

A

alkaloids bind to tubulin in M phase and block polymerization of microtubule so that mitotic spindle cannot form
use in solid tumor, leukemia, lymphoma
neurotoxicity: blast bone marrow, suppression

43
Q

paclitaxel

A

hyperstablize polymerized microtubules in M phase so that mitotic spindle cannot break down
use in ovarian and breast tumor
myelosuppressing and hypersensitivity

44
Q

cisplatin

A

cross-link DNA
testicular, bladder, ovary and lung carcinoma
nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine(free radical scavenger) and chloride diursis

45
Q

carboplatin

A

cross-link DNA
testicular, bladder, ovary and lung carcinoma
nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine(free radical scavenger) and chloride diursis

46
Q

amifostine

A

free radical scavenger
prevent nephrotoxicity in platins
“stine” in “platin”

47
Q

etoposide

A

inhibits topoisomerase II–>increase DNA degradation
use in solid tumors, leukemia, lymphomas
tox: myelosuppression, GI irritation, alopecia

48
Q

teniposide

A

inhibits topoisomerase II–>increase DNA degradation
use in solid tumors, leukemia, lymphomas
tox: myelosuppression, GI irritation, alopecia

49
Q

hydroxyurea

A

inhibits ribonucleotide reductase–> decrease DNA synthesis
use in melanoma, CML, sickle cell disease (increase HbF)
tox: bone marrow suppression
U－ribonucleo

50
Q

prednisone

A

trigger apoptosis, may even work on nondividing cell
use in glucocorticoid in cancer chemo, CLL, non-H lymphoma,
TOX: cushing like, immunosuppresive, cataracts, acne, osteoporosis, HTN, PU, hyperglycemia, psychosis

51
Q

prednisolone

A

trigger apoptosis, may even work on nondividing cell
use in glucocorticoid in cancer chemo, CLL, non-H lymphoma,
TOX: cushing like, immunosuppresive, cataracts, acne, osteoporosis, HTN, PU, hyperglycemia, psychosis

52
Q

tamoxifen

A

SERMs-receptor anta in breast and agonist in bone. block the binding of E to E receptor(+) cells “xifen－喜欢”
used in breast cancer treatment and prevention. also useful to prevent osteoporosis
TOX: partial agonist in endometrium, which increase the risk of endometrial cancer, hot flashes

53
Q

raloxifene

A

SERMs-receptor anta in breast and agonist in bone. block the binding of E to E receptor(+) cells “xifen－喜欢”
used in breast cancer treatment and prevention. also useful to prevent osteoporosis
TOX: no increase risk for endometrial CA, anta in endometrium,

54
Q

trastuzumab

herceptin

A

monoclonal antibody against HER-2(c-erbB2) a tyrosine kinase
helps kill breast cancer cells that overexpress Her-2, through antibody-dependent cytotoxicity
use in HER-2+breast cancer
tox: cardiotoxicity
吃完做什么？breast

55
Q

imatinib

gleevec

A

Philadelphia chromo bcr-abl tyrosine kinase inhibitor
use in CML, GI stromal tumors
tox: fluid retention
尼玛听你？费城是革命的地方，大雨奔腾

56
Q

rituximab

A

monoclonal antibody against CD20, which is found on most B-cell neoplasms
Non-H lymphoma, RA
tu->2, xi->C, think about CD20

57
Q

vemurafenib

A

small molecule inhibitor of forms of the B-raf kinase with the V600F mutation
use in metastatic melanoma
mura-mela

58
Q

bevaxizumab

A

monoclonal antibody against VEGF, inhibits angiogenesis
use in solid tumors
逼我吸祖，吸血鬼祖先要血

59
Q

hydroxyures

A

used in sickle anemia

increase fetal Hb (Hb F)

Pharm (13 decks)

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