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Pharma drugs > Hema/Onco > Flashcards

Hema/Onco Flashcards

1
Q

Heparin

MOA

A

Antithrombin activator.
Dec. thrombin, Dec. FXa.
Short half life.

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2
Q

Heparin

Clinical use

A

Immediate anticoagulation (PE, ACS, MI, DVT).
Can be used in pregnancy.
Monitor w/ PTT.

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3
Q

Heparin

[Toxicity, antidote]

A

Bleeding, thromboctyopenia
Osteoporosis
Drug-drug interactions
Antidote: Protamine sulfate

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4
Q

Heparin-induced Thrombocytopenia

A

Develop IgG-Abs against heparin-bound platelet factor 4 (PF4).
Complex activates platelets – thrombosis, thrombocytopenia.

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5
Q

Warfarin

MOA

A

Blocks epoxide reductase – prevents gamma-carboxylation of vit k-dependent clotting factors.
(Effects extrinsic pathway)

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6
Q

Warfarin

Clinical use

A

Chronic anticoagulation – venous thromboemobolism prophylaxis, prevent stroke in A-fib.
Not for pregnancy.
Follow w/ PT/INR.

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7
Q

Warfarin

Toxicity

A

Bleeding, teratogenic, skin/tissue necrosis.

Early transient hypercoagulability – proteins C and S have short half-lives.

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8
Q

Heparin Bridging

A

Heparin used when starting warfarin.
Heparin allows anticoagulation when in initial, transient hypercoagulable state caused by warfarin.
Reduces risk of venous thromboembolism and skin/tissue necrosis.

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9
Q

Thrombolytics

Drug names

A

Alteplase (tPA)
Reteplase (rPA)
Streptokinase
Tenecteplase (TNK-tPA)

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10
Q

Thrombolytics

MOA

A

Convert Plasminogen –> Plasmin.
Plasmin cleaves thrombin –> fibrin clots.
Inc. PT/PTT

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11
Q

Thrombolytics

Clinical use

A

Early MI
Early ischemic stroke
Severe PE

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12
Q

Thrombolytics

[Toxicity, CI, antidote]

A

Bleeding.
CI in pts. w/ active bleeding, hx of intracranial bleed, recent surgery, bleeding diatheses, severe HTN.
Antidote: aminocaproic acid (fibrinolysis inhibitor).

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13
Q

ADP receptor inhibitors

Drug names

A

Clopidogrel
Prasugrel
Ticagrelor (reversible)
Ticlodipine

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14
Q

ADP receptor inhibitors

MOA

A

Irreversibly blocks ADP receptors – Prevents GpIIb/IIIa expression on platelet surface – inhibits platelet aggregation

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15
Q

ADP receptor inhibitors

Clinical use

A

Acute coronary syndrome.

Dec. incidence/recurrence of thrombotic stroke.

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16
Q

Factor Xa inhibitors (Apixaban, Rivaroxaban)

[MOA, clinical use]

A

Bind and directly inhibit FXa.
For DVT, PE (rivaroxaban).
Stroke prophylaxis in pts w/ AFib.

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17
Q

Aspirin

[MOA, Labs, clinical use, Toxicity]

A

> Irreversibly inhibits COX-1 and COX-2.
Inc. BT, dec. TXA2, dec. PGs.
No effect on PT, PTT.
Antipyretic, analgesic, anti-inflammatory, Antiplatelet.
Toxicity: ARF, gastric ulcer, tinnitus; Reye syndrome in kids w/ viral infection.

18
Q

Gp IIb/IIIa inhibitors (Abciximab, Eptifibatide, Tirofiban)

[MOA, clinical use]

A

> Binds receptor for Gp IIb/IIIa on activated platelets – prevents aggregation.
For unstable angina, PTCA (percutaneous transluminal coronary angioplasty).

19
Q

Azathioprine, 6-MP, 6-TG

[MOA, clinical use, toxicity]

A

> Purine analogs; dec. de novo purine synthesis.
Activated by HGPRT.
Prevent organ rejection, RA, IBD, SLE.
Tox: myelosuppression; Azathioprine and 6-MP metabolized by xanthine oxidase – toxicity w/ Allopurinol or febuxostat.

20
Q

Cladribine (2-CDA)

[MOA, clinical use, toxicity]

A

> Purine analog; inhibits DNAp; DNA strand breaks.
For Hairy cell leukemia.
Tox: nephrotoxicity, neurotoxicity, myelosuppression.

21
Q

Cytarabine (arabinofuranosyl cytidine)

[MOA, clinical use, toxicity]

A

Pyrimidine analog – inhibits DNAp.
For AML, lymphomas.
Tox: pancytopenia

22
Q

5-FU

[MOA, clinical use, toxicity]

A

> Active metabolite is 5F-dUMP, w/c complexes w/ Folic acid – inhibits Thymidylate synthase – dec. dTMP – dec. DNA synthesis.
For colon cancer, pancreatic cancer, basal cell CA.
Tox: not reversible w/ Leucovorin (folinic acid, vs. Methotrexate)

23
Q

Methotrexate

[MOA, clinical use, toxicity]

A

> Folic acid analog; competitively inhibits dihydrofolate reductase – dec. dTMP – dec. DNA synthesis.
For cancers, ectopic pregnancy, medical abortion, RA, psoriasis, IBD, vasculitis.
Tox: hepatotoxic, pulmo fibrosis; reversible w/ Leucovorin (vs. 5-FU)

24
Q

Bleomycin

[MOA, clinical use, toxicity]

A

> Induces free radical formation – breaks in DNA strands.
For testicular cancer, Hodgkin Lymphoma.
Tox: pulmo fibrosis, skin hyperpigmentation

25
Q

Dactinomycin

[MOA, clinical use]

A

> Intercalates in DNA –> causes breaks in DNA.
For Wilms tumor, Ewing sarcoma, rhabdomyosarcoma.
Used for kids tumors.

26
Q

Doxorubicin, Daunorubicin

[MOA, clinical use, toxicity]

A

> Generates free radicals.
Intercalates in DNA –> causes breaks in DNA –> dec. replication.
For solid tumors, leukemias, lymphomas.
Tox: cardiotoxicity (prevent w/ Dexrazoxane, an iron chelator), myelosuppression, alopecia.

27
Q

Busulfan

[MOA, clinical use, toxicity]

A

Crosslinks DNA
For CML
Tox: severe myelosuppression (almost all cases)

28
Q

Cyclophosphamide, Ifosfamide

[MOA, clinical use, toxicity]

A

> Crosslink DNA at guanine N7. Needs bioactivation by liver.
For solid tumors, leukemia, lymphoma.
Tox: hemorrhagic cystitis – partially prevented w/ mesna, w/c binds to toxic metabs.

29
Q

Nitrosureas (Carmustine, Lomustine, Semustine, Streptozocin)

[MOA, clinical use, toxicity]

A

> Needs bioactivation. Cross BBB into CNS, where it crosslinks DNA.
For brain tumors (glioblastoma multiforme)
Tox: CNS toxicity

30
Q

Paclitaxel (other taxols)

[MOA, clinical use, toxicity]

A

> Hyperstabilizes polymerized microtubules in M phase so mitotic spindle can’t break down (prevents anaphase).
For ovarian and breast CA.
Tox: alopecia

31
Q

Vincristine, Vinblastine

[MOA, clinical use, toxicity]

A

> Bind B-tubulin, inhibit its polymerization into microtubules – prevent mitotic spindle formation (M phase arrest).
For Hodgkin (vinblastine), NHL (vincristine), solid tumors, leukemias.
Tox: neurotoxicity (vincristine), bone marrow suppression (vinblastine).

32
Q

Cisplatin, Carboplatin

[MOA, clinical use, toxicity]

A

> Crosslink DNA.
For bladder, lung, ovary, testicular CA (BLOT).
Tox: nephrotoxic, ototoxic.
*Prevent nephrotoxicity w/ amifostine (free radical scavenger) and chloride (saline) diuresis.

33
Q

Etoposide

[MOA, clinical use]

A

> Inhibits topoisomerase II – inc. DNA degradation.

>For solid tumors (testicular, small cell lung cancer), leukemias, lymphomas.

34
Q

Irinotecan, topotecan

[MOA, clinical use]

A

> Inhibits topoisomerase I and prevents DNA unwinding and replication.
For colon cancer (irinotecan); ovarian and small cell lung cancers (topotecan).

35
Q

Hydroxyurea

[MOA, clinical use]

A

Inhibits ribonucleotide reductase – dec. DNA synthesis (S phase).
For melanoma, CML, sickle cell dse (inc. HbF).

36
Q

Prednisone, Prednisolone

[MOA, clinical use, toxicity]

A

> Binds intracytoplasmic receptors; alters gene transcription.
Mostly for Chemotherapy. Use in CLL, NHL. Can be an immunosuppressant (autoimmune diseases).
Tox: Cushing-like ssx, weight gain, muscle breakdown, osteoporosis, peptic ulcers, psychosis.

37
Q

Imatinib

[MOA, clinical use]

A

Tyrosine kinase inhibitor of BCR-ABL and c-kit (GI stromal tumors).
For CML, GI stromal tumors.

38
Q

Rituximab

[MOA, clinical use, toxicity]

A

> Monoclonal antibody vs. CD20 on most B cell neoplasms.
For NHL, CLL, IBD, rheumatoid arthritis.
Tox: inc. risk of progressive multifocal leukoencephalopathy.

39
Q

Tamoxifen, Raloxifene

[MOA, clinical use]

A

> SERMs: receptor antags in breast, agonists in bone – block estrogen binding to ER-positive cells.
For breast cancer treatment (tamoxifen only) and prevention; can also prevent osteoporosis (raloxifene).

40
Q

Tamoxifen vs. Raloxifene

Toxicity

A

> Tamoxifen: partial agonist in endometrium – inc. risk of endometrial cancer.
Raloxifene: estrogen receptor antag in endometrial tissue – doesn’t inc. risk of cancer.

41
Q

Trastuzumab (Herceptin)

[MOA, clinical use, toxicity]

A

> Monoclonal antibody vs. HER2 (c-erbB2). >Kills cancer cells that overexpress HER2 by inhibiting HER2-initiated cell signaling and Ab-dependent cytotoxicity.
For HER2-positive breast cancer, gastric cancer.
Tox: cardiotoxicity

42
Q

Vemurafenib

[MOA, clinical use]

A

Inhibitor of BRAF oncogene-positive melanoma.

For metastatic melanoma.

Pharma drugs (12 decks)

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