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Hematology Flashcards

1
Q

<p>Heparin</p>

A

<p>1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe)

2) Anti-thrombin: antithrombin cofactor --> decr thrombin* + decr factor Xa
3) toxicity: bleeding, HIT, osteoporosis, Rx interactions; protamine sulfate antidote (pos charge molec that binds neg charge heparin)
4) short 1/2 life</p>

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2
Q

<p>Enoxaparin</p>

A

<p>1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe)

2) LMWH antithrombin: act more on factor Xa
3) toxicity but less risk than heparin: bleeding, HIT, osteoporosis, Rx interactions; no antidote
4) compared to heparin: better bioavail, 2~4x longer 1/2 life; sub-Q; no need to monitor</p>

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3
Q

<p>Dalteparin</p>

A

<p>1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe)

2) LMWH antithrombin: act more on factor Xa
3) toxicity but less risk than heparin: bleeding, HIT, osteoporosis, Rx interactions; no antidote
4) compared to heparin: better bioavail, 2~4x longer 1/2 life; sub-Q; no need to monitor</p>

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3
Q

Mineral/Vitamin: Folic Acid

A

1) Use: PND, traumatic cardiac hemolytic anemia, folate defiency (alcoholism)
2) Class/MOA:
3) Side effects/ADEs:
4) Fun Facts

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4
Q

<p>Lepirudin</p>

A

<p>1) immediate anticoag for pts w/ HIT

2) antithrombin
3) N/A
4) deriv of hirudin (leeches)</p>

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5
Q

<p>Bivalirudin</p>

A

<p>1) immediate anticoag for pts w/ HIT

2) antithrombin
3) N/A
4) deriv of hirudin (leeches)</p>

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5
Q

Desferrioxamine (Deferoozamine or Desferal)

A

1) Use: Thalasemias, or other disease with regular blood transfusions - helps avoid iron overload (causes cirrhosis, CHF, DM)
2) Class/MOA: IRON CHELATOR (NOT ORAL!)
3) Side effects/ADEs:
4) Fun Facts

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6
Q

<p>Warfarin (Coumadin)</p>

A

<p>1) chronic anticoag: post STEMI, VTE prophylaxis, prevent stroke in afib (teratogenic)

2) antiplt: interfere w/ nl syn + carboyxlation of vit-K clotting factors (1972: X, IX, VII, II) + proteins C, S
3) bleeding, teratogenic, skin/tissue necrosis*, Rx interactions; give vit K for OD, give FFP for severe OD
4) cyt P450 met; incr PT (extrinsic path); long 1/2 life; follow PT/INR; PO</p>

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7
Q

<p>Alteplase (tPA)</p>

A

<p>1) early MI, early ischemic stroke, direct thrombolysis of severe PE

2) thrombolytic: aid plasminogen --> plasmin to cleave thrombin + fibrin clots
3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis)
4) incr PT, PTT; no change in plt ct</p>

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7
Q

Epoeitin

A

1) Use: anemia
2) Class/MOA: GROWTH FACTOR EPO = increases RBC
3) Side effects/ADEs:
4) Fun Facts

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8
Q

<p>Reteplase (rPA)</p>

A

<p>1) early MI, early ischemic stroke, direct thrombolysis of severe PE

2) thrombolytic: aid plasminogen --> plasmin to cleave thrombin + fibrin clots
3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis)
4) incr PT, PTT; no change in plt ct</p>

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9
Q

<p>Tenecteplase (TNK-tPA)</p>

A

<p>1) early MI, early ischemic stroke, direct thrombolysis of severe PE

2) thrombolytic: aid plasminogen --> plasmin to cleave thrombin + fibrin clots
3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis)
4) incr PT, PTT; no change in plt ct</p>

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9
Q

IL-11 (Oprelvekin, Neumega) Rx: thrombocytopenia

A

1) Use: GROWTH FACTOR thrombocytopenia
2) Class/MOA: stimulates the growth of primative MEGAKARYOCYTE progenitors - increase megakaryocytes, increase peripheral platelets
3) Side effects/ADEs: fatigue, headache, CVE
4) Fun Facts:

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10
Q

<p>Aspirin (ASA)</p>

A

<p>1) antipyretic, analgesic, anti-infl, anti-plt (decr aggregation)

2) irreversibly inhibits COX-1 (and -2) via covalent acetylation --> decr TxA2 + prostaglandins
3) gastric ulcer, tinnitus (CN VIII); chronic use: acute renal failure, interstitial nephritis, upper GI bleed; Reye's syn in kids w/ viral infct; OD: respir alkalosis + met acidosis
4) plts can't syn new COX so effect lasts until new plts made; incr bleeding time; no effect on PT, PTT</p>

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10
Q

Growth Factor: Romiplostim (Nplade) - Thrombopoeitin analog - Rx for chronic ITP

A

1) Use: GROWTH FACTOR thrombocytopenia
2) Class/MOA: same as IL-12: stimulates growth of primative megakarycytic progenitors, increasing megakaryocytes, increasing platelets
3) Side effects/ADEs: fatigue, headache, CVE
4) Fun Facts

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11
Q

<p>Clopidogrel</p>

A

<p>1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke

2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa
3) N/A
4) N/A</p>

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12
Q

<p>Ticlopidine</p>

A

<p>1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke

2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa
3) neutropenia (unique)
4) N/A</p>

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12
Q

Ticlopidine, Clopidogrel (Plavix)

A

1) Use: PLATELET INHIBITOR
2) Class/MOA: Inhibit platelet aggregation by irreversibly blocking ADP RECEPTORS | inhibit fibrinogen binding by preventing glycoprotein Iib/I

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13
Q

<p>Prasugrel</p>

A

<p>1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke

2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa
3) N/A
4) N/A</p>

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14
Q

<p>Ticagrelor</p>

A

<p>1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke

2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa
3) N/A
4) N/A</p>

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14
Q

Dipyridamole

A

1) Use: PLATELET INHIBITOR
2) Class/MOA: increase cAMP = decrease ADENOSINE uptake/cyclic nucleotide PDE = decreased aggregation
3) Side effects/ADEs: serious bleeding risk
4) Fun Facts

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15
Q

<p>Cilostazol</p>

A

<p>1) intermittent claudication, coronary vasodilation, prevent stroke/TIAs (w/ ASA), angina prophylaxis

2) PDE III inhibitor --> incr cAMP in plts --> inhibit plt aggregation; vasodilator
3) nausea, HA, facial flush, hypotension, ab pain
4) N/A</p>

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15
Q

Heparin

A

1) Use: immediate ANTICOAG for PE, stroke, ACS, MI, DVT | used during pregnancy | follow PTT
2) Class/MOA: INHIBITS THROMBIN ACTION | cofactor for activation of ANTI-THROMBIN, decrease thrombin and Xa, short 1/2 life
3) Side effects/ADEs: Bleeding, thrombocytopenai (HIT),

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16
Q

<p>Dipyridamole</p>

A

<p>1) intermittent claudication, coronary vasodilation, prevent stroke/TIAs (w/ ASA), angina prophylaxis

2) PDE III inhibitor --> incr cAMP in plts --> inhibit plt aggregation; vasodilator
3) nausea, HA, facial flush, hypotension, ab pain
4) N/A</p>

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17

Abciximab

1) ACS, PTCA 2) Gp IIb/IIIa inhibitor: bind R on activated plts --> prevent aggregation 3) bleeding, thrombocytopenia 4) made from monoclonal ab Fab fragments (unique)

17
Lepirudin, Bilirudin
1) Use: 2) Class/MOA: Hirudin derivatives; directly INHIBITS THROMBIN 3) Side effects/ADEs: 4) Fun Facts: used as an alternative to heparin for anticoagulating patients with HIT
18

Eptifibatide

1) ACS, PTCA 2) Gp IIb/IIIa inhibitor: bind R on activated plts --> prevent aggregation 3) bleeding, thrombocytopenia 4) N/A

19

Tirofiban

1) ACS, PTCA 2) Gp IIb/IIIa inhibitor: bind R on activated plts --> prevent aggregation 3) bleeding, thrombocytopenia 4) N/A

19
Warfarin
1) Use: Chronic anticoagulation | not used in pregnat women | follow PT/INR values 2) Class/MOA: interfears with normal synthesis of K depedent clotting factors through blocking | INHIBIT THROMBIN GENERATION 3) Side effects/ADEs: bleeding, teratogenic,
20
Mineral/Vitamin: Ferrous Sulfate
1) Use: Iron defiecnt anemia 2) Class/MOA: 3) Side effects/ADEs: Constipation 4) Fun Facts
21
Mineral/Vitamin: Iron dextran = Iron sucrose
1) Use: FE Deficency Anemia 2) Class/MOA: 3) Side effects/ADEs: anaphalazis 4) Fun Facts
21
Protamine Sulfate
1) Use: REVERSES HEPRIN 2) Class/MOA: 3) Side effects/ADEs: 4) Fun Facts
23
Mineral/Vitamin: Vitamin B12
1) Use: Pernicious Anemia 2) Class/MOA: 3) Side effects/ADEs: 4) Fun Facts
23
Vitamin K
1) Use: REVERSES Warfarin 2) Class/MOA: 3) Side effects/ADEs: 4) Fun Facts
25
Deferasirox (EXJADE)
1) Use: Thalasemias, or other disease with regular blood transfusions - helps avoid iron overload (causes cirrhosis, CHF, DM) 2) Class/MOA: Iron Cheltors ORAL 3) Side effects/ADEs: 4) Fun Facts
25
Aminocaproid Acid (AMICAR)
TREATMENT OF BLEEDING all anti fibrinolytic - a drug to stop a clot from breaking down
27
Filgrastim (G-CSF; Neupogen); Sargramostim (GM-CSF; Leukine); Peg-Filgrastim (Neulasta)
1) Use: GROWTH FACTOR any chemo that causes neutropenia; meylosuppressive therapy 2) Class/MOA: stimulates proliferation, matruation and efficacy of NEUTROPHILS via JAK/STAT tyrosine kinase pathway 3) Side effects/ADEs: 4) Fun Facts: same as G-CSF
27
Busulfan
1) Use: CML - ablate bone marrow before BM transplant 2) Class/MOA: ANTINEOPLASTIC AGENT | ALYKATING AGENT | lkylates DNA 3) Side effects/ADEs: Pulmonary fibrosis, hyperpigmentation 4) Fun Facts
29
Nitrosoureas (BCNU - Carmustine) & (CCNU - Lomustine)
1) Use: Brain tumors (including glioblastoma multifome) 2) Class/MOA: ANTINEOPLASTIC AGENT | ALKYLATING AGENT | Require bioactivation | cross BBB = CNS 3) Side effects/ADEs: CNS tocicity (dizziness, ataxia) 4) Fun Facts
30
Asprinin
1) Use: PLATELET INHIBITOR 2) Class/MOA: Actylates and irreversibly inhibits COX-1 and COX-2 to prevent conversion of arachadonic acid to thromboxane A2 3) Side effects/ADEs: increase BT, no effect on PT, PTT | Gastric ulcertation, bleeding, hyperventilation, Reye's Syndr
31
Methotrexate - Leucivorin (Folinic Acid)
1) Use: Cancers (leukemias, lymphomas, choriocarcinoma, sarcoma) non-neoplastics (abortion, ectopic pregancy, RA, psoriasis) 2) Class/MOA: ANTINEOPLASTIC AGENT | ANTIMETABOLITE | FOLIC ACID ANALOG that inhibits dihydroredutase = decrease in dTMP = decrea
32
Abciximab (Rheopro), Eptidibatide (Integrilin) and Tirofibiban (Aggrastat)
1) Use: PLATELET INHIBITOR 2) Class/MOA: Monoclonal antibody that binds to the GLYCOPROTEIN RECEPTOR Ib/IIIa on activated platelets, preventing aggregation 3) Side effects/ADEs: bleeding, thrombocytop
33
5-Flurouracil
1) Use: Colon cancer and other solid tumors, basal cell carcinoma (topical), synergy with MTX 2) Class/MOA: ANTINEOPLASTIC AGENT | ANTIMETABOLITE | PYRIMIDINE ANALOG | bioactivated to 5F-dUMP, which covalently complexes folic acid | this complex inhibits
35
Enoxaparin (LMWH, Lovenox)
1) Use: Anticoagulation 2) Class/MOA: Cofactor for activation of ANTITHROMBIN and Xa (work better on Xa), better bioavailibilty and 2-4 times longer 1/2 life - can be administered subQ and without lab monitoring 3) Side effects/ADEs: can't reverse esily
35
Cytarabine (Ara-C)
1) Use: AML, ALL, high grade non-Hodgkin's lymphoma 2) Class/MOA: ANTINEOPLASTIC AGENT | ANTIMETABOLITE | PYRIMIDINE ANTAGONIST inhibition of DNA polymerase 3) Side effects/ADEs: Leukopenia, thrombocytopenia, megaloblastic anemia 4) Fun Facts
37
Argatroban
1) Use: HIT, patient with kidney dysfunction 2) Class/MOA: directly INHIBITS THROMBIN 3) Side effects/ADEs: falsely elevates INR levels 4) Fun Facts: irreversible
38
Bleomycin
1) Use: Testicular cancer, HD 2) Class/MOA: ANTINEOPLASTIC AGENT | NATURAL AGENT | Induces free radical formation; which causes BREAKS IN DNA strands 3) Side effects/ADEs: Pulomonary firbosis, skin changes, minimal myelosupression 4) Fun Facts
39
Alteplase (tPA)
1) Use: CVA, acute MI, PE 2) Class/MOA: converts plasminogen to plasmin and helps cleave fibrin mesh TPA 3) Side effects/ADEs: bleeding 4) Fun Facts
40
Etoposide
1) Use: Small Cell Cardinoma of the lung and prostate, testicular Carcinoma 2) Class/MOA: ANTINEOPLASTIC AGENT: NATURAL PRODUCT: Inhibits TOPOisomerase II = increase in DNA degradation 3) Side effects/ADEs: myelosupression, GI irritation, alopecia 4) F
41
DDAVP (Desmopressin)
1) Use: vWF disease 2) Class/MOA: RELEASES vWF stored in endothelium 3) Side effects/ADEs: 4) Fun Facts
42
Hydroxurea
1) Use: Melanoma, CML, sickle cell 2) Class/MOA: ANTINEOPLASTIC AGENT Inhibits RIBONUCULOTIDE REDUCTASE = decrease in DNA synthesis 3) Side effects/ADEs: BM supression, GI upset 4) Fun Facts
43
Novo VII
1) Use: potent means to stop bleeding! 2) Class/MOA: BASICALLY FACTOR VII | binds activated platelets and catalysex X-> Xa, which turns activated factor II -> Iia (thrombin) 3) Side effects/ADEs: thrombosis 4) Fun Facts
45
Cyclophoasphamide, Ifosphasmide
1) Use: NHL, breast/ovarian carcinomas | immunosupressant 2) Class/MOA: ANTINEOPLASTIC AGENT | ALKYLATING AGENT | Covalently links X-link (intrastrand) DNA at guanine N-7 | requires bioactivation by the liver 3) Side effects/ADEs: Myelosupression, hemor
45
Anastrolzole
1) Use: postmenopausal women with breast cancer 2) Class/MOA: ANTINEOPLASTIC AGENT: HORMONES : AROMATASE INHIBITOR 3) Side effects/ADEs: 4) Fun Facts
47
Bendamustine
1) Use: Refractory CLL, low NHL 2) Class/MOA: ANTINEOPLASTIC AGENT | Alkylating agent - Nitrogen Mustard 3) Side effects/ADEs: NO allopecia, liver irritation, fatigue, rash 4) Fun Facts
47
Fulvestrant
1) Use: advanced breast cancer 2) Class/MOA: ANTINEOPLASTIC AGENT | HORMONES | binds E receptor, accelerates destruction 3) Side effects/ADEs: E withdrawl, muscle wasting and gynecomastia 4) Fun Facts
49
Cisplatin (& mesna), Carboplatin
1) Use: Testicular, bladder, ovary and lung carcinomas 2) Class/MOA: ANTINEOPLASTIC AGENT | ALKYLATING AGENT | Cross-link DNA 3) Side effects/ADEs: Nephrotoxicity and acoustic nerve damage 4) Fun Facts
50
Rituximab (Rituxan)
1) Use: NHL, RA (with MTX) 2) Class/MOA: ANTINEOPLASTIC AGENT: MONOCLONAL ANTIBODY TO CD-20, which is found on most B-cell neoplasms 3) Side effects/ADEs: 4) Fun Facts
51
6-mercaptopurine and 6-thioguanine
1) Use: Leukemias, lymphomas (not CLL or HD) 2) Class/MOA: ANTINEOPLASTIC AGENT | ANTIMETABOLITE | PURINE ANALOG | Purine analog = decreased de novo purine syntehsis | activated by HGPRTas 3) Side effects/ADEs: BM, GI, Liver | metabolized by xanthene ox
52
Gemtuzumab Ogozamiin (Mylotarg)
Anti-CD33
53
5-azacitidine
1) Use: MDS 2) Class/MOA: ANTINEOPLASTIC AGENT | ANTIMETABOLITE | PYRIMIDINE ANALOG, also restore function of tumor supressor gene 3) Side effects/ADEs: 4) Fun Facts
55
Dactinomycin (Antinomycin D)
1) Use: Wilms tumor, Ewig's sarcoma, rahbdo, childhood tumors (kids ACT out!) 2) Class/MOA: ANTINEOPLASTIC AGENT | NATURAL PRODUCT | Intercalates in DNA 3) Side effects/ADEs: Myelosupression 4) Fun Facts
55
Bevacizumab (Avastin)
1) Use: Mets lung, colon, breast, renal cell, glioblastoma 2) Class/MOA: ANTINEOPLASTIC AGENT radioimmunotherapy, binds VEGF & prevents interaction with its R - decreased endothelial cell prolifeation and decreased new blood vessel formation 3) Side e
56
Doxorubicin (Adriamycin), Daunorubicin
1) Use: HD, myelomas, sarcomas and solid tumors 2) Class/MOA: ANTINEOPLASTIC AGENT | NATURAL PRODUCT | Generates free radicles | noncovalently intercalates in DNA = BREAKS IN DNA = decreased replicatoin 3) Side effects/ADEs: cardiotoxicity; myelosupress
58
Vincristine, Vinblastine
1) Use: HD, Wilms, Choriocarcinoma 2) Class/MOA: ANTINEOPLASTIC AGENT | NATURAL PRODUCT | Alkaloids that BIND TO TUBULIN in M-phase and block polyermization of MICROTUBULES so that mitotic spindle can't form 3) Side effects/ADEs: neurotoxicity | Blast's
60
Paclitaxel
1) Use: Ovarian and breast carcinomas 2) Class/MOA: ANTINEOPLASTIC AGENT | NATURAL PRODUCT hyperstablizes polymerized microtubules in M phase so that MITOTIC SPINDLE spindle can't break down (anaphase can't occur) 3) Side effects/ADEs: myelosuppresion
62
Thalidomide and Lenolidamide
1) Use: MM 2) Class/MOA: ANTINEOPLASTIC AGENT | SUPRESS ANGIONEOGENESIS, immunomodulate, pro-apoptottic? 3) Side effects/ADEs: Birth defects 4) Fun Facts
63
Tamoxifin, Raloxifene
1) Use: Breast cancer & osteoporosis 2) Class/MOA: SERM - receptor antagonists in the breast, and antagonist in bone | block the binding of estogren to estrogen receptor positive cells 3) Side effects/ADEs: T: increase risk of endometrial carcinoma via
65
Flutamide
1) Use: prostate carcinoma 2) Class/MOA: ANTINEOPLASTIC AGENT: HORMONES a nonsteroidal competitive inhibitor of androgens at the testosterone inhibitor 3) Side effects/ADEs: 4) Fun Facts
67
Leuprolide
1) Use: Infertility, prostate cancer, uterine fibrosis 2) Class/MOA: ANTINEOPLASTIC AGENT: HORMONE: GnRH analog with agonist properties when used in pulsatile fasion; antagonist properties wihen used in continous fashion 3) Side effects/ADEs: antiandrog
68
Ketoconazole
1) Use: PCOS to prevent hirtuism, 2) Class/MOA: ANTINEOPLASTIC AGENT: HORMONE inhibits STEROID syntehsis (inhibits desmolase) 3) Side effects/ADEs: Gynecomastia and amenorrhea 4) Fun Facts
70
Ibritumomab Tiuxetan (Zevalin)
1) Use: HD 2) Class/MOA: ANTINEOPLASTIC AGENT | MONOCLONAL ANTIBODY 3) Side effects/ADEs: infusion reactions 4) Fun Facts
72
Trastuxumab (Herceptin)
1) Use: Metastatic breast cancer 2) Class/MOA: monoclonal Ab against HER-2 (erb-B2) helps kill breast cancer cells that overexpress HER-2, possibly through antibody dependent cytotoxicity 3) Side effects/ADEs: Cardiotoxicity 4) Fun Facts
73
Cetuzimab (Erbitux)
1) Use: Metestatic Breast Cancer 2) Class/MOA: ANTINEOPLASTIC AGENT MONOCLONAL ANTIBODY TO HER-2 (erb-B2) | helps kill breast cancer cells that overexpress HER-2 possibly through antibody-dependent cytotoxicity 3) Side effects/ADEs: cardiotoxicity 4) F
75
Erlotinib (Tarceva)
1) Use: 2) Class/MOA: ANTINEOPLASTIC AGENT small molecule, inhibits EGFR - TK1 inhibitor, preents posphorylation, prevents phosphorylation of tyrosine kinase 3) Side effects/ADEs: Skin rash, fatigue, Diarrhea $$$ 4) Fun Facts
76
Bortexomib (Velcade)
1) Use: MM 2) Class/MOA: ANTINEOPLASTIC AGENT Small molecule, PROTEASE inhibitor - decrased NFKB activation (cells explode because they ant breakdown proteins they contain 3) Side effects/ADEs: Neruropathy, htormbocytopenia, fever, diarrhea, $$$$ 4) Fun
77
Imatinib (Gleevec)
1) Use: CML, GI stromal tumors 2) Class/MOA: ANTINEOPLASTIC AGENT PHILDELPHIA CHRphilidelphia chromosome bcr-abl tyrosine kinase inhibitor 3) Side effects/ADEs: fluid retention 4) Fun Facts

Drugs (11 decks)

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