hematology and oncology Flashcards
what does multidrug resistance gene (MDR1) code for?
p-glycoprotein (atp dependent efflux pump)
where is p glycoprotein found?
intestine, renal tubules, BBB
p glycoprotein features
upregulated in cancer cells and has broad specificity for hydrophobic compounds
mechanism of 6 mercaptopurine and azathioprine
they are purine (thiol analogs) they get combined with PRPP and made into thioinosinic acid (aka thioinsonic monophosphate) -> inhibition of multiple steps of purine sythesis -> decreased IMP/AMP/GMP
how are 6 mercaptopurine and azathioprine related?
azathioprine is a prodrug of 6 mercaptopurine
what is azathioprine mainly used for?
immunosuppression
lupus
ra, chrons, uc, kidney transplant rejection prevention
what is 6 mercaptopurine mainly used for?
cancner and immnusuprresion
all, cll, chron’s, uc
other uses of 6 mercaptopurine and azathioprine
use to wean people off steroid in chronic disease and to treat steroid refractory chronic disease
sided effects of 6 mercaptopurine and azathioprine
myelosuppression, gi, liver.
azathioprine and 6 mp metabolism
activated by HGPRT
inactivated by either xanthine oxidase or TPMT (polymorphisms)
increased toxicity with allopurional or febuxostat
folic acid metabolism
417
methotraxate mechnism
folic acid analog (anatagonist (u)) competitievly inhibits dihydrofolate reducatase
what happens to methotrexate once inside the cells?
417
methotrexate side effects
417
methotrexate side effects
417
5-fluorouracil mechanism
417
f-fluorouracil what does leucovorin do?
417
f-fluorouracil side effects
417
cladrabine mech
417
cladrabine use
417
cladrabine side effects
417
cytarabine (arabinofuranosyl cytidine) mech
417
cytarabine (arabinofuranosyl cytidine) use
417
cytarabine (arabinofuranosyl cytidine) side effects
417
antimetabolies work in what cycle?
s phase
bleomycin cell cycle
g2
bleomycin mec
418
dactinomycin (actinomycin d) mech
418
dactinomycin (actinomycin d) side effects
418
doxorubicin, daunorubicin cycle (athracyclines)
uworld said g2
dactinomycin (actinomycin d) mech
418
dactinomycin (actinomycin d) side effects
418
dactinomycin (actinomycin d) side effects
418
busulfan mech
418
busulfan use
418
busulfan side effects
418
busulfan side effects
418
cyclophosphamide, ifosfamide mech
418
cyclophosphamide, ifosfamide side effects
418
nitrosureas (carmustine) mech
418
nitrosureas (carmustine) use
418
nitrosureas (carmustine) use
418
nitrosureas (carmustine) side effect
419
microtubule inhibitors cell cycle
m phase specific
taxanes (paclitaxel, docetaxel, and other taxols) mech
419
taxanes (paclitaxel, docetaxel, and other taxols) side effects
419
vinca alkaloids (vincristine, vinblastine) mech
419
vinca alkaloids (vincristine, vinblastine) side effects
419
vinca alkaloids (vincristine, vinblastine) side effects
419
etoposide, teniposide cell cycle
s g2
cisplatin, carboplatin mech
419
cisplatin, carboplatin side effect
419
etoposide, teniposide cell cycle
s g2
etoposide, teniposide mech
419
etoposide, teniposide side effects
419
irinotecan, topotecan cell cycle
s1 g2
irinotecan, topotecan mech
419
irinotecan, topotecan use
419
irinotecan, topotecan side effect
419
hydroxyurea cell cycle
419
hydroxyurea mech
419
hydroxyurea use
419
hydroxyurea side effect
419
bevacizumab mech
420
bevacizumab side effect
420
erlotinib mech
420
erlotinib use
420
erlotinib side effect
420
cetuximab mech
420
cetuximab use
420
cetuximab side effect
420
imatinib mech
420
imatinib use
420
imatinib side effect
420
rituximab mech
420
rituximab use
420
rituximab sid effect
420
bortezomib, carfilzomib mech
420
bortezomib, carfilzomib use
420
bortezomib, carfilzomib side effect
420
tamoxifen, raloxifene mech
421
tamoxifen, raloxifene use
421
tamoxifen, raloxifene effects
421
trastuzumab (herceptin) mech
421
trastuzumab (herceptin) use
421
trastuzumab (herceptin) side effect
421
vemurafenib mech
421
vemurafenib clinical use
421
tumor lysis syndrome
421
rasburicase
421
LMWH
enoxaparin, tinzaparin, dalteparin
half life of heparin vs half life of LMWH
heparin has a short half life, LMWH have longer half life
advantage and drawback of LMWH
subcutaneous and without lab monitoring, drawback is not easily reversible
name the direct thrombin inhibitors
bivalirudin, argatroban, lepirudin, dabigatran (only noac)
direct thrombin inhibitor uses
venous thromboembolism (DVT), atrial fibrillation , pci
direct thrombin inhibitor advatage
no lab monitoring
direct thrombin inhibitor adverse effects
bleeding; can reverse dabigatran with idarucizumab.
other ways to reverse direct thrombin inhibtors
pcc and/or antifibrinolytics (tranexamic acid) if no reversal available (idarucizumab)
heparin route of administratoin
IV, SC
name of factor Xa inhibitors
apiXaban, rivaroXaban
thrombolytics mech
convert plasminogen to plasmin, cleaves fibrin and thrombin.
thrombolytics labs
increase PT and PTT, no change in platelet count
thrombolytics uses
early MI, early ischemic stroke, direct thrombolytics for PE
thrombolytics CI
pts with active bleeding, history of intracranial bleed, recent surgery, known bleeding diathesis, or sever HTN.
thrombolytics adverse effect
bleeding
thrombolytics reversal
415
adp receptor blocker names
415
adp inhibitors mech
415
adp inhibitors use
415
adp inhibitors effects
415
phosphdieasterse ihnibtors
cilostazol, dipyridamole (used for cardiac stress test (look for ekg abnormalaity))
phosphdieasterse ihnibtors mech
415
phosphdieasterse ihnibtors use
415
phosphdieasterse ihnibtors adverse
415
glycoprotein 2b/IIIa ini=hibtors names
415
glycoprotein 2b/IIIa ini=hibtors mech
415
glycoprotein 2b/IIIa ini=hibtors use
415
glycoprotein 2b/IIIa ini=hibtors side effects
415
