Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

USMLE 1 > Hematology and oncology- Pharmacology > Flashcards

Hematology and oncology- Pharmacology Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

Heparin-induced thrombocytopenia (HIT)

A

IgG antibodies against heparin bound platelet factor 4 (PF4). Antibody-heparin-PF4 complex activates platelets Ž thrombosis and thrombocytopenia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Heparin

  • Adverse effects
  • Antidote
A

Bleeding, thrombocytopenia (HIT), osteoporosis, drug-drug interactions.

For rapid reversal (antidote), use protamine sulfate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Direct thrombin inhibitors

  • Names
  • Clinical use
  • Adverse effects and antidote
A

Bivalirudin, Argatroban, Dabigatran.

Venous thromboembolism, atrial fibrillation. Can be used in HIT.

Bleeding; can reverse dabigatran with idarucizumab. Consider PCC and/or antifibrinolytics (eg, tranexamic acid) if no reversal agent available.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Warfarin

- Adverse effects

A

Bleeding, teratogenic, skin/tissue necrosis, drug-drug interactions. Initial risk of hypercoagulation: protein C
has a shorter half-life than factors II and X.

Cytochrome P-450 inhibitors increase warfarin effect.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Direct factor Xa inhibitors

  • Names
  • Clinical use
  • Adverse effects
A

ApiXaban, rivaroXaban.

Treatment and prophylaxis for DVT and PE; stroke prophylaxis in patients with atrial fibrillation

Bleeding. Not easily reversible.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Thrombolytics

  • Names
  • Clinical use
  • Contraindications
  • Antidote
A

Alteplase (tPA), reteplase (rPA), streptokinase, tenecteplase (TNK-tPA).

Early MI, early ischemic stroke, direct thrombolysis of severe PE.

Bleeding. Contraindicated in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding diatheses, or severe hypertension.

Nonspecific reversal with antifibrinolytics (eg, aminocaproic acid, tranexamic acid), platelet transfusions, and factor corrections (eg, cryoprecipitate, FFP, PCC).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ADP receptor inhibitors

  • Names
  • Clinical use
  • Adverse effects
A

Clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine

Acute coronary syndrome; coronary stenting

Neutropenia (ticlopidine). TTP may be seen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cilostazol, dipyridamole

  • Mechanism
  • Clinical use
  • Adverse effects
A

Phosphodiesterase inhibitors; increase cAMP in platelets, resulting in inhibition of platelet aggregation;
vasodilators.

Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (combined with aspirin).

Nausea, headache, facial flushing, hypotension, abdominal pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Glycoprotein IIb/IIIa inhibitors

  • Names
  • Clinical use
  • Adverse effects
A

Abciximab, eptifibatide, tirofiban

Unstable angina, percutaneous coronary intervention.

Bleeding, thrombocytopenia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cancer drugs—cell cycle (imagen)

A

Pag. 426

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Antimetabolites (mechanism and adverse effects)

- Azathioprine, 6-mercaptopurine

A

Purine (thiol) analogs, act in de novo purine synthesis.
Activated by HGPRT.

Myelosuppression; GI, liver toxicity.
Azathioprine and 6-MP are metabolized by xanthine
oxidase; thus both have toxicity with allopurinol or
febuxostat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Antimetabolites (mechanism and adverse effects)

- Cladribine

A

Purine analog Ž multiple mechanisms (eg, inhibition
of DNA polymerase, DNA strand breaks).

Myelosuppression, nephrotoxicity, and neurotoxicity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Antimetabolites (mechanism and adverse effects)

- Cytarabine (arabinofuranosyl cytidine)

A

Pyrimidine analog Ž DNA chain termination. At higher
concentrations, inhibits DNA polymerase.

Myelosuppression with megaloblastic anemia.
CYTarabine causes panCYTopenia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antimetabolites (mechanism and adverse effects)

- 5-fluorouracil

A

Pyrimidine analog bioactivated to 5-FdUMP, which
covalently complexes with thymidylate synthase and
folic acid. Capecitabine is a prodrug with similar activity.

Myelosuppression, palmarplantar erythrodysesthesia
(hand-foot syndrome).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Antimetabolites (mechanism and adverse effects)

- Methotrexate

A

Folic acid analog that competitively inhibits dihydrofolate reductase.

Myelosuppression, which is reversible with leucovorin. Hepatotoxicity.
Mucositis (eg, mouth ulcers).
Pulmonary fibrosis.
Folate deficiency, which may be teratogenic (neural tube defects) without supplementation.
Nephrotoxicity (rare).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q 
Antitumor antibiotics (mechanism and adverse effects)
- Bleomycin
A

Induces free radical formation Ž breaks in DNA strands.

Pulmonary fibrosis, skin hyperpigmentation. Minimal
myelosuppression.

17
Q 
Antitumor antibiotics (mechanism and adverse effects)
- Dactinomycin (actinomycin D)
A

Intercalates into DNA, preventing RNA synthesis.

Myelosuppression

18
Q 
Antitumor antibiotics (mechanism and adverse effects)
- Doxorubicin, daunorubicin
A

Generate free radicals. Intercalate in DNA Ž breaks in
DNA Ž replication. Interferes with topoisomerase II enzyme.

Cardiotoxicity (dilated cardiomyopathy), myelosuppression, alopecia. Dexrazoxane (iron chelating agent), used to prevent cardiotoxicity.

19
Q 
Alkylating agents (mechanism and adverse effects)
- Busulfan
A

Cross-links DNA.

Severe myelosuppression (in almost all cases), pulmonary fibrosis, hyperpigmentation.

20
Q 
Alkylating agents (mechanism and adverse effects)
- Cyclophosphamide, ifosfamide
A

Cross-link DNA at guanine. Require bioactivation by liver. A nitrogen mustard

Myelosuppression; SIADH; hemorrhagic cystitis,
prevented with mesna (thiol group of mesna binds toxic
metabolites) or adequate hydration.

21
Q 
Alkylating agents (mechanism and adverse effects)
- Nitrosoureas
A

Require bioactivation. Cross blood-brain barrier Ž CNS. Cross-link DNA.

CNS toxicity (convulsions, dizziness, ataxia)

22
Q 
Alkylating agents (mechanism and adverse effects)
- Procarbazine
A

Cell cycle phase–nonspecific alkylating agent, mechanism not yet defined.

Bone marrow suppression, pulmonary toxicity, leukemia

23
Q 
Microtubule inhibitors (mechanism and adverse effects)
- Paclitaxel, other taxanes
A

Hyperstabilize polymerized microtubules in M phase so
that mitotic spindle canno break down.

Myelosuppression, neuropathy, hypersensitivity.

24
Q 
Microtubule inhibitors (mechanism and adverse effects)
- Vincristine, vinblastine
A

bind β-tubulin and inhibit its polymerization into microtubules.

Vincristine: neurotoxicity, constipation.
Vinblastine: bone marrow suppression.

25
Q

Cisplatin, carboplatin

  • Mechanism
  • Adverse effects
A

Cross-link DNA.

Nephrotoxicity, peripheral neuropathy, ototoxicity. Prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis.

26
Q

Etoposide, teniposide

  • Mechanism
  • Adverse effects
A

Inhibit topoisomerase II Ž Increase DNA degradation

Myelosuppression, alopecia.

27
Q

Irinotecan, topotecan

  • Mechanism
  • Adverse effects
A

Inhibit topoisomerase I and prevent DNA unwinding and replication.

Severe myelosuppression, diarrhea.

28
Q

Hydroxyurea

  • Mechanism
  • Adverse effects
A

Inhibits ribonucleotide reductase Ž decrease DNA Synthesis (S-phase specific).

Severe myelosuppression.

29
Q

Bevacizumab

  • Mechanism
  • Adverse effects
A

Monoclonal antibody against VEGF. Inhibits angiogenesis.

Hemorrhage, blood clots, and impaired wound healing.

30
Q

Erlotinib

  • Mechanism
  • Adverse effects
A

EGFR tyrosine kinase inhibitor.

Rash

31
Q

Cetuximab

  • Mechanism
  • Adverse effects
A

Monoclonal antibody against EGFR

Rash, elevated LFTs, diarrhea.

32
Q

Imatinib

  • Mechanism
  • Adverse effects
A

Tyrosine kinase inhibitor of BCR-ABL (Philadelphia chromosome fusion gene in CML) and c-kit (common in GI stromal tumors)

Fluid retention.

33
Q

Rituximab

  • Mechanism
  • Adverse effects
A

Monoclonal antibody against CD20, which is found on most B-cell neoplasms.

risk of progressive multifocal leukoencephalopathy.

34
Q

Bortezomib, carfilzomib

  • Mechanism
  • Adverse effects
A

Proteasome inhibitors, induce arrest at G2-M phase and apoptosis.

Peripheral neuropathy, herpes zoster reactivation.

35
Q

Tamoxifen, raloxifene

  • Mechanism
  • Adverse effects
A

Selective estrogen receptor modulators (SERMs)—receptor antagonists in breast and agonists in bone. Block the binding of estrogen to ER ⊕ cells.

Tamoxifen—partial agonist in endometrium, which increase the risk of endometrial cancer; “hot flashes.”
Raloxifene—no increase in endometrial carcinoma (so you can relax!).
Both risk of thromboembolic events (eg, DVT, PE).

36
Q

Trastuzumab (Herceptin)

  • Mechanism
  • Adverse effects
A

Monoclonal antibody against HER-2 (c-erbB2), a tyrosine kinase receptor.

Cardiotoxicity

37
Q

Vemurafenib

  • Mechanism
  • Adverse effects
A

Small molecule inhibitor of BRAF oncogene ⊕ melanoma

Metastatic melanoma.

38
Q

Rasburicase

  • Mechanism
  • Clinical use
A

Recombinant uricase that catalyzes metabolism of uric acid to allantoin.

Prevention and treatment of tumor lysis syndrome

39
Q 
Common chemotoxicities
Cisplatin/Carboplatin 
Vincristine 
Bleomycin, Busulfan 
Doxorubicin
Trastuzumab (Herceptin) 
Cisplatin/Carboplatin 
CYclophosphamide
A 
Ž ototoxicity
Ž peripheral neuropathy
Ž pulmonary fibrosis
Ž cardiotoxicity
Ž cardiotoxicity
Ž nephrotoxicity
Ž hemorrhagic cystitis

USMLE 1 (73 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions