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PHARM SHELF AND BOARDS > HEMATOLOGY ONCOLOGY > Flashcards

HEMATOLOGY ONCOLOGY Flashcards

1
Q

What is the MOA of enoxaparin and dalteparin?

A

They are low molecular weight heparins so they bind to Factor Xa PREFERENTIALLY

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1
Q

Which disease is typified by IgG complexes against platelet factor 4/heparin complexes?

A

Heparin Induced Thrombocytopenia

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1
Q

4 AE of warfarin

A

Bleeding, teratogen, skin necrosis (esp. if protein C deficient pt), and drug-drug interactions

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1
Q

Which cancers can be treated with 5-Fluorouracil?

A

Colon cancer and Basal Cell CA

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1
Q

Which drug inhibits ribonucleotide reductase in the S phase of cell cycle?

A

Hydroxyurea

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1
Q

What kind of molecule is HER-2? What drug is a mab against it?

A

Tyrosine kinase expressed on HER2 positive breast CA? Trastuzumab

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1
Q

Which anticancer drugs have major AE of acoustic nerve damage and nephrotoxicity?

A

Carbaplatin and Cisplatin

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2
Q

Which clotting factors are affected by warfarin (6)?

A

II, VII (extrinsic), IX, and X as well as proteins C and S

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2
Q

What is the MOA of hydroxyurea?

A

inhibits ribonucleotide reductase in S phase

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3
Q

Major AE of trastuzumab

A

cardiotoxicity

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4
Q

Which drug is used to Tx colon cancer and is available topically for basal cell carcinoma?

A

5 Fluorouracil

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4
Q

Which drug is often used for childhood tumors?

A

Dactinomycin (actinomycin D), an antitumor antibiotic

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5
Q

Which 2 drugs inhibit phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation?

A

Cilostazol and Dipyridamole

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5
Q

Which aspect of the cell cycle do vinca alkaloids and taxols affect?

A

M phase

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6
Q

What kind of drug is ticagrelor?

A

An ADP receptor antagonist

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7
Q

What is the acid base status of an aspirin overdose?

A

Respiratory alkalosis (stimulation of respiratory centers) with metabolic alkalosis from the acetylsalycylic ACID

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7
Q

Which antimetabolite can cause megaloblastic anemia?

A

Cytarabine (arabinofuranosyl cytidine)

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9
Q

What is the MOA of drugs derived from leeches?

A

Direct thrombin inhibitors (come from hirudin)

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10
Q

What is the MOA of thrombolytics?

A

convert plasminogen to plasmin

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10
Q

What antimetabolite is a pyrimadine analog and inhibitds DNA polymerase? Phase of cycle?

A

Cytarabine (arabinofuranosyl cytidine); S phase

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11
Q

Long term reversal of Warfarin OD

A

Vitamin K

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11
Q

What is the antidote to thrombolytic toxicity?

A

aminocaproic acid

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12
Q

What would you use to anticoagulate a patient with a history of HIT?

A

A direct thrombin inhibitor (lepirudin and bivalrudin)

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12
Q

What are 2 AE of cyclophosphamide and ifosfamide?

A

Hemorrhagic cystitis and myelosuppression

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13
Q

What is the MOA of vincristine and vinblastine? Phase of cycle?

A

Bind tubulin in M PHASE and prevent polymerization

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13
Q

Aside from CML, imatinib can also Tx ________

A

GI stromal tumor (GIST)

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14
Q

Where is the site of action in the body of heparin and warfarin?

A

heparin acts in the blood but warfarin is in the liver (epoxide reductase)

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14
Q

What drug is anti-angiogenic by inhibiting VEGF in solid tumors?

A

Bevacizumab

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15
Q

How does protamine sulfate work?

A

It is a positively charged molecule that binds to the negatively charged heparin

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15
Q

Which aspect of the cell cycle does bleomycin affect?

A

G2

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16
Q

Name 4 ADP receptor antagonists on platelets

A

Prasugrel, Ticlopidine, Clopidogrel, and Ticagrelor

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16
Q

What is the MOA of mesna?

A

Binds the toxic thiol group of cyclophosphamide and ifosfamide to prevent hemorrhagic cystitis

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17
Q

What kind of cancer is treated with nitrosoureas?

A

Brain cancer including GBM

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18
Q

What is amifostine used for?

A

Preventing Carbaplatin/Cisplatin induced nephrotoxicity

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18
Q

What is the MOA of raloxifene and tamoxifen?

A

These are SERMs = antagonists to estrogen in breast and agonists in bone (thus, useful for BOTH osteoporosis and breast CA)

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20
Q

What drug is an inhibitor of B-Raf kinase with the V600E mutation?

A

Vemurafenib, for metastatic melanoma with this mutation

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21
Q

Which aspect of the cell cycle is affected by etoposide?

A

G2 and S

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22
Q

What is the MOA of methotrexate?

A

It is a folic acid analog that inhibits dihydrofolate reductase which decreases dTMP

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23
Q

What disease would result from an X-linked deficiency in the enzyme that activates 6 mercaptopurine and azathioprine?

A

Lesch-Nyhan syndrome (HGPRT)

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24
Q

What is the MOA of cytarabine?

A

Pyrimadine analog that inhibits DNA polymerase

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25
Q

What is the MOA of rituximab?

A

monoclonal antibody to CD20 used to treat B cell neoplasms

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26
Q

Major AE of vincristine

A

peripheral neuropathy (neurotoxicity)

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28
Q

Major AE of carbaplatin and cisplatin

A

acoustic nerve damage and nephrotoxicity

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29
Q

What kind of drugs are eptifibatide and tirofiban?

A

GpIIb/IIIa receptor antagonists (along with abciximab)

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31
Q

What are 4 AE of heparin?

A

Osteoporosis, HIT (thrombocytopenia), Bleeding, and drug-drug interactions

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32
Q

Rapid reversal of Warfarin OD

A

Fresh Frozen Plasma

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33
Q

Which DNA alkylating agents crosslink interstrand DNA at guanine N7?

A

cyclophosphamide and ifosfamide

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34
Q

3 results from chronic use of aspirin

A

Upper GI bleeding, Interstitial Nephritis, and Acute Renal failure

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36
Q

What is the MOA of 5 fluorouracil?

A

A pyrimidine analong activated to 5F-UMP which complexes with folic acid, that inhibits thymidilate synthase

36
Q

AE of vincristine? Vinblastine?

A

Vincristine = neurotoxicity; VinBlastine= Bone marrow suppression

36
Q

Which drug is used to treat metastatic melanoma?

A

Vemurafenib

37
Q

What drug is used to treat Wilm’s tumor, Ewings sarcoma, and Rhabdomyosarcoma?

A

Actinomycin D (Dactinomycin)

38
Q

What are the best drugs for intermittent claudication (2)?

A

dipyridamole and cilostazol

40
Q

MOA of paclitaxel and taxols

A

Hyperstabilize polymerized microtubules in M phase prevent depolymerization

42
Q

How do you reverse methotrexate-induced myelosuppression?

A

leucovorin (folinic acid) rescue

43
Q

Which lab value should be monitored for the patient on heparin? Warfarin?

A

PTT; PT (INR)

45
Q

MOA of doxorubicin and daunorubicin

A

Generates free radicals and non-covalently intercalates DNA

46
Q

What is the MOA of bleomycin

A

induces free radicals which break the DNA

48
Q

2 Anticancer drugs with pulmonary fibrosis as AE

A

Busulfan and Bleomycin

50
Q

Which type of heparin overdose is most amenable to treatment with protamine sulfate?

A

Unfractionated heparin? LMWH is more difficult to Tx

51
Q

Name 3 GpIIb/IIIa inhibitors

A

Abciximab, eptifibatide, and tirofiban

52
Q

MOA of vemurafenib

A

inhibitor of B-Raf kinase with V600E mutation in metastatic melanoma

53
Q

Which 2 GpIIb/IIIa inhibitors are NOT monoclonal antibodies?

A

eptifibatide and tirofiban (abciximab is a monoclonal ab)

53
Q

What is the MOA of imatinib?

A

Inhibits the bcr-abl fusion protein (tyrosine kinase) in philadelphia chromosome CML

54
Q

Which SERM increases the risk for endometrial cancer? Why?

A

Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe

55
Q

Explain how the MOA of GpIIb/IIIa inhibitors are similar and different from that of ADP receptor antagonists

A

ADP receptor antagonists ultimately block the expression of GpIIb/IIIa on the platelet, and, obviously, GpIIb/IIIa inhibitors directly block it

56
Q

What kind of drugs are carmustine, lomustine, semustine, and streptozocin?

A

Nitrosoureas–DNA alkylating agents

57
Q

Why are SERMs useful for both breast cancer and osteoporosis?

A

Because they are estrogen ANTAGONISTS in breast and AGONISTS in bone (estrogen builds blasts and kills clasts)

58
Q

What is the MOA of cilostazol?

A

An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation

59
Q

Aminocaproic acid is an antidote to what?

A

Thrombolytics toxicity i.e. alteplase, reteplase, and tenecteplase

60
Q

Common AE to trastuzumab and doxorubicin

A

cardiotoxicity

62
Q

What cancers are treated with azathioprine and 6MP?

64
Q

What drug helps to prevent cardiotoxicity in a patient on doxorubicin or daunorubicin?

A

Dexrazoxane (iron chelator)

65
Q

In whom (6) is thrombolytic therapy contraindicated?

A

Active bleeding, Hx of intracranial bleeding, current intracranial neoplasm/AVM, recent surgery, severe HTN, known bleeding diatheses

66
Q

What is the MOA of lepirudin and bivalrudin?

A

Direct thrombin inhibitors (come from hirudin)

68
Q

Which drugs prevent tublin polymerization in M phase?

A

Vincristine and Vinblastine

69
Q

Common AE to bleomycin and busulfan

A

pulmonary fibrosis

71
Q

What drug is used in HER2 positive breast CA?

A

Trastuzumab (Herceptin)

73
Q

Name 2 low molecular weight heparins

A

Dalteparin and Enoxaparin (parins)

75
Q

Which arm of the clotting cascade does warfarin affect?

A

Extrinsic (i.e. monitor PT and INR)

76
Q

Which drug is an inhibitor of the bcr-abl fusion protein of chronic myelogenous leukemia?

A

Imatinib (Gleevec)

77
Q

What is the MOA of etoposide and teniposide?

A

inhibit topoisomerase II to enhance DNA degradation

77
Q

Anticancer drug with peripheral neuropathy as major AE

A

Vincristine

78
Q

What is the MOA of dactinomycin? Used to tx?

A

intercalates DNA; childhood tumor i.e. Wilms, Rhabdomyosarcoma, and Ewing’s

79
Q

What cancers are treated with cytarabine?

A

leukemias and lymphomas

80
Q

This drug is an anti-CD20 antibody for B-cell neoplasms

82
Q

What 2 drugs are SERMs?

A

Raloxifene and Tamoxifen

83
Q

4 AE of methotrexate

A

Myelosuppression, Macrovesicular Fatty Change, Mucositis, teratogenic

84
Q

What antimetabolite covalently complexes with folic acid? Phase of cycle?

A

5-Fluorouracil; S phase

85
Q

Which cranial nerve may be affected by aspirin?

A

CN VIII (tinnitus)

86
Q

Name 3 thrombolytics

A

reteplase, alteplase, tecteplase

87
Q

This antitumor antibiotic is limited by pulmonary fibrosis

88
Q

Why can hydroxyurea be used to treat sickle cell disease?

A

increases the amount of fetal hemoglobin (HbF rather than HbS)

90
Q

4 cancers that are treated with methotrexate

A

Leukemias, Lymphomas, Sarcomas, and Choriocarcinoma

91
Q

Name 4 nitrosoureas

A

Carmustine, Lomustine, Semustine, and Streptozocin

92
Q

What is the AE of ADP receptor antagonists? Which is most notorious?

A

Neutropenia, ticlopidine

93
Q

Which antineoplastic drugs inhibit topoisomerase II?

A

Etoposide and Teniposide

94
Q

What drug that treats CML is limited by pulmonary fibrosis?

95
Q

What is the MOA of carbaplatin and cisplatin? What drug is often given along with them to prevent nephrotoxicity?

A

Cross-link DNA; amifostine

97
Q

What are 4 non-neoplastic uses of methotrexate?

A

Abortion, Ectopic Pregnancy, Rheumatoid arthritis, Psoriasis

98
Q

All antimetabolites affect this phase of the cell cycle _____

99
Q

This antitumor antibiotic is limited by cardiotoxicity

A

Doxorubicin (adriamycin) and Daunorubicin

100
Q

Why do you need to dose adjust 6MP and azathioprine when on allopurinol?

A

These drugs are metabolized by xanthine oxidase, allopurinol inhibits that

101
Q

Name 4 antitumor antibiotics

A

Dactinomycin (Actinomycin D), Doxorubicin (adriamycin), duanorubicin, and bleomycin

102
Q

What antimetabolites are purine analogs activated by HGPRT? Phase of Cell cycle?

A

Azathioprine, 6 mercaptopurine, and 6 thioguanine; S phase

103
Q

What enzyme is ultimately inhibited by 5-FU?

A

thymidylate synthase

104
Q

What is the effect on platelets, PT, and PTT for A) Aspirin and B) Thrombolytics

A

A) Aspirin increases bleeding time only because platelets cannot aggregate B) Thrombolytics increase PT and PTT but no effect on platelets

106
Q

What is the MOA of dipyridamole?

A

An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation

108
Q

What kind of drugs are used to treat Brain Tumors including GBM?

A

Nitrosoureas–DNA alkylating agents; these are carmustine, lomustine, semustine, and streptozocin

109
Q

What cancer is treated with Busulfan? Translocation? AE?

A

CML t(9;22), PULMONARY FIBROSIS

111
Q

A person treated for breast cancer with a drug that increases the risk for endometrial cancer must be taking _________

A

Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe

112
Q

What is the MOA of cyclophosphamide and ifosfamide?

A

Covalently crosslink interstrand DNA at guanine N7

113
Q

What 3 antimetabolites can cause myelosuppression?

A

5-FU, methotrexate, and 6-Mercaptopurine

114
Q

What cancers are treated by paclitaxel and taxols?

A

Breast CA and Ovarian

115
Q

What antimetabolite inhibits dihydrofolate reductase? Phase of cycle?

A

methotrexate; S phase

116
Q

How is the treatment of 5-FU-induced myelosuppression different from that caused by methotrexate?

A

Methotrexate is reversed with leucovorin; 5-FU cannot be treated with leukovorin! You rescue with thymidine

117
Q

What drug are cilostazol and dipyridamole often combined with for the prevention of TIAs and strokes?

118
Q

MOA of bevacizumab

A

antibody to VEGF, functions as anti-angiogenic in solid tumors

119
Q

Will you see in vitro anticoagulation with warfarin?

A

No it acts in the liver

120
Q

Explain Heparin Induced Thrombocytopenia

A

This is when a person develops IgG antibodies against complexes of heparin and platelet factor 4

121
Q

Which drugs prevent tubulin DEpolymerization in the M phase?

A

Paclitaxel and taxols

122
Q

Name 2 direct thrombin inhibitors

A

lepirudin and bivalrudin

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