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
1
Q
Which disease is typified by IgG complexes against platelet factor 4/heparin complexes?
A
Heparin Induced Thrombocytopenia
1
Q
4 AE of warfarin
A
Bleeding, teratogen, skin necrosis (esp. if protein C deficient pt), and drug-drug interactions
1
Q
Which cancers can be treated with 5-Fluorouracil?
A
Colon cancer and Basal Cell CA
1
Q
Which drug inhibits ribonucleotide reductase in the S phase of cell cycle?
A
Hydroxyurea
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
1
Q
Which anticancer drugs have major AE of acoustic nerve damage and nephrotoxicity?
A
Carbaplatin and Cisplatin
2
Q
Which clotting factors are affected by warfarin (6)?
A
II, VII (extrinsic), IX, and X as well as proteins C and S
2
Q
What is the MOA of hydroxyurea?
A
inhibits ribonucleotide reductase in S phase
3
Q
Major AE of trastuzumab
A
cardiotoxicity
4
Q
Which drug is used to Tx colon cancer and is available topically for basal cell carcinoma?
A
5 Fluorouracil
4
Q
Which drug is often used for childhood tumors?
A
Dactinomycin (actinomycin D), an antitumor antibiotic
5
Q
Which 2 drugs inhibit phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation?
A
Cilostazol and Dipyridamole
5
Q
Which aspect of the cell cycle do vinca alkaloids and taxols affect?
A
M phase
6
Q
What kind of drug is ticagrelor?
A
An ADP receptor antagonist
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
7
Q
Which antimetabolite can cause megaloblastic anemia?
A
Cytarabine (arabinofuranosyl cytidine)
9
Q
What is the MOA of drugs derived from leeches?
A
Direct thrombin inhibitors (come from hirudin)
10
Q
What is the MOA of thrombolytics?
A
convert plasminogen to plasmin
10
Q
What antimetabolite is a pyrimadine analog and inhibitds DNA polymerase? Phase of cycle?
A
Cytarabine (arabinofuranosyl cytidine); S phase
11
Q
Long term reversal of Warfarin OD
A
Vitamin K
11
Q
What is the antidote to thrombolytic toxicity?
A
aminocaproic acid
12
Q
What would you use to anticoagulate a patient with a history of HIT?
A
A direct thrombin inhibitor (lepirudin and bivalrudin)
12
Q
What are 2 AE of cyclophosphamide and ifosfamide?
A
Hemorrhagic cystitis and myelosuppression
13
What is the MOA of vincristine and vinblastine? Phase of cycle?
Bind tubulin in M PHASE and prevent polymerization
13
Aside from CML, imatinib can also Tx \_\_\_\_\_\_\_\_
GI stromal tumor (GIST)
14
Where is the site of action in the body of heparin and warfarin?
heparin acts in the blood but warfarin is in the liver (epoxide reductase)
14
What drug is anti-angiogenic by inhibiting VEGF in solid tumors?
Bevacizumab
15
How does protamine sulfate work?
It is a positively charged molecule that binds to the negatively charged heparin
15
Which aspect of the cell cycle does bleomycin affect?
G2
16
Name 4 ADP receptor antagonists on platelets
Prasugrel, Ticlopidine, Clopidogrel, and Ticagrelor
16
What is the MOA of mesna?
Binds the toxic thiol group of cyclophosphamide and ifosfamide to prevent hemorrhagic cystitis
17
What kind of cancer is treated with nitrosoureas?
Brain cancer including GBM
18
What is amifostine used for?
Preventing Carbaplatin/Cisplatin induced nephrotoxicity
18
What is the MOA of raloxifene and tamoxifen?
These are SERMs = antagonists to estrogen in breast and agonists in bone (thus, useful for BOTH osteoporosis and breast CA)
20
What drug is an inhibitor of B-Raf kinase with the V600E mutation?
Vemurafenib, for metastatic melanoma with this mutation
21
Which aspect of the cell cycle is affected by etoposide?
G2 and S
22
What is the MOA of methotrexate?
It is a folic acid analog that inhibits dihydrofolate reductase which decreases dTMP
23
What disease would result from an X-linked deficiency in the enzyme that activates 6 mercaptopurine and azathioprine?
Lesch-Nyhan syndrome (HGPRT)
24
What is the MOA of cytarabine?
Pyrimadine analog that inhibits DNA polymerase
25
What is the MOA of rituximab?
monoclonal antibody to CD20 used to treat B cell neoplasms
26
Major AE of vincristine
peripheral neuropathy (neurotoxicity)
28
Major AE of carbaplatin and cisplatin
acoustic nerve damage and nephrotoxicity
29
What kind of drugs are eptifibatide and tirofiban?
GpIIb/IIIa receptor antagonists (along with abciximab)
31
What are 4 AE of heparin?
Osteoporosis, HIT (thrombocytopenia), Bleeding, and drug-drug interactions
32
Rapid reversal of Warfarin OD
Fresh Frozen Plasma
33
Which DNA alkylating agents crosslink interstrand DNA at guanine N7?
cyclophosphamide and ifosfamide
34
3 results from chronic use of aspirin
Upper GI bleeding, Interstitial Nephritis, and Acute Renal failure
36
What is the MOA of 5 fluorouracil?
A pyrimidine analong activated to 5F-UMP which complexes with folic acid, that inhibits thymidilate synthase
36
AE of vincristine? Vinblastine?
Vincristine = neurotoxicity; VinBlastine= Bone marrow suppression
36
Which drug is used to treat metastatic melanoma?
Vemurafenib
37
What drug is used to treat Wilm's tumor, Ewings sarcoma, and Rhabdomyosarcoma?
Actinomycin D (Dactinomycin)
38
What are the best drugs for intermittent claudication (2)?
dipyridamole and cilostazol
40
MOA of paclitaxel and taxols
Hyperstabilize polymerized microtubules in M phase prevent depolymerization
42
How do you reverse methotrexate-induced myelosuppression?
leucovorin (folinic acid) rescue
43
Which lab value should be monitored for the patient on heparin? Warfarin?
PTT; PT (INR)
45
MOA of doxorubicin and daunorubicin
Generates free radicals and non-covalently intercalates DNA
46
What is the MOA of bleomycin
induces free radicals which break the DNA
48
2 Anticancer drugs with pulmonary fibrosis as AE
Busulfan and Bleomycin
50
Which type of heparin overdose is most amenable to treatment with protamine sulfate?
Unfractionated heparin? LMWH is more difficult to Tx
51
Name 3 GpIIb/IIIa inhibitors
Abciximab, eptifibatide, and tirofiban
52
MOA of vemurafenib
inhibitor of B-Raf kinase with V600E mutation in metastatic melanoma
53
Which 2 GpIIb/IIIa inhibitors are NOT monoclonal antibodies?
eptifibatide and tirofiban (abciximab is a monoclonal ab)
53
What is the MOA of imatinib?
Inhibits the bcr-abl fusion protein (tyrosine kinase) in philadelphia chromosome CML
54
Which SERM increases the risk for endometrial cancer? Why?
Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe
55
Explain how the MOA of GpIIb/IIIa inhibitors are similar and different from that of ADP receptor antagonists
ADP receptor antagonists ultimately block the expression of GpIIb/IIIa on the platelet, and, obviously, GpIIb/IIIa inhibitors directly block it
56
What kind of drugs are carmustine, lomustine, semustine, and streptozocin?
Nitrosoureas--DNA alkylating agents
57
Why are SERMs useful for both breast cancer and osteoporosis?
Because they are estrogen ANTAGONISTS in breast and AGONISTS in bone (estrogen builds blasts and kills clasts)
58
What is the MOA of cilostazol?
An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation
59
Aminocaproic acid is an antidote to what?
Thrombolytics toxicity i.e. alteplase, reteplase, and tenecteplase
60
Common AE to trastuzumab and doxorubicin
cardiotoxicity
62
What cancers are treated with azathioprine and 6MP?
leukemias
64
What drug helps to prevent cardiotoxicity in a patient on doxorubicin or daunorubicin?
Dexrazoxane (iron chelator)
65
In whom (6) is thrombolytic therapy contraindicated?
Active bleeding, Hx of intracranial bleeding, current intracranial neoplasm/AVM, recent surgery, severe HTN, known bleeding diatheses
66
What is the MOA of lepirudin and bivalrudin?
Direct thrombin inhibitors (come from hirudin)
68
Which drugs prevent tublin polymerization in M phase?
Vincristine and Vinblastine
69
Common AE to bleomycin and busulfan
pulmonary fibrosis
71
What drug is used in HER2 positive breast CA?
Trastuzumab (Herceptin)
73
Name 2 low molecular weight heparins
Dalteparin and Enoxaparin (parins)
75
Which arm of the clotting cascade does warfarin affect?
Extrinsic (i.e. monitor PT and INR)
76
Which drug is an inhibitor of the bcr-abl fusion protein of chronic myelogenous leukemia?
Imatinib (Gleevec)
77
What is the MOA of etoposide and teniposide?
inhibit topoisomerase II to enhance DNA degradation
77
Anticancer drug with peripheral neuropathy as major AE
Vincristine
78
What is the MOA of dactinomycin? Used to tx?
intercalates DNA; childhood tumor i.e. Wilms, Rhabdomyosarcoma, and Ewing's
79
What cancers are treated with cytarabine?
leukemias and lymphomas
80
This drug is an anti-CD20 antibody for B-cell neoplasms
rituximab
82
What 2 drugs are SERMs?
Raloxifene and Tamoxifen
83
4 AE of methotrexate
Myelosuppression, Macrovesicular Fatty Change, Mucositis, teratogenic
84
What antimetabolite covalently complexes with folic acid? Phase of cycle?
5-Fluorouracil; S phase
85
Which cranial nerve may be affected by aspirin?
CN VIII (tinnitus)
86
Name 3 thrombolytics
reteplase, alteplase, tecteplase
87
This antitumor antibiotic is limited by pulmonary fibrosis
bleomycin
88
Why can hydroxyurea be used to treat sickle cell disease?
increases the amount of fetal hemoglobin (HbF rather than HbS)
90
4 cancers that are treated with methotrexate
Leukemias, Lymphomas, Sarcomas, and Choriocarcinoma
91
Name 4 nitrosoureas
Carmustine, Lomustine, Semustine, and Streptozocin
92
What is the AE of ADP receptor antagonists? Which is most notorious?
Neutropenia, ticlopidine
93
Which antineoplastic drugs inhibit topoisomerase II?
Etoposide and Teniposide
94
What drug that treats CML is limited by pulmonary fibrosis?
busulfan
95
What is the MOA of carbaplatin and cisplatin? What drug is often given along with them to prevent nephrotoxicity?
Cross-link DNA; amifostine
97
What are 4 non-neoplastic uses of methotrexate?
Abortion, Ectopic Pregnancy, Rheumatoid arthritis, Psoriasis
98
All antimetabolites affect this phase of the cell cycle \_\_\_\_\_
S phase
99
This antitumor antibiotic is limited by cardiotoxicity
Doxorubicin (adriamycin) and Daunorubicin
100
Why do you need to dose adjust 6MP and azathioprine when on allopurinol?
These drugs are metabolized by xanthine oxidase, allopurinol inhibits that
101
Name 4 antitumor antibiotics
Dactinomycin (Actinomycin D), Doxorubicin (adriamycin), duanorubicin, and bleomycin
102
What antimetabolites are purine analogs activated by HGPRT? Phase of Cell cycle?
Azathioprine, 6 mercaptopurine, and 6 thioguanine; S phase
103
What enzyme is ultimately inhibited by 5-FU?
thymidylate synthase
104
What is the effect on platelets, PT, and PTT for A) Aspirin and B) Thrombolytics
A) Aspirin increases bleeding time only because platelets cannot aggregate B) Thrombolytics increase PT and PTT but no effect on platelets
106
What is the MOA of dipyridamole?
An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation
108
What kind of drugs are used to treat Brain Tumors including GBM?
Nitrosoureas--DNA alkylating agents; these are carmustine, lomustine, semustine, and streptozocin
109
What cancer is treated with Busulfan? Translocation? AE?
CML t(9;22), PULMONARY FIBROSIS
111
A person treated for breast cancer with a drug that increases the risk for endometrial cancer must be taking \_\_\_\_\_\_\_\_\_
Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe
112
What is the MOA of cyclophosphamide and ifosfamide?
Covalently crosslink interstrand DNA at guanine N7
113
What 3 antimetabolites can cause myelosuppression?
5-FU, methotrexate, and 6-Mercaptopurine
114
What cancers are treated by paclitaxel and taxols?
Breast CA and Ovarian
115
What antimetabolite inhibits dihydrofolate reductase? Phase of cycle?
methotrexate; S phase
116
How is the treatment of 5-FU-induced myelosuppression different from that caused by methotrexate?
Methotrexate is reversed with leucovorin; 5-FU cannot be treated with leukovorin! You rescue with thymidine
117
What drug are cilostazol and dipyridamole often combined with for the prevention of TIAs and strokes?
aspirin
118
MOA of bevacizumab
antibody to VEGF, functions as anti-angiogenic in solid tumors
119
Will you see in vitro anticoagulation with warfarin?
No it acts in the liver
120
Explain Heparin Induced Thrombocytopenia
This is when a person develops IgG antibodies against complexes of heparin and platelet factor 4
121
Which drugs prevent tubulin DEpolymerization in the M phase?
Paclitaxel and taxols
122
Name 2 direct thrombin inhibitors
lepirudin and bivalrudin
