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Heme and Cancer Flashcards

1
Q

Warfarin MOA

A

Inhibits epoxide reductase interfering with y-carboxylation of vit-k dependent factors

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2
Q

Lab to follow for Warfarin

A

PT (extrinsic pathway)

INR

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3
Q

Lab to follow for Haparin

A

PTT

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4
Q

What anticoagulant do you not want to give HIT pts and Why?

A

Warfarin

it causes warfarin skin necrosis

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5
Q

First line treatment for lead poisoning

A

Dimercaprol and EDTA

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6
Q

used for chelation in lead poisoning in kids

A

succimer

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7
Q

SS cell treatment

A

Hydroxyrea increase fetal Hb

BM transplant

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8
Q

Treatment for acute intermittent porphyria

A

Glucose and Heme

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9
Q

How does heme treat acute intermittent porphyria

A

It inhbits the synthesis of more porphyria

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10
Q

Treatment for vWF and the mechanism by which it does so

A

Desmopressin (DDAVP)- induces weibel palabel bodies in the endothelium cells to secrete more vWF

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11
Q

What is given in a warfarin overdose

A

FFP

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12
Q

What is used to treat coagulation factor deficiences involving fibrinogen and VIII

A

Cryoprecipitate

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13
Q

Hairy cell leukemia treatment and MOA

A

Cladribine (2-CDA) and adenosine deaminase inhibitor and adenosine accumulation is toxic to B-cells

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14
Q

Imatinib MOA and use

A

blocks excessive tyrosine kinase

CML–chronic myelogenous leukemia

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15
Q

Heparin MOA

A

Co-factor for the activation of antithrombin

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16
Q

Heparin ultimately reduces

A

Factor 10a and thrombin

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17
Q

Which anticoagulant is safe for preg?

A

Heparin

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18
Q

Heparin is used for

A

Immediate PE
Acute coronary syndrome
MI
DVT

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19
Q

Heparin toxicities

A

Bleeding
thrombocytopenia(HIT)
osteoporosis
Drug interactions

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20
Q

Drug and its MOA used for Heparin antidote

A

Protamine sulfate

+ charged so bind negatively charged heparin

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21
Q

List the low molecular weight haparins

A

Enoxaparin

dalteparin

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22
Q

What is different about the low mol weight heparins

A

act more on factor 10a
better bioavailability
greater t1/2

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23
Q

What is the alternative in pts with HIT

They are derivatives of

A

Lepirudin
bivalirudin
hirudin–leeches anticoagulant

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24
Q

What factors are affected by Warfarin

A

2,7,9,10, S, and C

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25
Warfarin uses
chronic anticoagulation after STEMI | Afib stroke prevention
26
Warfarin toxcity
Bleeding TERATOGEN Skin/tissue necrosis(esp with C and S deficiency) Drug interaction
27
For mere reversal of warfarin overdose give | For severe reversal of warfarin overdose give
Vit k | FFP
28
What do the thrombolytics do
Aid conversion of plasminogen to plasmin to thrombin and fibrin clots
29
List the thrombolytics
Alteplase(tPA) reteplase(rPA) tenecteplase(TNK-tPA)
30
The Thrombolytics are used for
Early MI Early ischemic stroke Severe PE thrombolysis
31
Thrombolystics toxicity and antidote
Bleeding | aminocaproic acid
32
Aminocaproic acid inhibits
fibrinolysis
33
Thrombolytics are contraindicated in
H/O intracranial bleed recent surg knwn diatheses severe HTN
34
ASA MOA
IRREVERSIBLY inhibtis COX-1 and COX-2 by covalent acetylation so TXA2 and prostaglandins are decreased
35
ASA increases
bleeding time only
36
ASA toxicity
Gastric ulceration tinnitus Chronic use==upper GI bleeding,nephritis, interstitial nephritis Reye's syndrome
37
ASA overdose causes
Repiratory alkalosis | metabolic acidosis
38
clopidogrel ticlopidine ticagrelor
IRREVERSIBLY block ADP receptors inhibiting IIb/IIIa binding to fibrinogen and thus plt aggregation
39
ADP receptor inhibitors | and use
Clopidogrel, ticlopidine, ticagrelor Acute coraonary syndrome coronary stenting reduce recurrence of thrombotic stroke
40
ADP receptor inhibitor tocixity
ticlopidine cause Neutropenia
41
Cilostazol and dipyridamole uses
Intermittent claudication coronary vasodilatio prevention of stroke of TIA Angina prophylaxis
42
Cilostazol and dupyridamole MOA
Phosphodiesterase III inhibitors that increase cAMP in PLT inhibiting aggragation. Also VD
43
Abciximab, eptifibatide, tirofiban MOA
Bind GPIIb/IIa receptor on PLT and prevent aggregation
44
GIIb/IIIa recepto inhibitors clinical use
Acute coronary syndromes | percutaneous translumunal coronary angioplasty
45
GIIb/IIIa receptor inhibitors toxicity
bleeding | thrombocytopenia
46
cilostazol and dipyridamole toxicity
``` Nausea HA flushing hypoTN Abd pain ```
47
List the antimetabolites and their general MOA
Methotrexate 5-flourouracil cytarabine azathioprine
48
Methotrexate MOA
A folic acid analog that inhibits dihydrofolate reductase= decrease DNA and protein syn
49
MTx clinical use
``` CA: Leukemia, lymphoma, choriocarcinoma, sarcoma abortion ectopic preg RA psoriaris ```
50
MTX toxicity
Myelosuppression macrovesicular fatty change in liver Mucositis teratogen
51
5-FU MOA
Pyrmidine analog that is converted to 5f-dUMP inhibiting thymidylate synthesis----decrease DNA and protein synthesis
52
5-FU use
Colon cancer | basal cell carcinoma
53
5-fluorouracil toxicity
myelosuppression | photsensitivity
54
Myeosuppression associated with MTX and 5-FU overdose can be rescued by
Leucovorin
55
Cytarabine MOA
Pyrimidine analog the inhibits DNA polymerase
56
cytarabine (arabinofuranosyl cytidine) toxicity
Leukopenia thombocytopenia megaloblastic anemia
57
cytarabine clinical use
leukemia and lymphomas
58
Azathioprine MOA
purine analog that is activated by HGPRT to decrease de novo purine synthesis
59
Azathioprine toxicity
BM, GI and liver stuff
60
List the antitumor antibodies
Bleomycin Dactinomycin Doxorubicin
61
Dactinomycin MOA and uses
Intercalates in DNA Wilms's tumor Ewing's sarcoma rhabdomyosarcoma
62
Dactinomycin toxicity
Myelosuppression
63
Doxorubicin MOA
Generates free redicals---breaks in DNA
64
Doxorubicin toxicity
Dilated cardiomyopathy myelosuppression alopecia
65
This drug will prevent doxorubicin cardiomyopathy
dexrazoxane
66
Bleomycin MOA
Induces free radical formation causing breaks in DNA
67
Bleomycin clinical use
Testicular cancer | Hodgkin's lymphoma
68
bleomycin toxicity
Pulmonary fibrosis | skin changes
69
List the alkylating agents and their general MOA
``` Cyclophospahmide ifosfamide nitrosoureas busulfan Alkylate and damage DNA ```
70
Cyclophophamide and ifosfamde MOA
Covalently X-Link DNA at guanine N-7
71
cyclophosphamide and ifosfamide toxicity
``` myelosuppression hemorrhagic cystitis( mesna prevents) ```
72
List the nitrosoureas
Carmustine lomustine semustine streptozocin
73
the ntirosourease uses
alkylating agent for Brain tumors like glioblastoma multiform
74
Whats special about the nitrosoureas and list toxicity
Can cross the BBB | CNS toxicity like diziness and ataxia
75
Busulfan MAO and use
Alkylates DNA CML Ablation of bone marrow b/f transplant
76
Busulfan toxicity
Pulmonary fibrosis | hyperpigmentation
77
Microtubule inhibitors
Vincristine vinblasitn Paclitaxel
78
Vincristine and vinbalstine MOA
Alkaloids that bind to tubulin in M phase blocking polymerization of microtubles
79
Vincristine and vinblastine use
Solid tumor, leukemias and lymphomas
80
vincritine toxicity
neurotoxicity: areflexia peripheral neuritis paralytic ileus
81
Vinblastine toxicity
Blast the bone marrow
82
Paclitaxel MOA
hyperstabilizes polymerized microtubules in M phase so that mitotic spindle cannot break down
83
Paclitaxel clinical use
Ovarian and breast carcinomas
84
Paclitaxel toxicity
Myelosuppression | hypersensitivity
85
Cisplatin and carboplastin MOA
cross link DNA
86
cisplastin and carboplastin use
``` carcinomas: Testicular bladder ovary lung ```
87
cisplastin and carboplastin toxicity
Nephrotoxicity (give amifostine) acoustic nerve damage chloride diuresis
88
Etoposide and teniposide MOA
inhibits topoisomerase II and thus increases DNA degradation
89
Etoposide and teniposide use and toxicity
solid tumor, leukemia, lymphocytes myelosuppression GI irritation alopecia
90
Hydroxyurea MOA
Inhibits ribonucleotide reductase decreasing synthesis
91
hydroxyurea use
Melanoma CML sickle cell
92
How does hydroxyurea work for SS
it increases fetal Hb
93
Hyrdoxyurea toxicity
BM supression | GI upset
94
Prednisone/predinosolone MOA for CA cells
May trigger apotosis
95
Tamoxifen and raloxifene MOA
Blocks the binding of estrogen to estrogen receptors. Agonist in bones Antagonist in breast
96
Tamoxifen and reloxifene use
Breast CA prevention and treatment | Osteoporosis prevention
97
Tamoxifen toxicity
Agonist in endometrium--cancer | hot flashes
98
Trastuzumab MOa
Monoclonal Ab against HER-2 for HER-2 expressing BCA
99
Trastuzumab toxicity
cardiotoxicity
100
Imatinib (Gleevec) MOA
9, 22 abl-bcr tyrosine kinase inhibitor
101
Imatinib use and toxicity
CML and GI stromal tumors | Fluid retention
102
Rituximab MOA
Monoclonal AB against CD20
103
rituximab MOA
Nonhodgkin's lyphoma | in combo with methotrexate for RA
104
Vemurafenib MOA
inhibit the forms of B-Raf kinase with the V600E mutation
105
Vemurafenib use
Metastatic melanoma
106
Bevacizumab MOA
monoclonal AB against VEGF to inhibit angiogenesis
107
Bevacizumab clinicla use
solid tumors

Pharmacology (13 decks)

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