Heme and Oncology I

Question 1

Heparin (mechanism, use, toxicity)

Answer 1

Activates antithrombin, which inactivates thrombin and Xa; used for immediate coagulation and in pregnant women; some patients develop antibodies to platelet factor 4 (Hepran induced thrombocytopenia (HIT))

Question 2

Warfarin (mechanism, use, toxicity)

Answer 2

Inactivated gamma-carboxylation of factors II, VII, IX, X, C, and S (Vitamin K); used for long-term and non-immediate anticoagulation; can cause tissue necrosis, teratogenic

Question 3

Alteplase, reteplase, tenecteplase (mechanism, use, toxicity)

Answer 3

Converts plasminogen to plasmin; used as a thrombolytic

Question 4

Aspirin (mechanism, use, toxicity)

Answer 4

Irreversibly inhibits COX-1 and COX-2; anti-platelet and anti-inflammatory; gastric ulcers, tinnitus, Reye’s syndrome in childhood viral infections

Question 5

Clopidogrel, ticlodipine, prasugrel, ticagrelor (mechanism, use, toxicity)

Answer 5

Irreversibly blocks ADP receptors on platelets, preventing degranulation; used for acure coronary syndrome; ticlodipine causes neutropenia

Question 6

Cilostazol, dipyridamole (mechanism, use, toxicity)

Answer 6

Phosphodiesterase inhibitor, increases cAMP and decreases ADP, preventing platelet degranulation; nausea, headache, facial flushing, hypotension

Question 7

Abciximab, eptifibatide, tirofiban (mechanism, use, toxicity)

Answer 7

GPIIb/IIIa inhibitors, preventing platelet aggregation; bleeding, thrombocytopenia