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Heme/Onc Flashcards

1
Q

What is the mechanism of antiplatelet drugs?

A

decreases platelet aggregation and inhibits thrombus formation. They are effective in arterial circulation where anticoags have little effects

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2
Q

What is the mechanism of action of the anticoagulant drugs?

A

suppressing the synthesis or function of various clotting factors

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3
Q

What is the MOA of fibrinolytics?

A

lytic= lysis=breakdown

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4
Q

What is the heparin antagonist/reversal agent?

A

Protamine sulfate

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5
Q

What is Kcentra?

A

Vitamin K antagonist. Prothrombin complex concentrate (Human). Warfarin antagonist

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6
Q

What coagulation factors does Kcentra act on?

A

It supplies factors II, VII, IX, X, and protein C and S, promoting coagulation.

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7
Q

What is the reversal agent for apixaban and rivaroxaban?

A

Andexxa is a coagulation factor Xa inhibitor

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8
Q

What is antibody mediated cell mediated cytotoxicity?

A

Antibodies bind to antigens on the surface of target cells and NK cell CD16 Fc receptors recognize cell-bound antibodies which leads to crosslinking and eventually apoptosis

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9
Q

Which blood product IS NOT commonly used?

A

whole blood products

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10
Q

What are the two colony-stimulating factors?

A

Epogen and Filagrastim (Neupogen)

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11
Q

What is the goal of the chemotherapy drugs?

A

to inhibit mitosis and cell division

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12
Q

What is the MOA of aspirin?

A

IRREVERSIBLY blocks the formation of thromboxane A2 in platelets during the affected platelets (8-9 days)

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13
Q

What is the main indication for the use of clopidogrel?

A

dual antiplatelet therapy in combination with aspirin in post stroke conditions.

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14
Q

What is an important safety tip when using clopidogrel?

A

Do not drink too much while taking this because it can cause an upset stomach

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15
Q

How does heparin work in the coagulation cascade?

A

binds to antithrombin III

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16
Q

What is the most potent form of heparin?

A

unfractionated heparin, but it is the least consistent

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17
Q

What is the MOA of LMWH?

A

activates prothrombin and is more consistent

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18
Q

What is Type I HIT?

A

presents within first 2 days after exposure to heparin and platelets will normalize within 4 days after discontinuing heparin. NON IMMUNE

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19
Q

What is Type II HIT?

A

IMMUNE mediated disorder that typically occurs 4-10 days after exposure and has a life and limb threatening thrombotic complications. HIT w/ thrombosis is more worrisome than Type I

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20
Q

What are some of the advantages to LMWH?

A

More predictable, so it does not require monitoring. It has a longer half life, can be administered subQ and has lower incidence of HIT.

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21
Q

What patient population would we more likely use heparin in than LMWH?

A

Patients with renal failure

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22
Q

How long does it take for Warfarin to become therapeutic?

A

5-7 days and need to recheck INR daily

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23
Q

What is the major contraindication for streptokinase?

A

Cannot administer 2 doses within 6 months of each other due to febrile reactions to the strep bacteria within

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24
Q

What are some contraindications to using thrombolytics?

A

Arteriovenous malformations, intracranial bleeding, active bleeding, recent streptokinase use

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25
Q

What are the key facts of alteplase in terms of its use and administration?

A

very short half life (like 5 mins) and must be administered with heparin immediately after in cases of DVT/PE

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26
Q

What are the contraindications of alteplase?

A

People over 80

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27
Q

What is the risk of bleeding among the classes? (rank 1 most to 3 least)

A
  1. thrombolytics
  2. anticoagulants
  3. antiplatelets agents
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28
Q

What is the indicated INR to transfuse FFP?

A

greater than 1.5

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29
Q

What are the three ways to reverse warfarin? (rank 1 most emergent and 3 least)

A
  1. Kcentra
  2. FFP
  3. Viatmin K
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30
Q

What are the side effects of FFP?

A

nausea and itchiness

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31
Q

What are the storage and administration requirements for FFP?

A

When frozen, it can last about a year, but must be used within 4 hours and cannot be refrozen.

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32
Q

Which blood component is vitually absent in FFP?

A

platelets

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33
Q

What are the indications for transfusing platelets?

A

No rush. Platelet count is less than 20,000 AND bleeding. Patients with kidney disease AND uremic.

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34
Q

What are the indications for packed RBCs?

A

Improve oxygen carrying capacity in anemia
Hemoglobin is 7-8 g/dL

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35
Q

What results should we expect with packed RBC transfusion?

A

in adults, Hgb should rise 1g per infusion. If you do not get an appropriate response, there is still ongoing bleeding and hemolysis

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36
Q

What are the administration guidelines for packed RBCs?

A

give over 1-2 hours, but no longer than 4 hours

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37
Q

What is the MOA of colony-stimulating factors?

A

stimulate the production of blood cells and promote their ability to function

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38
Q

What are the two CSFs we use most often?

A

Epoetin alfa and Filgrastim

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39
Q

What is the MOA of Epoetin alfa?

A

synthetic form of EPO

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40
Q

What patient population benefits most from epoetin alfa?

A

patients with CKD and are on dialysis and in religious patients who deny blood transfusion, epoetin alfa can be given in bloodless form that is basically IV iron

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41
Q

What is the most common side effect of iron?

A

constipation

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42
Q

What is the most common IV preparation of iron?

A

iron sucrose (venofer)

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43
Q

What is important in regards to patient education on taking Iron?

A

Vitamin C is a cofactor found in the GI tract that helps the body absorb iron

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44
Q

What kinds of foods contain high amounts of folic acid?

A

dried beans, peas, lentils, oranges, whole wheat, liver, asparagus

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45
Q

What is the MOA of folic acid?

A

helps prevent changes to DNA that may lead to cancer

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46
Q

What is the most important indication of folic acid?

A

lowers the risk of a fetus having neural tube defects

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47
Q

What is the MOA of aspirin?

A

reducing thromboxane A2

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48
Q

What are the safety warnings to aspirin?

A

reduces heart attack, stroke risk, and cancer risk
Increases risk of tinnitus and can cause reye’s syndrome

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49
Q

What is the MOA of clopidogrel?

A

IIREVERSIBLE binds to P2Y12 adenosine receptors

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50
Q

What are the important uses of clopidogrel?

A

acute coronary syndrome and thrombotic event PREVENTION

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51
Q

What is the indication for clopidogrel and surgery?

A

should stop clopidogrel 5 days before surgery to reduce bleeding risk

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52
Q

What is the BBW of clopidogrel?

A

diminished antiplatelet effect in CYP2C19. Poor metabolizers

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53
Q

What is the MOA of Tricagrelor?

A

REVERSIBLY binds to P2Y12 adenosine receptors

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54
Q

What is the BBW for Tricagrelor?

A

contraindicated in intracranial hemorrhage

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55
Q

What is the MOA of dipyridamole?

A

inhibits platelet adenosine uptake, reducing platelet aggregation

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56
Q

What are the indications for dipyridamole?

A

cardiac stress testing and stroke prevention when combined with aspirin (Aggrenox)

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57
Q

What is the MOA of heparin?

A

binds to antithrombin III and inactivates thrombin

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58
Q

What is the MOA of warfarin?

A

Vitamin K antagonist

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59
Q

What will we have to monitor with heparin?

A

PTT

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60
Q

What will we have to monitor with warfarin?

A

INR until it is in the therapeutic range

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61
Q

What is the direct thrombin inhibitor?

A

argatroban

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62
Q

What is the indication to use argatroban?

A

HIT type II

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63
Q

What can be some of the side effects of argatroban?

A

Hypotension and intracranial bleeding

64
Q

What is the MOA of apixaban and rivaroxaban?

A

Factor Xa inhibitors

65
Q

What is the major side effect of apixaban and rivaroxaban?

66
Q

What is the BBW of apixaban and rivaroxaban?

A

PREMATURE discontinuation of treatment before the 3-month time period is up and epidural and spinal hematoma

67
Q

What does it mean that apixaban and rivaroxaban are started on a loading dose?

A

Start strong (1 week for apixaban and 3 weeks for rivaroxaban) and then wean down

68
Q

What is the MOA of Enoxaparin?

A

binds to antithrombin III and acclerates activity inhibiting thrombin and factor Xa

69
Q

What is the reversal agent for heparin and LMWH?

A

protamine sulfate

70
Q

What is the major reaction or side effect of enoxaparin?

A

in patients with prosthetic heart valves, thrombosis may occur

71
Q

What is the BBW for enoxaparin?

A

spinal/epidural hematomas may occur in anticoagulated patients that are receiving anesthesia or spinal puncture

72
Q

What are the side effects of protamine sulfate?

A

anaphylaxis, bronchospasm, and angioedema

73
Q

What is the BBW for protamine sulfate?

A

severe hypotension

74
Q

What is the MOA for Kcentra?

A

supplies factors II, VII, IX, and X, and proteins C and S promoting coagulation, because it provides K

75
Q

What is the Vitamin K reversal medication?

A

Kcentra is used in life-threatening bleeding that has to be stopped promptly

76
Q

What are the major side effects of Kcentra?

A

A fib and sudden death

77
Q

What is the reversal agent for DOACs?

78
Q

What is the MOA for Andexxa?

A

binds and sequesters factor Xa inhibitor and inhibits tissue factor pathway inhibitor

79
Q

What is the BBW for Andexxa?

A

increases risk of life-threatening thromboembolism event

80
Q

What are the thrombolytic drugs?

A

Alteplase and TNKase

81
Q

What is the MOA for thrombolytics?

A

binds to fibrin and converts tissue plasminogen and plasmin, promoting fibrinolytics

82
Q

What are the indications of Alteplase?

A

Acute MI (STEMI) if cath lab is unavailable in 2 hours

83
Q

What are the safety warnings for Alteplase?

A

Do not use if over 80 YO or uncontrolled HTN
Need to start heparin in a separate line

84
Q

Why would we use TNKase over Alteplase?

A

easier to dose in acute and emergent situations and NOW CONSIDERED FIRST LINE

85
Q

What is the use of FFP?

A

replacement of multiple coagulation factors in patients with live disease or cardiac surgery. Reverse meds like warfarin and plasma exchange in TTP

86
Q

What are the common side effects of FFP?

A

Pruritus and paresthesia
anaphylactic shock and severe hypotension

87
Q

What is the warning for transfusion reactions for all blood components?

A

If a transfusion reaction is supected, the transfusion should be stopped, the patient assessed and stabilized, the blood bank notified, and a transfusion reaction investigation initiated

88
Q

What should we NOT use FFP for?

A

volume replacement

89
Q

What are the contraindications to platelets?

A

TTP, HUS, HIT

90
Q

What are the safety warnings for platelets?

A

do not rush. risk of spontaneous bleeding is not until <10,000. Really only give platelets if count is low and they are bleeding. Low platelet count or poor platelet function. Often used in cancer pts who have pancytopenia.

91
Q

What is the safety warning for packed red blood cells?

A

give over 1-2 hours

92
Q

What are the major side effects of epoetin alfa?

A

mortlity increase, tumor progression, pure red cell aplasia

93
Q

What are the safety warnings for epoetin alfa?

A

increased mortality and serious CV events in CKD pts, cancer pts, and increased thromboembolic events in surgery

94
Q

What is the MOA for Filgrastim?

A

hematopoietic cells that increase neutrophil production

95
Q

What med is for neutropenia?

A

Filgrastim

96
Q

What is one of the major side effects of Filgrastim?

97
Q

What is the safety warning for Filgrastim?

A

Absolute Neutrophil Count: get the number from CBC w/diff. reported in a percentage. Worried about patients being immunocompromised

98
Q

What is the MOA of phytonadine (Vitamin K)?

A

cofactor in the hepatic production of active factors II, VII, IX, and X

99
Q

What are the uses of phytonadine?

A

Hypoprothrombinemia and reversal of warfarin (Vit K antagonist)

100
Q

What are the major side effects of phytonadione?

A

taste change and flushing

101
Q

What are the main uses of folic acid?

A

supplements during pregnancy and lactation and before pregnancy to prevent neural tube defects

102
Q

What are the main side effects of B9?

A

bloating/gas, bitter taste

103
Q

What is the MOA of Cyanobalamin (aka B12)?

A

essential for the synthesis of purines and pyrimidines that form DNA

104
Q

What are the uses for B12?

A

treat B12 deficiency and pernicious anemia

105
Q

What are some unusual the side effects of Vitamin B12?

A

blue lips and fingernails and pink frothy cough

106
Q

Is Vitamin B12 okay for pregnancy?

A

yes! it may help prevent spina bifida

107
Q

What is the MOA of Rituximab?

A

monoclonal antibodies. CD20 expressing cells via antibody-dependent cell mediated cytotoxicity

108
Q

What are the uses for Rituximab?

A

CD-positive B cell Non Hodgkin’s Lymphoma
RA and Myasthenia Gravis

109
Q

What are the safety warnings Rituximab?

A

Infusion reaction on the first infusion can cause death. Severe mucocutaneous reactions. HBC reactivation. Progressive multifocal leukocephalopathy.

110
Q

What is the major use for hydroxyurea?

A

sickle cell anemia

111
Q

What is a differentiating factor about Dactinomycin?

A

it is an oncologic antibiotic

112
Q

What are the uses for Dactinomycin?

A

Wilms tumor and Ewing sarcoma

113
Q

What is the main use for Doxorubicin?

114
Q

What is the BBW warning for Doxorubicin?

A

“Doxorubicin is Deadly at Heart”
Cardio toxicity and will need echo to see baseline

115
Q

What is the MOA of Tamoxifen?

A

estrogen antagonist that prevents tumor growth

116
Q

What are the indications for Tamoxifen?

A

Ductal Breast cancer in situ (DCIS), breast cancer, breast cancer prevention

117
Q

What are the major side effects of Tamoxifen?

A

thromboembolism

118
Q

What is the BBW for Tamoxifen?

A

endometrial cancer

119
Q

When would Tamoxifen treatment need to be stopped?

A

should be discontinued after 5 years to avoid the development of drug-resistent breast tumors or uterine cancer

120
Q

What is the MOA of methotrexate?

A

folate antagonist

121
Q

What are the indications for Methotrexate?

A

ALL and autoimmune disease like RA and psoriasis

122
Q

What is the indication for 5-Fluorouracil?

A

it is a topical medication that works for actinic keratosis and superficial basal cell carcinoma

123
Q

What is the indication for Fluorouracil?

A

Colon cancer

124
Q

What is the indication for Leucovorin?

A

colerectal cancer combo w/ Fluorouracil and methotrexate rescue

125
Q

What is the MOA for Leucovorin?

A

folate acid agonist

126
Q

What are the indications for 6-Mercaptopurine?

A

ALL and inflammatory bowel issues like Crohn’s and ulcerative colitis

127
Q

What are the side effects of 6-Mercaptopurine?

A

neutropenia

128
Q

What is the MOA for Cyclophosphamide?

129
Q

What is Cyclophosphamide indicated for?

A

Hodgkin’s and non-Hodgkin’s Lymphoma and has been known to be helpful in Immunosppression in transplant medicine

130
Q

What is the MOA for Imatinib (Gleevac)?

A

Inhibits Philadelphia Chromosome kinase and induces apoptosis

131
Q

What are the uses for Imatinib (Gleevac)?

A

CML, ALL and myelodysplastic syndromes

132
Q

What are the side effects of Imatinib (Gleevac)?

A

once the medication is stopped, the disease comes back. Tumor lysis syndrome can also occur

133
Q

What is tumor lysis syndrome?

A

widespread cell death especialy from liquid tumors

134
Q

What is the MOA of Vincristine (Oncovin)?

A

inhibits microtubule formation

135
Q

What is the BBW for Vincristine (Oncovin)?

A

IV only and is fatal if given in the spinal (intrathecally)

136
Q

What is the MOA of Cisplatin?

A

platinum based. binds and crosslinks DNA, preventing DNA synthesis

137
Q

What are the indications for Cisplatin?

A

ADVANCED GU and reproductive cancers. Not a first line.

138
Q

What is Interfern Alfa 2B used for? What is the important monitoring for Interfern Alfa 2B

A

Hairy cell leukemia
screening for psych disorders because it has severe psychiatric effects

139
Q

What is goserelin?

A

Basically, it is chemical castration that inhibits gonadotropin release. It will have GI/GU side effects and must be avoided in pregnancy

140
Q

What is the MOA of Rituximab (Rituxan)?

A

Monoclonal antibodies
binds to CD20-positive B-Cell surface antigens producing lysis of CD20 expressing cells via antibody-dependent and complement-dependent cytotoxicity

141
Q

What is Rituximab (Rituxan) used for?

A

CD20-positive B-Cell non-Hodgkin lymphoma, RA, and Myasthenia Gravis

142
Q

What is a serious side effect of Rituximab (Rituxan)?

A

Tumor lysis syndrome

143
Q

What is the safety warning for Rituximab (Rituxan)?

A

HBV rectivation, mucocutaneous reactions

144
Q

What ia the MOA for Pembrolizumab (Keytruda)?

A

binds to PD-1 receptor on T cells to inhibit antitumor response to decrease tumor growt

145
Q

What are the uses for Pembrolizumab (Keytruda)?

A

First designed to treat melanoma, but now used to treat urothelial cancers

146
Q

Why is PD-1 a target for Pembrolizumab (Keytruda)?

A

A monoclonal antibody targets the host cell but not cancer cell
events the cancer cell from suppressing of the activation of the immune cell.
Both tumor and immune cell have PD-L1 receptors that are attracted to each other

147
Q

What meds are monoclonal antibodies?

A

Rituximab (Rituxan) and Pembrolizumab (Keytruda)

148
Q

What cancer meds are monoclonal antibodies that bind to host cell?

A

Rituximab (Rituxan)

149
Q

What are the cytotoxic cancer meds?

A

Hydroxyurea (antimetabolite), Dactinomycin, Doxrubicin, Methotrexate, 5-Fluorouracl, 6-Mercaptopurine, Cyclophosphamide, Vincristine, Cisplatin

150
Q

What are the 3 main side effects of cytotoxic cancer meds?

A

bone toxicity, Infection risks increase, and GI tract issues occur because GI cells divide more rapid

151
Q

What are the noncytotoxic cancer meds?

A

Rituximab (monoclonal antibody), Tamoxifen (estrogen modulator), Leucovorin (folate agent), Imatinib (TKI), Interferon Alfa 2B (Immunomodulator)

152
Q

What cancer meds can be used in pregnancy

A

Rituximab (Rituxan)

153
Q

What cancer meds should be avoided in the first trimester?

A

Dactinomycin (Cosmegen), Doxorubicin (Adriamycin), 6-Mercaptopurine (Purinethol), Cyclophosphamide, Vincristine

154
Q

What cancer meds should be avoided in pregnancy?

A

5-Fluorouracil (Efudex), Fluorouracil, Imatinib (Gleevac)

155
Q

What meds are contraindicated in pregnancy?

A

Pembrolizumab, Warfarin (Coumadin)

156
Q

Tumor lysis syndrome can lead to other what other serious conditions?

A

hyperkalemia, CKD and heart issues

157
Q

For what medication should full dose be avoided in the 3rd trimester?

Pharm II (4 decks)

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