Heme Onc Flashcards
Heparin
- Activates AT3 which cleaves factors 2 and 10
- Highle negatively charged and rapid action
- Used in acute settings
- Reversal is protamine
- Use in pregnant women instead of warfarin
- Follow effect with PTT
- Can cause HIT with a hapten to platelet facto 4 that cuases activation, thrombosis and thromboytopenia, use lepirudin/valirudin instead
Lepirudin/Bivalirudn
-Direct thrombin inhibitors that are used in pts with HIT
Enoxparin, daliparin
- LMWH have longer halflife and can be adminitered subQ
- Easier to control
Warfarin
- Inhibits gamma crboxylation and Ca binding site of vitamin K dependent clotting factors (2,7,9,10, C, S)
- Used as long teerm antocoagulation
- Check with PT/INR
- Vitamin K will decrese effec
- CYp metabolism
- Antidote is FFP and vitamin K
- Take effect in days
- Teratotgen that can cause hydrops and death, most associated with bleeds and retinopathy in infant
- Skin Necrosis from differentia C and S half lfe
- C activated by thrombomodulin and S to cleave factor 5
Urokinase
-Prtoease that activates TPA
Ateleplse, reteleplase
Thrombolytics that activate tPA
- Used in acute stroke, embolism, etc
- Contraindicated in active bleeds/HTN
- Aminocaproic acid is antidote
- Plasminogen cleaves thrombin and fibrin leading to elevation in PT and PTT
ASA
IRreversible acetylation of COX leads to impaired TXA2 function and decreased aggregation
- Used prophylaxis in MI and cloting
- Increase in bleeding time with normal PT and PTT
- Can cause renal failure (decrease in PGE at afferent arteriole), interstitial nephritis, decreased PGE leads to GI bleeding and ulcers
- Reye’s with mitochondrial dysfunction
- Overdose is rapid respiratory alkalosis followed by metabolic acidosis
Clopidrogel, toclodipine,tigrecglacor
- ADP recepor inhibitors that are irreversible
- Prevent expression of GP2b3a on cell surface and decrease aggreation
- Increase BT with no change in PT/PTT
- used post stent commonly
Cilostazol, dipyramidole
- PDE inhibitors lead to decreeased platelet activation and also vasodilation
- Can be used as angina prophylaxis and TIA
- Can cause hypotenion, fatigue, abdomiinal and headache
Abciximab, tirofiban, excibitide
- Inhibitors of GP2b3a
- Prevent aggregation and increase BT wiht no change in PT or PTT
- Used stenting and MI
Rivaroxiban, apixiban, idoparinox
-Direct factor 10 inhibitors that can be taken orally and have minimal S/E
S phase
- ANtimetabolites
- MTX, 5FU, HU, 6MP, Cytarabine
G2
- Etoposides
- Bleomycin
M
Taxols and vinca
MTX
- Folate analog that inhibits DHFR
- Bone marrow supression is reversible with leucoverin
- Also causes mucocitis
- Can also be used as an immunosupressant, abortifactant
5-FU
Inhibitor of thymitdylate synthase leads to decreased DNA synthesis S phasse
-Myelsupresion without leucoverin
Cytarabine
Pyrimidine analog that inactivates DNA pol
6-MP
- Pyrimidine synthesis inhibitor
- BM supression, not reversible with leucoverin
- Activated by HGPRT and metabolized by xanthine oxidase. Use of allopurinol will increase side effects
Doxirubicine
- DNA intercalator
- CAuses DCM use dexrzoxane to prevent DCM
Bleomycin
- Generates free radicals that destroy DNA
- Causes pulmonary fibrosis and changes in skin
Cyclophosphamide
- Cross links DNA
- Caues hemorrhagic cystitis, treat with mesna (thiol group that scavenges metabolite
Nitrosamines
- Cross BBB and cross link DNA
- Can be used for GBM
Busulfan
- Alkylating agent
- Causes pulmonary fibrosis and skin changess
Vincristine and blastine
- Bind to tubulin dimers and prevent MT frmation, used only in M phase
- Cause neurotoxicity (ileus or peripheral neuropathy)
