Heme/Onc

Question 1

activation of anti-thrombin (decrease thrombin and factor Xa). use: immediate anti-coag for PE, acute coronary syndrome, MI, DVT. PRegnancy safe. effects PTT.

Answer 1

Heparin

Question 2

act more on factor Xa, better bioavailability and 2-4 times longer half life than normal heparin

Answer 2

Low molecular weight heparins: enoxaparin, dalteparin

Question 3

direct thrombin inhibitors. used instead of heparin in patients with heparin induced thrombocytopenia.

Answer 3

argatroban, bivalirudin

Question 4

interferes with normal synthesis and gamma-carboxylation of K-dependent clotting factors (2, 7, 9, 10 and protein C ans S). metabolized by P450. measured by PT/INR. use: chronic coagulation, not during pregnancy.

Answer 4

Warfarin (coumadin)

Question 5

Direct factor 10 inhibitors. treatment and prophylaxis of DVT and PE. stroke prophylaxis in patients w/a-fib.

Answer 5

Apixaban, riveroxaban

Question 6

conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. increase PTT and PT but no change in platelets. Early MI, ischemic stroke, and severe PE.

Answer 6

alteplase (tPA), reteplase (rPA), tenecteplase (TNK-tPA)

Question 7

irreversibly inhibit COX-1 and 2). new platelets cannot be synthesized. increase bleed time, decrease TXA2 and prostaglandins. no effect on PT and PTT. antipyretic, analgesic, anti-inflamm, antiplatelet.

Answer 7

aspirin

Question 8

ADP receptor inhibitor, inhibit platelet aggregation. prevents glycoprotein 2b/3a from binding fibrinogen. treat acute coronary syndrome, coronary stenting.

Answer 8

clopidogrel, ticlopidine, prasugrel, ticagrelor.

Question 9

PDE3 inhibitor. increase cAMP in platelets, thus inhibiting aggregation. vasodilate. treat: intermitten claudication. coronary vasodilation, prevent stroke or TIA.

Answer 9

cilostazole, dipyridamole

Question 10

GP2a/3b inhibitors. prevent aggregation. made from mAb fragments. treat unstable angina, percutaneous transluminal coronary angioplasty`

Answer 10

abciximab, eptifibatice, tirofiban

Question 11

folic acid analog, inhibits dihydrofolate reductase, DNA and protein synth. treat both cancer and non-neoplastics. SE: myelosuppression (reversible with leucovorin (folinic acid)

Answer 11

Methotrexate

Question 12

pyrimidine analog, covalently complexes folic acid. inhibits thymidylate synthetase, decrease DNA and protein synth. treat cancer. SE: myelosuppression, OD (rescue with uridine)

Answer 12

5-fluorouracil

Question 13

Pyrimidine analog. inhibits DNA polymerase. treat leukemias and lymphomas. SE: pancytopenia.

Answer 13

Cytarabine (arabinofuranosyl cytidine)

Question 14

Purine analog. decrease de novo purine synth. activated by HGPRT. PRevent organ transplant, RA, SLE, leukemia, IBD. toxic to bone marrow. metabolized by xanthine oxidase so allopurinol increases toxicity.

Answer 14

Azathioprine, 6-mercaptopurine, 6-thioguanine

Question 15

anti-tumor antibiotic. intercalates in DNA. treat childhood tumors. SE: myelosuppression.

Answer 15

Dactinomycin (actinomycin D)

Question 16

anti-tumor antibiotic. generates free radicals causing breaks in DNA. treat solid tumor, leukemia, lymphoma. SE: cardiotoxicity.

Answer 16

Doxorubicin and daunorubicin

Question 17

anti-tumor antibiotic. free radical formation, breaks in DNA. treat: testicular cancer and hodgkin’s. SE: pulmonary fibrosis.

Answer 17

Bleomycin

Question 18

Alkylating agent. Covalently X-link DNA at guanine N-7. cause myelosuppression, hemorrhagic cystitis (prevent w/mensa)

Answer 18

Cyclophosphamide, ifosfamide

Question 19

Alkylating agent. Crosses BBB. cross link DNA. BRain tumors. SE: CNS toxicity.

Answer 19

Nitrosoureas: carmustine, lomustine, semustine, streptozocin

Question 20

Alkylating agent. cross-link DNA. Treat CML and ablate BM before BM transplant. SE: severe myelosuppression, pulmonary fibrosis.

Answer 20

Busulfan

Question 21

Microtubule inhibitor. bind Beta-tubulin, and inhibit polymerization into microtubules. treat solid tumors, leukemia, lymphoma.

Answer 21

Vinca alkaloids: vincristine (neurotoxicity) and vinblastine (Myelosuppression)

Question 22

Microtubule inhibitor. Hyperstabilize polymerized tubules in M phase. Ovarian and breast cancer. SE: Myelosuppression.

Answer 22

Paclitaxel and other taxols

Question 23

Cross link DNA. treat testicular, ovarian, bladder and lung cancer. Nephrotoxic and acoustic nerve damage.

Answer 23

Cisplatin, carboplatin

Question 24

inhibit topoisomerase 2 causing DNA degradation. Treat: solid tumors, leukemias, lymphomas. SE: myelosuppression.

Answer 24

Etoposide, teniposide.

Question 25

inhibit topoisomerase 1, preventing DNA unwinding and replication. treat colon, ovarian, and small cell lung cancers. SE: myelosuppression.

Answer 25

Irinotecan, topotecan

Question 26

inhibits ribonucleotide reductase inhibiting DNA synth (S-phase). treat: Melanoma, CML, sickle cell (increase HbF). SE: bone marrow suppression.

Answer 26

hydroxyurea

Question 27

triggers apoptosis, even in non-dividing cells. most commonly used GC in chemo. CLL and non-hodgkins. SE: cushing-like symptoms.

Answer 27

Prednisone, prednisolone.

Question 28

SERM. estrogen receptor antagonists in breast and agonist in bone. Breast cancer and osteoporosis.

Answer 28

tamoxifen: BReast cancer. SE: endometrial cancer.
raloxifene: osteoporosis. SE: endometrial antagonist.

Question 29

Tyrosine kinase inhibitor of bcr-abl gene and c-KIT. treat CML and GI stromal tumors. SE: fluid retention.

Answer 29

Imatinib (Gleevec)

Question 30

mAb against CD20 (B-cells). treat: non-hodgkin’s, RA, Idiopathic thrombocytopenic purpura. SE: increase rick of PML

Answer 30

rituximab

Question 31

inhibitor of B-Raf kinase w.the V600E mutation. treat metastatic cancers.

Answer 31

Vemurafenib

Question 32

mAb against VEGF. inhibits angiogenesis. treat: solid tumors (colorectal and renal cell). SE: hemorrhage, impaired wound healing.

Answer 32

Bevacizumab