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Heme/Onc Flashcards

1
Q

Drug class for iron

A

Hematinic

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2
Q

MoA for iron

A

supplement

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3
Q

Indications of iron

A

iron deficiency

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4
Q

SE/ADRs for iron

A

N/V/D
constipation, abd cramps
black stools
anaphylaxis

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5
Q

Contra-indications for iron

A

hemochromatosis, anaphylaxis, hemolytic anemia

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6
Q

Dx-Dx for iron

A

antacids, phenytoin

quinolone & tetracycline abxs bind Fe

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7
Q

monitoring for iron

A

serum ferritin
transferrin saturation
Hgb
reticulocytes

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8
Q

Drug class for deferoxamine

A

iron chelator

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9
Q

indications for deferoxamine

A

excessive serum iron levels

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10
Q

MoA for deferoxamine

A

chelates iron from hemosiderin, ferritin, transferrin (not from hemoglobin or cytochromes)

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11
Q

SE/ADRs for deferoxamine

A 
fever, leg cramps
tachy, hypotension
allergic drug runs
'pulmonary syndrome'
neurotoxicity
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12
Q

Drug class for Cyanacobalamin B12

A

vitamin

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13
Q

MoA for cyanacobalamin B12

A

rate limiting cofactor in conversion of folate to active form & DNA synthesis

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14
Q

indications for cyanacobalamin B12

A

B12 deficiency (megaloblastic anemia, peripheral neuropathy, depression, CVD)

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15
Q

SE/ADRs for cyanacobalamin B12

A

painful by injection site

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16
Q

Dx-Dx for cyanacobalamin B12

A

long term acid suppression therapy

metformin (can inhibit B12 absorption), phenytoin

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17
Q

monitoring for cyanacobalamin B12

A

[B12, folate] serum

MMA levels, homocysteine levels

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18
Q

Drug class for folic acid

A

nutritional

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19
Q

MoA for folic acid

A

cofactor in DNA synthesis

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20
Q

indications fo folic acid

A

folate deficiency (megaloblastic anemia, prevention of neural tube defects, CVD)

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21
Q

SE/ADRs for folic acid

A

bronchospasms, flushing, pruritis (rare)

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22
Q

Contra-indications for folic acid

A

hypersensitivity

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23
Q

Dx-Dx for folic acid

A
  • phenobarbitol, phenytoin, primidone levels decreased by folic acid
  • phenytoin, trimethoprim, methotrexate deplete folic acid levels
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24
Q

monitoring for folic acid

A

serum folic acid

RBC folate level

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25
Q

Drug class for epoetin alfa

A

erythrocyte-stimulating agent

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26
Q

MoA for epoetin alfa

A

stimulates erythroid proliferation & differentiation; induces release of reticulocytes

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27
Q

indications for epoetin alfa

A

low RBC secondary to ESRD, HIV, antineoplastic therapy, RA

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28
Q

SE/ADRs for epoetin alfa

A

secondary impact on iron deficiency, clotting

hypertensions, thrombosis, seizures

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29
Q

What disease should we think about using Epoetin alfa (Epogin) for?

A

Chronic kidney disease

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30
Q

Drug class for filgrastim

A

myeloid growth factor: G-CSF

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31
Q

MoA for filgrastim

A
  1. stimulates proliferation & differentiation of myeloid cells
  2. increase phagocytic capacity & prolongs survival of mature neutrophils
  3. mobilizes peripheral neutrophils
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32
Q

indications for filgrastim

A

neutropenia secondary to chemotherapy

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33
Q

SE/ADRs for filgrastim

A

fever, petechiae, bone pain

splenomegaly

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34
Q

What is the major cause for people stopping iron supplementation?

A

GI complications

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35
Q

Which form has the most elemental iron in it?

A

FeSO4

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36
Q

Why don’t you want to give Epogin with Hgb levels over 11?

A

increased risk for blood clots, MI, and strokes

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37
Q

How long does it take to completely correct & replete iron stores? But when will you see effects of iron supplementation?

A

3-6 months for complete restoration

see increase in 2-3 weeks

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38
Q

Drug class for unfractionated heparin

A

indirect thrombin inhibitors

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39
Q

MoA for unfractionated heparin

A

accelerates degradation of XA & thrombin (Ila)

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40
Q

indications for unfractionated heparin

A

thrombotic disorders

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41
Q

SE/ADRs for unfractionated heparin

A

bleeding, allergic rxn, alopecia

long term: osteoporosis; HIT (after 7 days); skin necrosis

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42
Q

Contra-indications for unfractionated heparin

A

prior HIT, pre-existing severe thrombocytopenia, intra-cranial bleeding

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43
Q

Dx-Dx for unfractionated heparin

A

other anticoagulants
tNSAIDs
NTG decreases effectiveness

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44
Q

monitoring for unfractionated heparin

A

aPTT, platelet counts
H&H
fecal occult blood

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45
Q

Why can’t unfractionated heparin lyse an established clot?

A

it has no fibrinolytic activity

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46
Q

Drug class for low-molecular-weight heparin (lmwh enoxaparin)

A

indirect thrombin inhibitors

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47
Q

MoA for low-molecular-weight heparin

A

increases degradation of Xa

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48
Q

indications for low-molecular-weight heparin

A

acute coronary syndrome, DVT (prevention & treatment)

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49
Q

SE/ADRs for low-molecular-weight heparin

A
  • injection site hematoma, fever, increased AST/ALT
  • bleeding
  • hypersensitivity rxn
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50
Q

Contra-indications for low-molecular-weight heparin

A
  • active major bleeding
  • hypersensitivity to pork, heparin
  • thrombocytopenia
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51
Q

monitoring for low-molecular-weight heparin

A

platelet count, CrCl

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52
Q

How is low-molecular-weight heparin eliminated?

A

renally

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53
Q

Drug class for fondaparinux

A

indirect thrombin inhibitors

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54
Q

MoA for fondaparinux

A

accelerates factor Xa degradation

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55
Q

Indications for fondaparinux

A
  • DVT prophylaxis

- TX acute PE/DVT without PE

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56
Q

SE/ADRs for fondaparinux

A
  • moderate thrombocytopenia
  • bleeding, rash
  • fever, nausea
  • anemia, edema
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57
Q

Contra-indications for fondaparinux

A
  • hypersensitivity
  • active bleeding
  • CrCl less than 30ml/min
58
Q

Dx-Dx for fondaparinux

A

-tNSAIDs

o/w minimal

59
Q

monitoring for fondaparinux

A

CBC, CrCl

fecal occult blood

60
Q

How is fondaparinux administered?

A

only sub-Q

61
Q

Drug class for protamine sulfate

A

antagonist of indirect thrombin inhibitors

62
Q

MoA for protamine sulfate

A

binds to heparin & neutralizes its anticoagulant effect

63
Q

indications for protamine sulfate

A

excess heparin impact

64
Q

Drug class for dabigatran

A

oral direct thrombin inhibitor

65
Q

MoA for dabigatran

A

directly inhibits thrombin (Ila) action to convert fibrinogen to fibrin; inhibits platelet aggregation

66
Q

indications for dabigatran

A

prevent stroke in non-valvular A fib

67
Q

SE/ADRs for dabigatran

A

bleeding, gastric irritation

gastritis

68
Q

Contra-indications for dabigatran

A

severe renal disease (CrCl less than 15 ml/min)

69
Q

Dx-Dx for dabigatran

A

P-gp inducers antagonize (rifampin); P-gp inhibitors (clopidogrel, amiodarone) increase levels

70
Q

monitoring for dabigatran

A

H&H, ECT (ecarine clotting time)

aPTT, CrCl

71
Q

PG category for dabigatran

72
Q

What is the shelf life for dabigatran once opened? Unopened?

A

30 days once opened
very moisture sensitive
4 months unopened

73
Q

Drug class for warfarin

A

coumarin anticoagulants

74
Q

MoA for warfarin

A

block Vit K mediated carboxylation of clotting factors VII, IX, X, II & proteins C & S

75
Q

indications for warfarin

A

prevention & treatment of venous thrombosis

76
Q

SE/ADRs for warfarin

A

easy bruising; skin/tissue necrosis
hypersensitivity rxn
vasculitis

77
Q

contra-indicaitons for warfarin

A

active bleeding

prior hx of skin necrosis

78
Q

Dx-Dx for warfarin

A

other anticoagulants

gingo biloba

79
Q

monitoring for warfarin

A

PT/INR

H&H

80
Q

drug class for vitamin k

A

antagonist of coumarin anticoagulants

81
Q

MoA for vitamin k

A

promotes liver synthesis of II, VII, IX, X

82
Q

indications for vitamin k

A

counteract excess warfarin anticoagulation or vit k deficiency

83
Q

SE/ADRs for vitamin k

A

primarily w/ IV dosing-flushing, hypotension, cyanosis, rash

84
Q

contra-indications for vitamin k

A

hypersensitivity to vit k (IV)

85
Q

Dx-Dx for vitamin k

A

decreases coumarin anticoagulation; Orlistat decreases PO absorption

86
Q

monitoring for vitamin k

A

PT/INR

H&H

87
Q

Drug class for Rivaroxaban

A

direct factor Xa inhibitor

88
Q

MoA for Rivaroxaban

A

directly & selectively inhibits factor Xa

89
Q

indications for Rivaroxaban

A

to reduce risk of clots w/ knee & hip replacement, non-valvular atrial fib, DVT/PE

90
Q

SE/ADRs for rivaroxaban

A

bleeding, peripheral edema, diarrhea, dizziness

91
Q

contra-indications for rivaroxaban

A

active pathological bleeding, hypersensitivity, mod-severe liver disease (Child-Pugh class B or C), coagulopathy

92
Q

Dx-Dx for rivaroxaban

A
  • CYP3A4/P-gp inhibitors (clarithromycin, flucanazole) increase [drug]
  • CYP3A4/P-gp inducers (carbamazepine, phenytoin, rifampin, St Johns wort) decrease [drug]
93
Q

monitoring for rivaroxaban

A
  • initially CBC, CrCl, LFT

- chronic: none

94
Q

Pg for rivaroxaban

A

avoid in PG

95
Q

drug class for streptokinase

A

fibrinolytic

96
Q

MoA for streptokinase

A

activates conversion of plasminogen to plasmin which degrades fibrin, fibrinogen to lyse cloth (both physiologic & pathologic thrombi)

97
Q

indications for streptokinase

A

severe DVT, PE, AMI, occluded AV cannulas

98
Q

SE/ADRs for streptokinase

A

bleeding, fever, pruritis

99
Q

drug class for aminocaproic acid

A

fibrinolysis inhibitors

100
Q

MoA for aminocaproic acid

A

binds to plasminogen & plasma & blocks plasmin lysis of fibrin (but some thrombi continue to form)

101
Q

indications for aminocaproic acid

A

state of excess fibrinolysis

102
Q

SE/ADRs for aminocaproic acid

A

hypotension, abd discomfort, diarrhea, myopathy, muscle necrosis (rare)

103
Q

drug class for alteplase

A

plasminogen activator tPAs

104
Q

MoA for alteplase

A

preferentially activates plasminogen bound to fibrin (theory-confines thrombolysis to formed thrombus)

105
Q

indications for altetplase

A

thrombus lysis in AMI, PE

106
Q

SE/ADRs for alteplase

A

bruising, fever, bleeding, hypotension, reperfusion arrhythmias

107
Q

drugs class for aspirin

A

anti-platelet drugs

108
Q

MoA for aspirin

A

irreversible inactivation (via acetylation) of cyclo-oxygenase- inhibits synthesis of thromboxane A2-prevents platelet aggregation & vasoconstriction by thromboxane A2

109
Q

indications for aspirin

A

secondary prophylaxis s/p MI, CVA

110
Q

SE/ADRs for aspirin

A

gastritis (30%), dyspepsia; bleeding, tinnitus (high dose)

111
Q

contra-indications for aspirin

A

hypersensitivity, nasal polyposis + bronchospasms

112
Q

Dx-Dx for aspirin

A

other anticoagulants, NSAIDs

113
Q

monitoring for aspirin

A

none specifically

114
Q

drug class for clopidogrel

A

platelet ADP inhibitor

115
Q

MoA for clopidogrel

A

irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding & platelet aggregation

116
Q

indications for clopidogrel

A

secondary prevention AMI, CVA, PAD

117
Q

SE/ADRs for clopidogrel

A

gastritis (27%), abd pain, dyspepsia, thrombocytopenia, leukopenia (rare)

118
Q

contra-indications for clopidogrel

A

active bleeding, hypersensitivity

119
Q

Dx-Dx for clopidogrel

A

other anti-platelet or anti-coagulatn drugs, gingko biloba (increase effect); atorvostatin, macrolide abs (decrease)

120
Q

monitoring for clopidogrel

121
Q

drug class for abciximab

A

glycoprotein IIB/IIIA inhibitors

122
Q

MoA for abciximab

A

blocks platelet GBIIb/IIIa receptors for thromboxane A2, thrombin, collagen & prevents platelet aggregation

123
Q

indications for abciximab

A

coronary artery stent surgery, acute coronary syndrome

124
Q

SE/ADRs for abciximab

125
Q

contra-indications for abciximab

126
Q

Dx-Dx for abciximab

A

anticoagulants

127
Q

How is abciximab administered?

128
Q

drugs class for dipyridamole

A

phosphodiesterase inhibitor

129
Q

MoA for dipyridamole

A

increases platelet concentration of AMP decreasing platelet aggregation

130
Q

indications for dipyridamole

A

post-op primary prophylaxis s/p prosthetic heart valves; prophylaxis after CVA

131
Q

SE/ADRs dipyridamole

A

dizziness, HA, abd discomfort, confusion, blurred vision, dyspepsia, hypotension

132
Q

contra-indications for dipyridamole

A

hypersensitivity; severe hepatic or renal impairment

133
Q

Dx-Dx for dipyridamole

134
Q

monitoring for dipyridamole

135
Q

What is added to dipyridamole to increase effectiveness?

136
Q

drug class for cilostazole

A

phosphodiesterase inhibitor

137
Q

MoA for cilostazole

A

inhibits platelet phosphodiesterase thus preventing aggregation

138
Q

indications for cilostazole

A

peripheral artery disease (intermittent claudication)

139
Q

SE/ADRs for cilostazole

A

rhinitis, HA, abnormal stools

140
Q

contra-indications for cilostazole

A

thrombocytopenia, heart failure, severe renal or hepatic impairment

141
Q

Dx-Dx for cilostazole

A
  • CYP3A4 inhibitors-macorlide abx (increase effect
  • NSAIDs & omeprazole (increase)
  • anticoagulants (increase)
142
Q

monitoring for cliostazole

A

CrCl, walking distance

Pharmacology (16 decks)

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