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heme onc > Heme Onc Pharm > Flashcards

Heme Onc Pharm Flashcards

1
Q

heparin MOA

A

activates antithrombin III and decreases thrombin and factor Xa

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2
Q

how do you follow heparin values in the lab

A

PTT

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3
Q

Do you use warfarin or heparin for DVT prevention during pregnancy?

A

heparin

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4
Q

antidote for heparin

A

protamine sulfate

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5
Q

LMWH vs. unfractionated heparin in terms of half life

A

LMWH halflife is much longer

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6
Q

LMWH moa

A

act more on Xa than thrombin

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7
Q

what is heparin induced thrombocytopenia?

A

IgG antibodies against heparin-bound platelet factor 4 –> complex activates platelets –> can cause both thrombosis and thrombocytopenia

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8
Q

How do you treat heparin-induced thrombocytopenia?

A

direct thrombin inhibitors (argatroban bivalirudin dabigatran)

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9
Q

how do you track warfarin effect?

A

PT INR (want INR to be between 2-3)

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10
Q

how is warfarin administered vs. heparin?

A

warfarin = oral heparin is subq or IV

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11
Q

apixaban MOA

A

bind to and directly inhibit factor Xa

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12
Q

rivoroxaban moa

A

bind to and directly inhibit factor Xa

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13
Q

alteplase MOA

A

directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots

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14
Q

reteplase MOA

A

directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots

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15
Q

stretokinase MOA

A

directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots

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16
Q

tenecteplase moa

A

directly or indirectly aid conversion of plasminogen to plasmin which cleaves thrombin and fibrin clots

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17
Q

how do thrombolytics (such as fibrinolytics) change lab values?

A

increase PT and PTT by decreasing fibrin (common pathway)

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18
Q

how do you treat thrombolytics (alteplase reteplase…) overdose/toxicity?

A

aminocaproic acid FFP or cryoprecipitate)

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19
Q

how does aspirin irreversibily inhibit COX-1 and COX-2

A

covalent acetylation

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20
Q

how does aspirin affect pt and ptt

A

doesn’t!

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21
Q

clopidoral MOA

A

inhibits platelet aggregation by irreversibly blocking ADP receptor on platelets - prevents expression of gp IIb/IIIa on platelet surface

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22
Q

prasugrel MOA

A

inhibits platelet aggregation by irreversibly blocking ADP receptor on platelets - prevents expression of gp IIb/IIIa on platelet surface

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23
Q

ticlopidine MOA

A

inhibits platelet aggregation by irreversibly blocking ADP receptor on platelets - prevents expression of gp IIb/IIIa on platelet surface

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24
Q

ticlopidine toxicity

A

neutropenia (presents with fever and mouth ulcers)

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25
Q

cilostazol MOA

A

phosphodiesterase III inhibitor –> increases cAMP in platelets

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26
Q

dipyridamole moa

A

phosphodiesterase III inhibitor –> increases cAMP in platelets resulting inhibition of platelet aggregation. Also vasodilates.

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27
Q

Abciximab MOA

A

binds to gp IIb/IIIa on activated platelets preventing aggregation. made of monoclonal antibody Fab fragments

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28
Q

eptifibatide MOA

A

binds to gp IIb/IIIa on activated platelets preventing aggregation. made of monoclonal antibody Fab fragments

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29
Q

tirofiban MOA

A

binds to gp IIb/IIIa on activated platelets preventing aggregation. made of monoclonal antibody Fab fragments

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30
Q

azathioprine works during what cell cycle phase

A

s

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31
Q

cladribineworks during what cell cycle phase

A

s phase

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32
Q

6 MPworks during what cell cycle phase

A

s phase

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33
Q

azathioprine/6 MP/6-TG are activated by what enzyme

A

HGPRT

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34
Q

azathioprine MOA

A

purine (thiol) analog - decrease de novo purine synthesis

35
Q

6 MP MOA

A

purine (thiol) analog (decrease de novo purine synthesis)

36
Q

6 -TG moa

A

purine (thiol) analog (decrease de novo purine synthesis)

37
Q

azathioprine and 6 MP are metabolized by what enzyme

A

xanthine oxidase

38
Q

azathioprine/6 MP are affected how by allopurinol?

A

increased toxicity (allopurinol blocks XO)

39
Q

cladribine MOA

A

purine analog that is resistant to adenosine deaminase (purine degradation pathway) - increased intracellular adenosine concentration) - kills cell

40
Q

cladribine is used for what use

A

hairy cell leukemia

41
Q

cytarabine MOA

A

pyrimidine analog - inhibits DNA polymerase

42
Q

5 FU MOA

A

pyrimidine analog –> bioactivated to dUMP which covalently complexes with folic acid which then inhibits thymidylate snythase (decreases dtmp –> decreasea DNA synthesis)

43
Q

methotrexate MOA

A

folic acid analog that inhibits DHF reductase –> dtmp –> dna synthesis

44
Q

leucovorin is used to rescue side effects of what drug

A

methotrexate

45
Q

bleomycin MOA

A

induces free radical formation (breaks DNA strands)

46
Q

bleomycin toxicity

A

pulmonary fibrosis

47
Q

dactinomycin moa

A

intercalates in dna

48
Q

doxorubin MOA

A

generates free radicals and intercalate in dna (breaks in dna) –> decreased replication

49
Q

doxorubicin toxicity

A

cardiotoxicity (dilated cardiomyopathy)

50
Q

What is used to prevent cardiotoxicity in doxorubicin?

A

dexrazoxane (iron chelating agent)

51
Q

busulfan mOA

A

cross-links DNA

52
Q

busulfan toxicity

A

pulmonary fibrosis

53
Q

cyclophosphamide MOA

A

cross links DNA

54
Q

carmustine MOA

A

cross links DNA

55
Q

lomustine MOA

A

cross links DNA

56
Q

semustine

A

cross links DNA

57
Q

stretozocin MOA

A

cross links DNA

58
Q

what causes hemorrhagic cystitis&nbsp

A

cyclophosphamide

59
Q

hemorrhagic cystitis related to cyclophosphamide can be reversed using

A

mesna

60
Q

paclitaxel MOA

A

hyperstabilizes microtubules in M phase such that spindle cannot seperate (no anaphase)

61
Q

vincristine vinblastine MOA

A

vinca alkaloids that bind beta-tubulin and inhibit its polymerization into microtubules

62
Q

vincristine/vinblastine cell cycle phase

A

m phase

63
Q

vinblastine toxicity

A

bone marrow supression

64
Q

vincristine side effects

A

neurotoxicity (peripheral neuropathy)

65
Q

cisplatin/carboplatin MOA

A

cross-links DNA using ROS

66
Q

cisplatin/carbopalatin toxicity

A

ototoxicity and nephrotoxicity

67
Q

how can u stop nephrotoxity with carboplatin/cisplatin

A

amifostine (free radical scavenger) and chloride (saline) diuresis - cisplatin stays in non-reactive state when there is a higher chloride concentration

68
Q

etoposide mOA

A

topoisomerase II inhibitor

69
Q

irinotecan/topotecan

A

topoisomerase 1 inhibitor

70
Q

hydroxyurea moa

A

inhibitors ribonucleotide reductase (increases HbF)

71
Q

bevacizumab moa

A

monoclonal antibody against VEGF

72
Q

erlotinib moa

A

EGFR tyrosine kinase inhibitor

73
Q

imatinib moa

A

tyrosine kinase inhibitor of BCR-ABL

74
Q

rituximab moa

A

monoclonal antibody against CD20

75
Q

tamoxifen/raloxifene moa

A

selective estrogen receptor modulator - receptor antagonist in breast receptor agonist in bone. blocks binding of estrogen to ER positive cells

76
Q

tamoxifen toxicity

A

agonist in endometrium so increases risk of endometrial cancer

77
Q

does raloxifene increase risk of endometrial cancer

A

estrogen receptor antagonist in endometrial tissue so no increased risk of endometrial cancer

78
Q

trastuzumab moa

A

monoclonal antibody against her2/neu (c-erb-b2) - tyrosine kinase receptor

79
Q

trastuzumab side effects

A

cardiotoxicity

80
Q

vemurafenib moa

A

small molecule inhibtor of braf oncogene positive melaonoma

81
Q

5 fu and 6 mp toxicity

A

myelosuppression

82
Q

methotrexate toxicity

A

myelosupression

83
Q

dense granules in platelets contain what

A

ADP, ca+2

84
Q

alpha granules in platelets contain what

A

vWF and fibrinogen

heme onc (2 decks)

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