Heme Onc Review Flashcards
1
Q
what are the four antiplatelet medications
A
aspirin
clopigogrel
ticagrelor
dipyridamole
2
Q
what are the six anticoagulants
A
heparin
warfarin
enoxaparin
argatroban
apixaban
rivaroxaban
3
Q
what are the two fibrinolytic
A
alteplase
streptokinase
4
Q
what is the heparin reversal agent
A
protamine sulfate
5
Q
what is the warfarin reversal agent
A
prothrombin complex concentrate (Kcentra)
6
Q
what factors are the vitamin K dependent factors
A
II
VII
IX
X
protein C and protein S
7
Q
what is the DOAC reversal agent
A
Andexxa
8
Q
how does Andexxa work
A
coagulation factor Xa recombinant
binds and sequesters factor Xa inhibitor which reverse anti-Xa activity and restores thrombin generation
9
Q
what are the three blood product types that can be administered
A
fresh frozen plasma
platelets
packed red blood cells
10
Q
what are the colony stimulating factors
A
epoetin alfa (epogen)
filagrastim (neupogen)
11
Q
how do colony stimulating factors work
A
secrete glycoproteins that bind to receptor proteins on the surfaces of hemopoietic stem cells
activates intracellular signaling pathways that can cause the cells to proliferate and differentiate into a specific kind of blood cells
12
Q
what are four vitamins that can be used as therapeutic agents
A
vitamin k
iron
folic acid (B9)
cyanocobalamin (B12)
13
Q
what is the antimetabolite medication
A
hydroxyurea
14
Q
how does hydroxyurea work
A
inhibits DNA synthesis by inhibiting the use of a metabolite that is required
15
Q
what are the key factors of aspirin
A
lowers the risk of heart attacks and stroke
reduces risk of cancer
increases risk of tinnitus and Reye’s syndrome (in children)
16
Q
MOA of aspirin
A
irreversibly blocks the formation of thromboxane A2 in platelets
this produces an inhibitory effect on platelet aggregation during the lifetime of the affected platelet (which is 5-10 days)
17
Q
what does aspirin treat/used for
A
acute coronary syndrome
MI prevention
TIA/thromboembolic stroke prevention
pain/fever
18
Q
what are the serious reactions of aspirin
A
anaphylaxis
angioedema
bronchospasm
bleeding
GI perforation/ulcer
19
Q
what are the guides for aspirin usage during pregnancy
A
may use in low dose but avoid full dose in 3rd trimester
20
Q
what are the key facts of clopidogrel
A
antiplatelet medication
can be used with or instead of low dose aspirin
main side effects is bleeding more than normal
can drink with clopidogrel
21
Q
what is dual anti-platelet therapy
A
aspirin and plavix
22
Q
how does clopidogrel work (MOA)
A
irreversibly binds to adenosine diphosphate receptors, reducing platelet activation and aggregation
23
Q
what is ticagrelor used for
A
acute coronary syndrome
cardiovascular/cerebrovascular event risk reduction
24
Q
what is the serious reaction of ticagrelor
A
contraindicated in intracranial hemorrhage
25
when is dipyridamole used
mostly cardiac stress testing
also generally used in combination with warfarin and aspirin
26
what is the direct thrombin inhibitor
argatroban
27
what factor does argatrobin work on
factor IIa --> thrombin
28
where does heparin bind to in the coagulation process
antithrombin III
29
what are the two main formulations of heparin
unfractionated
low molecular weight heparin
30
what is the most potent form of heparin
UFH
also has the most side effects
31
how is heparin administered
IV
32
what is type 2 HIT
immune-mediated disorder that present around 2-10 days after exposure and has life/limb threatening thrombotic complications
33
what is type 1 HIT
presents within the first 2 days after exposure to heparin, and the platelet count normalizes within 4 days after discontinuing heparin therapy
nonimmune disorder
34
how does HIT manifest clinically
skin lesions at heparin injection sites
acute system reactions --> chills, fever, dyspnea, chest pain
venous thromboembolism is the most common complication
35
when is heparin used
thromboembolism prophylaxis
percutaneous coronary intervention
acute coronary syndrome
36
when is LMWH used
prevention of blood clots
treatment of DVT and MI
37
advantages of LMWH
less potent --> safer
more predictable effect
does not require monitoring
lower incidence of HIT
has a longer half life
38
what is the black box warning for LMWH agents
spinal/epidural hematomas may occur in anticoagulated patients receiving neuraxial anesthesia or spinal puncture
39
what formulation of heparin is used for patients with renal failure
heparin (UFH)
40
what monitoring needs to be used when dealing with UFH
PTT while on an IR drip
41
what is the black box warning for protamine sulfate
heparin reversal agent
causes severe hypotension, cardiovascular collapse, pulmonary edema/HTN
42
what is warfarin
used to treat or prevent blood clots in veins or arteries
prevents strokes in people who have atrial fibrillation, valvular heart disease, or artificial heart valves
43
what is the most common side effect of warfarin
bleeding
44
what is the MOA of warfarin
inhibits vitamin-K dependent coagulation factor synthesis
45
what is the black box warning for heparin
major or fatal bleeding; more likely during starting period
if the INR is greater than 4, at risk for bleeding
46
what is the black box warning for Kcentra
increases the risk of thromboembolic events
47
when is argatroban used for
anticaogulation prophylaxis and treatment of thrombosis in patients with HITT
48
if a patient has a type 2 HITT reaction, what anticoagulant should be prescribed
argatroban
49
what is the mechanism of action behind argatroban
selectively inhibits free and clot-bound thrombin -- it is a direct thrombin inhibitor
50
when is apixaban used
thromboembolism/stroke prophylaxis
DVT treatment and prophylaxis
51
what is the black box warning with DOACs
do not prematurely discontinue
epidural/spinal hematoma risk
52
when is rivaroxaban used
thromboembolism/stroke prophylaxis
DVT treatment and prophylaxis
53
what are thrombolytics
drugs that dissolve a clot and reopen an artery
54
when should thrombolytics be used
treat a heart attack, stroke, DVT, PE, and occlusion of a peripheral artery or indwelling catheter
55
what are the absolute contraindications of thrombolytics
history of intracranial hemorrhage
ischemic stroke within 3 months
active internal bleeding
uncontrolled hypertension
56
what are the key facts of alteplase (tPA)
very short half-life so it is critical to start another agent
heparin in a separate line
57
what are the cautions/contraindications when using tPA
if over 80 years old
if uncontrolled HTN
58
when is alteplase used
acute STEMI
acute ischemic stroke
acute massive pulmonary embolism
59
how do thrombolytics work
binds to fibrin and converts tissue plasminogen to plasmin, which promotes fibrinolysis
60
what is now considered first line thrombolytic due to cost
tenectaplase
61
key facts about streptokinase
no longer used in the US
because it is produced from streptococcal bacteria, it also causes febrile reactions and other allergic problems
cannot be administered a second time within 6 months because of the antibodies
62
what is fresh frozen plasma
a blood product made up from the liquid portion of whole blood
63
when is FFP used
replacement of multiple coagulation factors in patients with acquired decificencies
plasma exchange in patients with TTP
64
what medication do you give with patients suffering from TTP
fresh frozen plasma
65
when are platelets given
in patients with a platelet count below 10,000
Dr. McGinnis says give platelets when patient count is below 20,000 AND bleeding
66
when are packed red blood cells given
when hemoglobin is lower than 7 or lower than 8 in patients that have heart disease
67
how much should one unit of RBCs raise the Hgb
about 1 g/dL
68
how long should packed red blood cells be given
given over 1-2 hours but not longer than 4 due to infection
69
what are the uses for packed red blood cells
insufficient tissue oxygen delivery due to acute bleeding
symptomatic anemia (Hgb < 7)
70
what are colony stimulating factors
substances that stimulate the production of blood cells and promote their ability to function
helps support the immune system during cancer treatment
71
what is epoetin alfa
identical to a erythropoietin
stimulates red blood cell production
72
what are the indications for epoetin alfa
chronic kidney disease associated anemia
HIV associated anemia
chemo-related anemia
73
what is the black box warning for epoetin
increased mortality and serious cardiovascular events in CKD patients
increased morality and/or tumor progression in cancer patients
increased thromboembolic events in surgery patients
74
when in filagrastim used for
neutropenia
75
when is vitamin K used
hypoprothrombinemia
reversal of warfarin
76
what is hypoprothrombinemia
a rare blood deficiency in immunoreactive prothrombin, produced in the liver, results in an impaired blood clotting reaction, leading to an increased physiological risk for spontaneous bleeding
77
what are some of the common reactions with vitamin K
taste changes
flushing
78
when is iron used
iron deficiency
79
what is the patient education for prescribing iron
take iron with vitamin c because it helps absorption
80
what is the IV form of iron
iron sucrose
81
what are the key facts about folic acid
helps the human body produce and maintain new cells
also helps prevent changes to DNA that may lead to cancer
lowers the risk of an unborn baby having a neural tube defect
82
when is folic acid used
megaloblastic anemia
macrocytic anemia (folate deficiency)
vitamin/mineral supplement during pregnancy and lactation
83
when is cyanocobalamin used
macrocytic anemia
treats vitamin B12 deficiency in people with pernicious anemia
84
how should B12 be administered in people with pernicious anemia
IM injection
85
when is hydroxyurea used
sickle cell anemia
refractory chronic myeloid leukemia
86
when is dactinomycin used
Ewing sarcoma
Wilms tumor
**antibiotic oncotic medication
87
when is doxorubicin used
leukemia lymphoma
88
what is the black box warning for doxorubicin
cardiotoxicity
doxorubicin is deadly at heart
89
when is tamoxifen used
hormone receptor-positive breast cancer
breast cancer prevention
90
how long should tamoxifen be used for
5 years due to development of drug resistance
91
what is the mechanism of action of methotrexate
immunosuppresant that inhibits lymphocyte proliferation
folate antagonists
92
which chemotherapy medication is a folate antagonist
methotrexate
93
what is methotrexate used for
rheumatoid arthritis
psoriasis
acute lymphoblastic leukemia
94
what is 5-fluorouracil used for
actinic keratosis
superficial basal cell carcinoma
95
what is fluorouracil used for
breast cancer
head and neck cancer
anal cancer
stomach cancer
96
what is a common reaction with using fluorouracil
mouth sores (mucositis)
97
when is leucovorin used
colorectal cancer combination with fluorouracil
methotrexate rescue
98
how does leucovorin work
participates in reactions utilizing folates, counteracting folate antagnoists
99
when is 6-mercaptopurine used
ALL
chron's disease
ulcerative colitis
100
when is cyclophosphamide used
Wegners granulomatosis
hodgkin lymphoma
non-hodgkin lymphoma
CML/AML
solid tumors
101
how does cyclophosamide work
alkalytes and crosslinks DNA
disease modifying anti-rheumatologic drug
102
what is imatinib used for
Ph-positive CML
Ph positive ALL
103
how does imatinib work
inhibits philadelphia chromosomal and induces apoptosis
104
what is vincristine used for
ALL
hodgkin lymphoma
non-hodkin lymphoma
solid tumors
105
how does vincristine work
inhibits microtubule formation, arresting mitosis in metaphase
106
what is the black box warning for vincristine
give only IV
107
when is cisplastin used
advanced testicular, ovarian, bladder cancer
108
how does cisplastin work
platinum-based chemotherapy, binds and crosslinks DNA
109
when is goserelin used
advanced prostate cancer
goserelin is GI/GU
110
how does goserelin work
inhibits gonadotropin release
essentially is a chemical castration
111
what chemotherapy medication could cause pituitary tumors because of the inhibition of hormones
goserelin
112
when is interferon Alfa 2b used
hairy cell leukemia
melanoma
113
how does interferon Alfa 2b work
antiviral, anti-proliferative, and immunomodulatory effects
114
what is the black box warning for interferon Alfa 2b
causes life-threatening neuropsychiatric effects
115
what are the two immunotherapy medications
rituximab
pembrolizumab
116
how does rituximab work
binds to B-lymphocyte CD20 surface antigens
it is a monoclonal antibody and causes antibody-dependent and complement dependent cytotoxicity
117
how does pembroizumab work
binds to PD-1 receptor on T-cells, blocking the PD-1 pathway-mediated inhibition of anti-tumor immune response, resulting in decreased tumor growth (monoclonal antibody)
118
what is the first thing you do when someone comes into the ER with chest pain
give an aspirin
119
what is a medication that can cause a gout flare and why?
aspirin
becomes a competitive inhibitor for the enzyme that produces uric acid
120
what two ways can we replace clotting factors in the body
fresh frozen plasma
vitamin k
121
what is a common side effect of iron and how do you reduce it
constipation
have patients take their iron supplement with vitamin c to enhance absorption and reduce constiption
122
what chemotherapy agent reduces ejection fraction
doxurubicin
123
what is the perfect chemotherapy medication for CML
imantinib (Gleevec)
124
what is a life threatening reaction to chemotherapy for the treatment of liquid tumors
tumor lysis syndrome
125
what is tumor lysis syndrome
when there is widespread cell death (especially from liquid tumors) and you start killing them, the cells release contents in circulation
increased potassium can cause cardiac arrest
126
what complication occurs with tamoxifen through increasing estrogen
blood clots
127
what is one of the worst side effects of methotrexate
bone marrow suppresion --> aplastic anemia
128
what is the topical chemotherapy medication
5-fluorouracil
(AK and superficial BCC)
129
what medication is used in conjunction with fluorouracil for colon cancer
leucovorin
130
what medication can be used to reverse toxic effects of methotrexate along with folate deficiency
leucovorin
131
what are the two medicines (chemotherapy agents) for autoimmune issues
methotrexate - RA
6 mercaptopurine - IBS
** they both have the primary indication to treat ALL
132
what lymphocytic cancer typically occurs in younger patients
Hodgkin lymphoma
133
what medication targets the Philadelphia chromosome
Imatinib (gleevec)
134
what two cancers have a mutation on the Philadelphia chromosome
CML and ALL
135
what is the medication that inhibits pulling apart of microtubules (inhibiting cell reproduction)
vincristine
136
which is the platinum based chemotherapy
cisPLATin
137
what is the chemical castration chemotherapy
goserelin
used for prostate cancer
138
what is the biggest thing to know about interferon (side effect)
causes severe neuropsychiatric effects
need to go through an eval before it is prescribed
139
what does rituximab recognize
recognizes CD20 antigens on B cells
this recognization causes other antibodies to kill antibody-mediated cytotoxicity or complement-mediated cytotoxicity
140
what are the two mechanisms of action that rituximab uses
anti-body-mediated cytotoxicity
complement-mediated cytotoxicity
141
what does keytruda recognize
recognizes the PD-1 antigen on the HOST immune cell
by blocking this receptor, it blocks the binding of the cancer cell which would cause inactivation of the immune cell
essentially keytruda allows the immune cell to stay active by inhibiting inactivation from the cancer cell
