Heme/ onco Flashcards
What is the mechanism of action of argatroban or bivalirudin? what is their main use?
derived from leeches
directly inhibit thrombin
Used for: HIT
Name at least one potentially life-threatening toxicity of the antiplatelet drug ticlopidine.
neutropenia (ticlopidine only) and TTP/HUS may arise as toxicities of ADP receptor inhibitor
What is the effect of aspirin on bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT)?
inc bleeding time only
doesnt affect clotting factors
What is the mechanism of action of abciximab?
It binds the glycoprotein IIb/IIIa receptor on activated platelets and prevents aggregation
What is the mechanism of action for the anticoagulants apixaban and rivaroxaban?
bind xa directly
Xa is in the name!!!
A patient who was started on heparin therapy develops heparin-induced thrombocytopenia. How should you change his treatment regimen
Use argatroban or bivalirudin (direct thrombin inhibitors) instead of heparin
What are three common clinical uses of clopidogrel, ticlopidine, prasugrel, and ticagrelor? MOA?
ADP receptor inhibitors
Acute coronary syndrome, during coronary stenting, and to reduce the incidence or recurrence of thrombotic stroke
What are clinical uses of abciximab?
Unstable angina or during percutaneous transluminal coronary angioplasty
A patient with recurrent DVTs is prescribed a direct factor Xa inhibitor in hopes of preventing a pulmonary embolus. Which is he prescribed?
Rivaroxaban
How is warfarin metabolized?
By the cytochrome P-450 pathway in the liver
What are the clinical uses of cilostazol and dipyridamole?
Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs, angina prophylaxis
During pregnancy, is heparin or warfarin the preferred method of anticoagulation?
heparin - doesnt cross the placenta
How would you reverse
heparin
warfarin
heparin - protamine sulfate
warfarin - vit K , fresh frozen plasma
Name three types of glycoprotein IIb/IIIa inhibitors.
Abciximab, eptifibatide, tirofiban
Name the two phosphodiesterase inhibitors and how exactly they function
cilostazol, dipyridamole
inc cAMP and prevent platelet aggregation
Which alkylating agent requires activation by the liver (and thus might not be effective in a patient with liver failure)?
cyclophosphamide
Which antineoplastic agents interfere with nucleotide synthesis?
Methotrexate and 5-fluorouracil decrease thymidine synthesis, and 6-mercaptopurine decreases purine synthesis
What are three neoplasms in which dactinomycin is commonly used?
Ewing sarcoma, Wilms tumor, rhabdomyosarcoma (in childhood tumors, actinomycin D, because children act out)
What common mechanism is seen in the antineoplastic drugs bleomycin, daunorubicin, and doxorubicin?
These drugs generate free radicals, which can cause DNA strand breaks and halt cell replication
Which alkylating agent would you choose in a patient about to undergo hematopoietic stem cell transplantation?
Busulfan, which will ablate the host bone marrow before transplantation (also used in the treatment of chronic myelogenous leukemia)
Name two neoplasms commonly treated with bleomycin
Testicular cancer and Hodgkin lymphoma
What anti-neoplastic can cause hemorrhagic cystitis
cyclophosphamide
What can you prevent hemorrhagic cystitis from cyclophosphamide with?
messna
What is the main s/e of doxorubicin
cardiotoxicity
what are the nitrosureas - carmustine, lomustine used for?
brain tumors
What drug is used to treat hairy cell lukemia?
cladribine
What is the s/e of cytarabine?
pancytopenia
Name the alkylating agents
- busulfan
- cyclophosphamide
- nitrosureas
