Heme/ onco

Question 1

What is the mechanism of action of argatroban or bivalirudin? what is their main use?

Answer 1

derived from leeches
directly inhibit thrombin

Used for: HIT

Question 2

Name at least one potentially life-threatening toxicity of the antiplatelet drug ticlopidine.

Answer 2

neutropenia (ticlopidine only) and TTP/HUS may arise as toxicities of ADP receptor inhibitor

Question 3

What is the effect of aspirin on bleeding time, prothrombin time (PT), and partial thromboplastin time (PTT)?

Answer 3

inc bleeding time only

doesnt affect clotting factors

Question 4

What is the mechanism of action of abciximab?

Answer 4

It binds the glycoprotein IIb/IIIa receptor on activated platelets and prevents aggregation

Question 5

What is the mechanism of action for the anticoagulants apixaban and rivaroxaban?

Answer 5

bind xa directly

Xa is in the name!!!

Question 6

A patient who was started on heparin therapy develops heparin-induced thrombocytopenia. How should you change his treatment regimen

Answer 6

Use argatroban or bivalirudin (direct thrombin inhibitors) instead of heparin

Question 7

What are three common clinical uses of clopidogrel, ticlopidine, prasugrel, and ticagrelor? MOA?

Answer 7

ADP receptor inhibitors

Acute coronary syndrome, during coronary stenting, and to reduce the incidence or recurrence of thrombotic stroke

Question 8

What are clinical uses of abciximab?

Answer 8

Unstable angina or during percutaneous transluminal coronary angioplasty

Question 9

A patient with recurrent DVTs is prescribed a direct factor Xa inhibitor in hopes of preventing a pulmonary embolus. Which is he prescribed?

Answer 9

Rivaroxaban

Question 10

How is warfarin metabolized?

Answer 10

By the cytochrome P-450 pathway in the liver

Question 11

What are the clinical uses of cilostazol and dipyridamole?

Answer 11

Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs, angina prophylaxis

Question 12

During pregnancy, is heparin or warfarin the preferred method of anticoagulation?

Answer 12

heparin - doesnt cross the placenta

Question 13

How would you reverse
heparin
warfarin

Answer 13

heparin - protamine sulfate

warfarin - vit K , fresh frozen plasma

Question 14

Name three types of glycoprotein IIb/IIIa inhibitors.

Answer 14

Abciximab, eptifibatide, tirofiban

Question 15

Name the two phosphodiesterase inhibitors and how exactly they function

Answer 15

cilostazol, dipyridamole

inc cAMP and prevent platelet aggregation

Question 16

Which alkylating agent requires activation by the liver (and thus might not be effective in a patient with liver failure)?

Answer 16

cyclophosphamide

Question 17

Which antineoplastic agents interfere with nucleotide synthesis?

Answer 17

Methotrexate and 5-fluorouracil decrease thymidine synthesis, and 6-mercaptopurine decreases purine synthesis

Question 18

What are three neoplasms in which dactinomycin is commonly used?

Answer 18

Ewing sarcoma, Wilms tumor, rhabdomyosarcoma (in childhood tumors, actinomycin D, because children act out)

Question 19

What common mechanism is seen in the antineoplastic drugs bleomycin, daunorubicin, and doxorubicin?

Answer 19

These drugs generate free radicals, which can cause DNA strand breaks and halt cell replication

Question 20

Which alkylating agent would you choose in a patient about to undergo hematopoietic stem cell transplantation?

Answer 20

Busulfan, which will ablate the host bone marrow before transplantation (also used in the treatment of chronic myelogenous leukemia)

Question 21

Name two neoplasms commonly treated with bleomycin

Answer 21

Testicular cancer and Hodgkin lymphoma

Question 22

What anti-neoplastic can cause hemorrhagic cystitis

Answer 22

cyclophosphamide

Question 23

What can you prevent hemorrhagic cystitis from cyclophosphamide with?

Answer 23

messna

Question 24

What is the main s/e of doxorubicin

Answer 24

cardiotoxicity

Question 25

what are the nitrosureas - carmustine, lomustine used for?

Answer 25

brain tumors

Question 26

What drug is used to treat hairy cell lukemia?

Answer 26

cladribine

Question 27

What is the s/e of cytarabine?

Answer 27

pancytopenia

Question 28

Name the alkylating agents

Answer 28

1. busulfan
2. cyclophosphamide
3. nitrosureas