heme pharm

Question 1

Heparin

Answer 1

Anticoagulation for immediate use and can be used in pregnancy

Toxicity: Increased bleeding, PROATMINE sulfate for antidote

Heparin induced thrombocytopenia -> IgG vs heparin platelet factor 4 leading to thrombosis

Question 2

Enoxaparin/dalteparin

Answer 2

Low molecular weight heparin acting on factor Xa -> better half life than heparin but cannot be reversed as easily

Question 3

Lepirudin/bivalirudin

Answer 3

Inhibit thrombin

Question 4

Warfarin

Answer 4

PT, extrinsic pathway

Stops epoxide reductase blocking gamma carboxylation of vitamin K factors (II, VII, IX, X, C, C)

Used as chronic anticoagulation, but not used in pregnancy

Toxicity: Warfarin tissue necrosis if protein C and S low -> give vitamin K or fresh frozen plasma as antidote

Question 5

Alteplase/reteplace

Answer 5

Thrombolytics aiding plasminogen to plasmin

Inc PT and PTT

Used vs early MI

Toxicity: Bleeding

Antidote: Aminocaproic acid

Question 6

Aspirin

Answer 6

COX2 inhibitor leading to decreased TXA2 decreasing platelet aggregation

Inc bleeding time

toxicity: gastric ulcer, tinnitis, reye’s syndrome in children, respiratory alk and metabolic acid

Question 7

Clopidogrel/ticlopidine/ticagrelor

Answer 7

Block ADP receptors -> stop platelet aggegation. stop gpIIb/gpIIIa binding fibrinogen

Question 8

Cilostazol/dipyridamole

Answer 8

Phosphodiesterase III inhibitors, increasing cAMP stoping aggegation of platelets

Tox: nausea, facial flushing, hypotension

Question 9

Abciximab/eptifibatide/tirofiban

Answer 9

gpIIb/IIIa inhibitors

stop platelet aggegation

tox: bleeding, thrombocytopenia

Question 10

Dactinomycin

Answer 10

Intercalates in DNA

Used vs childhood tumors

Toxicity: myelosuppression

Question 11

Doxorubicin

Answer 11

Increase free radical breaks in DNA

vs tumors and leukemia

Toxicity: Dilated cardiomyopathy, alopecia, dexrazoxane used to prevent cardiotoxicity

Question 12

Bleomycin

Answer 12

Free radicals causing DNA breaks

Used in Hodgkin’s lymphoma, testicular cancer

Toxicity: Pulmonary fibrosis

Question 13

Cyclophosphamide/ifosfamide

Answer 13

X link DNA at guanin N-7

Used vs cancer

Toxicity: Myelosuppression, hemorrhagic cystitis (prevented with mesna)

Question 14

Carmustine/lomustine/streptozocin

Answer 14

Cross blood brain barrier

aklylating agent

toxicity: CNS toxicity (ataxia)

Question 15

Busulfan

Answer 15

Alkylating agent

Vs CML

Toxcity: Pulmonary fibrosis, hyperpigmentation

Question 16

Vincristine/vinblastine

Answer 16

Vinca alklaloids bind to tubuin and stop polymerazation

Toxicity: Vinblastine: bone suppression

vincristine: neurotoxicity, paralytic ileus

Question 17

Paclitaxel

Answer 17

Stabilize microtubules so spindle cannot break down

vs ovarian and breaest cancer

toxicity: myelosuppression

Question 18

Cisplatin

Answer 18

Cross links DNA

Vs testicular/bladder/ovary/lung cancer

Toxicity: nephrotoxicity and acoustic nerve damage

Prevent nephrotoxicity with amifostine

Question 19

Etoposide

Answer 19

Stops topoisomerase II

vs tumors

toxicity: alopecia, GI irritation

Question 20

Hydroxyurea

Answer 20

Vs ribonucleotide reductase -> Decreased DNA synthesis (S phase)

Vs CML, sickle cell

Toxicity: GI upset

Question 21

Prednisone

Answer 21

Apoptosis mechanism

Vs CLL, non hodgkin lymphoma

toxicity: cushing like syndrome, immunosuppression, cataracts, osteoporosis, peptic ulcers

Question 22

tamoxifen

Answer 22

SERM-> antagonist of estrogen in breast and agonist in bone

Toxicity: endometrial cancer

Question 23

Trastuzumab

Answer 23

Monoclonal antibody vs HER2

toxicity: cardiotoxic

Question 24

Imatinib

Answer 24

tyrosine kinase inhibitor in CML

Toxicity: fluid retention

Question 25

Rituximab

Answer 25

Monoclonal antibody vs CD20 (B cell)

Question 26

Vemurafenib

Answer 26

Vs Braf kinase w/ V500 E mutation in melanoma

Question 27

Bevacizumab

Answer 27

vs VEGF stopping angiogenesis