heme pharm Flashcards
Heparin
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
Enoxaparin/dalteparin
Low molecular weight heparin acting on factor Xa -> better half life than heparin but cannot be reversed as easily
Lepirudin/bivalirudin
Inhibit thrombin
Warfarin
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
Alteplase/reteplace
Thrombolytics aiding plasminogen to plasmin
Inc PT and PTT
Used vs early MI
Toxicity: Bleeding
Antidote: Aminocaproic acid
Aspirin
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
Clopidogrel/ticlopidine/ticagrelor
Block ADP receptors -> stop platelet aggegation. stop gpIIb/gpIIIa binding fibrinogen
Cilostazol/dipyridamole
Phosphodiesterase III inhibitors, increasing cAMP stoping aggegation of platelets
Tox: nausea, facial flushing, hypotension
Abciximab/eptifibatide/tirofiban
gpIIb/IIIa inhibitors
stop platelet aggegation
tox: bleeding, thrombocytopenia
Dactinomycin
Intercalates in DNA
Used vs childhood tumors
Toxicity: myelosuppression
Doxorubicin
Increase free radical breaks in DNA
vs tumors and leukemia
Toxicity: Dilated cardiomyopathy, alopecia, dexrazoxane used to prevent cardiotoxicity
Bleomycin
Free radicals causing DNA breaks
Used in Hodgkin’s lymphoma, testicular cancer
Toxicity: Pulmonary fibrosis
Cyclophosphamide/ifosfamide
X link DNA at guanin N-7
Used vs cancer
Toxicity: Myelosuppression, hemorrhagic cystitis (prevented with mesna)
Carmustine/lomustine/streptozocin
Cross blood brain barrier
aklylating agent
toxicity: CNS toxicity (ataxia)
Busulfan
Alkylating agent
Vs CML
Toxcity: Pulmonary fibrosis, hyperpigmentation
Vincristine/vinblastine
Vinca alklaloids bind to tubuin and stop polymerazation
Toxicity: Vinblastine: bone suppression
vincristine: neurotoxicity, paralytic ileus
Paclitaxel
Stabilize microtubules so spindle cannot break down
vs ovarian and breaest cancer
toxicity: myelosuppression
Cisplatin
Cross links DNA
Vs testicular/bladder/ovary/lung cancer
Toxicity: nephrotoxicity and acoustic nerve damage
Prevent nephrotoxicity with amifostine
Etoposide
Stops topoisomerase II
vs tumors
toxicity: alopecia, GI irritation
Hydroxyurea
Vs ribonucleotide reductase -> Decreased DNA synthesis (S phase)
Vs CML, sickle cell
Toxicity: GI upset
Prednisone
Apoptosis mechanism
Vs CLL, non hodgkin lymphoma
toxicity: cushing like syndrome, immunosuppression, cataracts, osteoporosis, peptic ulcers
tamoxifen
SERM-> antagonist of estrogen in breast and agonist in bone
Toxicity: endometrial cancer
Trastuzumab
Monoclonal antibody vs HER2
toxicity: cardiotoxic
Imatinib
tyrosine kinase inhibitor in CML
Toxicity: fluid retention
