Pharm

Question 1

Heparin

Answer 1

M: Activates antithrombin (decreases thrombin and factor Xa) – Unfractionated binds antithrombin and thrombin — LMWH (enoxaprin, dalteparin, fondaparinux) act more on factor Xa
C: Immediate for PE, acute coronary syndrome, MI, DVR – okay in pregnancy
T: HIT, osteoporosis – reversal with protamine sulfate

Question 2

Heparin induced thrombocytopenia

Answer 2

IgG antibodies against heparin-bound platelet factor 4 –> activates platelets –> thrombosis and thrombocytopenia (Tx: Argatroban/Bivalirudin - direct thrombin inhibitors)

Question 3

Argatroban, bivalirudin, dabigatrin

Answer 3

Inhibits thrombin directly – can be used instead of heparin if suffering from HIT

Question 4

Warfarin

Answer 4

M: Blocks y-carboxylation of vitamin K factors – affected by mutations in VKORC1 gene
C: Chronic anticoagulation – NOT IN PREGNANCY
T: Bleeding, skin/tissue necrosis, early transient hypercoagulability (start with heparin)
Antidote: Reverse with vitamin K, rapid reversal with fresh frozen plasma

Question 5

Heparin vs. Warfarin differences

Answer 5

H is parenteral, W is oral — H works in blood, W works in liver — H is acute, W is chronic — H is water soluble, W is lipid soluble (reason to use H in pregnancy)

Question 6

Direct factor Xa inhibitors

Answer 6

Apixaban, rivaroxaban

C: Treatment/prophylaxis for DVT and PE

Question 7

Thrombolytics

Answer 7

tPA, rPA, streptokinase, tenecteplase
M: Plasminogen to plasmin, cleaves thrombin and fibrin clots, increases PT/PTT
C: Early MI (within 6 hours), early ischemic stroke, severe PE
T: NO in active bleeding, recent surgery, or severe HTN – Tx toxicity with aminocaproic aicd

Question 8

Aspirin

Answer 8

M: IRREVERSIBLY inhibits COX1 and COX2 via acetylation – effect lasts 120 days (until new platelets are produced)
C: Antipyretic, analgesic, anti-inflammatory, antiplatelet
T: Gastric ulcers, tinnitus, renal failure, interstitial nephritis, Reye syndrome (microvesicular fatty necrosis in liver of children with virus)
OVERDOSE: Initial respiratory alkalosis then mixed metabolic acidosis-respiratory alkalosis

Question 9

ADP receptor inhibitors

Answer 9

Clopidogrel, prasugrel, ticagrelor, ticlopidine
M: Inhibit platelet aggregation by irreversibly blocking ADP receptors – prevent IIb/IIIa platelet surface
C: Acute coronary syndrome, coronary stenting
T: Neutropenia

Question 10

Cilostazol, dipyridamole

Answer 10

M: Phosphodiesterase III inhibitors, increase cAMP in platelets, resulting in platelet aggregation (vasodilators)
C: Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs

Question 11

Abciximab, eptifibatide, tirofiban

Answer 11

M: GPIIb/IIIA inhibitors - prevent platelet aggregation
C: Unstable angina

Question 12

Azathioprine, 6-mercaptopurine, 6-thioguanine

Answer 12

M: Purine analogs (decrease de novo purine synthesis) - activated by HGPRT
T: Myelosuppression

Question 13

Cladribine (2-CDA)

Answer 13

M: Purine analog, high intracellular concentrations due to adenosine deaminase resistance
T: Myelosuppression, nephrotoxicity, neurotoxicity

Question 14

Cytarabine (Ara-C)

Answer 14

M: Pyrimidine analog
T: Pancytopenia

Question 15

5-fluorouracil

Answer 15

M: Binds to folic acid and inhibits thymidylate synthase
T: Myelosuppression (not reversible)

Question 16

Methotrexate

Answer 16

M: Folic acid analog that inhibits dihydrofolate reductase
T: Myelosuppresion (reversible with leucovorin), hepatotoxicity, pulmonary fibrosis

Question 17

Bleomycin

Answer 17

M: Inhibits free radical formation and breaks DNA strands
T: Pulmonary fibrosis

Question 18

Dactinomycin

Answer 18

M: Intercalates in DNA
C: CHILDHOOD TUMORS
T: Myelosuppression

Question 19

Doxorubicin, daunorubicin

Answer 19

M: Generates free radicals and decreases DNA replication
C: KIDS CANCER
T: Dilated cardiomyopathy, alopecia, myelosuppression

Question 20

Busulfan

Answer 20

M: Cross links DNA
T: Pulmonary fibrosis

Question 21

Cyclophosphamide, ifosfamide

Answer 21

M: Cross link DNA at guanine N-7
T: Hemorrhagic cystitis (prevent with mesna)

Question 22

Nitrosoureas

Answer 22

M: Crosses blood-brain barrier, cross-link DNA
C: BRAIN TUMORS
T: CNS toxicity

Question 23

Paclitaxel

Answer 23

M: Stabilize microtubules so mitotic spindles can’t break down
T: Myelosuppression

Question 24

Vincristine, vinblastine

Answer 24

M: Bind B-tubulin and inhibit polymerization into microtubules
T: Peripheral neuropathy

Question 25

Cisplatin, carboplatin

Answer 25

M: Cross links DNA
T: Nephrotoxicity, ototoxicity

Question 26

Etoposide, teniposide

Answer 26

M: Inhibits topoisomerase II and increases DNA degradation

Question 27

Irinotecan, topotecan

Answer 27

M: Inhibit topoisomerase I and prevent DNA unwinding and replication

Question 28

Hydroxyurea

Answer 28

M: Inhibit ribonucleotide reductase and decrease DNA synthesis

Question 29

Prednisone, prenisolone

Answer 29

M: Alter gene transcription
T: Cushing-like symptoms, weight gain, central obesity, muscle breakdown, acne, osteoporosis, hypertension

Question 30

Bevacizumab

Answer 30

M: Monoclonal antibody against VEGF - inhibit angiogenesis

Question 31

Erlotinib

Answer 31

M: EGFR tyrosine kinase inhibitor

Question 32

Imatinib

Answer 32

M: Tyrosine kianse inhibitor of BCR-ABL and c-kit

Question 33

Rituximab

Answer 33

M: Monoclonal antibody against CD20 on B cell neoplasms

Question 34

Tamoxifen, raloxifene

Answer 34

M: SERMs - receptor antagonists in breast and agonist in bone
C: Breast cancer treatment (tamoxifen), osteoporosis prevention (raloxifene
T: Tamoxifen (increase endometrial cancer)

Question 35

Trastuzumab

Answer 35

M: Monoclonal antibody against HER2
T: Cardiotoxicity

Question 36

Vemurafenib

Answer 36

M: BRAF small molecule inhibitor
C: Metastatic melanoma