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Pharm Flashcards

1
Q

Ondansetron (zofran)

A

Anti-emetic - acute

MOA: bind serotonin receptors in GI tract

Tox: Headache, hiccups, QT long, constipation

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2
Q

Aprepitant (Emend)

A

Anti-emetic - delayed

MOA: NK1 receptor antagonist (central and peripheral action)

Tox: drug interaction, hiccups, fatigue

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3
Q

Prochlorperazine (compazine)

A

Anti-emetic - delayed

MOA: bind dopamine D1/D2 receptors in chemoreceptor trigger zone

Tox: extrapyramidal side effects, sedation

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4
Q

Dexamethasone (Decadron)

A

corticosteroid used for anti-emetic properties

MOA: unknown

Tox: glucose intolerance, insomnia, agitation

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5
Q

Lorazepam (Ativan)

A

benzo used for anit-emetic properties

MOA: limbic, thalamic and hypothalamic areas via GABA

Tox: sedation, retrograde amnesia

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6
Q

Metoclorpramide (Reglan)

A

Anti-emetic

MOA: bind dopamine D1/D2 receptors in chemoreceptor trigger zone

Tox: extrapyramidal side effects, sedation

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7
Q

Epoetin alfa

A

short acting RBC growth factor
- must have adequate iron stores

Tox: hypertension, rash, arthralgias

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8
Q

Darbepoetin

A

long acting RBC growth factor

- must have adequate iron stores

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9
Q

Filgrastim

A

G-CSF - myeloid growth factor for neutropenia

Tox: fever (cytokines), bone pain (marrow elements), increase in uric acid, LDH, alk phos, rash

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10
Q

Pegfilgrastim

A

G-CSF - myeloid growth factor for neutropenia

  • also has PEG to double weight (decreases clearance)

Tox: fever (cytokines), bone pain (marrow elements), increase in uric acid, LDH, alk phos, rash

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11
Q

Alkylating agents toxicity

A
  • Bone marrow suppression
  • nausea, vomiting diarrhea, anorexia
  • sterility
  • amenorrhea
  • 2nd malignancy
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12
Q

MOA of platinum compounds

A

binds to DNA, RNA and produces covalent crosslinks

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13
Q

resistance mechanisms

A
  • increase glutathione-S-transferase
  • augmented DNA repair
  • altered cellular transport
  • altered DNA repair mechanism
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14
Q

Cisplatin

A

Platinum alkylating agent

  • highly emetogenic (use zofran and dexamethasone)
  • nephrotoxic
  • neurotoxic
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15
Q

Cisplatin nephrotoxicity

A

inactivation of renal brush border (rf = high plasma levels, kidney damage, hypoalbumin, female, other drugs)

  • acute - decrease electrolyte, increase BUN
  • chronic - reduced GFR, normal creatinine
  • anemia

Prevention - hydration, hypertonic saline, mannitol (osmotic diuretic), infusions

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16
Q

cisplatin neurotoxicity

A
  • axonal degeneration
  • peripheral neuropathy (stocking glove, cumulative doses)
  • auditory impairment
  • visual disturbances
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17
Q

oxaliplatin

A

Platinum alkylating agent

  • sensory neuropathy in cold
  • infusion reaction
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18
Q

carboplatin

A

Platinum alkylating agent

  • hypersensitivity
  • nausea vomiting
  • neurotoxicity
  • taxane?
  • no nephrotoxicity
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19
Q

cyclophosphamide

A

Nitrogen mustard alkylator

MOA: binds to nucleophiles, DNA crosslinking, inactivation of template

Extra: removed by dialysis, is a prodrug activiated in lived

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20
Q

cyclophosphamide toxicity

A
  • N/V
  • myelosuppressive
  • cardionecrosis
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21
Q

ifosfamide

A

nitrogen mustard alkylator

  • requires hepatic P450 for activation
  • produces acrolein
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22
Q

acrolein

A

metabolite of cyclophosphamide and ifosfamide

urotoxic

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23
Q

ifosfamide toxicity

A

neurotoxicity
hemorrhagic cystitis
neutropenia
nephrotoxicity - ATN

treated with methylene blue

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24
Q

mensa

A

binds acrolein in the bladder, requires multiple doses

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25
prednisone
glucocorticoid - immunsuppressive effects - lympholytic
26
flutamide
anti androgen receptor Tox: hot flashes, gynecomastia and breast tenderness
27
bicalutamide
anti androgen receptor Tox: hot flashes, gynecomastia and breast tenderness
28
tamoxifen
anti estrogen binder, cell cycle specific | stimulates TGF-beta which inhibits TGF alpha and IGF-1 leading to decreased proliferation
29
raloxifene
anti estrogen binder, cell cycle specific | stimulates TGF-beta which inhibits TGF alpha and IGF-1 leading to decreased proliferation
30
letrozole
aromatase inhibitor - blocks conversion of androgen to estrogen, no effects of cotricosteroid Tox: arthralgias, ms pain, hot flashes, LFT
31
anastrozole
aromatase inhibitor - blocks conversion of androgen to estrogen, no effects of corticosteriod Tox: astheia, hot flashes, peripheral edema, arthralgias
32
exemestane
aromatase inhibitor - blocks conversion of androgen to estrogen, no effects of corticosteriod Tox: hot flashes, fatigue, headache
33
leuprolide
LH-RH agonist - suppression of gonadotropin, results in LH/FSH decrease Usually has short term disease flare due to short term surge
34
goserelin
LH-RH agonist - suppression of gonadotropin, results in LH/FSH decrease Usually has short term disease flare due to short term surge
35
methotrexate
binds reversibly to DHF reductase, S phase specific - leads to no purine synthesis
36
methotrexate pharmokinetics
- binds to albumin = drug interactions - can accumulate in effusions - high doses can cross to CNS
37
most important type of methotrexate metabolism
polyglutamation by enzyme FPGS
38
leucovorin
stable form of reduced folate, used for rescue of healthy cells timing is very important should be continued until MTX is less than .05uM
39
methotrexate toxicity
- renal toxicity (need to hydrate/alkalyze urine) - GI toxicity - effusions Rare - hepatotoxicity - derm - myelosuppression - others
40
methotrexate drug interactions
- albumin binding - nephrotoxic drugs - * can be helped with L-asparaginase
41
cytarabine
Chain elongation terminator | only available as an infusion, can cross BBB, can distribute into tears
42
cytarabine toxicity
normal - myelosuppression - flu like - mucositis - hand and foot high - cerebellar tox - ocular tox - tearing - pulmonary edema
43
5-Fluorouracil
false pyrimidine that inhibits formation of thymidine, effects augmented by leucovorin
44
5-Fluorouracil pharmacokinetis
metabolized by DPD (many polymorphisms) can be used in pts with hepatics and renal dysfunction
45
5-Fluorouracil toxicity
- myelosuppresion - mucositis/diarrhea - hand/foot - neurotox - chest pain, EKG - photosensitivity
46
gemcitabine
similar to cytarabine, can incorporate in RNA, metabolized by cytidine deaminase (in urine)
47
gemcitabine tox
- myelosuppression - flu - flushing/headache
48
gemcitabine interactions
radiosensitizer, enhances cytotoxicity of cisplatin
49
anthracyclines MOA
passive diffusion, nucleated cells, intercalate DNA, Topo 2 inhibitor, form reactive compounds, oxygen radicals, uses iron 3+, important in cardiotox
50
anthracyclines Tox
- myelosuppression - alopecia - N/V - extravasation - *cardiotoxicity acute and chronic (EKG changes vs LVEF chagnes)
51
dexrazoxane
chelating agent used to prevent cardiotoxicity in anthracycline use, EDTA analog, binds to iron
52
doxorubicin
anthracyclines
53
daunorubicin
anthracyclines
54
liposomal anthracycline
made to reduce cardiotoxicity, slows release of the drug
55
irinotecan
topo 1 inhibitor, given by IV
56
irinotecan side effects
neutropenia, thrombocytopenia, eosinophilia - diarrhea (early cholinergic - late watery diarrhea) - N/V - rare pneumonitis
57
irinotecan resistance
p-glycoprotein - reduced drug accumulation - altered intracellular drug distribution - variability in drug metabolism - differences in Topo 1 expression/mutation
58
vinca alkaloids MOA
disturb microtuble formation, prevent formation of mitotic spindle
59
vinca alkaloids tox
vincristine - neurotoxicity (peripheral neuropathy) - decrease autonomic - NOT bone marrow vinblastine - myelosuppression
60
vinblastine
vinca alkaloid - bone marrow problems
61
vincristine
vinca alkaloid - neurotoxicity problems vesicant
62
vinorelbine
vinca alkaloid - same toxicity as other vinca alkaloid
63
paclitaxel
M phase - enhances microtubule polymerization - resistance in MDR, alterations in tubules tox: myelosuppression, meuropathy, infusion reaction
64
docetaxel
M phase - enhances microtubule polymerization - resistance in MDR, alterations in tubules tox: myelosuppression, meuropathy, infusion reaction
65
rituximab
anti-CD20, used in non-hodgkin lymphoma and RA
66
rituximab
immunosuppressive, infusion related, tumor lysis, HAMA/HACA
67
cetuximab
binds to EGFR tox: infusion related, rash, asthenia, N/V, hepato
68
trastuzumab
anti HER2/neu monoclonal Tox: infusion related, pain, myelosuppresion, cardiotox`
69
bevacizumab
anti VEGF preventing angiogenesis Tox: imparied wound healing, hemorrhage, hypertension, trombotic events, bleeding
70
ecluzimab
anti-complement (C5) used to treat PNH
71
imatinib
small molecule inhibitor of BRC-ABL tyrosine kinase Tox: edema, cytopenias, LFT, cardiotoxicity
72
erlotinib
EGFR inhibitor
73
MOA of imids
antiangiogensis - basic fibroblast growth factor and VEGF - immunomodulatory - induces apoptosis
74
drugs that cause delayed nausea and vomiting
Cyclophosphamide, cisplatinum, and doxorubicin
75
unfractionated hepartin
requires AT-III, augments its, neutralizes thrombin, 10, 9 and 11a
76
argatroban
direct thrombin inhibitors used in HIT
77
enoxaparin
LMWH inhibits factor Xa more than 2 (thrombin) - leads to less bleeding
78
dalteparin
LMWH
79
Fondaparinux
synthetic low molecular weight heparin
80
protamine
used to reverse heparin, cant be used with fondazparinux
81
Idarucizamab
reversal agent of direct thrombin inhibitors
82
Lepirudin
direct thrombin inhibitor, no AT3 necessary
83
Dabigatran
direct thrombin inhibitor - no ATIII necessary
84
Rivaroxaban
direct factor Xa inhibitor
85
Clopidogrel
ADP receptor antagonist
86
Prasugrel
ADP receptor antagonist
87
abciximab
GPIIb/IIIa blockers – IV
88
tetratogenic antithromin med
warfarin

Heme/onc (5 decks)

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