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PAM Semester 2 > Pharm Exam Heme/Onc > Flashcards

Pharm Exam Heme/Onc Flashcards

1
Q

What does type 4 hyper sensitivity reaction have to do with?

A

Inflammation

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2
Q

What are the Cardinal Signs of Chronic inflammation

A

There are no cardinal signs for chronic inflammation

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3
Q

5 classic signs of inflammation

A 
pain
Heat
Redness
Swelling
Loss of function
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4
Q

Steroid Side effects

A

??????????????

Wheel O side effects

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5
Q

Short acting Glucocorticoids

A

Hydrocortisone
Cortisol
Cortisone

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6
Q

Intermediate acting Glucocorticoids

A

Prednisone
Prednisolone
Methylprednisolone
Triamcinolone

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7
Q

Long acting Glucocorticoids

A

Dexamethasone

Betamethasone

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8
Q

Hydrocortisone 2.5% cream

A

Responsive Dermatomes

Contraindications
Do not use super potent from on face, groin, axillae
Exclude viral diseases i.e. chicken pox, measles

Adverse:
Burning, stinging, pruritis, erythema, skin atrophy

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9
Q

Prednisone

A

Glucocorticoid

Interactions:
Barbiturates may decrease effects,
potentiated by ketoconazole

Contra:
Fungal, live vaccines

Warnings:
Strongyloidies, hypothyroidism, ocular herpes, cirrhosis, renal failure, hypertension, osteoporosis, diabetes, Tuberculosis, amebiasis

Adverse:
infection, glaucoma, cataracts, hypokalemia, hypocalcemia, hypernatremia, hypertension, CHF, psych, osteoporosis

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10
Q

Dexamethasone

A

Injection, IV, IM, joint, intra-lesion
Glucocorticoid

When oral therapy is not feasible

Contra:
Systemic fungal, Live vaccine

Adverse:
can mask infections, infection, glaucoma, cataracts, hypokalemia, hypocalcemia, hyponatremia, hypertension, CHF, psych, osteoporosis, hyperglycemia

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11
Q

Where does histamine come from?

A

Mast Cells

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12
Q

Histamine H1 receptors

A

smooth muscle contraction increasing capillary permeability

Histamine promote vasodilation through release of Nitric Oxide

H1 receptors mediate pathological response like allergic reaction, atopic derm, conjunctivitis, urticaria, bronchoconstriction, asthma, anaphylaxis

Smooth muscle, vasc perm via NO, Skin Resp

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13
Q

Examples of H1 receptor blockers

A

diphenhydramine
Cetirizine
Loratadine

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14
Q

Examples of H2 receptor blockers

A

Cimetidine

Ranitidine

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15
Q

H2 receptors mediate

A

Gastric acid secretory action of histamine

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16
Q

H1 receptors mediate

A 
smooth muscle contraction
increased vascular permeability
pruritus
Prostaglandin generation
Decreased AV conduction time + Tachycardia

VAPPS

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17
Q

First generation H1 receptor blockers

A

Diphenhydramine

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18
Q

Why use 2nd generation Antihistamines

A

they reduce allergic response with little to no sedation

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19
Q

Examples of 2nd generation Antihistamines

A

Cetirizine
Loratadine
Fexofenadine

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20
Q

Side effects of antihistamine

same as anticholinergics

A 
Hot
Red
Dry
Blind
Mad
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21
Q

diphenhydramine

A

antihistamine

Interactions:
potentiates CNS depression with alcohol & other CNS depressants

Adverse: Drowsiness, dizziness, anticholinergic effects, excitability in children

25-50mg q4-6 max 300mg

Warnings:
Asthma, resp disorders, glaucoma, hyperthyroidism, hypertension, CVD, Pregnancy Cat B in 3rd trimester, not recommended

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22
Q

Cetirizine

A

Allergic rhinitis

Interactions:
potentiates CNS depression with alcohol & other CNS depressants

Adverse:
Drowsiness, somnolence, fatigue, dry mouth

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23
Q

Causes of microcytic Anemia

A

TICS

Thalassemia
Iron deficiency
Chronic disease
Sideroblastic

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24
Q

Causes of normocytic anemia

A

Aplasia
Renal disease
inflammation
Chronic disease

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25
Causes of macrocytic anemia
B12 deficiency Folate deficiency Myelodysplasia Alcohol MCV over 100
26
Thalassemia
Hgb H Thal A = need folic acid supplements avoid iron and oxidative drugs like dapsone, quinidine, primaquine, sulfonamides, nitrofurantoin Thal B Major needs transfusions to keep levels at 12g/dl Iron overload may result in hemosiderosis, HF, cirrhosis, endocrinopathies DQPSN dapsone, quinidine, primaquine, sulfonamides, nitrofurantoin
27
Deferoxamine
Acute iron intoxication Chronic iron overload (multiple transfusions) Iron chelating agent Contra: Renal disease, anuria
28
Ferrous sulfate
Iron deficiency, iron anemia 325mg TiD Contra: Hemochromatosis Hemosiderosis Interactions Tetracycline (inhibits) Adverse: Nausea, abdominal discomfort, pain, constipation, diarrhea
29
Anemia of chronic disease (inflammation) | diseases
``` Chronic infections: TB Chronic UTI neoplastic Liver disease from ETOH Hyperthyroidism/hypothyroidism auto immune SLE/RA ``` TTULAC
30
Anemia of chronic disease (inflammation) | Treatment
treat underlying cause possible transfusion EPO No iron Cause, Transfusion, EPO, no Iron
31
Sideroblastic anemia
B6 deficient, fix with B6 Chronic Alcoholism, B6 deficiency Tx: treat underlying disease chelating agent for lead transfusion, remove toxins
32
What is pernicious anemia
decrease in red blood cells when the body can't absorb enough vitamin B-12
33
Who is at risk for pernicious anemia
Vegan, vegetarian diet, gastric or bariatric surgery
34
B12 MOA
Conversion of homocysteine to methionine | Conversion of L methylmalonyl CoA to succinyl CoA
35
Medicines that lead to B12 deficiency
Metformin | Colchicine
36
Folic Acid
megaloblastic anemia with folic acid deficiency from nutrition, pregnancy, childhood Pregnancy cat A May antagonize phenytoin False low serum and red cell folate levels may occur with antibiotics (i.e. tetracycline) Phenytoin, tetracycline, Cat A
37
Hemochromatosis Tx
Iron chelating agent | IV deferoxamine or PO defrasirox
38
Hereditary Hemochromatosis Tx:
Phlebotomy
39
Hemolytic anemia
SPIRE ``` Splenectomy Prednisone IVIG Rituximab EPO ```
40
Rituximab
CD20 directed cytolytic monoclonal antibody ``` Adverse: Fatal infusion related reaction Severe mucocutaneous reactions Hep B virus reactivation Progressive multifocal leukoencephalopathy ```
41
IVIG
IV immune globulin Indications: ITP Immune thrombocytopenia AIHA Autoimmune hemolytic anemia
42
Hydroxurea
reduces the need for transfusion in sickle cell, reduces pain Warning: Myelosuppression, malignancy Kills babies (fetal tox) Adverse: Leukopenia, Thrombocytopenia, anemia, neutropenia, GI upset, anorexia, hair loss MOA: Improved tissue oxygenation and decreased inflammation
43
Transfusion reaction treatment
Supportive benadryl allergic reactions (mild) tylenol for fever
44
Secondary causes of polycythemia vera
Tobacco use Living at high altitude
45
Polycythemia vera treatment
Serial phlebotomy
46
one major cause of reactive thrombosis
inflammation
47
Treatment for VTE (DVT/PE)
Antiplatelet (aspirin Clopidigrel) Thrombolytics (TPA) Anticoags (Heparin/warfarin) Indirect thrombin inhibitors (heparin/lovenox) Direct thrombin inhibitors (dabigatran) Direct factor X inhibitors (apixaban/rivaroxaban) Vitamin K antagonists (warfarin)
48
Clopidigrel
Plavix P2Y12 platelet inhibitor Contra: active bleed Interactions: Avoid CYP2C19 inhibitors (omeperazole)
49
Ticagrelor
Brilinta P2Y12 platelet inhibitor Adverse: Active bleed (fatal) Warning: Bleed risk Contra: History of intracranial hemorrhage Active bleed
50
Aggrenox
Combination anti platelet Interactions: increased risk of bleeding with anitcoags and anti platelets Contraindications: NSAID allergy, asthma, rhinitis, polyps, Viral infections in children (reyes)
51
Anti coagulant prophylaxis | to prevent or treat DVT, PE, Arterial thromobosis
Heparin Lovenox Fondaparinux
52
Oral anti coagulants for long term use
Coumadin Dabigatran Apixaban
53
Anti coagulants and their factors
LMWH (Xa) UFH (IIa, Xa) Warfarin (IIa, VIIa, IXa, Xa) Direct Thrombin inhibitor (IIA)
54
Unfractionated heparin | administration
Unfractionated heparin generally is administered intravenously as an initial bolus followed by a continuous infusion using a nomogram. Subsequent dose adjustments are made based on aPTT or anti-factor Xa activity values
55
Heparin MOA
Indirect inhibitor of thrombin factor IIa and Xa Greatly enhances antithrombin to inactivate these
56
low molecular weight (LMW) heparins | MOA
low molecular weight (LMW) heparins efficiently inactivate factor Xa via antithrombin
57
Baseline testing prior to administration of unfractionated heparin or LMW heparin generally includes
coagulation studies (prothrombin time [PT], activated partial thromboplastin time [aPTT]), and a complete blood count (CBC) with platelet count.
58
Heparin antidote
Protamine sulfate | slow IV infusion
59
Enoxaparin
Lovenox (LMWH) Contra: major bleeding, History of HIT within 100 days, Warning: Spinal/epidural hematomas Adverse: Bleeding
60
fondaparinux
Arixtra Warning: Spinal/epidural hematomas Factor Xa inhibitor
61
Coumadin dosing
Warfarin is monitored by PT/INR For most patients initiating warfarin therapy, we suggest an initial dose of ≤5 mg daily for the first two days rather than higher "loading" doses We generally use 5 mg for most healthy adults but might use a lower dose (eg, 2.5 mg daily, 5 mg alternating with 2.5 mg) for women older than 70, men older than 80, or those who are frail, malnourished, have liver or kidney disease, heart failure, or are receiving a medication known to increase warfarin sensitivity. An automated dosing calculator is available at www.WarfarinDosing.org/Source/Home.aspx. Dosing on subsequent days is guided by the PT/international normalized ratio (INR) value
62
Direct thrombin inhibitors & Factor Xa blockers
DTI = dabigatran (Pradaxa) ``` Factor Xa blockers apixaban (eliquis) Rivaroxaban (Xarelto) LMWH (lovenox) UFH (heparin) Vitamin K (Coumadin) ```
63
dabigatran
Pradaxa (Direct thrombin inhibitors) Contra: active bleeds, mechanical prosthetic heart valve Warnings: Spinal/epidural hematomas premature discontinuation increases thombolytic events
64
Apixaban
Eliquis (Factor Xa inhibitor) Contra: active bleeding Warnings: Spinal/epidural hematomas premature discontinuation increases thombolytic events
65
Coumadin antidote
Vitamin K
66
Dabigatran antidote
Idaruvizumab
67
Apixaban Rivaroxaban Antidote
PCC or Recombinant coagulation factor Xa (Prothrombin complex concentrate, also known as factor IX complex, is a medication made up of blood clotting factors II, IX, and X) Prothrombin complex or factor 10
68
Fibrinolytics MOA
breaks down clots via conversion of plasminogen to plasmin
69
ITP Treatments
Immune thrombocytopenia ( Glucocorticoids IVIG Anti-RhoD RhoGAM
70
TTP/HUS Treatment
``` Emergent plasma exchange if TTP>HUS, eculizumab if HUS>TTP, RBC transfusions, Hemodialysis IVIG Corticosteroids Rituximab Splenectomy ```
71
Eculizumab
Soliris Treatment of atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy. Warnings: Serious meningococcal infections Pregnancy Contra: Unresolved serious Neisseria meningitidis infection. Individuals not vaccinated against Neisseria meningitidis. If pregnant and exposed call number Soliris, HUS, No Pregnancy, meningitis or no vaccine
72
HELLP Treatment
Hemolysis, elevated liver enzymes & low platelet syndrome Prompt delivery is main goal, IV magnesium sulfate to prevent seizures, anti-hypertensives, blood product transfusions Delivery, mag, ACE/ARB, blood
73
Qualitative platelet disorder
Von Williebrands Disease
74
Von Williebrands Disease Treatment
``` Hemostatic medications (for bleeding prevention) Desmopressin(DDAVP), Aminocaproic acid, TXA ``` ``` Replacement therapy (if necessary) vWF concentrate and/or factor VIII concentrate ``` Pressors, TXA, von willie factor, factor 8
75
DDAVP (Desmopressin)
Class Vasopressin (synthetic) MOA Stimulates vWF release from endothelium
76
Hemophilia Treatment
Factor 8 or 9 infusions Desmopressin, aminocaproic acid, TXA (no blood thinners, trauma, contact sports)
77
Vitamin K deficiency treatment
Give vitamin K
78
DIC treatmtent
correct underlying cause, FFP or cryoprecipitate transfusion, platelet transfusion if bleeding predominates, tissue plasminogen activator (TPA) if clots predominate
79
AML treatment | Acute Myeloid Leukemia
Chemo | Palliative chemo option = hydroxyurea
80
ALL | Acute Lymphoid Leukemia
As with AML, treatment is aggressive induction chemotherapy then consolidation +/- bone marrow transplant
81
Chronic Myelogenous Leukemia (CML) | Treatment
Treatment: tyrosine kinase inhibitors, which inhibit the bcr-abl oncogene. Examples: imatinib (Gleevec®),
82
tyrosine kinase inhibitors,
imatinib (Gleevec®),
83
imatinib (Gleevec®) MOA
Prevents ATP binding Blocks proliferation and induces apoptosis in Bcr-Abl and Philadelphia chromosomes Also inhibits tyrosine kinase for platelet derived growth factor Prevents ATP, TKI ,oncogene
84
Chronic Lymphocytic Leukemia (CLL/SLL) treatment
Brutons TKI (ie ibrutinib)
85
Ibrutinib
Imbruvica Chronic Lymphocytic Leukemia (CLL) Bruton tyrosine kinase (BTK) inhibitor BTK for CLL
86
Hodgkin’s Lymphoma Treatment
ABVD chemotherapy +/- radiation therapy
87
ABVD Therapy
ABVD Adriamycin Bleomycin Vinblastine Dacarbazine
88
Non-Hodgkin’s Lymphoma Treatment
Rituximab, R-CHOP chemotherapy, & radiation RRCR
89
CHOP
CHOP Cyclophosphamide Hydroxydoxorubicin (doxorubin) Oncovin (Vincristine) Prednisone
90
Multiple myeloma Treatment
Treated with RVD chemotherapy +/- autologous bone marrow transplant +/- palliative radiation or kyphoplasty
91
RVD therapy
RVD Revlimid Velcade dexamethasone
92
Myelodysplastic Syndrome Treatments
Observation vs hypomethylating agents (ie azacytidine), immunomodulators (ie lenalidomide),
93
Which type of hypersensitivity reaction is most associated with an inflammatory process? I II III IV 
IV
94
Which of the following medications is considered a first-generation histamine (H1) antagonist fexofenadine (Allegra) cetirizine (Zyrtec) diphenhydramine (Benadryl) desloratadine (Clarinex)
diphenhydramine (Benadryl)
95
Which of the following systemic glucocorticoids is considered long-acting glucocorticoids? prednisone (Prednose) dexamethasone (Decadron) hydrocortisone (Hytone) prednisolone (Orapred)
dexamethasone (Decadron)
96
Which of the following conditions is considered a contraindication for most systemic glucocorticoid medications? Live vaccinations Pregnancy (Category X) Pulmonary embolism Hypothyroidism
Live vaccinations
97
Which of the following adverse effects is considered a common effect for patients taking antihistamine (H1 antagonists)? miosis excitability in adults dry mouth excessive lacrimation
dry mouth
98
Which treatment of concentrates is sometimes used for the treatment of von Willebrand disease? factor VII factor VIII factor IX factor X
factor VIII
99
Which of the following medications is considered the best treatment for chronic lymphocytic leukemia? cyclophosphamide (Cytoxan) rituximab (Rituxan) fludarabine (Fludara) ibrutinib (Imbruvica) 
ibrutinib (Imbruvica) 
100
Which of the following leukemias is usually treated with tyrosine kinase inhibitors such as imatinib (Gleevec)? Acute lymphocytic leukemia Chronic lymphocytic leukemia Chronic myelogenous leukemia Acute myelogenous leukemia
Chronic myelogenous leukemia
101
What is the recommended initiating loading dosage for an middle-aged adult patient starting warfarin (Coumadin)? 2 mg PO daily 5 mg PO daily 7.5 mg PO daily 10 mg PO daily
5 mg PO daily
102
Which of the following treatments is considered a treatment for disseminated intravascular coagulopathy? clopidogrel (Plavix) fresh frozen plasma (FFP) aspirin (ASA) warfarin (Coumadin)
fresh frozen plasma (FFP)
103
What is ITP
Immune Thrombocytopenia (ITP) a condition that causes your immune system to attack your own blood platelets
104
What is AIHA
Autoimmune Hemolytic Anemia (AIHA), a condition that leads to the destruction of your own red blood cells

PAM Semester 2 (22 decks)

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