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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
Q

Causes of macrocytic anemia

A

B12 deficiency
Folate deficiency
Myelodysplasia
Alcohol

MCV over 100

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26
Q

Thalassemia

A

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

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27
Q

Deferoxamine

A

Acute iron intoxication
Chronic iron overload (multiple transfusions)

Iron chelating agent

Contra:
Renal disease, anuria

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28
Q

Ferrous sulfate

A

Iron deficiency, iron anemia

325mg TiD

Contra:
Hemochromatosis
Hemosiderosis

Interactions
Tetracycline (inhibits)

Adverse:
Nausea, abdominal discomfort, pain, constipation, diarrhea

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29
Q

Anemia of chronic disease (inflammation)

diseases

A 
Chronic infections:
TB
Chronic UTI
neoplastic
Liver disease from ETOH
Hyperthyroidism/hypothyroidism
auto immune SLE/RA

TTULAC

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30
Q

Anemia of chronic disease (inflammation)

Treatment

A

treat underlying cause
possible transfusion
EPO
No iron

Cause, Transfusion, EPO, no Iron

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31
Q

Sideroblastic anemia

A

B6 deficient, fix with B6

Chronic Alcoholism, B6 deficiency

Tx: treat underlying disease
chelating agent for lead
transfusion,
remove toxins

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32
Q

What is pernicious anemia

A

decrease in red blood cells when the body can’t absorb enough vitamin B-12

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33
Q

Who is at risk for pernicious anemia

A

Vegan, vegetarian diet, gastric or bariatric surgery

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34
Q

B12 MOA

A

Conversion of homocysteine to methionine

Conversion of L methylmalonyl CoA to succinyl CoA

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35
Q

Medicines that lead to B12 deficiency

A

Metformin

Colchicine

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36
Q

Folic Acid

A

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

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37
Q

Hemochromatosis Tx

A

Iron chelating agent

IV deferoxamine or PO defrasirox

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38
Q

Hereditary Hemochromatosis Tx:

A

Phlebotomy

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39
Q

Hemolytic anemia

A

SPIRE

Splenectomy
Prednisone
IVIG
Rituximab
EPO
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40
Q

Rituximab

A

CD20 directed cytolytic monoclonal antibody

Adverse:
Fatal infusion related reaction
Severe mucocutaneous reactions
Hep B virus reactivation
Progressive multifocal leukoencephalopathy
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41
Q

IVIG

A

IV immune globulin

Indications:
ITP Immune thrombocytopenia

AIHA Autoimmune hemolytic anemia

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42
Q

Hydroxurea

A

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
Q

Transfusion reaction treatment

A

Supportive

benadryl allergic reactions (mild)
tylenol for fever

44
Q

Secondary causes of polycythemia vera

A

Tobacco use

Living at high altitude

45
Q

Polycythemia vera treatment

A

Serial phlebotomy

46
Q

one major cause of reactive thrombosis

A

inflammation

47
Q

Treatment for VTE (DVT/PE)

A

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
Q

Clopidigrel

A

Plavix P2Y12 platelet inhibitor

Contra:
active bleed

Interactions:
Avoid CYP2C19 inhibitors (omeperazole)

49
Q

Ticagrelor

A

Brilinta P2Y12 platelet inhibitor

Adverse: Active bleed (fatal)

Warning: Bleed risk

Contra:
History of intracranial hemorrhage
Active bleed

50
Q

Aggrenox

A

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
Q

Anti coagulant prophylaxis

to prevent or treat DVT, PE, Arterial thromobosis

A

Heparin
Lovenox
Fondaparinux

52
Q

Oral anti coagulants for long term use

A

Coumadin
Dabigatran
Apixaban

53
Q

Anti coagulants and their factors

A

LMWH (Xa)
UFH (IIa, Xa)
Warfarin (IIa, VIIa, IXa, Xa)
Direct Thrombin inhibitor (IIA)

54
Q

Unfractionated heparin

administration

A

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
Q

Heparin MOA

A

Indirect inhibitor of thrombin factor IIa and Xa

Greatly enhances antithrombin to inactivate these

56
Q

low molecular weight (LMW) heparins

MOA

A

low molecular weight (LMW) heparins efficiently inactivate factor Xa via antithrombin

57
Q

Baseline testing prior to administration ofunfractionated heparinor LMW heparin generally includes

A

coagulation studies (prothrombin time [PT],

activated partial thromboplastin time [aPTT]),

and a complete blood count (CBC)
with platelet count.

58
Q

Heparin antidote

A

Protamine sulfate

slow IV infusion

59
Q

Enoxaparin

A

Lovenox (LMWH)

Contra:
major bleeding, History of HIT within 100 days,

Warning: Spinal/epidural hematomas

Adverse: Bleeding

60
Q

fondaparinux

A

Arixtra

Warning: Spinal/epidural hematomas

Factor Xa inhibitor

61
Q

Coumadin dosing

A

Warfarin is monitored by PT/INR

For most patients initiatingwarfarintherapy, 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 atwww.WarfarinDosing.org/Source/Home.aspx.

Dosing on subsequent days is guided by the PT/international normalized ratio (INR) value

62
Q

Direct thrombin inhibitors
&
Factor Xa blockers

A

DTI = dabigatran (Pradaxa)

Factor Xa blockers
apixaban (eliquis)
Rivaroxaban (Xarelto)
LMWH (lovenox)
UFH (heparin)
Vitamin K (Coumadin)
63
Q

dabigatran

A

Pradaxa (Direct thrombin inhibitors)

Contra:
active bleeds, mechanical prosthetic heart valve

Warnings:
Spinal/epidural hematomas
premature discontinuation increases thombolytic events

64
Q

Apixaban

A

Eliquis (Factor Xa inhibitor)

Contra: active bleeding

Warnings:
Spinal/epidural hematomas
premature discontinuation increases thombolytic events

65
Q

Coumadin antidote

A

Vitamin K

66
Q

Dabigatran antidote

A

Idaruvizumab

67
Q

Apixaban
Rivaroxaban
Antidote

A

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
Q

Fibrinolytics MOA

A

breaks down clots via conversion of plasminogen to plasmin

69
Q

ITP Treatments

A

Immune thrombocytopenia (

Glucocorticoids
IVIG
Anti-RhoD
RhoGAM

70
Q

TTP/HUS Treatment

A 
Emergent plasma exchange if TTP>HUS, 
eculizumab if HUS>TTP, 
RBC transfusions, 
Hemodialysis
IVIG
Corticosteroids
Rituximab
Splenectomy
71
Q

Eculizumab

A

Soliris

Treatment of atypical hemolytic uremic syndrome (aHUS) to inhibit complement-mediated thrombotic microangiopathy.

Warnings:
Serious meningococcal infections
Pregnancy

Contra:
Unresolved seriousNeisseria meningitidisinfection. Individuals not vaccinated againstNeisseria meningitidis.

If pregnant and exposed call number

Soliris, HUS, No Pregnancy, meningitis or no vaccine

72
Q

HELLP Treatment

A

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
Q

Qualitative platelet disorder

A

Von Williebrands Disease

74
Q

Von Williebrands Disease Treatment

A 
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
Q

DDAVP (Desmopressin)

A

Class
Vasopressin (synthetic)

MOA
Stimulates vWF release from endothelium

76
Q

Hemophilia Treatment

A

Factor 8 or 9 infusions
Desmopressin, aminocaproic acid, TXA
(no blood thinners, trauma, contact sports)

77
Q

Vitamin K deficiency treatment

A

Give vitamin K

78
Q

DIC treatmtent

A

correct underlying cause,
FFP or cryoprecipitate transfusion,

platelet transfusion if bleeding predominates,

tissue plasminogen activator (TPA) if clots predominate

79
Q

AML treatment

Acute Myeloid Leukemia

A

Chemo

Palliative chemo option = hydroxyurea

80
Q

ALL

Acute Lymphoid Leukemia

A

As with AML, treatment is aggressive induction chemotherapy then consolidation +/- bone marrow transplant

81
Q

Chronic Myelogenous Leukemia (CML)

Treatment

A

Treatment: tyrosine kinase inhibitors,

which inhibit the bcr-abl oncogene. Examples: imatinib (Gleevec®),

82
Q

tyrosine kinase inhibitors,

A

imatinib (Gleevec®),

83
Q

imatinib (Gleevec®) MOA

A

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
Q

Chronic Lymphocytic Leukemia (CLL/SLL) treatment

A

Brutons TKI (ie ibrutinib)

85
Q

Ibrutinib

A

Imbruvica

Chronic Lymphocytic Leukemia (CLL)

Bruton tyrosine kinase (BTK) inhibitor

BTK for CLL

86
Q

Hodgkin’s Lymphoma Treatment

A

ABVD chemotherapy +/- radiation therapy

87
Q

ABVD Therapy

A

ABVD

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

88
Q

Non-Hodgkin’s Lymphoma Treatment

A

Rituximab, R-CHOP chemotherapy, & radiation

RRCR

89
Q

CHOP

A

CHOP

Cyclophosphamide
Hydroxydoxorubicin (doxorubin)
Oncovin (Vincristine)
Prednisone

90
Q

Multiple myeloma Treatment

A

Treated with RVD chemotherapy +/- autologous bone marrow transplant +/- palliative radiation or kyphoplasty

91
Q

RVD therapy

A

RVD

Revlimid
Velcade
dexamethasone

92
Q

Myelodysplastic Syndrome Treatments

A

Observation vs hypomethylating agents (ie azacytidine), immunomodulators (ie lenalidomide),

93
Q

Which type of hypersensitivity reaction is most associated with an inflammatory process?

I
II
III
IV

A

IV

94
Q

Which of the following medications is considered a first-generation histamine (H1) antagonist

fexofenadine (Allegra)
cetirizine (Zyrtec)
diphenhydramine (Benadryl)
desloratadine (Clarinex)

A

diphenhydramine (Benadryl)

95
Q

Which of the following systemic glucocorticoids is considered long-acting glucocorticoids?

prednisone (Prednose)
dexamethasone (Decadron)
hydrocortisone (Hytone)
prednisolone (Orapred)

A

dexamethasone (Decadron)

96
Q

Which of the following conditions is considered a contraindication for most systemic glucocorticoid medications?

Live vaccinations
Pregnancy (Category X)
Pulmonary embolism
Hypothyroidism

A

Live vaccinations

97
Q

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

A

dry mouth

98
Q

Which treatment of concentrates is sometimes used for the treatment of von Willebrand disease?

factor VII
factor VIII
factor IX
factor X

A

factor VIII

99
Q

Which of the following medications is considered the best treatment for chronic lymphocytic leukemia?

cyclophosphamide (Cytoxan)
rituximab (Rituxan)
fludarabine (Fludara)
ibrutinib (Imbruvica)

A

ibrutinib (Imbruvica)

100
Q

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

A

Chronic myelogenous leukemia

101
Q

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

A

5 mg PO daily

102
Q

Which of the following treatments is considered a treatment for disseminated intravascular coagulopathy?

clopidogrel (Plavix)
fresh frozen plasma (FFP)
aspirin (ASA)
warfarin (Coumadin)

A

fresh frozen plasma (FFP)

103
Q

What is ITP

A

Immune Thrombocytopenia (ITP)

a condition that causes your immune system to attack your own blood platelets

104
Q

What is AIHA

A

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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