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STEP 1 > Pharm Hemato/onco > Flashcards

Pharm Hemato/onco Flashcards

1
Q

Heparin (MOA)

A

Activates antithrombin (which decrease action primarily of factors IIa (thrombin) and Xa)

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2
Q

Heparin (clinical use) : in the intrinsic

A

Pulmonary embolism
Acute coronary syndrome
MI
DVT
(Used in pregnancy= does not cross placenta)
Monitor PTT

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3
Q

Heparin Adverse effects:

A

Bleeding
Heparin induced thrombocytopenia (HIT)
Osteoporosis (long term use)

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4
Q

HIT type 1:

A

Mild (pc > 100,000)
Non immunologic drop in platelet count.
Highest risk w unfractionated heparin

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5
Q

HIT type 2:

A

Development IgG ab against (PF4)
5-10 days after heparin administration
Ab- heparin complex binds and activates platelets —- removal by splenic macrophages. Decrease platelet count.

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6
Q

Low molecular weight heparins: Examples

A

Enoxaparin, dalteparin:
Act mainly on factor Xa

Fondaparinux: acts only on factor Xa

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7
Q

LMWHs: notes

A

Undergo renal clearance: use w caution with renal insufficiency

Can be administered subscutaneosly
No lab monitoring required

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8
Q

Warfarin (MOA):

A

Inhibits vitamin K epoxide reductase
Inhibitions of Vit K dependent gamma carboxylations of clotting factors: 2,7,9,10 and protein C,S
Extrinsic pathway: high PT

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9
Q

Warfarin (clinical use)

A

Chronic anticoagulation (venous thromboembolism prophylaxis and prevention of stoke in AF)
Not for pregnant patients
Monitor PT/INR

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10
Q

Warfarin (adverse effects)

A

Bleeding
Teratogenic
Skin/tissue necrosis

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11
Q

Warfarin reversal:

A

Vitamin K
For rapid reversal: FFP, PCC

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12
Q

Warfarin administration

A

Oral

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13
Q

Heparin administration

A

Parenteral (IV, SC)

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14
Q

Site of action Warfarin:

A

Liver

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15
Q

Site of action of heparin:

A

Blood

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16
Q

MOA:
Bivalirudin
Argatroban
Dabigatran

A

Directly inhibit thrombin (factor IIa)

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17
Q

Clinical use of:
Bivalirudin
Argatroban
Dabigatran (oral)

A

Venous thromboembolism
Atrial fibrillation
Can be used in HIT
Does not require lab monitoring

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18
Q

MOA:
ApiXAban
EndoXAban
RivaroXAban

A

Directly inhibit factor Xa

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19
Q

Clinical use:

ApiXAban
EndoXAban
RivaroXAban

A

Tx and prophylaxis for DVT and PE
Stroke prophylaxis in pte with AF

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20
Q

Adverse effects:

ApiXAban
EndoXAban
RivaroXAban

A

Bleeding
Reverse with andeXAnet alfa

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21
Q

Dabigatran reversal:

A

Idarucizumab

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22
Q

Antiplatelets (MOA): Aspirin

A

Blocks COX —> decrease TXA2 release

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23
Q

Aspirin (Adverse effects):

A

Gastric ulcer
Tinnitus
Allergic reaction
Renal injury

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24
Q

Antiplatelets (MOA):

Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine

A

Block ADP (P2Y12) Receptor:
Decrease ADP- induced expression of GpIIb/IIIa

25
Q

Antiplatelets (AE):

Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine

A

Neutropenia (ticlopidine)
TTP

26
Q

Antiplatelets (MOA):

Abciximab
Eptifibatide
Tirofiban

A

A GpIIb/IIIa Receptor antagonist , inhibits binding of this receptor to fibrinogen.

27
Q

Antiplatelets (clinical use):

Abciximab
Eptifibatide
Tirofiban

A

Unstable angina
Percutaneous coronary intervention

28
Q

Antiplatelets (AE)

Abciximab
Eptifibatide
Tirofiban

A

Bleeding
Thrombocytopenia

29
Q

Antiplatelets (MOA):

Cilostazol
Dipyridamole

A

Block phosphodiesterase —> decrease cAMP in platelets

30
Q

Antiplatelets (CU):

Cilostazol
Dipyridamole

A

Intermittent claudication
Stroke prevention
Cardiac stress testing
Prevention of coronary stent restenosis

31
Q

Antiplatelets (AE):

Cilostazol
Dipyridamole

A

Nausea
Headache
Facial flushing
Hypotension
Abdominal pain

32
Q

Thrombolytics: MOA
Alteplase
Reteplase
Streptokinase
Tenecteplase

A

Aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots.

Aumenta PT and PTT, no change in platelet count

33
Q

Antifibrinolytics

A

Aminocaproic acid
Tranexamic acid

34
Q

Antitumor antibiotics: MOA

Bleomycin

A

Induce free radical formation = breaks in DNA strands

35
Q

Antitumor antibiotics: CU

Bleomycin

A

Testicular cancer
Hodgkin lymphoma

36
Q

Antitumor antibiotics: AE

Bleomycin (specific G2/M phase)

A

Pulmonary fibrosis
Skin hyperpigmentation

37
Q

Antitumor antibiotics: MOA

Dactinomycin (actinomycin D)

A

Intercalates into DNA, preventing RNA synthesis

38
Q

Antitumor antibiotics: CU

Dactinomycin (actinomycin D)

A

Wilms tumor
Ewing sarcoma
Rhabdomyosarcoma

39
Q

Antitumor antibiotics: AE

Dactinomycin (actinomycin D)

A

Myelosuppression

40
Q

Antitumor antibiotics: MOA
Anthracyclines:
Doxorubicin
Daunorubicin

A

Generate free radicals
Intercalate in DNA- breaks in DNA -> decrease replication.

Inhibits topoisomerase II

41
Q

Antitumor antibiotics: CU
Anthracyclines:
Doxorubicin
Daunorubicin

A

Solid tumors
Leukemia
Lymphomas

42
Q

Antitumor antibiotics: AE
Anthracyclines:
Doxorubicin
Daunorubicin

A

Dilated cardiomyopathy (prevent w/ dexrazoxane)

Myelosuppression
Alopecia

43
Q

Platinum compounds: MOA
Cisplatin
Carboplatin
Oxaliplatin

A

Cross link DNA (cell cycle nonspecific)

44
Q

Platinum compounds: clinical use
Cisplatin
Carboplatin
Oxaliplatin

A

Solid tumors: testicular, bladder, ovarian, GI, lung, lymphomas

45
Q

Platinum compounds: AE
Cisplatin
Carboplatin
Oxaliplatin

A

Nephrotoxicity (fanconi synd)
Peripheral neuropathy
Ototoxicity

46
Q

Rituximab (MOA)

A

Monoclonal ab against the CD20 antigen

47
Q

Warfarin can be monitored with

A

INR
an Prothrombin time (PT)

48
Q

Anthracyclines (doxorubicin) MOA and SE:

A

Binds w topoisomerase II to cleave DNA
Binds w iron to generate free radicals

Dilated cardiomyopathy

49
Q

Bleomycin MOA and SE :

A

Induces free radical formation

Pulmonary fibrosis

50
Q

Cisplatin (MOA) and (SE)

A

Cross- link DNA to inhibits DNA synthesis.

Nephrotoxicity
Ototoxicity
Peripheral neuropathy

51
Q

Cyclophosphamide MOA and SE:

A

Cross-link DNA to inhibit DNA synthesis

Hemorrhagic cystitis
Bladder cancer

52
Q

Paclitaxel MOA and SE:

A

Inhibits microtubule disassembly

Neuropathy

53
Q

Vincristine/ vinblastine MOA/ SE:

A

Binds beta-tubulin to inhibit microtubule formation

Neuropathy

54
Q

Trastuzumab (MOA):

A

Is for HER2 + cancer
Its binds to a portion of the extracellular domain of HER2 and prevents activation of a transmembrane tyrosine kinase.
This downregulates cellular proliferation and promotes apoptosis.

55
Q

Emicizumab (for hemophilia A) MOA:

A

Mimics the activity of factor 8 by binding to both factor 9a and factor 10, bringing them into close proximity to allow for factor 10 activation.

56
Q

Heparin coagulation changes

A

Thrombin time: prolonged
PTT: prolonged
Activity of factor Xa: decreased

57
Q

CYP450 inhibitors

A

Antibiotics (metronidazole, macrolides)
Azole
Amiodarone
Cimetidine
Grapefruit

58
Q

CYP450 inducers

A

Carbamazepine
Phenytoin
Phenobarbital
Rifampin
St. John wort

59
Q

6-mercaptopurine (6-MP) (pro drug: azathioprine) is inactivates by the following enzymes:

A

Xanthine oxidase and thiopurine methyltransferase

STEP 1 (18 decks)

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