21 Therapeutic Modalities in Hematology

Question 1

Irreversibly binds COX-1 and COX-2

Answer 1

Aspirin

Question 2

Antiplatelet drugs

Answer 2

Aspirin
Thienopyridines
Dipyridamole
Abeiximab, eptifibatide, tirofiban

Question 3

Inhibit ADP-induced platelet aggregation

SE: bleeding

Answer 3

Thienopyridines

Question 4

Prodrugs that require metabolic activation by the hepatic cytochrome P450 enzyme system

Answer 4

Clopidogrel

Prasugrel

Question 5

Indication of thienopyridines

Answer 5

Oral, Prasugrel for patients undergoing stenting

Question 6

Inhibits PDE, increases cAMP, reduce Ca ions leading to inhibition of activation
SE: vasodilation

Answer 6

Dipyridamole

Question 7

GpIIb/IIIa inhibitor

SE thrombocytopenia, bleeding

Answer 7

Abeiximab, eptifibatide, tirofiban

Question 8

Administration of Abeiximab, eptifibatide, tirofiban

Answer 8

IV bolus then infusion

Question 9

Fab fragment of a humanized murine monoclonal AB directed against the activated form of GpIIb/IIIa
Binds to the activated receptor with high affinity and blocks the binding of adhesive molecules

Answer 9

Abciximab

Question 10

Cyclic heptatide that bind GpIIb/IIIa because it incorporates the KGD motif

Answer 10

Eptifibatide

Question 11

Anonpeptidic tyrosine derivative that acts as an RGD mimetic

Answer 11

Tirofiban

Question 12

Anticoagulant drugs

Answer 12

Heparin
Low molecular weight heparin
Fondaparinux
Lepirudin, argatroban, bivalrudin
Vitamin K antagonist (warfarin)

Question 13

Activates antithrombin III
IV or SC, monitored via PTT
SE: Bleeding, thrombocytopenia

Answer 13

Heparin

Question 14

Activates antithrombin III
SC or IV, high bioavailability, monitored by anti FXa levels
SE: bleeding
Low risk of thrombocytopenia

Answer 14

Low molecular weight heparin (enoxaparin)

Question 15

Synthetic analogue of ATIII activating sequence
Binds and activates antithrombin III
SC, high bioavailability
SE: bleeding
Does not cause HIT

Answer 15

Fondaparinux

Question 16

Direct thrombin inhibitor
IV infusion, monitored via PTT
SE: bleeding

Answer 16

Lepirudin
Argatroban
Bivalirudin

Question 17

Inhibits carboxylation of vitamin K dependent clotting factors
Oral, metabolized by CYP450 system, narrow therapeutic window, monitored by INR and PT
SE: Bleeding, skin necrosis, embryopathy

Answer 17

Warfarin

Question 18

Drugs that attack diseases more precisely via specific unique pathways and cell surface markers

Answer 18

Targeted therapy

Question 19

Targeted therapy drugs

Answer 19

Gemtuzumab + ozogamicin
Denileukin + diptheria toxin
Ibritumomab + 90Y

Question 20

Anti CD33 + calicheamicin

For AML

Answer 20

Gemtuzumab + ozogamicin

Question 21

Anti-IL2 + protein synthesis inhibitor

For cutaneous T-cell lymphoma

Answer 21

Denileukin + Diptheria toxin

Question 22

Anti-CD20 + ionizing radiation

Refractory B-cell lymphoma

Answer 22

Ibritumomab + 90Y

Question 23

Replace an abnormal but non-malignant lymphohematopoietic with one from a normal donor
Replace a malignant hematopoietic system with one from a normal donor

Answer 23

Hematopoietic stem cell transplant

Question 24

2 types of hematopoietic stem cell transplant

Answer 24

Allogeneic bone marrow transplant

Autologous bone marrow transplant

Question 25

From another member of the same species

Answer 25

Allogeneic bone marrow transplant

Question 26

Type of transplant that makes use of a person's own stem cells for treatment Can be used for lymphoma-related diseases Can't be used for aplastic anemia or thalassemia

Answer 26

Autologous bone marrow transplant

Question 27

Large needle is connected to a large machine and centrifuges the blood that comes in the machine and it just gets the stem cells The other components of blood are returned to the patient

Answer 27

Apheresis

Question 28

Frequent complication of allogeneic stem cell transplantation, in which lymphocytes from the donor attack and cannot be eliminated by an immunodeficient host

Answer 28

Graft-versus-host disease

Question 29

Provides immediate correction of deficient cellular and soluble blood components

Answer 29

Transfusion therapy

Question 30

To treat fibrinogen deficiencies

Answer 30

Cryoprecipitate

Question 31

To treat or prevent bleeding due to low platelet levels | To correct functional platelet problems

Answer 31

Concentrate of platet

Question 32

To correct a deficiency in coagulation factors or to treat shock due to plasma loss from burns or massive bleeding

Answer 32

Fresh frozen plams

Question 33

To increase the amount of RBC after trauma or surgery or to treat severe anemia

Answer 33

RBC

Question 34

``` Storage period; RBC FFP Plasma concentrate Cryoprecipitate ```

Answer 34

42 days (ref) or 10y (freezer) 1y (freezer) 5 days (RT) 1y (freezer)

Question 35

Never requested unless for emergencies

Answer 35

Fresh whole blood

Question 36

Oxygen carrying capacity + volume expansion No viable platelets, degraded coagulation factors Immunogenic due to presence of plasma For exchange transfusion in neonates

Answer 36

Whole Blood

Question 37

Fibrinogen and FVII and vWF

Answer 37

Cryoprecipitate

Question 38

Decreased fibrinogen, FII, FVII, FIX, X No large multimers of vWF Plasma exchange in thrombotic thrombocytopenic purpura

Answer 38

Cryosupernatant

Question 39

This is performed before the transfusion of red cells | Donor red cells are mixed mixed with the patient serum

Answer 39

Cross matching

Question 40

Usually due to ABO incompatibility | Hypotension, tachycardia, fever, chills, hemoglobinuria

Answer 40

Acute hemolytic transfusion reaction

Question 41

Due to sensitization from previous reaction

Answer 41

Delayed hemolytic transfusion reaction

Question 42

Most frequent reaction to transfusion Chilled, rigors, increase in temperature by 1 deg Antibodies against donor leukocytes

Answer 42

Febrile nonhemolytic transfusion reaction

Question 43

Treatment for FNHTR

Answer 43

Use of leukodepleted products

Question 44

Due to presence of plasma proteins

Answer 44

Allergic transfusion reactions

Question 45

Treatment for allergic transfusion reactions

Answer 45

Premedicate with antihistamines

Question 46

T-lymphocytes from donor attack the immunodeficient host

Answer 46

Graft versus host disease

Question 47

Most common cause of transfusion related mortalities | Signs of acute lung injury after transfusion of plasma

Answer 47

Transfusion related acute lung injury

Question 48

Volume expansion due to transfusion

Answer 48

Transfusion associated circulatory overload