Myeloid Proliferative Disorder Chemos

Question 1

Polycythemia Vera definition

Answer 1

Erthyrocytosis that occurs in combination with leukocytosis, thrombocytosis and/or splenomegaly
- also presents with sticky platelets in histology slides

presents with high hemoglobin/hematocrit and red cell count

General Symptoms

• vertigo
• visual issues
• systolic hypertension
• erythema and burning/pain inextremeities

Question 2

Treatment of polycythemia Vera

Answer 2

Most important aspect to treat is thrombocytosis via erthrocytosis

• women = get hemoglobin below 120 g/L (42%)
• men = get hemoglobin below 140 g/L (45%)

Treated via phlebotomy and Hydroxyurea if phlebotomy isnt treating it properly.

If hyperuricemia is present, use allopurinol to prevent excess elevation of Uric acid

Anticoagulants are indicated for thrombosis treatment also

Question 3

TxA2 and ADP molecules

Answer 3

2 substances responsible for stimulating platelet aggregation

Question 4

Salicylate MOA

Answer 4

Non-selective NSAID used to irreversibly inhibit Cox-1 and reversibly inhibit Cox-2 in platelets and inhibits production of TxA2

“D”

Question 5

Heparin (HMW)

Enoxaparin (LMW) MOAs

Answer 5

Heparin is better effects but is not predictable and can causes dangerous side effects

Enoxaparin is less effective but predictable responses and less serious side effects

Both function to enhance protease Anti-thrombin 3.
- Anti-thrombin 3 functions to inactivate thrombin and Factor X

“C”

Question 6

Rivaroxaban and Apixaban (Factor Xa inhibitors)

Answer 6

Functions to inhibit factor Xa in the coagulation cascade

“C”

Question 7

Warfarin MOA

Answer 7

Inhibits liver vitamin K reductase which inhibits regeneration of Vitamin K
- factors 2,8,9 and 10 are all knocked out

“X” and “D” for patients with mechanical heart valves

Question 8

Xanthine oxidase inhibitors (allopurinol) MOA

Answer 8

Inhibts xanthine oxidase which is the enzyme used to convert hypoxanthine -> xanthine and utricle acid
- reduces urate crystal formation

“B”

Question 9

Tyrosine kinase inhibitors (ruxolitnib) MOA

Answer 9

Selectively inhibits Janus Associated Kinases (JAK 1/2)

“C”

Question 10

Pegylated interferon (a) MOA

Answer 10

Enhance host immune system by increasing activation of T-lymphocytes, NK-cells and macrophages

“C”

Question 11

Hydroxyurea MOA

Answer 11

Inhibits ribonucelotide reductase and inhibits DNA synthesis

“D”

Question 12

Primary Myelofibrosis (PMF)

Answer 12

Mutations inJAK2 which increases cell growth and proliferation

Characterized by marrow fibrosis and hematopoiesis and splenomegaly

Diagnosis of exclusion once PV and thrombocytosis is excluded

Question 13

Treatment of PMF

Answer 13

Glucocorticoids and low-dose thalidomide

• also consider chemo/interferon treatment for splenomegaly*
• if high uric acid levels exist = use allopurinol*