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hema Flashcards

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0
Q

enoxaparin,

A

Low-molecular-weight heparin
act on factor Xa
better bioavailability and 2-4times longer half life
administered subcutaneously without monitering, not easily reversed

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1
Q

Heparin

A

cofactor for the activation of antithrombin, decrease thrombin, and decrease factor Xa.short half-life.
use for immediate anticoagulation for pulmonary embolism, acute coronary syndrome, MI, DVT. Used during pregnancy(does not cross placenta) follow PTT!!!!!!!!!!
TOX :HIT, reverse by protamine sulfate

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2
Q

dalteparin

A

Low-molecular-weight heparin
act on factor Xa
better bioavailability and 2-4times longer half life
administered subcutaneously without monitering, not easily reversed

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3
Q

heparin-induced thrombocytopenia

A

development of IgG antibodies against heparin bound to PLT factor 4 (PF4). Antibody-heparin-PF4 complex activates PLT–>thrombosis and thrombocytopenia

nonimmune: 1-2days, thrombocytopenia moderate to mild
immune: HITT, 4-14 days, thrombocytopenia

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4
Q

Lepirudin

A

derivatives of hirudin, anticoagulant used by leeches
inhibit thrombin
used as an alternative to heparin for anticoagulating pt with HIT

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5
Q

bivalirudin

A

derivatives of hirudin, anticoagulant used by leeches
inhibit thrombin
used as an alternative to heparin for anticoagulating pt with HIT

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6
Q

Warfarin

coumadin

A

involves synthesis and gamma-carboxylation of vit K-dependent factor II, VII, IX, X and protein C and S. FOLLOW PT/ INR
cytochrome P450. long half life.
use in chronic anticoagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation)
NOT used in pregnancy!!!! tox: bleeding, teratogenic, skin/tissue necrosis,drug interaction. reversal use Vit K

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7
Q

streptokinase

A

causes thrombolysis through formation of plasmin by forming activator complex with plasminogen to cleave arginine-valine bond

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8
Q

argastroban

A

PT, PTT decrease

no antidote/ careful in patient with liver disease.

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9
Q

alteplase

tPA

A

thrombolytics: aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots.
increase PT and PTT, no change in PC
Use in early MI, early ischemic stroke, direst htombolysis of severe pulmonary embolism
TOX: bleeding, CI in pt with active bleeding and his of surgery, HTN
treat with aminocaproic acid

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10
Q

aminocaproic acid

A

inhibitor of fibrinolysis
antidote for thrombolytics
can also use tranexamic acid or fresh frozen plasma

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11
Q

aspirin

ASA

A

irreversibly inhibits COX-1 and COX-2 by acetylation,serine
PLT cannot synthesis new enzyme, effect lasts until new PLT produced
increase bleeding time & decrease TXA2 and PG. no effect on PT and PTT.
use: antipyretic, analgesic, antii-nflammatory, anti-PLT
TOX: GI, tinnitus, renal failure, reye’s, resp alka, meta acid

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12
Q

clopidogrel

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in prophylaxis acute coronary syndrome; prevention of AS following recent myocardial infarction.

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13
Q

ticlopidine

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in coronary stenting, decrease incidence or recurrence of thrombotic stroke.
TOX: Neutropenia, agranulocytosis, TTP, aplastic anemia

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14
Q

prasugrel

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in acute coronary syndrome; coronary stenting, decrease incidence or recurrence of thrombotic stroke.

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15
Q

ticagrelor

A

inhibits PLT aggregation by irreversibly blocking ADP receptor. inhibit fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen.
Use in acute coronary syndrome; coronary stenting, decrease incidence or recurrence of thrombotic stroke

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16
Q

cilostazol

A

phosphodiesterase III inhibitor; increase cAMP in PLT, thus inhibiting PLT aggreagtion; vasodilator.
Use:intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (with aspirin), angina prophylaxis
TOX: nausea, headache, facial flushing, hypotension, abdominal pain

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17
Q

dipyridamole

A

phosphodiesterase III inhibitor; increase cAMP in PLT, thus inhibiting PLT aggreagtion; vasodilator.
Use:intermittent claudication, coronary vasodilation, prevention of stroke or TIAs (with aspirin), angina prophylaxis
TOX: nausea, headache, facial flushing, hypotension, abdominal pain

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18
Q

abciximab

A

monoclonal antibody Fab fragment.
bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty, use with heparin sometimes
TOX: bleeding, thrombocytopenia

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19
Q

eptifibatide

A

bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty
TOX: bleeding, thrombocytopenia

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20
Q

tirofiban

A

bind to the glycoprotein receptor IIb/IIIa on activated PLT, preventing aggregation.
use in acute coronary syndrome, percutaneous transluminal coronaryangioplasty
TOX: bleeding, thrombocytopenia

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21
Q

methotrexate

A

folic acid analog that inhibits dihydrofolate reductase–> decrease dTMP–>decrease DNA and protein synthesis.
use: leukemias, lymphoma, choriocarcinoma, sarcoma
non-neoplastic: abortion, ectopic pregnancy, RA, psoriasis.
TOX: myelosuppression, which is reversible with leucovorin
macrovesicular fatty change to liver, mucositis, teratogenic

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22
Q

5-FU

A

pyrimidine analog bioactivated to 5-F-dUmp, which covalently complexes folic acid.
inhibits thymidylate synthase–>decrease dTMP->decrease DNA and protein synthesis
Use in colon cancer, basal cell carcinoma,
tox: photosensitivity, myesupression, not reversible by leucovorin, rescue with thymidine

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23
Q

cytarabine

arabinofuranosyl

A

pyrimidine analog–> inhibition of DNA polymerase
use in leukemias, lymphomas
tox: leukopenia, thrombocytopenia, megaloblastic anemia

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24
6-MP | mercaptopurine
purine (thiol) analogs-->decrease de novo purine synthesis. activated by HGPRT leukemia TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol
25
azathioprine
purine (thiol) analogs-->decrease de novo purine synthesis. activated by HGPRT leukemia TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol
26
6-TG | thioguanine
purine (thiol) analogs-->decrease de novo purine synthesis. activated by HGPRT leukemia TOX: bone marrow, GI, liver, metabolized by xanthine oxidase, thus increase toxicity with allopurinol
27
cladribine
purine analog, use in hairy cell leukemia, resistant to adenosine deaminase
28
dactinomycin
intercalates in DNA use in Wilm's tumor, Ewing's sarcoma, rhabdomyosarcoma, childhood tumors tox; myelosuppression
29
doxorubicin | adriamycin
generate free radicals noncovalently intercalate in DNA-->breaks in DNA-->decrease replication use in: soild tumors, leukemias, lymphomas TOX: cardiotoxicity (dilated cardiomyopathy)"use dexrazoxane", myelosuppression, alopecia. tissue following extravasation
30
dauorubicin
generate free radicals noncovalently intercalate in DNA-->breaks in DNA-->decrease replication use in: soild tumors, leukemias, lymphomas TOX: cardiotoxicity (dilated cardiomyopathy)"use dexrazoxane", myelosuppression, alopecia. tissue following extravasation
31
dexrazozane
iron chelation agents | prevent cardiotoxicity in doxorubicin and daunorubin
32
Bleomycin
induces free radical formation, which causes breaks in DNA strands use in testicular cancer, Hodgkin's lymphoma TOX: pulmonary fibrosis, skin changes, minimal myelosuppression.
33
cyclophosphamide
covalently X-linked(interstrand) DNA at guanine N-7. require bioactivation by liver use in solitumor, leukemia, lymphomas and some brain cancers tox: myelosuppression; hemorrhagic cystitis, partially prevented with mesna
34
mesna
thiol group of mesna binds toxic metabolite in cyclophosphamide
35
ifosfamide
covalently X-linked(interstrand) DNA at guanine N-7. require bioactivation by liver use in solitumor, leukemia, lymphomas and some brain cancers tox: myelosuppression; hemorrhagic cystitis, partially prevented with mesna
36
carmustine
nitrosoureas: requires bioactivation. cross BBB-->CNS brain tumors (glioblastoma multiforme) TOX: CNS toxicity (dizziness, ataxia)
37
lomustine
nitrosoureas: requires bioactivation. cross BBB-->CNS brain tumors (glioblastoma multiforme) TOX: CNS toxicity (dizziness, ataxia)
38
semustine
nitrosoureas: requires bioactivation. cross BBB-->CNS brain tumors (glioblastoma multiforme) TOX: CNS toxicity (dizziness, ataxia)
39
streptozocin
nitrosoureas: requires bioactivation. cross BBB-->CNS brain tumors (glioblastoma multiforme) TOX: CNS toxicity (dizziness, ataxia)
40
busulfan
alkaylates DNA CML, also use to ablate pt bone marrow before transplant pulmonary fibrosis hyperpigmentation
41
vincristine
alkaloids bind to tubulin in M phase and block polymerization of microtubule so that mitotic spindle cannot form use in solid tumor, leukemia, lymphoma neurotoxicity: areflexia, peripheral neuritis paralytic ileus
42
vinblastine
alkaloids bind to tubulin in M phase and block polymerization of microtubule so that mitotic spindle cannot form use in solid tumor, leukemia, lymphoma neurotoxicity: blast bone marrow, suppression
43
paclitaxel
hyperstablize polymerized microtubules in M phase so that mitotic spindle cannot break down use in ovarian and breast tumor myelosuppressing and hypersensitivity
44
cisplatin
cross-link DNA testicular, bladder, ovary and lung carcinoma nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine(free radical scavenger) and chloride diursis
45
carboplatin
cross-link DNA testicular, bladder, ovary and lung carcinoma nephrotoxicity and acoustic nerve damage. Prevent nephrotoxicity with amifostine(free radical scavenger) and chloride diursis
46
amifostine
free radical scavenger prevent nephrotoxicity in platins "stine" in "platin"
47
etoposide
inhibits topoisomerase II-->increase DNA degradation use in solid tumors, leukemia, lymphomas tox: myelosuppression, GI irritation, alopecia
48
teniposide
inhibits topoisomerase II-->increase DNA degradation use in solid tumors, leukemia, lymphomas tox: myelosuppression, GI irritation, alopecia
49
hydroxyurea
inhibits ribonucleotide reductase--> decrease DNA synthesis use in melanoma, CML, sickle cell disease (increase HbF) tox: bone marrow suppression U－ribonucleo
50
prednisone
trigger apoptosis, may even work on nondividing cell use in glucocorticoid in cancer chemo, CLL, non-H lymphoma, TOX: cushing like, immunosuppresive, cataracts, acne, osteoporosis, HTN, PU, hyperglycemia, psychosis
51
prednisolone
trigger apoptosis, may even work on nondividing cell use in glucocorticoid in cancer chemo, CLL, non-H lymphoma, TOX: cushing like, immunosuppresive, cataracts, acne, osteoporosis, HTN, PU, hyperglycemia, psychosis
52
tamoxifen
SERMs-receptor anta in breast and agonist in bone. block the binding of E to E receptor(+) cells "xifen－喜欢" used in breast cancer treatment and prevention. also useful to prevent osteoporosis TOX: partial agonist in endometrium, which increase the risk of endometrial cancer, hot flashes
53
raloxifene
SERMs-receptor anta in breast and agonist in bone. block the binding of E to E receptor(+) cells "xifen－喜欢" used in breast cancer treatment and prevention. also useful to prevent osteoporosis TOX: no increase risk for endometrial CA, anta in endometrium,
54
trastuzumab | herceptin
monoclonal antibody against HER-2(c-erbB2) a tyrosine kinase helps kill breast cancer cells that overexpress Her-2, through antibody-dependent cytotoxicity use in HER-2+breast cancer tox: cardiotoxicity 吃完做什么？breast
55
imatinib | gleevec
Philadelphia chromo bcr-abl tyrosine kinase inhibitor use in CML, GI stromal tumors tox: fluid retention 尼玛听你？费城是革命的地方，大雨奔腾
56
rituximab
monoclonal antibody against CD20, which is found on most B-cell neoplasms Non-H lymphoma, RA tu->2, xi->C, think about CD20
57
vemurafenib
small molecule inhibitor of forms of the B-raf kinase with the V600F mutation use in metastatic melanoma mura-mela
58
bevaxizumab
monoclonal antibody against VEGF, inhibits angiogenesis use in solid tumors 逼我吸祖，吸血鬼祖先要血
59
hydroxyures
used in sickle anemia | increase fetal Hb (Hb F)

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