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Flashcards in HEMATOLOGY ONCOLOGY Deck (122):
1

What is the MOA of enoxaparin and dalteparin?

They are low molecular weight heparins so they bind to Factor Xa PREFERENTIALLY

1

Which disease is typified by IgG complexes against platelet factor 4/heparin complexes?

Heparin Induced Thrombocytopenia

1

4 AE of warfarin

Bleeding, teratogen, skin necrosis (esp. if protein C deficient pt), and drug-drug interactions

1

Which cancers can be treated with 5-Fluorouracil?

Colon cancer and Basal Cell CA

1

Which drug inhibits ribonucleotide reductase in the S phase of cell cycle?

Hydroxyurea

1

What kind of molecule is HER-2? What drug is a mab against it?

Tyrosine kinase expressed on HER2 positive breast CA? Trastuzumab

1

Which anticancer drugs have major AE of acoustic nerve damage and nephrotoxicity?

Carbaplatin and Cisplatin

2

Which clotting factors are affected by warfarin (6)?

II, VII (extrinsic), IX, and X as well as proteins C and S

2

What is the MOA of hydroxyurea?

inhibits ribonucleotide reductase in S phase

3

Major AE of trastuzumab

cardiotoxicity

4

Which drug is used to Tx colon cancer and is available topically for basal cell carcinoma?

5 Fluorouracil

4

Which drug is often used for childhood tumors?

Dactinomycin (actinomycin D), an antitumor antibiotic

5

Which 2 drugs inhibit phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation?

Cilostazol and Dipyridamole

5

Which aspect of the cell cycle do vinca alkaloids and taxols affect?

M phase

6

What kind of drug is ticagrelor?

An ADP receptor antagonist

7

What is the acid base status of an aspirin overdose?

Respiratory alkalosis (stimulation of respiratory centers) with metabolic alkalosis from the acetylsalycylic ACID

7

Which antimetabolite can cause megaloblastic anemia?

Cytarabine (arabinofuranosyl cytidine)

9

What is the MOA of drugs derived from leeches?

Direct thrombin inhibitors (come from hirudin)

10

What is the MOA of thrombolytics?

convert plasminogen to plasmin

10

What antimetabolite is a pyrimadine analog and inhibitds DNA polymerase? Phase of cycle?

Cytarabine (arabinofuranosyl cytidine); S phase

11

Long term reversal of Warfarin OD

Vitamin K

11

What is the antidote to thrombolytic toxicity?

aminocaproic acid

12

What would you use to anticoagulate a patient with a history of HIT?

A direct thrombin inhibitor (lepirudin and bivalrudin)

12

What are 2 AE of cyclophosphamide and ifosfamide?

Hemorrhagic cystitis and myelosuppression

13

What is the MOA of vincristine and vinblastine? Phase of cycle?

Bind tubulin in M PHASE and prevent polymerization

13

Aside from CML, imatinib can also Tx ________

GI stromal tumor (GIST)

14

Where is the site of action in the body of heparin and warfarin?

heparin acts in the blood but warfarin is in the liver (epoxide reductase)

14

What drug is anti-angiogenic by inhibiting VEGF in solid tumors?

Bevacizumab

15

How does protamine sulfate work?

It is a positively charged molecule that binds to the negatively charged heparin

15

Which aspect of the cell cycle does bleomycin affect?

G2

16

Name 4 ADP receptor antagonists on platelets

Prasugrel, Ticlopidine, Clopidogrel, and Ticagrelor

16

What is the MOA of mesna?

Binds the toxic thiol group of cyclophosphamide and ifosfamide to prevent hemorrhagic cystitis

17

What kind of cancer is treated with nitrosoureas?

Brain cancer including GBM

18

What is amifostine used for?

Preventing Carbaplatin/Cisplatin induced nephrotoxicity

18

What is the MOA of raloxifene and tamoxifen?

These are SERMs = antagonists to estrogen in breast and agonists in bone (thus, useful for BOTH osteoporosis and breast CA)

20

What drug is an inhibitor of B-Raf kinase with the V600E mutation?

Vemurafenib, for metastatic melanoma with this mutation

21

Which aspect of the cell cycle is affected by etoposide?

G2 and S

22

What is the MOA of methotrexate?

It is a folic acid analog that inhibits dihydrofolate reductase which decreases dTMP

23

What disease would result from an X-linked deficiency in the enzyme that activates 6 mercaptopurine and azathioprine?

Lesch-Nyhan syndrome (HGPRT)

24

What is the MOA of cytarabine?

Pyrimadine analog that inhibits DNA polymerase

25

What is the MOA of rituximab?

monoclonal antibody to CD20 used to treat B cell neoplasms

26

Major AE of vincristine

peripheral neuropathy (neurotoxicity)

28

Major AE of carbaplatin and cisplatin

acoustic nerve damage and nephrotoxicity

29

What kind of drugs are eptifibatide and tirofiban?

GpIIb/IIIa receptor antagonists (along with abciximab)

31

What are 4 AE of heparin?

Osteoporosis, HIT (thrombocytopenia), Bleeding, and drug-drug interactions

32

Rapid reversal of Warfarin OD

Fresh Frozen Plasma

33

Which DNA alkylating agents crosslink interstrand DNA at guanine N7?

cyclophosphamide and ifosfamide

34

3 results from chronic use of aspirin

Upper GI bleeding, Interstitial Nephritis, and Acute Renal failure

36

What is the MOA of 5 fluorouracil?

A pyrimidine analong activated to 5F-UMP which complexes with folic acid, that inhibits thymidilate synthase

36

AE of vincristine? Vinblastine?

Vincristine = neurotoxicity; VinBlastine= Bone marrow suppression

36

Which drug is used to treat metastatic melanoma?

Vemurafenib

37

What drug is used to treat Wilm's tumor, Ewings sarcoma, and Rhabdomyosarcoma?

Actinomycin D (Dactinomycin)

38

What are the best drugs for intermittent claudication (2)?

dipyridamole and cilostazol

40

MOA of paclitaxel and taxols

Hyperstabilize polymerized microtubules in M phase prevent depolymerization

42

How do you reverse methotrexate-induced myelosuppression?

leucovorin (folinic acid) rescue

43

Which lab value should be monitored for the patient on heparin? Warfarin?

PTT; PT (INR)

45

MOA of doxorubicin and daunorubicin

Generates free radicals and non-covalently intercalates DNA

46

What is the MOA of bleomycin

induces free radicals which break the DNA

48

2 Anticancer drugs with pulmonary fibrosis as AE

Busulfan and Bleomycin

50

Which type of heparin overdose is most amenable to treatment with protamine sulfate?

Unfractionated heparin? LMWH is more difficult to Tx

51

Name 3 GpIIb/IIIa inhibitors

Abciximab, eptifibatide, and tirofiban

52

MOA of vemurafenib

inhibitor of B-Raf kinase with V600E mutation in metastatic melanoma

53

Which 2 GpIIb/IIIa inhibitors are NOT monoclonal antibodies?

eptifibatide and tirofiban (abciximab is a monoclonal ab)

53

What is the MOA of imatinib?

Inhibits the bcr-abl fusion protein (tyrosine kinase) in philadelphia chromosome CML

54

Which SERM increases the risk for endometrial cancer? Why?

Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe

55

Explain how the MOA of GpIIb/IIIa inhibitors are similar and different from that of ADP receptor antagonists

ADP receptor antagonists ultimately block the expression of GpIIb/IIIa on the platelet, and, obviously, GpIIb/IIIa inhibitors directly block it

56

What kind of drugs are carmustine, lomustine, semustine, and streptozocin?

Nitrosoureas--DNA alkylating agents

57

Why are SERMs useful for both breast cancer and osteoporosis?

Because they are estrogen ANTAGONISTS in breast and AGONISTS in bone (estrogen builds blasts and kills clasts)

58

What is the MOA of cilostazol?

An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation

59

Aminocaproic acid is an antidote to what?

Thrombolytics toxicity i.e. alteplase, reteplase, and tenecteplase

60

Common AE to trastuzumab and doxorubicin

cardiotoxicity

62

What cancers are treated with azathioprine and 6MP?

leukemias

64

What drug helps to prevent cardiotoxicity in a patient on doxorubicin or daunorubicin?

Dexrazoxane (iron chelator)

65

In whom (6) is thrombolytic therapy contraindicated?

Active bleeding, Hx of intracranial bleeding, current intracranial neoplasm/AVM, recent surgery, severe HTN, known bleeding diatheses

66

What is the MOA of lepirudin and bivalrudin?

Direct thrombin inhibitors (come from hirudin)

68

Which drugs prevent tublin polymerization in M phase?

Vincristine and Vinblastine

69

Common AE to bleomycin and busulfan

pulmonary fibrosis

71

What drug is used in HER2 positive breast CA?

Trastuzumab (Herceptin)

73

Name 2 low molecular weight heparins

Dalteparin and Enoxaparin (parins)

75

Which arm of the clotting cascade does warfarin affect?

Extrinsic (i.e. monitor PT and INR)

76

Which drug is an inhibitor of the bcr-abl fusion protein of chronic myelogenous leukemia?

Imatinib (Gleevec)

77

What is the MOA of etoposide and teniposide?

inhibit topoisomerase II to enhance DNA degradation

77

Anticancer drug with peripheral neuropathy as major AE

Vincristine

78

What is the MOA of dactinomycin? Used to tx?

intercalates DNA; childhood tumor i.e. Wilms, Rhabdomyosarcoma, and Ewing's

79

What cancers are treated with cytarabine?

leukemias and lymphomas

80

This drug is an anti-CD20 antibody for B-cell neoplasms

rituximab

82

What 2 drugs are SERMs?

Raloxifene and Tamoxifen

83

4 AE of methotrexate

Myelosuppression, Macrovesicular Fatty Change, Mucositis, teratogenic

84

What antimetabolite covalently complexes with folic acid? Phase of cycle?

5-Fluorouracil; S phase

85

Which cranial nerve may be affected by aspirin?

CN VIII (tinnitus)

86

Name 3 thrombolytics

reteplase, alteplase, tecteplase

87

This antitumor antibiotic is limited by pulmonary fibrosis

bleomycin

88

Why can hydroxyurea be used to treat sickle cell disease?

increases the amount of fetal hemoglobin (HbF rather than HbS)

90

4 cancers that are treated with methotrexate

Leukemias, Lymphomas, Sarcomas, and Choriocarcinoma

91

Name 4 nitrosoureas

Carmustine, Lomustine, Semustine, and Streptozocin

92

What is the AE of ADP receptor antagonists? Which is most notorious?

Neutropenia, ticlopidine

93

Which antineoplastic drugs inhibit topoisomerase II?

Etoposide and Teniposide

94

What drug that treats CML is limited by pulmonary fibrosis?

busulfan

95

What is the MOA of carbaplatin and cisplatin? What drug is often given along with them to prevent nephrotoxicity?

Cross-link DNA; amifostine

97

What are 4 non-neoplastic uses of methotrexate?

Abortion, Ectopic Pregnancy, Rheumatoid arthritis, Psoriasis

98

All antimetabolites affect this phase of the cell cycle _____

S phase

99

This antitumor antibiotic is limited by cardiotoxicity

Doxorubicin (adriamycin) and Daunorubicin

100

Why do you need to dose adjust 6MP and azathioprine when on allopurinol?

These drugs are metabolized by xanthine oxidase, allopurinol inhibits that

101

Name 4 antitumor antibiotics

Dactinomycin (Actinomycin D), Doxorubicin (adriamycin), duanorubicin, and bleomycin

102

What antimetabolites are purine analogs activated by HGPRT? Phase of Cell cycle?

Azathioprine, 6 mercaptopurine, and 6 thioguanine; S phase

103

What enzyme is ultimately inhibited by 5-FU?

thymidylate synthase

104

What is the effect on platelets, PT, and PTT for A) Aspirin and B) Thrombolytics

A) Aspirin increases bleeding time only because platelets cannot aggregate B) Thrombolytics increase PT and PTT but no effect on platelets

106

What is the MOA of dipyridamole?

An inhibitor of phosphodiesterase III in platelets leading to increased cAMP and decreased platelet aggregation

108

What kind of drugs are used to treat Brain Tumors including GBM?

Nitrosoureas--DNA alkylating agents; these are carmustine, lomustine, semustine, and streptozocin

109

What cancer is treated with Busulfan? Translocation? AE?

CML t(9;22), PULMONARY FIBROSIS

111

A person treated for breast cancer with a drug that increases the risk for endometrial cancer must be taking _________

Tamoxifen, it is a partial agonist on endometrium, Raloxifene is safe

112

What is the MOA of cyclophosphamide and ifosfamide?

Covalently crosslink interstrand DNA at guanine N7

113

What 3 antimetabolites can cause myelosuppression?

5-FU, methotrexate, and 6-Mercaptopurine

114

What cancers are treated by paclitaxel and taxols?

Breast CA and Ovarian

115

What antimetabolite inhibits dihydrofolate reductase? Phase of cycle?

methotrexate; S phase

116

How is the treatment of 5-FU-induced myelosuppression different from that caused by methotrexate?

Methotrexate is reversed with leucovorin; 5-FU cannot be treated with leukovorin! You rescue with thymidine

117

What drug are cilostazol and dipyridamole often combined with for the prevention of TIAs and strokes?

aspirin

118

MOA of bevacizumab

antibody to VEGF, functions as anti-angiogenic in solid tumors

119

Will you see in vitro anticoagulation with warfarin?

No it acts in the liver

120

Explain Heparin Induced Thrombocytopenia

This is when a person develops IgG antibodies against complexes of heparin and platelet factor 4

121

Which drugs prevent tubulin DEpolymerization in the M phase?

Paclitaxel and taxols

122

Name 2 direct thrombin inhibitors

lepirudin and bivalrudin