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Pharm II > Heme > Flashcards

Heme Flashcards

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1
Q

Asprin

A

Analgesic, antipyretic, anti-inflammatory, anti-platelet

MOA:
Irreversible COX 1&2 inhibitor by covalent acetylation
Plts cant synth new COX
Increased Bleeding time,
Reduced TXA2 and PGs
No effect PT and PTT

Toxicity:
Gastric ulceration, CNVIII
Chronic use -> acute renal failure, interstitial nephritis, upper GI bleed
Reye syndrome w/ virus in peds
OD -> resp alkalosis and then superimposed metabolic acidosis

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2
Q

ibuprofen

A 
Analgesic
MOA:
reversible COX inhibitors
half-life ~2h
hold 1-2 days preop
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3
Q

Naproxen

A 
Analgesic
reversible cox inhibitor
Tmax 1-2h
half life 12-17h
Hold several days preop
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4
Q

Clopidogrel

A

ADP receptor inhibitor
MOA:
Inhibits plt aggregation; irreversibly blocks ADP receptors

Clinical:
ACS, Coronary Stenting, prophylactic for thrombotic stroke

Tox: TTP/HUS

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5
Q

Prasugrel

A

ADP receptor inhibitor
MOA:
Inhibits plt aggregation; irreversibly blocks ADP receptors

Clinical:
ACS, Coronary Stenting, prophylactic for thrombotic stroke

Tox: TTP/HUS

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6
Q

Ticagrelor

A

ADP receptor inhibitor
MOA:
Inhibits plt aggregation; irreversibly blocks ADP receptors

Clinical:
ACS, Coronary Stenting, prophylactic for thrombotic stroke

Tox: TTP/HUS

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7
Q

Heparin

A

Anticoagulant

MOA:
cofactor for activation of antithrombin. Reduces thrombin, Factor Xa and IIa
short half life

Clinical use:
imediate anticoagulation for PE, ACS, MI DVT.
used during pregnancy (wont cross placenta)
Follow PTT

Tox:
Bleeding, thrombocytopenia(HIT)
osteoporosis, DDI,
Reversal = protamine sulfate

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8
Q

Enoxaparin

A

Anti-coagulant
LMWH

MOA:
LMWH acts more on Factor Xa are cofactor for activation of antithrombin. Reduces thrombin,
longer half life

Clinical use:
imediate anticoagulation for PE, ACS, MI DVT.
used during pregnancy (wont cross placenta)
SC administration
No lab monitoring

Not easily reversible

Tox:
Bleeding, thrombocytopenia(HIT)
osteoporosis, DDI,

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9
Q

Dalteparin

A

Anti-coagulant
LMWH

MOA:
LMWH acts more on Factor Xa are cofactor for activation of antithrombin. Reduces thrombin,
longer half life

Clinical use:
imediate anticoagulation for PE, ACS, MI DVT.
used during pregnancy (wont cross placenta)
SC administration
No lab monitoring

Not easily reversible

Tox:
Bleeding, thrombocytopenia(HIT)
osteoporosis, DDI,

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10
Q

Tinzaparin

A

Anti-coagulant
LMWH

MOA:
LMWH acts more on Factor Xa are cofactor for activation of antithrombin. Reduces thrombin,
longer half life

Clinical use:
imediate anticoagulation for PE, ACS, MI DVT.
used during pregnancy (wont cross placenta)
SC administration
No lab monitoring

Not easily reversible

Tox:
Bleeding, thrombocytopenia(HIT)
osteoporosis, DDI,

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11
Q

Fondaparinux

A

Anti-coagulant
LMWH

MOA:
LMWH acts more on Factor Xa are cofactor for activation of antithrombin. Reduces thrombin,
longer half life

Clinical use:
immediate anticoagulation for PE, ACS, MI DVT.
used during pregnancy (wont cross placenta)
SC administration
No lab monitoring

Not easily reversible

Tox:
Bleeding, thrombocytopenia(HIT)
osteoporosis, DDI,

No reversal agent!!

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12
Q

Protamine sulfate

A

basic protein binds negatively charged heparins

Heparin reversal agent

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13
Q

warfarin

A 
Anticoagulant
MOA:
interferes w. gamma carboxylation of vit K dependent clotting factors II, VII, IX, X; proteins C&S
CYP450 metabolism
Extrinsic pathway 
Elevates PT
Long half-life

Clinical:
chronic anticoagulation (STEMI, venous thromboembolism prophylaxis, A.fib.
Not used in pregnancy
Follow PT/INR

Tox:
bleeding, teratogenic, skin/tissue necrosis

Reversal:
Vitamin K, Fresh Frozen Plasma

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14
Q

Argatroban

A

Anticoagulant

Hirudin derivative (leeches)
Direct thrombin inhibitor

heparin contraindications (HIT)

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15
Q

Bivalirudin

A

Anticoagulant

Hirudin derivative (leeches)
Direct thrombin inhibitor

heparin contraindications (HIT)

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16
Q

Dabigatran

A

Oral anticoagulant
Direct thrombin inhibitor
IIa inhibitor

Heparin contraindications (HIT)

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17
Q

Rivaroxaban

A

Anticoagulant
MOA:
Direct factor Xa inhibitor

Clinical:
Treatment/prophylaxis of DVT/PE, Afib(stroke)
Oral
no monitoring

Tox:
bleeding
no reversal agents

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18
Q

Apixaban

A

Anticoagulant
MOA:
Direct factor Xa inhibitor

Clinical:
Treatment/prophylaxis of DVT, Afib(stroke)
Oral
no monitoring

Tox:
bleeding
no reversal agents

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19
Q

tPA

A

Thrombolytics
MOA:
directly/indirectly aid conversion of plasminogen -> plasmin; cleaves thrombin and fibrin clots
^^PT, ^^PTT

Clinical:
Early MI, early ischemic stroke, direct thrombolysis of severe PE

Tox:
bleeding
Contraindicated in actively bleeding, hx of intracranial bleed, recent surgery, known bleeding diathesis, severe HTN

Reversal:
fibrinolysis inhibitor = aminocaproic acid
FFP/cryoprecipitate to correct factor deficiences

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20
Q

Urokinase Plasminogen

A 
Fibrinolytic
Thrombolytics
MOA:
directly/indirectly aid conversion of plasminogen -> plasmin; cleaves thrombin and fibrin clots
^^PT, ^^PTT

Clinical:
Early MI, early ischemic stroke, direct thrombolysis of severe PE

Tox:
bleeding
Contraindicated in actively bleeding, hx of intracranial bleed, recent surgery, known bleeding diathesis, severe HTN

Reversal:
fibrinolysis inhibitor = aminocaproic acid
FFP/cryoprecipitate to correct factor deficiences

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21
Q

streptokinase

A 
fibrinolytic
Thrombolytics
MOA:
Binds plasminogen cleaves fibrin clots
^^PT, ^^PTT

Clinical:
Early MI, early ischemic stroke, direct thrombolysis of severe PE

Tox:
bleeding
Contraindicated in actively bleeding, hx of intracranial bleed, recent surgery, known bleeding diathesis, severe HTN

Reversal:
fibrinolysis inhibitor = aminocaproic acid
FFP/cryoprecipitate to correct factor deficiences

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22
Q

Herbal clotting inhibitors

A

eg Ginko

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23
Q

cyclophosphamide

A

Alkylating agent

Commonly used

MOA:
covalently crosslink DNA at Guanine N-7; requires hepatic bioactivation.

Clinical:
Solid tumors, leukemia, lymphomas, some brain

Tox:
myelosuppression, **hemorrhagic cystitis, partially prevented w. **mesna (binds toxic metabolites)

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24
Q

Cisplatin

A

bifunctional alkylating agent
MOA:
crosslinks DNA

Clinical:
testicular, bladder, ovary, lung carcinomas

Tox:
nephrotox, CNVIII damage
prevent nephrotox w/ amifostine (free radical scavenger) chloride diuresis

Renal insufficiency

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25
Ondanestron
``` Antiemetic MOA: 5-HT3 central antagonist decreases vagal stim powerful central acting anti-emetic ``` Clinical: antiemetic; post op and chemo Tox: Headache, constipation
26
Aprepitant
Antiemetic Neurokinin 1 antagonist CYP3A4 metabolism
27
Methotrexate
anti-metabolite MOA: folic acid analogue inhibits dihydrofolate reductase --v dTMP --> --v DNA and --v protein synth Leucovorin Rescue for bone marrow Clinical: cancers, leukemia, lymphomas, choriocarcinomas, sarcomas, Non-neoplastic: abortion, ectopic pregnancy, rheumatoid arthritis, psoriasis, IBD TOX: myelosuppression, reversible w/ leucovorin "rescue" Macrovesicular fatty liver mucositis, teratogenic
28
5-flurouricil
Nucleoside analogue MOA: pyrimidine analog, bioactivated to 5fF-dUMP, covalently complexes folic acid: complex inhibits thymidylate synthase -->--vdTMP-->--vDNA and protein synth Clinical: colon cancer, pancreatic cancer, basal cell carcinoma ``` Tox: myelosuppression, ***leucovorin potentiates OD rescue w/ uridine photosensitivity ```
29
Leucovorin
*Methotrexate myelosuppression rescue
30
Cytarabine (Ara-C
nucleoside analogue arabinofuranosyl cytidine MOA: pyrmadine analog; Inhibits DNA pol S-phase specifric Clinical: Leukemias, lymphomas Tox: leukopenia, thrombocytopenia, megaloblastic anemia pancytopenia
31
Daunorubicin
Anthracycline antibiotic MOA: Generates free radicals that intercalate into DNA; breaks DNA and --v replication Clinical: solid tumors, leukemias, lymphomas Tox: cardiotox (dilated cardiomyopathy) myelosuppression, alopecia, tissue tox from extravisation Dexrasoxane prevents cardiotox (iron chelator)
32
Doxorubicin
Anthracycline antibiotic MOA: Generates free radicals that intercalate into DNA; breaks DNA and --v replication Clinical: solid tumors, leukemias, lymphomas Tox: cardiotox (dilated cardiomyopathy) myelosuppression, alopecia, tissue tox from extravisation Dexrasoxane prevents cardiotox (iron chelator)
33
Etoposide
MOA: inhibits Topo II --^ DNA degredation Clinical: solid tumors, leukemias, lymphomas Tox: myelosuppression, GI, alopecia
34
Topotecan
MOA: inhibits topo I prevents DNA unwinding and replication Clinical: ovarian and SCLCs Tox: severe myelosuppression
35
Irinotecan
MOA: inhibits topo I prevents DNA unwinding and replication Clinical: Colon cancers Tox: severe myelosuppression
36
Bortezomib/Carfilzomib
Chemo; Multiple myeloma and Mantle Cell lymphoma
37
Thalidomide
Oral immuno suppression Multiple Myeloma GVHD, leprosy
38
Lenalidomide and Pomalidomide
Oral immune suppression newer better thalidomide mess up protein processing Relapsed and refractory Multiple myeloma
39
Vinblastine
Microtubule inhibitor MOA: Vinca alkaloid binds B-tubulin; inhibits polymerization; prevents mitotic spindle formation Clinical: solid tumors, leukemias, lymphomas, Tox: marrow suppression
40
Vincristine
Microtubule inhibitor MOA: Vinca alkaloid binds B-tubulin; inhibits polymerization; prevents mitotic spindle formation Clinical: solid tumors, leukemias, lymphomas, Tox: neurotoxicity
41
Paclitaxel and Taxols
Taxol MOA: hyperstabilizes polymerized microtubules in M-phase; mitotic spindle can not break down; anaphase doesnt occur. Clinical: ovariann, breast carcinomas Tox: myelosuppression, alopecia, hypersensitivity.
42
G-CSF
shortens time that pt is neutropenis, minimizes infection risk Neutropenia
43
GM-CSF
Neutropenia Granulocyte-macrophage colony stimulating factor Stimulates production of granulocytes and monocytes
44
Erythropoietin
Anemia erythrocyte production for chronic renal failure, ACD, MDS, AIDS, chemo
45
IL-11
Thrombocytopenia
46
Thrombopoeitin
Thrombocytopenia
47
Darbepoietin alpha
Anemia
48
IL-2
Stimulates anti tumor response Growth factor fo T-cells and NK Renal cell carcinoma
49
Interferons
Stimulates anti tumor response SC admin
50
Rituximab
Monoclonal Ab MOA: monoclonal Ab vs. CD20 (found in most B-cell neoplasms) Clinical: lymphoma rheumatoid arthritis (w/ MTX) ITP Tox: --^ risk of progressive multifocal leukoencephalopathy
51
5-Azacytidine
epigenetic Chemotherapeutic cant be methylated incorporated and tunr on genes that cancer cells have methylated/shut off
52
Suberoylanilide Hydroxamic acid
Chemotherapeutic
53
Nivolumab
Monoclonal Ab | unresectible or metastatic melanoma; squamous NSCLC
54
Pembrolizumab
monoclonal Ab | unresectable or metastatic melanoma; metastatic NSCLC
55
Trastuzumab
Mab Her2/neu receptor Her2+ breast cancer ADR Cardiac tox dyspnea allergy
56
Imatinib mesylate
RTK inhibitor MOA: Tyrosine kinase inhibitor or bcr-abl and c-kit CYP3A4 Clinical: CML, GI stromal tumors Tox: fluid retention Cardiac
57
Erlotinib
Chemotherapeutic Tarceva EGFR inhibitor
58
Bevacizumab
MOA: monoclonal Ab vs VEGF; inhibits angiogenesis Clinical: solid tumors Tox: hemorrhage and impaired wound healing
59
Abciximab
Fab fragment against GPIIb/IIIa prevention of acute clotting/vessel closure in PCI 2x major bleed
60
Eptifibatide
GPIIb/IIIa inhibitor Rarely used thrombocytopenia
61
Tirofiban
GPIIb/IIIa inhibitor Rarely used thrombocytopenia
62
Alkylating agents
reactive organic moleucles alkylate DNA Phase non-specific linear dose-response ADR: nausea, marrow suppression, mutagenesis, secondary carcinomas
63
Methchlorethamine
Nitrogen mustard Alkylating agent First chemo agent no longer used
64
Melphalan
Nitrogen mustard alkylating agent commonly used few side effects
65
ifosphamide
Nitrogen mustard alkylating agent commonly used few side effects
66
chlorambucil
Nitrogen mustard alkylating agent commonly used few side effects
67
Gemtuzumab
monoclonal Ab carries toxin to CD33 cells AML
68
Tiuxetan
MAB anti CD20 radioactivity
69
cetuximab
MAB | EGFR target
70
Vemurafenib
protein kinase inhibitor B-Raf mutation Oral for metastatic melanoma

Pharm II (3 decks)

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