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Heme/Onc Flashcards

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1
Q

Drug class for iron

A

Hematinic

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2
Q

MoA for iron

A

supplement

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3
Q

Indications of iron

A

iron deficiency

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4
Q

SE/ADRs for iron

A

N/V/D
constipation, abd cramps
black stools
anaphylaxis

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5
Q

Contra-indications for iron

A

hemochromatosis, anaphylaxis, hemolytic anemia

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6
Q

Dx-Dx for iron

A

antacids, phenytoin

quinolone & tetracycline abxs bind Fe

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7
Q

monitoring for iron

A

serum ferritin
transferrin saturation
Hgb
reticulocytes

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8
Q

Drug class for deferoxamine

A

iron chelator

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9
Q

indications for deferoxamine

A

excessive serum iron levels

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10
Q

MoA for deferoxamine

A

chelates iron from hemosiderin, ferritin, transferrin (not from hemoglobin or cytochromes)

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11
Q

SE/ADRs for deferoxamine

A 
fever, leg cramps
tachy, hypotension
allergic drug runs
'pulmonary syndrome'
neurotoxicity
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12
Q

Drug class for Cyanacobalamin B12

A

vitamin

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13
Q

MoA for cyanacobalamin B12

A

rate limiting cofactor in conversion of folate to active form & DNA synthesis

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14
Q

indications for cyanacobalamin B12

A

B12 deficiency (megaloblastic anemia, peripheral neuropathy, depression, CVD)

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15
Q

SE/ADRs for cyanacobalamin B12

A

painful by injection site

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16
Q

Dx-Dx for cyanacobalamin B12

A

long term acid suppression therapy

metformin (can inhibit B12 absorption), phenytoin

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17
Q

monitoring for cyanacobalamin B12

A

[B12, folate] serum

MMA levels, homocysteine levels

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18
Q

Drug class for folic acid

A

nutritional

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19
Q

MoA for folic acid

A

cofactor in DNA synthesis

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20
Q

indications fo folic acid

A

folate deficiency (megaloblastic anemia, prevention of neural tube defects, CVD)

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21
Q

SE/ADRs for folic acid

A

bronchospasms, flushing, pruritis (rare)

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22
Q

Contra-indications for folic acid

A

hypersensitivity

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23
Q

Dx-Dx for folic acid

A
  • phenobarbitol, phenytoin, primidone levels decreased by folic acid
  • phenytoin, trimethoprim, methotrexate deplete folic acid levels
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24
Q

monitoring for folic acid

A

serum folic acid

RBC folate level

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25
Drug class for epoetin alfa
erythrocyte-stimulating agent
26
MoA for epoetin alfa
stimulates erythroid proliferation & differentiation; induces release of reticulocytes
27
indications for epoetin alfa
low RBC secondary to ESRD, HIV, antineoplastic therapy, RA
28
SE/ADRs for epoetin alfa
secondary impact on iron deficiency, clotting | hypertensions, thrombosis, seizures
29
What disease should we think about using Epoetin alfa (Epogin) for?
Chronic kidney disease
30
Drug class for filgrastim
myeloid growth factor: G-CSF
31
MoA for filgrastim
1. stimulates proliferation & differentiation of myeloid cells 2. increase phagocytic capacity & prolongs survival of mature neutrophils 3. mobilizes peripheral neutrophils
32
indications for filgrastim
neutropenia secondary to chemotherapy
33
SE/ADRs for filgrastim
fever, petechiae, bone pain | splenomegaly
34
What is the major cause for people stopping iron supplementation?
GI complications
35
Which form has the most elemental iron in it?
FeSO4
36
Why don't you want to give Epogin with Hgb levels over 11?
increased risk for blood clots, MI, and strokes
37
How long does it take to completely correct & replete iron stores? But when will you see effects of iron supplementation?
3-6 months for complete restoration | see increase in 2-3 weeks
38
Drug class for unfractionated heparin
indirect thrombin inhibitors
39
MoA for unfractionated heparin
accelerates degradation of XA & thrombin (Ila)
40
indications for unfractionated heparin
thrombotic disorders
41
SE/ADRs for unfractionated heparin
bleeding, allergic rxn, alopecia | long term: osteoporosis; HIT (after 7 days); skin necrosis
42
Contra-indications for unfractionated heparin
prior HIT, pre-existing severe thrombocytopenia, intra-cranial bleeding
43
Dx-Dx for unfractionated heparin
other anticoagulants tNSAIDs NTG decreases effectiveness
44
monitoring for unfractionated heparin
aPTT, platelet counts H&H fecal occult blood
45
Why can't unfractionated heparin lyse an established clot?
it has no fibrinolytic activity
46
Drug class for low-molecular-weight heparin (lmwh enoxaparin)
indirect thrombin inhibitors
47
MoA for low-molecular-weight heparin
increases degradation of Xa
48
indications for low-molecular-weight heparin
acute coronary syndrome, DVT (prevention & treatment)
49
SE/ADRs for low-molecular-weight heparin
- injection site hematoma, fever, increased AST/ALT - bleeding - hypersensitivity rxn
50
Contra-indications for low-molecular-weight heparin
- active major bleeding - hypersensitivity to pork, heparin - thrombocytopenia
51
monitoring for low-molecular-weight heparin
platelet count, CrCl
52
How is low-molecular-weight heparin eliminated?
renally
53
Drug class for fondaparinux
indirect thrombin inhibitors
54
MoA for fondaparinux
accelerates factor Xa degradation
55
Indications for fondaparinux
- DVT prophylaxis | - TX acute PE/DVT without PE
56
SE/ADRs for fondaparinux
- moderate thrombocytopenia - bleeding, rash - fever, nausea - anemia, edema
57
Contra-indications for fondaparinux
- hypersensitivity - active bleeding - CrCl less than 30ml/min
58
Dx-Dx for fondaparinux
-tNSAIDs | o/w minimal
59
monitoring for fondaparinux
CBC, CrCl | fecal occult blood
60
How is fondaparinux administered?
only sub-Q
61
Drug class for protamine sulfate
antagonist of indirect thrombin inhibitors
62
MoA for protamine sulfate
binds to heparin & neutralizes its anticoagulant effect
63
indications for protamine sulfate
excess heparin impact
64
Drug class for dabigatran
oral direct thrombin inhibitor
65
MoA for dabigatran
directly inhibits thrombin (Ila) action to convert fibrinogen to fibrin; inhibits platelet aggregation
66
indications for dabigatran
prevent stroke in non-valvular A fib
67
SE/ADRs for dabigatran
bleeding, gastric irritation | gastritis
68
Contra-indications for dabigatran
severe renal disease (CrCl less than 15 ml/min)
69
Dx-Dx for dabigatran
P-gp inducers antagonize (rifampin); P-gp inhibitors (clopidogrel, amiodarone) increase levels
70
monitoring for dabigatran
H&H, ECT (ecarine clotting time) | aPTT, CrCl
71
PG category for dabigatran
PG C
72
What is the shelf life for dabigatran once opened? Unopened?
30 days once opened very moisture sensitive 4 months unopened
73
Drug class for warfarin
coumarin anticoagulants
74
MoA for warfarin
block Vit K mediated carboxylation of clotting factors VII, IX, X, II & proteins C & S
75
indications for warfarin
prevention & treatment of venous thrombosis
76
SE/ADRs for warfarin
easy bruising; skin/tissue necrosis hypersensitivity rxn vasculitis
77
contra-indicaitons for warfarin
active bleeding | prior hx of skin necrosis
78
Dx-Dx for warfarin
other anticoagulants | gingo biloba
79
monitoring for warfarin
PT/INR | H&H
80
drug class for vitamin k
antagonist of coumarin anticoagulants
81
MoA for vitamin k
promotes liver synthesis of II, VII, IX, X
82
indications for vitamin k
counteract excess warfarin anticoagulation or vit k deficiency
83
SE/ADRs for vitamin k
primarily w/ IV dosing-flushing, hypotension, cyanosis, rash
84
contra-indications for vitamin k
hypersensitivity to vit k (IV)
85
Dx-Dx for vitamin k
decreases coumarin anticoagulation; Orlistat decreases PO absorption
86
monitoring for vitamin k
PT/INR | H&H
87
Drug class for Rivaroxaban
direct factor Xa inhibitor
88
MoA for Rivaroxaban
directly & selectively inhibits factor Xa
89
indications for Rivaroxaban
to reduce risk of clots w/ knee & hip replacement, non-valvular atrial fib, DVT/PE
90
SE/ADRs for rivaroxaban
bleeding, peripheral edema, diarrhea, dizziness
91
contra-indications for rivaroxaban
active pathological bleeding, hypersensitivity, mod-severe liver disease (Child-Pugh class B or C), coagulopathy
92
Dx-Dx for rivaroxaban
- CYP3A4/P-gp inhibitors (clarithromycin, flucanazole) increase [drug] - CYP3A4/P-gp inducers (carbamazepine, phenytoin, rifampin, St Johns wort) decrease [drug]
93
monitoring for rivaroxaban
- initially CBC, CrCl, LFT | - chronic: none
94
Pg for rivaroxaban
avoid in PG
95
drug class for streptokinase
fibrinolytic
96
MoA for streptokinase
activates conversion of plasminogen to plasmin which degrades fibrin, fibrinogen to lyse cloth (both physiologic & pathologic thrombi)
97
indications for streptokinase
severe DVT, PE, AMI, occluded AV cannulas
98
SE/ADRs for streptokinase
bleeding, fever, pruritis
99
drug class for aminocaproic acid
fibrinolysis inhibitors
100
MoA for aminocaproic acid
binds to plasminogen & plasma & blocks plasmin lysis of fibrin (but some thrombi continue to form)
101
indications for aminocaproic acid
state of excess fibrinolysis
102
SE/ADRs for aminocaproic acid
hypotension, abd discomfort, diarrhea, myopathy, muscle necrosis (rare)
103
drug class for alteplase
plasminogen activator tPAs
104
MoA for alteplase
preferentially activates plasminogen bound to fibrin (theory-confines thrombolysis to formed thrombus)
105
indications for altetplase
thrombus lysis in AMI, PE
106
SE/ADRs for alteplase
bruising, fever, bleeding, hypotension, reperfusion arrhythmias
107
drugs class for aspirin
anti-platelet drugs
108
MoA for aspirin
irreversible inactivation (via acetylation) of cyclo-oxygenase- inhibits synthesis of thromboxane A2-prevents platelet aggregation & vasoconstriction by thromboxane A2
109
indications for aspirin
secondary prophylaxis s/p MI, CVA
110
SE/ADRs for aspirin
gastritis (30%), dyspepsia; bleeding, tinnitus (high dose)
111
contra-indications for aspirin
hypersensitivity, nasal polyposis + bronchospasms
112
Dx-Dx for aspirin
other anticoagulants, NSAIDs
113
monitoring for aspirin
none specifically
114
drug class for clopidogrel
platelet ADP inhibitor
115
MoA for clopidogrel
irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding & platelet aggregation
116
indications for clopidogrel
secondary prevention AMI, CVA, PAD
117
SE/ADRs for clopidogrel
gastritis (27%), abd pain, dyspepsia, thrombocytopenia, leukopenia (rare)
118
contra-indications for clopidogrel
active bleeding, hypersensitivity
119
Dx-Dx for clopidogrel
other anti-platelet or anti-coagulatn drugs, gingko biloba (increase effect); atorvostatin, macrolide abs (decrease)
120
monitoring for clopidogrel
H&H
121
drug class for abciximab
glycoprotein IIB/IIIA inhibitors
122
MoA for abciximab
blocks platelet GBIIb/IIIa receptors for thromboxane A2, thrombin, collagen & prevents platelet aggregation
123
indications for abciximab
coronary artery stent surgery, acute coronary syndrome
124
SE/ADRs for abciximab
bleeding
125
contra-indications for abciximab
bleeding
126
Dx-Dx for abciximab
anticoagulants
127
How is abciximab administered?
IV
128
drugs class for dipyridamole
phosphodiesterase inhibitor
129
MoA for dipyridamole
increases platelet concentration of AMP decreasing platelet aggregation
130
indications for dipyridamole
post-op primary prophylaxis s/p prosthetic heart valves; prophylaxis after CVA
131
SE/ADRs dipyridamole
dizziness, HA, abd discomfort, confusion, blurred vision, dyspepsia, hypotension
132
contra-indications for dipyridamole
hypersensitivity; severe hepatic or renal impairment
133
Dx-Dx for dipyridamole
aspirin
134
monitoring for dipyridamole
CrCl, H&H
135
What is added to dipyridamole to increase effectiveness?
aspirin
136
drug class for cilostazole
phosphodiesterase inhibitor
137
MoA for cilostazole
inhibits platelet phosphodiesterase thus preventing aggregation
138
indications for cilostazole
peripheral artery disease (intermittent claudication)
139
SE/ADRs for cilostazole
rhinitis, HA, abnormal stools
140
contra-indications for cilostazole
thrombocytopenia, heart failure, severe renal or hepatic impairment
141
Dx-Dx for cilostazole
- CYP3A4 inhibitors-macorlide abx (increase effect - NSAIDs & omeprazole (increase) - anticoagulants (increase)
142
monitoring for cliostazole
CrCl, walking distance

Pharmacology (16 decks)

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