Heme Onc Drugs Flashcards Preview

First Aid Drugs > Heme Onc Drugs > Flashcards

Flashcards in Heme Onc Drugs Deck (76)
Loading flashcards...
1
Q

heparin mechanism

A

activation of antithrombin III. major effect is decrease of factor 2a and 10a.

2
Q

does heparin have a short or long half life

A

short

3
Q

how to monitor heparin use

A

PTT

4
Q

major complication with heparin

A

HIT or heparin induced thrombocytopenia.

5
Q

rapid reversal of heparin

A

protamine sulfate- this is a positively charged molecule that binds negatively charged heparin.

6
Q

enoxaparin and dalteparin

A

these are two low molecular weight heparins.

7
Q

why is low moelcular weight heparin used

A

longer half life, better oral bioavilability. can be given subQ.

8
Q

HIT

A

IgG antibodies against heparin bound to platelet factor 4. antibody and platelet complex activates the platelets so you get thrombosis and thrombocytopenia.

9
Q

argatroban

A

hirudin derivative. anticoagulant used by leeches. inhibits thrombin directly. use with patients with HIT

10
Q

bivalirudin

A

hirudin derivative. anticoagulant used by leeches. inhibits thrombin directly. use with patients with HIT

11
Q

warfarin/coumadin

A

prevents gamma carboxylation of factors 2,7,9,10 C and S. metabolized by P450 system.

12
Q

how to monitor warfarin dosing

A

PT

13
Q

if skin tissue necrosis with warfain

A

think about protein C deficiency.

14
Q

reversal of warfarin dose

A

vitamin K

15
Q

rapid reversal of warfarin dose

A

fresh frozen plasma

16
Q

apixaban and ribaroxaban

A

bind and inhibit xa. used for treatment and prohpylaxis of DVT and PE. also used as prophylaxis in patients with a fib.

17
Q

one benefit of apixaban and ribaroxaban

A

oral agents

18
Q

is warfarin oral

A

yes

19
Q

which of heparin or warfain is teratogenic

A

warfarin

20
Q

alteplase, reteplase and tenecteplase

A

these are all thrombolytics. they directly or indirectly convert plasminogen into plasmin. which cleaves thrombin and fibrin clots.

21
Q

how to treat tpa or other thrombolytic overdose

A

aminocaproic acid. can also give fresh frozen plasma if needed.

22
Q

how does aspirin increase bleeding time

A

mainly prevents TXA2 production from platelet which means no platelet aggregation.

23
Q

aspirin overdose metabolic state

A

causes a respiratory alkalosis first and then metabolic acidosis. RK… MC.. gives a low Pco2 and low bicarbonate.

24
Q

clopidogrel, ticlopidine, prasugrel and ticagrelor

A

ADP receptor blockers. prevent the Gp2b/3a from being produced. inhibits fibrinogen from making a clot. used mostly for coronary stenting.

25
Q

clopidogrel, ticlopidine, prasugrel and ticagrelor side effects

A

neutropenia (ticlopidine). TTP and HUS may be seen

26
Q

cilostazol and dipyridamole

A

phosphodiesterase III inhibitors. increase cAMP and therefore prevent platelets from aggregating. also cause vasodilation- used for claudication issues, prevention of stroke, angina etc

27
Q

Abciximab, eptifibatide, tirofiban

A

bind to the glycoprotein Gp2b/3a and prevent aggregation. made from monoclonal antibody Fab fragments. used for angioplasty or unstable angina. can cause thrombocytopenia.

28
Q

antimetabolites work in ____ cell cycle phase

A

S phase- DNA synthesis

29
Q

Etoposide works in _____ cell cycle phase

A

G2 and S.

30
Q

Bleomycin works in _____ cell cycle phase

A

G2

31
Q

Vinca alkaloids and taxols work in ____ cell cycle phase

A

M phase

32
Q

MTX mechanism

A

inhibits dihydrfolate rectase so decrease dTMP synthess. decreases both DNA replication and protein synthesis.

33
Q

how to reverse myelosupression from MTX

A

leucovorin- folinic acid rescue

34
Q

5FU mechanism

A

pyrimidine analog bioactivated to 5FdUMP. inhibits thymidylate synthase so decrease in dTMP and decrease DNA and protein synthesis. can cause photosensitivity

35
Q

how to treat overdose of 5FU

A

uridine.

36
Q

Cytarabine mechanism

A

pyrimidine analog so it inhibits DNA polymerase.

37
Q

side effect of cytarabine

A

pancytopenia

38
Q

aza mechanism

A

purine (thiol) analog. decreases de novo purine synthesis. activated by HGPRT

39
Q

what drug can increase AZA toxicity

A

allopurinol. because Aza is broken down by xanthine oxidase

40
Q

dactinomycin

A

intercalates DNA. used for childhood tumors. wilm tumor, ewing sarcoma etc.

41
Q

doxorubicin - adriamycin and daunorubicin

A

generate free radicals and intercalate DNA. breaks in the DNA decrease its replication. used for solid tumors.

42
Q

important toxicity with doxurubicin

A

cardiotoxicity - causes dilated cardiomyopathy

43
Q

how to prevent cardiac toxicity with doxurubicin

A

dexrazoxane. iron chelating agent

44
Q

bleomycin mechanism

A

induces free radicals which causes breaks in DNA strands. used for testicular cancer and Hodgkin Lymphoma

45
Q

major side effect of bleomycin

A

pulmonary fibrosis. note- really minimal myelosupression

46
Q

alkylating agent

A

adds an alkyl group to the guanine in the DNA at the 7th N in the purine ring.

47
Q

cyclophosphamide and ifosfamide

A

covalently link an alkyl group to DNA at guanine N-7. requires bioactivation by the liver.

48
Q

major side effect of cyclophosphamide and ifosfamide

A

hemorrhagic cystitis prevented with mesna- binds to the toxic metabolite

49
Q

carmustine, lomustine, seustine, streptozocin

A

these are all nitrosourease= alkylating agents. require bioactivation. can cross the blood brain barrier. used for brain tumors! can cause cause CNS toxicity like ataxia

50
Q

busulfan

A

cross links dna. it is an alkylating agent. used only in CML and to white out bone marrow before transplant.

51
Q

side effects of busulfan

A

severe myelosupression, pulmonary fibrosis, hyperpigmentation

52
Q

vincristine and vinblastine

A

these are vinca alkaloids that bind to beta tubulin and inhibit its polyermization- can’t form microtubules. this means no mitotic spindle formation in the cell- M phase arrest. used for solid tumors, leukemia and lymphoma.

53
Q

vincristine toxicity

A

neurotoxicity - areflexia, peripheral neuritis, paralytic ileus

54
Q

vinblastine toxicity

A

myelosupression- blasts away the marrow

55
Q

paclitaxel and other taxols

A

hyeprstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down- no anaphase. used to treat ovarian and breast cancer.

56
Q

cisplatin and carboplatin

A

cross link DNA. used for testicular, blader, ovary and lung cancer.

57
Q

cisplatin and carboplatin toxicity

A

nephrotoxicity and acoustic nerve damage.

58
Q

how to prevent nephrotoxicity from cisplatin and carboplatin

A

amifostine- free radical scavenger and chloride diuresis

59
Q

etoposide, teniposide

A

topoisomerase II inhibitor- leads to DNA degradation. works for like testicular cancer and small cell lung cancer

60
Q

irinotecan and topotecan

A

inhibit topoisomerase I. prevents DNA unwinding and replication. used in colon cancer (I) and ovarian and small cell lung cancer (T)

61
Q

hydroxyurea

A

inhibits ribonucleotide reductase- decreases DNA synthesis. S phase specific. used in CML, melanoma and sickle cell disease (increases fetal hemoglobin)

62
Q

Tamoxifen and raloxifene

A

selective estrogen receptor modulators- antagonist in breast and agonist in the bone. block the binding of estrogen to the ER in cells. use T for breast cancer and R for treatment of osteoporosis. T is an agonist in endometrium so you can get endometrial cancer. R is an endometrial antagonist so no increase in endometrial cancer.

63
Q

Trastuzumab

A

this is herceptin. it is a monoclonal antibody against Her2 which is a tyrosine kinase receptor. used for two things- Her2 positive breast cancer and gastric cancer.

64
Q

major toxicity of traztuzumab

A

cardiac-

65
Q

Imatinib

A

this is gleevac. tyrosine kinase inhibitor of bcr-abl and cKit. used for CML and GI stromal tumors.

66
Q

toxicity from Imatinib

A

fluid retention.

67
Q

Rituximab

A

anti B cell- against CD20 which is found in most B cell cancers. increased risk of PML

68
Q

Vemurafenib

A

inhibits the B raf kinase with the V600 E mutation. used only for metastatic melanoma.

69
Q

bevacizumab

A

this is a monoclonal antibody against VEGF. inhibits angiogenesis. used for solid tumors like colon cancer and renal cell carcinoma. may cause hemorrhage and impaired wound healing

70
Q

cisplatin/carboplatin toxicity

A

nephrotoxic and ototoxic- acoustic nerve damage

71
Q

vincristine

A

this one causes the nerve issues- peripheral neuropathy and other neurologic issues

72
Q

doxurubicin toxicity

A

cardiac

73
Q

trastuzumab toxicity

A

cardiac

74
Q

bleomycin and busulfan toxicity

A

both cause pulmonary fibrosis

75
Q

cyclophosphamide toxicity

A

hemorraghic cystitis

76
Q

5FU, 6MP and MTX toxicity

A

myelosupression