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STEP 1 > Pharm Hemato/onco > Flashcards

Pharm Hemato/onco Flashcards

(59 cards)

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1
Q

Heparin (MOA)

A

Activates antithrombin (which decrease action primarily of factors IIa (thrombin) and Xa)

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2
Q

Heparin (clinical use) : in the intrinsic

A

Pulmonary embolism
Acute coronary syndrome
MI
DVT
(Used in pregnancy= does not cross placenta)
Monitor PTT

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3
Q

Heparin Adverse effects:

A

Bleeding
Heparin induced thrombocytopenia (HIT)
Osteoporosis (long term use)

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4
Q

HIT type 1:

A

Mild (pc > 100,000)
Non immunologic drop in platelet count.
Highest risk w unfractionated heparin

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5
Q

HIT type 2:

A

Development IgG ab against (PF4)
5-10 days after heparin administration
Ab- heparin complex binds and activates platelets —- removal by splenic macrophages. Decrease platelet count.

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6
Q

Low molecular weight heparins: Examples

A

Enoxaparin, dalteparin:
Act mainly on factor Xa

Fondaparinux: acts only on factor Xa

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7
Q

LMWHs: notes

A

Undergo renal clearance: use w caution with renal insufficiency

Can be administered subscutaneosly
No lab monitoring required

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8
Q

Warfarin (MOA):

A

Inhibits vitamin K epoxide reductase
Inhibitions of Vit K dependent gamma carboxylations of clotting factors: 2,7,9,10 and protein C,S
Extrinsic pathway: high PT

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9
Q

Warfarin (clinical use)

A

Chronic anticoagulation (venous thromboembolism prophylaxis and prevention of stoke in AF)
Not for pregnant patients
Monitor PT/INR

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10
Q

Warfarin (adverse effects)

A

Bleeding
Teratogenic
Skin/tissue necrosis

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11
Q

Warfarin reversal:

A

Vitamin K
For rapid reversal: FFP, PCC

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12
Q

Warfarin administration

A

Oral

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13
Q

Heparin administration

A

Parenteral (IV, SC)

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14
Q

Site of action Warfarin:

A

Liver

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15
Q

Site of action of heparin:

A

Blood

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16
Q

MOA:
Bivalirudin
Argatroban
Dabigatran

A

Directly inhibit thrombin (factor IIa)

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17
Q

Clinical use of:
Bivalirudin
Argatroban
Dabigatran (oral)

A

Venous thromboembolism
Atrial fibrillation
Can be used in HIT
Does not require lab monitoring

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18
Q

MOA:
ApiXAban
EndoXAban
RivaroXAban

A

Directly inhibit factor Xa

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19
Q

Clinical use:

ApiXAban
EndoXAban
RivaroXAban

A

Tx and prophylaxis for DVT and PE
Stroke prophylaxis in pte with AF

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20
Q

Adverse effects:

ApiXAban
EndoXAban
RivaroXAban

A

Bleeding
Reverse with andeXAnet alfa

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21
Q

Dabigatran reversal:

A

Idarucizumab

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22
Q

Antiplatelets (MOA): Aspirin

A

Blocks COX —> decrease TXA2 release

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23
Q

Aspirin (Adverse effects):

A

Gastric ulcer
Tinnitus
Allergic reaction
Renal injury

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24
Q

Antiplatelets (MOA):

Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine

Study These Flashcards
A

Block ADP (P2Y12) Receptor:
Decrease ADP- induced expression of GpIIb/IIIa

25
Antiplatelets (AE): Clopidogrel Prasugrel Ticagrelor Ticlopidine
Neutropenia (ticlopidine) TTP
26
Antiplatelets (MOA): Abciximab Eptifibatide Tirofiban
A GpIIb/IIIa Receptor antagonist , inhibits binding of this receptor to fibrinogen.
27
Antiplatelets (clinical use): Abciximab Eptifibatide Tirofiban
Unstable angina Percutaneous coronary intervention
28
Antiplatelets (AE) Abciximab Eptifibatide Tirofiban
Bleeding Thrombocytopenia
29
Antiplatelets (MOA): Cilostazol Dipyridamole
Block phosphodiesterase —> decrease cAMP in platelets
30
Antiplatelets (CU): Cilostazol Dipyridamole
Intermittent claudication Stroke prevention Cardiac stress testing Prevention of coronary stent restenosis
31
Antiplatelets (AE): Cilostazol Dipyridamole
Nausea Headache Facial flushing Hypotension Abdominal pain
32
Thrombolytics: MOA Alteplase Reteplase Streptokinase Tenecteplase
Aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. Aumenta PT and PTT, no change in platelet count
33
Antifibrinolytics
Aminocaproic acid Tranexamic acid
34
Antitumor antibiotics: MOA Bleomycin
Induce free radical formation = breaks in DNA strands
35
Antitumor antibiotics: CU Bleomycin
Testicular cancer Hodgkin lymphoma
36
Antitumor antibiotics: AE Bleomycin (specific G2/M phase)
Pulmonary fibrosis Skin hyperpigmentation
37
Antitumor antibiotics: MOA Dactinomycin (actinomycin D)
Intercalates into DNA, preventing RNA synthesis
38
Antitumor antibiotics: CU Dactinomycin (actinomycin D)
Wilms tumor Ewing sarcoma Rhabdomyosarcoma
39
Antitumor antibiotics: AE Dactinomycin (actinomycin D)
Myelosuppression
40
Antitumor antibiotics: MOA Anthracyclines: Doxorubicin Daunorubicin
Generate free radicals Intercalate in DNA- breaks in DNA -> decrease replication. Inhibits topoisomerase II
41
Antitumor antibiotics: CU Anthracyclines: Doxorubicin Daunorubicin
Solid tumors Leukemia Lymphomas
42
Antitumor antibiotics: AE Anthracyclines: Doxorubicin Daunorubicin
Dilated cardiomyopathy (prevent w/ dexrazoxane) Myelosuppression Alopecia
43
Platinum compounds: MOA Cisplatin Carboplatin Oxaliplatin
Cross link DNA (cell cycle nonspecific)
44
Platinum compounds: clinical use Cisplatin Carboplatin Oxaliplatin
Solid tumors: testicular, bladder, ovarian, GI, lung, lymphomas
45
Platinum compounds: AE Cisplatin Carboplatin Oxaliplatin
Nephrotoxicity (fanconi synd) Peripheral neuropathy Ototoxicity
46
Rituximab (MOA)
Monoclonal ab against the CD20 antigen
47
Warfarin can be monitored with
INR an Prothrombin time (PT)
48
Anthracyclines (doxorubicin) MOA and SE:
Binds w topoisomerase II to cleave DNA Binds w iron to generate free radicals Dilated cardiomyopathy
49
Bleomycin MOA and SE :
Induces free radical formation Pulmonary fibrosis
50
Cisplatin (MOA) and (SE)
Cross- link DNA to inhibits DNA synthesis. Nephrotoxicity Ototoxicity Peripheral neuropathy
51
Cyclophosphamide MOA and SE:
Cross-link DNA to inhibit DNA synthesis Hemorrhagic cystitis Bladder cancer
52
Paclitaxel MOA and SE:
Inhibits microtubule disassembly Neuropathy
53
Vincristine/ vinblastine MOA/ SE:
Binds beta-tubulin to inhibit microtubule formation Neuropathy
54
Trastuzumab (MOA):
Is for HER2 + cancer Its binds to a portion of the extracellular domain of HER2 and prevents activation of a transmembrane tyrosine kinase. This downregulates cellular proliferation and promotes apoptosis.
55
Emicizumab (for hemophilia A) MOA:
Mimics the activity of factor 8 by binding to both factor 9a and factor 10, bringing them into close proximity to allow for factor 10 activation.
56
Heparin coagulation changes
Thrombin time: prolonged PTT: prolonged Activity of factor Xa: decreased
57
CYP450 inhibitors
Antibiotics (metronidazole, macrolides) Azole Amiodarone Cimetidine Grapefruit
58
CYP450 inducers
Carbamazepine Phenytoin Phenobarbital Rifampin St. John wort
59
6-mercaptopurine (6-MP) (pro drug: azathioprine) is inactivates by the following enzymes:
Xanthine oxidase and thiopurine methyltransferase

STEP 1 (18 decks)

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