Fa: Hem / Onc - Pharmacology

Front 1

What is the mechanism of Heparin?

Back 1

Cofactor for the activation of antithrombin, ↓ thrombin, and ↓ factor Xa

Short t1/2

Front 2

What are the uses of Heparin?

Back 2

- Immediate anticoagulation for Pulmonary Embolism, Acute Coronary Syndrome, MI, and Deep Venous Thrombosis
- Used during pregnancy (doesn't cross placenta)

Front 3

What do you need to monitor in patients taking Heparin?

Back 3

Follow PTT

Front 4

What are the toxic side effects of Heparin?

Back 4

- Bleeding
- Thrombocytopenia (HIT)
- Osteoporosis
- Drug-drug interactions

Front 5

What is HIT?

Back 5

Heparin Induced Thrombocytopenia (HIT)
- Development of IgG antibodies against heparin bound to platelet factor 4 (PF4)
- Antibody-heparin-PF4 complex activates platelets → thrombosis and thrombocytopenia

Front 6

How do you rapidly reverse an overdose of Heparin? Mechanism?

Back 6

Protamine Sulfate (positively charged molecule that binds negatively charged heparin)

Front 7

What are the types of low molecular weight heparins (LMWH)? Mechanism? How are they different?

Back 7

Enoxaparin and Dalteparin
- Act more on Factor Xa
- Better bioavailability and 2-4 times longer half-life
- Can be administered subcutaneously and without lab monitoring
- Not as easily reversible

Front 8

What drugs can you use in a patient who requires anticoagulation but was taking heparin and got heparin-induced thrombocytopenia (HIT)? Source?

Back 8

Argatroban or Bivalirudin
- Derivatives of hirudin, the anticoagulant used by leeches

Front 9

What is the mechanism and use of Argatroban?

Back 9

- Inhibits thrombin directly
- Used instead of heparin for anticoagulating patients with Heparin-induced thrombocytopenia (HIT)

Front 10

What is the mechanism and use of Bivalirudin?

Back 10

- Inhibits thrombin directly
- Used instead of heparin for anticoagulating patients with Heparin-induced thrombocytopenia (HIT)

Front 11

What is the mechanism of Warfarin?

Back 11

Interferes with normal synthesis and γ-carboxylation of vitamin K-dependent clotting factors II, VII, IX, and X and proteins C and S

Front 12

What clotting factors and proteins are affected by Warfarin?

Back 12

- Factor II
- Factor VII
- Factor IX
- Factor X
- Protein C
- Protein S

Front 13

What is the effect of warfarin on blood tests?

Back 13

Increases PT (extrinsic pathway) / INR

Front 14

What are the clinical uses of Warfarin?

Back 14

- Chronic anti-coagulation (after STEMI, venous thromboembolism prophylaxis, and prevention of stroke in atrial fibrillation)

*NOT used in pregnant women (can cross placenta = teratogen)

Front 15

What are the toxic side effects of Warfarin?

Back 15

- Bleeding
- Teratogen
- Skin / tissue necrosis
- Drug-drug interactions

Front 16

How can you reverse a warfarin overdose?

Back 16

- Give Vitamin K
- For severe overdose, give fresh frozen plasma

Front 17

What drugs are direct factor Xa inhibitors?

Back 17

- Apixaban
- Rivaroxaban

Front 18

What is the mechanism of Apixaban and Rivaroxaban?

Back 18

Binds and directly inhibits activity of factor Xa

Front 19

What are the clinical uses of Apixaban and Rivaroxaban?

Back 19

- Treatment and prophylaxis of DVT and PE (rivaroxaban)
- Stroke prophylaxis in patients with atrial fibrillation
- Oral agents do not require coagulation monitoring!

Front 20

What are the side effects of Apixaban and Rivaroxaban?

Back 20

Bleeding (no specific reversal agent available)

Front 21

What is the structure of heparin and warfarin?

Back 21

- Heparin: large, anionic, acidic polymer
- Warfarin: small lipid-soluble molecule

Front 22

What is the route of administration of heparin and warfarin?

Back 22

- Heparin: parenteral (IV, SC)
- Warfarin: oral

Front 23

What is the site of action of heparin and warfarin?

Back 23

- Heparin: blood
- Warfarin: liver

Front 24

What is the relative onset of action of heparin and warfarin?

Back 24

- Heparin: rapid (seconds)
- Warfarin: slow, limited by half-lives of normal clotting factors

Front 25

What is the mechanism of action of heparin and warfarin?

Back 25

- Heparin: activates antithrombin, which ↓ the action of IIa (thrombin) and factor Xa
- Warfarin: impairs the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X (vitamin K antagonist)

Front 26

What is the duration of action of heparin and warfarin?

Back 26

- Heparin: acute (hours)
- Warfarin: chronic (days)

Front 27

Do heparin and warfarin inhibit coagulation in vitro?

Back 27

- Heparin: yes
- Warfarin: no

Front 28

How do you treat an acute overdose of heparin and warfarin?

Back 28

- Heparin: protamine sulfate
- Warfarin: IV vitamin K and fresh frozen plasma

Front 29

What should you monitor in patients taking heparin and warfarin?

Back 29

- Heparin: PTT (intrinsic pathway)
- Warfarin: PT / INR (extrinsic pathway)

Front 30

Do heparin and warfarin cross the placenta?

Back 30

- Heparin: no
- Warfarin: yes (teratogenic)

Front 31

What are the types of thrombolytics?

Back 31

- Alteplase (tPA)
- Reteplase (rPA)
- Tenecteplase (TNK-tPA)

Front 32

What is the mechanism of Alteplase (tPA), Reteplase (rPA), and Tenecteplase (TNK-tPA)?

Back 32

Thrombolytics
- Directly or indirectly aids conversion of plasminogen to plasmin
- Plasmin cleaves thrombin and fibrin clots
- ↑ PT, ↑ PTT, and no change in platelet count

Front 33

What are the clinical uses of Alteplase (tPA), Reteplase (rPA), and Tenecteplase (TNK-tPA)?

Back 33

- Early MI
- Early ischemic stroke
- Direct thrombolysis of severe PE

Front 34

What are the side effects and contraindications of Alteplase (tPA), Reteplase (rPA), and Tenecteplase (TNK-tPA)?

Back 34

- Bleeding
- Contraindicated in patients with active bleeding, history of intracranial bleeding, recent surgery, known bleeding diatheses, or severe hypertension

Front 35

How do you treat toxicity of Alteplase (tPA), Reteplase (rPA), and Tenecteplase (TNK-tPA)? Mechanism?

Back 35

- Aminocaproic Acid - inhibits fibrinolysis

- Fresh frozen plasma and cryoprecipitate can also be used to correct factor deficiencies

Front 36

What is the mechanism of aspirin (ASA)?

Back 36

- Irreversibly inhibits cyclooxygenase (both COX-1 and COX-2) enzyme by covalent acetylation
- Platelets cannot synthesize new enzyme so effect lasts until new platelets are produced

Front 37

What lab values change in patients taking aspirin (ASA)?

Back 37

- ↑ Bleeding time, ↓ TXA2 and prostaglandins
- No effect on PT or PTT

Front 38

What are the clinical uses of aspirin (ASA)?

Back 38

- Antipyretic
- Analgesic
- Anti-inflammatory
- Antiplatelet (↓ aggregation)

Front 39

What are the toxic side effects of aspirin (ASA)?

Back 39

- Gastric ulceration
- Tinnitus (CN VIII)
- Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding
- Reye syndrome in children with viral infection

Front 40

What can an overdose of aspirin (ASA) cause?

Back 40

Respiratory alkalosis initially, which is then superimposed by metabolic acidosis

Front 41

What is the cause of Reye syndrome?

Back 41

Children with a viral infection who take aspirin

Front 42

What are the types of ADP receptor inhibitors?

Back 42

- Clopidogrel
- Ticlopidine
- Prasugrel
- Ticagrelor

Front 43

What is the mechanism of Clopidogrel, Ticlopidine, Prasugrel, and Ticagrelor?

Back 43

- Inhibit platelet aggregation by irreversibly blocking ADP receptors
- Inhibits fibrinogen binding by preventing glycoprotein IIb/IIIa from binding to fibrinogen

Front 44

What are the clinical uses of Clopidogrel, Ticlopidine, Prasugrel, and Ticagrelor?

Back 44

- Acute coronary syndrome
- Coronary stenting
- ↓ Incidence or recurrence of thrombotic stroke

Front 45

What are the side effects of Clopidogrel, Ticlopidine, Prasugrel, and Ticagrelor?

Back 45

- Neutropenia (ticlopidine)
- TTP / HUS may be seen

Front 46

What drugs inhibit platelet aggregation via inhibition of phosphodiesterase III?

Back 46

Cilostazol and Dipyridamole

Front 47

What is the mechanism of Cilostazol and Dipyridamole?

Back 47

- Phosphodiesterase III inhibitor
- ↑ cAMP in platelets, thus inhibiting platelet aggregation
- Vasodilates

Front 48

What are the uses of Cilostazol and Dipyridamole?

Back 48

- Intermittent claudication
- Coronary vasodilation
- Prevention of stroke or TIAs (combined with aspirin)
- Angina pectoris

Front 49

What are the side effects of Cilostazol and Dipyridamole?

Back 49

- Nausea
- Headache
- Facial flushing
- Hypotension
- Abdominal pain

Front 50

What are the types of GpIIb/IIIa inhibitors?

Back 50

- Abciximab
- Eptifibatide
- Tirofiban

Front 51

What is the mechanism of Abciximab, Eptifibatide, and Tirofiban?

Back 51

- Binds to the glycoprotein receptor IIb/IIIa on activated platelets, preventing aggregation
- Abciximab is made from monoclonal antibody Fab fragments

Front 52

What are the uses of Abciximab, Eptifibatide, and Tirofiban (GpIIb/IIIa inhibitors)?

Back 52

- Unstable angina
- Percutaneous transluminal coronary angioplasty

Front 53

What are the side effects of Abciximab, Eptifibatide, and Tirofiban (GpIIb/IIIa inhibitors)?

Back 53

- Bleeding
- Thrombocytopenia

Front 54

What are the drugs that interact with the cell cycle? Which part?

Back 54

- Antimetabolites (affect S)
- Etoposide (affects S and G2)
- Bleomycin (affects G2)
- Vinca alkaloids and taxols (affects M)

Front 55

What anti-neoplastic drugs affect nucleotide synthesis? How?

Back 55

- Methotrexate and 5-Fluorouracil: ↓ thymidine synthesis
- 6-Mercaptopurine: ↓ purine synthesis

Front 56

What anti-neoplastic drugs inhibit DNA synthesis? How?

Back 56

- Alkylating agents, Cisplatin: cross-link DNA
- Dactinomycin, Doxorubicin: intercalates into DNA
- Etoposide: inhibits topoisomerase II

Front 57

What anti-neoplastic drugs inhibit cellular division? How?

Back 57

- Vinca alkaloids: inhibit microtubule formation
- Paclitaxel: inhibits microtubule disassembly

Front 58

What are the anti-metabolite drugs?

Back 58

- Methotrexate (MTX)
- 5-Fluorouracil (5-FU)
- Cytarabine (Arabinofuranosyl Cytidine)
- Azathioprine, 6-Mercaptopurine (6-MP), 6-Thioguanine (6-TG)

Front 59

What is the mechanism of Methotrexate (MTX)?

Back 59

Folic acid analog that inhibits Dihydrofolate Reductase → ↓ dTMP → ↓ DNA and ↓ protein synthesis

Front 60

What are the clinical uses of Methotrexate (MTX)?

Back 60

- Cancers: leukemias, lymphomas, choriocarcinoma, sarcomas
- Non-neoplastic: abortion, ectopic pregnancy, rheumatoid arthritis, psoriasis, IBD

Front 61

What are the toxic side effects of Methotrexate (MTX)?

Back 61

- Myelosuppression
- Macrovesicular fatty change in liver
- Mucositis
- Teratogenic

Front 62

How can you reverse the myelosuppression induced by Methotrexate (MTX)?

Back 62

Reversible with leucovorin (folinic acid) "rescue"

Front 63

What is the mechanism of 5-Flurouracil (5-FU)?

Back 63

- Pyrimidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid
- This complex inhibits thymidylate synthase → ↓ dTMP → ↓ DNA and ↓ protein synthesis

Front 64

What is 5-fluorouracil (5-FU) used for?

Back 64

- Colon cancer
- Pancreatic cancer
- Basal cell carcinoma (topical)

Front 65

What are the toxic side effects of 5-fluorouracil (5-FU)?

Back 65

- Myelosuppression
- Photosensitivity

Front 66

How can you reverse the myelosuppression induced by 5-Fluorouracil (5-FU)?

Back 66

Reversible with uridine "rescue"

Front 67

What is the mechanism of Cytarabine (Arabinofuranosyl Cytidine)?

Back 67

Pyrimidine analog → inhibition of DNA polymerase

Front 68

What is Cytarabine (Arabinofuranosyl Cytidine) used for?

Back 68

- Leukemias
- Lymphomas

Front 69

What are the toxic side effects of Cytarabine (Arabinofuranosyl Cytidine)?

Back 69

- Leukopenia
- Thrombocytopenia
- Megaloblastic anemia
- CYTarabine causes panCYTopenia

Front 70

What is the mechanism of Azathioprine, 6-Mercaptopurine (6-MP), and 6-Thioguanine (6-TG)?

Back 70

- Purine (thiol) analogs → ↓ de novo purine synthesis
- Activated by HGPRT

Front 71

What are the clinical uses of Azathioprine, 6-Mercaptopurine (6-MP), and 6-Thioguanine (6-TG)?

Back 71

- Preventing organ rejection
- Rheumatoid Arthritis

- Azathioprine: Systemic Lupus Erythematosus (SLE)

- 6-MP and 6-TG: Leukemia and Inflammatory Bowel Disease

Front 72

What are the toxic side effects of Azathioprine, 6-Mercaptopurine (6-MP), and 6-Thioguanine (6-TG)?

Back 72

- Bone marrow, GI, and liver toxicity

- Azathioprine and 6-MP are metabolized by xanthine oxidase; thus both have ↑ toxicity with allopurinol, which inhibits their metabolism

Front 73

What are the anti-tumor antibiotics?

Back 73

- Dactinomycin (Actinomycin D)
- Doxorubicin (Adriamycin), Danorubicin
- Bleomycin

Front 74

What is the mechanism of Dactinomycin (Actinomycin D)?

Back 74

Intercalates in DNA

Front 75

What are the clinical uses of Dactinomycin (Actinomycin D)?

Back 75

- Wilms tumor
- Ewing sarcoma
- Rhabdomyosarcoma
- Used for childhood tumors ("children act out")

Front 76

What are the toxic side effects of Dactinomycin (Actinomycin D)?

Back 76

Myelosuppression

Front 77

What is the mechanism of Doxorubicin (Adriamycin) and Daunorubicin?

Back 77

- Generates free radicals
- Intercalates in DNA → breaks in DNA → ↓ replication

Front 78

What are the clinical uses of Doxorubicin (Adriamycin) and Daunorubicin?

Back 78

- Solid tumors
- Leukemias
- Lymphomas

Front 79

What are the toxic side effects of Doxorubicin (Adriamycin) and Daunorubicin?

Back 79

- Cardiotoxicity (dilated cardiomyopathy)
- Myelosuppression
- Alopecia
- Toxic to tissues following extravasation

- Dexrazoxane (iron chelating agent), used to prevent cardiotoxicity

Front 80

What is the mechanism of Bleomycin?

Back 80

Induces free radical formation, which causes breaks in DNA strands

Front 81

What are the clinical uses of Bleomycin?

Back 81

- Testicular cancer
- Hodgkin lymphoma

Front 82

What are the toxic side effects of Bleomycin?

Back 82

- Pulmonary fibrosis
- Skin changes
- Mucositis
- Minimal myelosuppression

Front 83

What are the alkylating agent drugs?

Back 83

- Cyclophosphamide, Ifosfamide
- Nitrosoureas (Carmustine, Lomustine, Semustine, Streptozocin)
- Busulfan

Front 84

What is the mechanism of Cyclophosphamide and Ifosfamide?

Back 84

- Covalently X-link (interstrand)
- DNA at guanine N-7
- Requires bioactivation by liver

Front 85

What are the clinical uses of Cyclophosphamide and Ifosfamide?

Back 85

- Solid tumors
- Leukemia
- Lymphomas
- Some brain cancers

Front 86

What are the toxic side effects of Cyclophosphamide and Ifosfamide?

Back 86

- Myelosuppression
- Hemorrhagic cystitis

Front 87

How can you limit the hemorrhagic cystitis caused by Cyclophosphamide and Ifosfamide? Mechanism?

Back 87

Mesna - thiol group of mesna binds toxic metabolites

Front 88

What is the mechanism of Nitrosoureas (Carmustine, Lomustine, Semustine, and Streptozocin)?

Back 88

- Requires bioactivation
- Crosses blood-brain-barrier → CNS
- Cross-links DNA

Front 89

What are the clinical uses of Nitrosoureas (Carmustine, Lomustine, Semustine, and Streptozocin)?

Back 89

Brain tumors (including glioblastoma multiforme)

Front 90

What are the toxic side effects of Nitrosoureas (Carmustine, Lomustine, Semustine, and Streptozocin)?

Back 90

CNS toxicity (convulsions, dizziness, ataxia)

Front 91

What is the mechanism of Busulfan?

Back 91

Cross-links DNA

Front 92

What are the clinical uses of Busulfan?

Back 92

- CML
- Also used to ablate patient's bone marrow before bone marrow transplantation

Front 93

What are the toxic side effects of Nitrosoureas (Carmustine, Lomustine, Semustine, and Streptozocin)?

Back 93

- Severe myelosuppression (in almost all cases)
- Pulmonary fibrosis
- Hyperpigmentation

Front 94

What are the types of microtubule inhibitors?

Back 94

- Vincristine and Vinblastine
- Paclitaxel and other Taxols

Front 95

What is the mechanism of Vincristine and Vinblastine?

Back 95

- Vinca alkaloids that bind β-tubulin
- Inhibits its polymerization into microtubules
- Prevents mitotic spindle formation (M-phase arrest)

Front 96

What are the clinical uses of Vincristine and Vinblastine?

Back 96

- Solid tumors
- Leukemias
- Lymphomas

Front 97

What are the toxic side effects of Vincristine and Vinblastine?

Back 97

- Vincristine: neurotoxicity (areflexia, peripheral neuritis), paralytic ileus

- Vinblastine: blasts bone marrow (myelosuppression)

Front 98

What is the mechanism of Paclitaxel and other Taxols?

Back 98

- Hyperstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down (anaphase cannot occur)
- It is taxing to stay polymerized

Front 99

What are the clinical uses of Paclitaxel and other Taxols?

Back 99

Ovarian and breast carcinomas

Front 100

What are the toxic side effects of Paclitaxel and other Taxols?

Back 100

- Myelosuppression
- Alopecia
- Hypersensitivity

Front 101

What is the mechanism and clinical uses of Cisplatin and Carboplatin?

Back 101

- Cross-links DNA
- Used for testicular, bladder, ovary, and lung carcinomas

Front 102

What are the toxic side effects of Cisplatin and Carboplatin?

Back 102

- Nephrotoxicity
- Acoustic nerve damage
- Prevents nephrotoxicity with amifostine (free radical scavenger) and chloride diuresis

Front 103

What is the mechanism and clinical uses of Etoposide and Teniposide?

Back 103

- Inhibits topoisomerase II → ↑ DNA degradation
- Used for solid tumors (particularly testicular and small cell lung cancer), leukemias, and lymphomas

Front 104

What are the toxic side effects of Etoposide and Teniposide?

Back 104

- Myelosuppression
- GI irritation
- Alopecia

Front 105

What is the mechanism and clinical uses of Irinotecan and Topotecan?

Back 105

- Inhibits topoisomerase I and prevents DNA unwinding and replication
- Used for colon cancer (irinotecan)
- Used for ovarian and small cell lung cancers (topotecan)

Front 106

What are the toxic side effects of Irinotecan and Topotecan?

Back 106

- Severe myelosuppression
- Diarrhea

Front 107

What is the mechanism and clinical uses of Hydroxyurea?

Back 107

- Inhibits ribonucleotide reductase → ↓ DNA synthesis (S-phase specific)
- Used for melanoma, CML, sickle cell disease (↑ HbF)

Front 108

What are the toxic side effects of Hydroxyurea?

Back 108

- Bone marrow suppression
- GI upset

Front 109

What is the mechanism of Prednisone and Prednisolone?

Back 109

- May trigger apoptosis
- May even work on non-dividing cells

Front 110

What are the clinical uses of Prednisone and Prednisolone?

Back 110

- Most commonly used glucocorticoids in cancer chemotherapy
- Used in CLL, non-Hodgkin lymphomas (part of combination chemotherapy regimen)
- Also used as immunosuppressants (eg, autoimmune disease)

Front 111

What are the toxic side effects of Prednisone and Prednisolone?

Back 111

Cushing like symptoms:
- Weight gain
- Central obesity
- Muscle breakdown
- Cataracts
- Acne
- Osteoporosis
- Hypertension
- Peptic ulcers
- Hyperglycemia
- Psychosis

Front 112

What is the mechanism of Tamoxifen and Raloxifene?

Back 112

- Selective estrogen receptor modulator (SERMs)
- Receptor antagonists in breast and agonists in bone
- Blocks the binding of estrogen to ER (+) cells

Front 113

What are the clinical uses of Tamoxifen and Raloxifene?

Back 113

- Breast cancer treatment (tamoxifen only) and prevention
- Raloxifene also useful to prevents osteoporosis

Front 114

What are the toxic side effects of Tamoxifen and Raloxifene?

Back 114

- Tamoxifen: partial agonist in endometrium, which ↑ the risk of endometrial cancer, "hot flashes"

- Raloxifene: no ↑ in endometrial carcinoma because it is an endometrial antagonist

Front 115

What is the mechanism of Trastuzumab (Herceptin)?

Back 115

- Monoclonal antibody against HER-2 (c-erbB2), a tyrosine kinase receptor
- Helps kill breast cancer cells that overexpress HER-2, through inhibition of HER2-initiated cellular signaling and antibody-dependent cytotoxicity

Front 116

What are the clinical uses of Trastuzumab (Herceptin)?

Back 116

HER-2 positive breast cancer and gastric cancer (Tras2zumab)

Front 117

What are the toxic side effects of Trastuzumab (Herceptin)?

Back 117

- Cardiotoxicity ("HEART"ceptin damages the heart)

Front 118

What is the mechanism of Imatinib (Gleevec)?

Back 118

Tyrosine kinase inhibitor of bcr-abl (Philadelphia chromosome fusion gene in CML) and c-Kit (common in GI stromal tumors)

Front 119

What are the clinical uses of Imatinib (Gleevec)?

Back 119

- CML
- GI stromal tumors

Front 120

What are the toxic side effects of Imatinib (Gleevec)?

Back 120

Fluid retention

Front 121

What is the mechanism of Rituximab?

Back 121

Monoclonal Ab against CD20, which is found on most B-cell neoplasms

Front 122

What are the clinical uses of Rituximab?

Back 122

- Non-Hodgkin Lymphoma (CD20 positive cells)
- Rheumatoid arthritis (with MTX)
- Idiopathic Thrombocytopenic Purpura (ITP)

Front 123

What are the toxic side effects of Rituximab?

Back 123

Increased risk of progressive multifocal leukoencephalopathy

Front 124

What is the mechanism and use of Vemurafenib?

Back 124

- Small molecule inhibitor of forms of the B-Raf kinase with the V600E mutation
- Used for metastatic melanoma

Front 125

What is the mechanism and clinical uses of Bevacizumab?

Back 125

- Monoclonal antibody against VEGF, inhibits angiogenesis
- Used for solid tumors (colorectal cancer, renal cell carcinoma)

Front 126

What are the toxic side effects of Bevacizumab?

Back 126

Hemorrhage and impaired wound healing

Front 127

Which chemo drug(s) cause(s) acoustic nerve damage?

Back 127

Cisplatin / Carboplatin

(and nephrotoxicity)

Front 128

Which chemo drug(s) cause(s) peripheral neuropathy?

Back 128

Vincristine

Front 129

Which chemo drug(s) cause(s) pulmonary fibrosis?

Back 129

- Bleomycin
- Busulfan

Front 130

Which chemo drug(s) cause(s) cardiotoxicity?

Back 130

- Doxorubicin
- Trastuzumab

Front 131

Which chemo drug(s) cause(s) nephrotoxicity?

Back 131

Cisplatin and Carbolatin (and acoustic nerve damage)

Front 132

Which chemo drug(s) cause(s) hemorrhagic cystitis?

Back 132

Cyclophosphamide

Front 133

Which chemo drug(s) cause(s) myelosuppression?

Back 133

- 5-FU
- 6-MP
- Methotrexate