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359 Cards in this Set
- Front
- Back
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List 3 dysfunctions of blood
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Thrombosis
bleeding anemia |
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What is the most common abnormality of hemostasis
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Thrombosis
|
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Name 4 thrombotic disorders
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Acute MI
DVT PE Acute ischemic stroke |
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What class of drugs treat thrombotic disorders
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Anticoagulants
Fibrinolytics |
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Name 2 bleeding disorders involving failure of hemostasis
|
Hemophilia
Vitamin K deficiency |
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How is hemophilia treated
|
Factor VIII transfusion
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How is Vit K deficiency treated
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Dietary supplements of the vitamin
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A clot that adheres to a vessel wall is called ____
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Thrombus
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Intravascular clot that floats in the blood is termed ____
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Embolus
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T or F: Arterial thrombosis occurs in medium-sized vessels rendered thrombogenic by surface lesions of endothelial cells caused by atherosclerosis.
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True
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Does arterial or venous thrombosis consist of platelet rich clot
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Arterial
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T or F: Venous thrombosis is triggered by blood stasis or inappropriate activation of the coagulation cascade
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True
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Does venous or arterial thrombosis typically involves a clot that is rich in fibrin, with fewer platelets
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Venous
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What chemical mediators are synthesized by intact endothelial cells and act as inhibitors of platelet aggreation
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Prostacyclin and Nitric Oxide
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T or F: Damaged endothelial cells synthesize more prostacyclin
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False: Less
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T or F: Platelet membrane contains receptors that can bind thrombin, thromboxanes, and exposed collagen
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True
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In intact, normal vessel, are circulating levels of thrombin and thromboxane low or high
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Low
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T or F: Endothelium covers the collagen in the subendothelial layers and the platelet receptors are thus unoccupied and remain inactive
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True
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T or F: When platelet receptors are occupied, each of these receptor types triggers a series of reactions leading to the release into the circulation of intracellular granules by the platelets. This ultimately stimulates platelet aggregation
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True
|
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T or F: When endothelium is injured, platelets adhere to and virtually cover the exposed collagen of the subendothelium. this triggers a complex series of chemical rxns resulting in platelet activation
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True
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During platelet activation, receptors on the surface of the adhering platelets are activated by what?
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Collagen of the underlying connective tissue
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When platelets go through morphologic changes, what chemical mediators do they release which ultimately bind to receptors of the resting platelets
|
Adenosine diphoshate (ADP)
Thromboxane A2 Serotonin Platelet-activation factor Thrombin |
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T or F: activation of IIb/IIIa receptors that bind fibrinogen regulate platelet-platelet interaction and thrombus formation
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True
|
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What substance simultaneously binds to GP IIb/IIIa receptors on two separate platelets, resulting in platelet cross-linking and platelet aggregation
|
Fibrinogen
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Local stimulation of the coagulation cascade by tissue factors released from the injured tissue and by mediators on the surface of platelets results in formation of what?
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Thrombin
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Thrombin catalyzes the hydrolysis of ____ to ____, which is incorporated into the plug
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Fibrinogen to fibrin
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T or F: Cross-linking of the fibrin strands stabilizes the clot and forms a hemostatic platelt-fibrin plug
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True
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What substance limits the growth of a clot, dissolving the fibrin network as wounds heal
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Plasmin
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T or F: The last step in the response to vascular trauma depends on a family of membrane GP receptors
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True
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What is the most GP receptors that regulates platelet-platelet interaction and thrombus formation
|
IIb/IIIa receptor
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What platelet activation agents promote the conformational change necessary for the GP IIb/IIIa receptor to bind ligands, particularly fibrinogen
|
Thromboxane A2
ADP Thrombin Serotonin Collagen |
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T or F: Fibrinogen simultaneously binds to GP IIb/IIIa receptors on two separate platelets, resulting in platelet cross-linking and aggregation.
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True
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Platelet aggregation inhibitors inhibit what 3 receptors, interfering in the signals that promote platelet aggregation
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COX-1
GP IIb/IIIa ADP |
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Stimulation of platelets by thrombin, collagen and ADP results in activation of platelet membrane phospholipase that liberate what substance
|
arachidonic acid
|
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Arachidonic acid is first converted to what prostaglandin by COX-1
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H2
|
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Prostaglandin H2 is further metabolized to what substance
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Thromboxane A2
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T or F: Thromboxane A2 produced by the aggregating platelets further promotes the clumping process essential to the formation of a hemostatic plug
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True
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What drug inhibits thromboxane A2 synthesis from arachidonic acid in platelets by irreversible acetylation of COX-1
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Aspirin
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Aspirin-induced suppression of thromboxane A2 synthetase results in suppression of platelet aggregation, which lasts for how long?
|
Life of platelet: 7-10 days
|
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What drug is used as prophylactic tx of transient cerebral ischemia, recurrent MI, and pre and post-MI pts
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Aspirin
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What is the recommended daily dose of ASA
|
81-165 mg
|
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Bleeding time is prolonged by ASA tx, this causes an increased incidence of what?
|
Hemorrhagic stroke and GI bleed, esp in higher doses
|
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What drug, if taken concominantly, can antagonize the platelet inhibition by aspirin
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Ibuprofen
|
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T or F: Selective COX-2 inhibitors may contribute to CV events by shifting the balance of chemical mediators in favor of thromboxane A2
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True
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What 2 drugs block platelet aggregation by interfering with the binding of ADP to its receptors on platelets, thus inhibiting the activation of GP IIb/IIIa receptors
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Ticlopidine and Clopidogrel
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What two drugs have been effective in preventing cerebrovascular, cardiovascular, and peripheral vascular disease, which are used in stent insertion during an MI
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Ticlopidine and Clopidogrel
|
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Most serious adverse effect of ticlopidine
|
Neutropenia
|
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T or F; Key role of platelet GP IIb/IIIa receptor is platelet aggregation
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True
|
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By binding to GP IIb/IIIa, this antibody blocks the binding of fibrinogen, inhibiting aggregation
|
Abciximab
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Through what route is Abciximab administered as an adjunct to percutaneous coronary intervention
|
IV
|
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What is the mechanism of action of Eptifibatide and tirofiban
|
blocking the GP IIb/IIIa receptor
|
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T or F: when intravenous infusion is stopped, Eptifibatide and tirofiban are slowly cleared from the plasma
|
False: rapidly
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Is Dipyridamole a vasoconstrictor or a vasodilator
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Vasodilator
|
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Dipyridamole is a prophylactic drug used in treating what condition
|
Angina Pectoris
|
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Dipyridamole results in decreased levels of what molecule
|
Thromboxane A2
|
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Does the intrinsic, extrinsic, or both systems produce Factor Xa, which converts prothrombin to thrombin
|
Both
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Thrombin is responsible for the generation of what glycoprotein, which is responsible for mesh-like matrix of the blood clot
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Fibrin
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T or F: If thrombin is not formed or if its function is impeded, coagulation is inhibited
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True
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Does Heparin or Warfarin inhibit the action of coagulation factors
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Heparin
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Does heparin or warfarin interfere with the synthesis of the coagulation factors
|
Warfarin
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What drug is used acutely to interfere with the formation of thrombi
|
Heparin
|
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T or F: unfractionated heparin has a wide range of molecular weights
|
True
|
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Heparin is used in the prevention of what diseases
|
venous thrombosis, PE, and MI
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What drug is used prophylactically to prevent post-op venous thrombosis in pts having hip replacement and in acute MI
|
Heparin
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What drug is used in extracorporeal devices, such as dialysis machines, to prevent thrombosis
|
Heparin
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What drugs are anticoagulants of choice in pregnant women w/ prosthetic heart valves or venous thromboembolism
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Heparin and LMWH
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Why is Heparin the DOC for anticoagulation in pregnant women
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It doesn't cross the placenta
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LMWH, such as Enoxaparin and Dalteparin can be administered through what route, making them useful in outpatient therapy
|
Sub q
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Why is IM administration of LMWH contraindicated
|
because of hematoma formation
|
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What is the dosage recommendations for Heparin
|
Bolus IV, followed by continuous infusion for 7-10 days
|
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When administering continuous infusion of heparin, how should you titrate the dose
|
so that PTT is 1.5 - 2.5 fold the normal
|
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Is it necessary to obtain the same index of PTT in LMWH
|
No
|
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Are thromboembolic problems less common with LMWH or Heparin
|
LMWH
|
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What is the chief complication of heparin therapy
|
Hemorrhage
|
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How is heparin reversed
|
Protamine sulfate
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Heparin preparations are from animal sources and may have the following adverse reactions
|
Urticaria and anaphylactic shock
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T or F: Thrombocytopenia is a common abnormality among hospital pts
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True
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What type of heparin-induced thrombocytopenia (HIT) is common, not serious, mild decrease in platelet number
|
Type I
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When does Type I HIT occurs
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Within the first 5 days of treatment
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What dangerous effect does Type II HIT produce
|
Platelet aggregation which can result in thrombocytopenia and thrombosis
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When does Type II HIT occur
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Between 5-14 days of treatment
|
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Type 2 HIT can have a platelet drop up to what %?
|
50%
|
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Is Type I or II HIT relatively rare
|
Type II
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When Type II HIT occurs, heparin tx should be discountinued and replaced with what other anticoagulant
|
Lepirudin
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Heparin is contraindicated in pts with a hx of the following surgeries
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Brain, eye, or spinal cord
|
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T or F: Heparin is contraindicated for pts who have bleeding disorders and alcoholics
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True
|
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What drug is a direct thrombin antagonist related to hirudin - a thrombin inhibitor from the leech
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Lepirudin
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T or F: One molecule of lepirudin binds to one molecule of thrombin, resulting in blockade of the thrombogenic activity of thrombin
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True
|
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T or F: Lepirudin has large effect on platelet aggregation
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False: little effect
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T or F: IV Lepirudin is effective in the treatment of HIT, it can prevent further thromboembolic complications
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True
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What is the major adverse effect of Lepirudin
|
Bleeding
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T or F: Bleeding from Lepirudin can be exacerbated by concomitant thrombolytic tx, w/ streptokinase or alteplase
|
True
|
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This drug's anti-Factor Xa activity far exceeds its antithrombin activity and is administered sub q
|
Danaparoid
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Danaparoid is effective in what type of HIT
|
Type II
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T or F: Even careful monitoring to keep the PT time at 1.5-2.5 fold longer than normal does not prevent bleeding complications in about 20% of pts taking Warfarin
|
True
|
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What cofactor do Factors II, VII, IX, and X require for their synthesis by the liver
|
Vitamin K
|
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What enzyme is inhibited by warfarin
|
Vitamin K epoxide reductase
|
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Effects of warfarin can be overcome by the administration of what?
|
Vitamin K
|
|
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How long does the reversal of warfarin w/ Vit K take
|
24 hrs
|
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Thrombolytic agents all act to convert ____ to ____
|
Plasminogen to plasmin
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Plasmin is a protease that hydrolyzes ____ and thus dissolves clots
|
Fibrin
|
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What 2 thrombolytic drugs are unsuccessful about 20 % of the time
|
Alteplase and Streptokinse
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T or F: Clots become resistant to lysis as they age
|
True
|
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For MI, where is the delivery of thrombolytic agents most reliable in terms of achieving recanalization, but may not be possible in the 2-6 hr "therapeutic window"
|
Intracoronary
|
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If intracoronary administration of thromboylitcs is not possible, which route is used
|
IV
|
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What is a major side effect of thrombolytics
|
Hemorrhage
|
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T or F: Unsuspected lesion such as peptic ulcer may hemorrhage if given thrombolytic tx
|
True
|
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What are contraindications for thrombolytic agents
|
Healing wounds
pregnancy cerebrovascular accident Mets |
|
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What drug has low affinity for free plasminogen in the plasma, but it rapidly activates plasminogen that is bound to fibrin in a thrombus or a hemostatic plug
|
Alteplase
|
|
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This drug is said to be "fibrin selective"
|
Alteplase
|
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What drug acts on free plasminogen and induces a general fibrinolytic state
|
Streptokinase
|
|
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Is alteplase or streptokinase superior in dissolving older clots
|
Alteplase
|
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|
what drug, when administered w/in 3 hrs of an ischemic stroke significantly improves clinical outcome
|
Alteplase
|
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What are adverse effects of Alteplase
|
GI and Cerebral hemorrhage
|
|
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What drug is a protein purified from culture broths of Group C Beta hemolytic streptococci
|
Streptokinase
|
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T or F: Streptokinase works by hydrolyzing fibrin plugs and catalyzing degradation of fibrinogen
|
True
|
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Streptokinase is approved for use in what conditions
|
Acute PE
DVT acute MI Arterial thrombosis |
|
|
Streptokinase is instituted within how many hours of an MI
|
4
|
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On discontinuation of streptokinase tx, what drugs may be administered
|
Heparin or oral anticoagulants
|
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Streptokinase may precipitate bleeding. In the rare instance of life-threatening hemorrhage, what can be administered?
|
Aminocaproic acid
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What needs to be done to prevent potential therapeutic failure of streptokinase
|
Need sufficient quantities of it to overwhelm the antibodies that may have accumulated in inds who have had a streptococcal infections
|
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Hemophilia is a consequence of a deficiency of what factors
|
VIII and IX
|
|
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Concentrations of factors VIII and IX are available from human donors, but they carry what risk
|
Transferring viral infections
|
|
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Fibrinolytic states can be controlled by what synthetic agent which inhibits plasminogen activation
|
Aminocaproic acid
|
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This agent antagonizes the anticoagulant effects of heparin
|
Protamine sulfate
|
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T or F: Positively charged protamine interacts with the negatively charged heparin, forming a stable complex w/o anticoagulant activity
|
True
|
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What is another name for vitamin K
|
Phytonadione
|
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The response to Vitamin K is slow, requiring 24 hrs. If immediate hemostasis is required, what should be used instead
|
Fresh frozen plasma
|
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This agent stops bleeding by blocking plasmin. It is approved for prophylactic use to reduce perioperative blood loss in pts undergoing bypass surgery
|
Aprotinin
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Iron is stored in intestinal mucosal cells as ____
|
Ferritin
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A negative iron balance produces what type of anemia
|
Hypochromic microcytic
|
|
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Supplementation with what substance is required to correct iron deficiency
|
Ferrous sulfate
|
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What are the most common adverse effects of iron supplements
|
GI disturbance
|
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What is a primary result of folic acid deficinecy
|
Megaloblastic anemia
|
|
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What are the causes of folate deficiency
|
Increased demand (pregnancy)
Poor absorption Alcoholism Dihydrofolate reductase inhibitors |
|
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Name 2 dihydrofolate reductase inhibitors
|
Methotrexate
Trimethoprim |
|
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What are 2 causes of vit B12 deficiency
|
low dietary levels or
poor absorption |
|
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What causes poor absorption of vit B12
|
failure of gastric parietal cells to produce intrinsic factor
|
|
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Failure to produce intrinsic factor results in what type of anemia
|
Pernicious
|
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T or F: malabsorption syndromes or gastric resection can cause vit B12 deficiency
|
True
|
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For dietary deficiency of vit B12, how should it be administered
|
Orally
|
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How should vit B12 be administered for pernicious anemia
|
IM or Sub q
|
|
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T or F: Folic acid alone reverses the hematologic abnormality and masks the B12 deficiency, which can then proceed to severe neurologic dysfunction
|
True
|
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For a pt suffering from pernicious anemia, how long should tx be administered
|
for life
|
|
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What glycoprotein is made by the kidney, regulate red cell proliferation and differentiation in bone marrow
|
Erythropoietin
|
|
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Human erythropoietin is effective in the treatment of anemia caused by what disease
|
End-stage renal disease
|
|
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What other supplement may be required for adequate response in tx of ESRD
|
Iron
|
|
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What drug has been shown to relieve the painful clinical course of sickle-cell disease
|
Hydroxyurea
|
|
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T or F: In sickle-cell disease, hydroxyurea increases fetal Hgb levels, thus diluting the abnormal HgbS
|
True
|
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T or F: Polymerization of HgbS is delayed in treated pts, so that painful crises are not caused by sickled cells blocking capillaries and causing tissue hypoxia
|
True
|
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What corticosteroid has excellent antiemetic properties
|
Dexamethasone
|
|
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What are 3 major causative factors of PUD
|
H. pylori
Increased HCl secretion Inadequate mucosal defense |
|
|
Optimal tx for pts w/ PUD who are infected w/ H. Pylori requires what type of treatment
|
Antimicrobial
|
|
|
What tests are used to diagnoise H. pylori infection
|
Endoscopic bx of gastric mucosa
Serologic tests Breath tests for urea |
|
|
T or F: Eradication of H. pylori results in rapid healing of active peptic ulcers and low recurrence rates
|
True
|
|
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What is the typical triple tx of PUD
|
PPI w/ either Metronidazole or amoxicillin plus clarithromycin
|
|
|
What is the typical quadruple tx of PUD
|
Bismuth subsalicylate and metronidazole plus tetracycline plus H2 receptor blocker or a PPI
|
|
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How long are the triple and quadruple therapies for PUD administered
|
2 weeks
|
|
|
How do Bismuth salts work
|
increase the secretion of mucus
|
|
|
Does GERD respond to antibiotic tx? Why or why not
|
No, b/c it is not associated w/ H. pylori
|
|
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Gastric acid secretion by parietal cells is stimulated by what 3 factors
|
Acetylcholine
Histamine Gastrin |
|
|
What 2 factors diminish gastric acid production
|
Prostaglandin E2
Somatostatin |
|
|
What drugs are particularly effective aganst nocturnal acid secretion
|
H2 receptor antagonists
|
|
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Name four H2 receptor antagonists used in US that inhibit basal, food-stimulated, and nocturnal secretion of gastric acid
|
Cimetidine
Ranitidine Nizatidine Famotidine |
|
|
Do H2 receptor antagonists effect H1 receptors
|
No
|
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T or F: H2 receptor antagonists completely inhibit gastric acid secretion induced by histamine or gastrin; however, they only partially inhibit gastric acid secretion induced by Acetylcholine
|
True
|
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T or F: The therapeutic use of H2 antagonists has increased with the advent of PPIs
|
False: decreased
|
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What H2 antagonists are equally effective in promoting healing of duodenal gastric ulcers, but whose recurrence is common after treatment is stopped
|
Cimetidine
Ranitidine Nizatidine Famotidine |
|
|
T or F: Low dose of H2 antagonists are effective for prevention and tx of heartburn; however, about 50% pf pts do not find benefit and PPIs are now used preferentially
|
True
|
|
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H2 receptor antagonists act by stopping acid secretion, but they may not relieve symptoms for how long
|
At least 45 minutes
|
|
|
How do antacids work
|
They neutralize secreted acid already in the stomach, but their effects are shorter lasting
|
|
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What H2 antagonist is inactivated by the liver's microsomal mixed-function oxygenase system and can interfere in the metabolism of many other drugs
|
Cimetidine
|
|
|
Which drug is longer lasting, Cimetidine or Ranitidine
|
Ranitidine
|
|
|
Nizatidine is eliminated principally by what route?
|
By the kidney
|
|
|
What H2 antagonist has endocrine effects such as gynecomastia, galactorrhea, and reduced sperm count
|
Cimetidine
|
|
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What H2 antagonist inhibits cytochrome P450 and can slow metabolism, thus potentiating the action of drugs like warfarin
|
Cimetidine
|
|
|
Except ____, all H2 antagonists inhibit the gastric first-pass metabolism of ethanol
|
Famotidine
|
|
|
T or F: Drugs such as ketoconazole which depend on an acidic medium for gastric absorption, will not be efficiently absorbed if taken with one of the H2 antagonists.
|
True
|
|
|
This drug binds to the proton pump of the parietal cell, thereby suppressing secretion of hydrogen ions into the gastric lumen
|
Omeprazole
|
|
|
Name 4 PPIs that are now available, in addition to Omeprazole
|
Pantoprazole
Esomeprazole Rabeprazole Lansoprazole |
|
|
T or F: all PPIs inhibit both basal and stimulated gastric acid secretion more than 90%.
|
True
|
|
|
Acid suppression begins within how many hrs of PPI administration
|
1-2
|
|
|
what are DOC for tx of erosive esophagitis, active duodenal ulcer, GERD and hypersecretory conditions such as Zollinger-Ellison syndrome
|
PPIs
|
|
|
These drugs reduce the risk of bleeding from an ulcer caused by ASA and other NSAIDS
|
PPI's
|
|
|
This PPI interferes in the oxidation of warfarin
|
Omeprazole
|
|
|
T or F: Drug interactions are a big problem with PPIs
|
False: not a problem, except for omeprazole
|
|
|
Prolonged tx w/ PPIs and H2 antagonists may result in this deficiency
|
Vitamin B12
|
|
|
This substance is produced by the gastric mucosa, inhibits secretion of HCL and stimulates secretion of mucus and bicarb (cytoprotective effect)
|
Prostaglandin E2
|
|
|
Deficiency of prostaglandins is thought to be involved in the pathogenesis of what disease
|
Peptic ulcers
|
|
|
Name the drug that is an analog of prostaglandin E1, that has cytoprotective actions
|
Misoprostol
|
|
|
Routine prophylactic use of misoprostol is justified in what pts
|
Those taking NSAIDS and are at high risk of NSAID induced ulcers, such as the elderly
|
|
|
Like other prostaglandins, misoprostol produces uterine contractions and is contraindicated in whom?
|
Pregnant women
|
|
|
These drugs are weak bases that react with gastric acid and may have other actions such as reduction of H. pylori colonization and stimulation of prostaglandin synthesis
|
Antacids
|
|
|
Name 3 commonly used antacids
|
aluminum hydroxide
magnesium hydroxide calcium carbonate |
|
|
Systemic absorption of the following antacid can produce transient metabolic alkalosis, it is not recommended for long term use
|
Sodium bicarbonate
|
|
|
Calcium carbonate preparations are also used as calcium supplements for the treatment of this disease
|
Osteoporosis
|
|
|
Which antacid may be constipating
|
Aluminum hydroxide
|
|
|
Which antacid may produce diarrhea
|
Magnesium hydroxide
|
|
|
Preparations that combine which 2 antacids aid in normalizing bowel function
|
Aluminum hydroxide and
Magnesium hydroxide |
|
|
____ content of antacids is an important consideration in pts w/ HTN or CHF
|
Sodium
|
|
|
By forming complex gels w/ epithelial cells, this mucosal protective agent creates a physical barrier that impairs diffusion of HCL and prevents degradation of mucus by pepsin and acid
|
Sucralfate
|
|
|
T or F: Sucralfate stimulates prostaglandin release as well as mucus and bicarb output, thereby effectively healing duodenal ulcers
|
True
|
|
|
This mucosal protective agent heals peptic ulcers, increase secretion of mucus, and coat and protect the ulcer crater
|
Colloidal bismuth
|
|
|
What side effects of chemo demand effective management
|
Nausea and vomiting
|
|
|
Who is more susceptible to nausea and vomiting
|
Young and women more than older pts and men
|
|
|
Uncontrolled vomiting can produce what side effects
|
Dehydration
Metabolic imbalances Nutrient depletion |
|
|
The chemoreceptor trigger zone is located where in the brainstem?
|
Area postrema at the caudal end of the 4th ventricle, outside the blood-brain barrier
|
|
|
Where is the vomiting center located
|
lateral reticular formation of the medulla
|
|
|
What does the vomiting center do
|
coordinates the motor mechanisms of vomiting
|
|
|
The vomiting center also responds to afferent input from this system
|
vestibular
|
|
|
The vestibular system functions mainly in this condition
|
Motion sickness
|
|
|
What 2 chemoreceptors play critical roles in the vomiting center activation
|
Dopamine receptor type 2
5-HT3 |
|
|
Name an anticholinergic, antiemetic drug
|
Scopolamine
|
|
|
Name 2 H1 antagonist, antiemetic drugs that are useful in motion sickness but are ineffective against substances that act directly on the chemoreceptor trigger zone
|
Dimenhydrinate
Meclizine |
|
|
Prochlorperazine belongs to what class of drugs
|
Phenothiazines
|
|
|
This drug acts by blocking dopamine receptors, and is effective against low or moderately emetogenic chemotherapeutic agents
|
Prochlorperazine (phenothiazines)
|
|
|
What is an adverse reaction of Prochlorperazine (phenothiazines)
|
Extrapyramidal sx
|
|
|
Ondansetron and Granisetron belong to this group of drugs
|
5-HT3 receptor antagonists
|
|
|
Where in the body do 5-HT3 receptor antagonists work
|
Periphery (visceral vagal afferent fibers)
Brain (chemoreceptor trigger zone) |
|
|
T or F: 5-HT3 antagonists have a short duration of action and are cheap
|
False: long duration and are costly
|
|
|
This drug belongs to the substituted benzamides class
|
Metoclopramide
|
|
|
T or F: Metoclopramide has antidopaminergic side effects such as extrapyramidal sx
|
True
|
|
|
name 2 drugs that belong to the Butyrophenones class and act by blocking dopamine receptors
|
Droperiodol
Domperidone |
|
|
Lorazepam belongs to what class of drugs
|
Benzodiazepines
|
|
|
Name the drug whose beneficial effects are due to its sedative, anxiolytic, and amnesic properties. It's useful in treating anticipatory vomiting
|
Lorazepam (benzodiazepine)
|
|
|
These 2 corticosteroids are effective against mildly to moderately emetogenic chemotherapy. Most frequently, they are used in combination w/ other agents
|
Dexamethasone and methylprednisolone
|
|
|
what is a potential side effect of corticosteroids
|
Insomnia and hyperglycemia in pts w/ DM
|
|
|
Dronabinol belongs to what class of drugs, it's seldom used as a first-line antiemetic
|
Cannabinoids (marijuana derivatives)
|
|
|
Dexamethasone increases its antiemetic activity when given with this 5-HT3 antagonist
|
Metoclopramide
|
|
|
This antihistamine is administered w/ metoclopramide to reduce extrapyramidal reactions
|
Diphenhydramine
|
|
|
Increased motility of the GI tract and decreased absorption of fluid are major factors in this condition
|
Diarrhea
|
|
|
What two antimotility agents are widey used to control diarrhea
|
Diphenoxylate
Loperamide |
|
|
T or F: dephenoxylate and loperamide have opioid-like actions on the gut, inhibit acetylcholine release, and decrease peristalsis
|
True
|
|
|
Diphenoxylate and loperamide can cause what side effect
|
Toxic megacolon
|
|
|
These adsorbents act by adsorbing intestinal toxins or microorganisms/coating or protecting the intestinal mucosa.
|
Kaolin
Pectin Methylcellulose |
|
|
Are antimotility agents or adsorbents more effective
|
Antimotility agents
|
|
|
Bismuth subsalicylate is used for this type of diarrhea
|
Traveler's
|
|
|
T or F: NSAIDS, such as ASA and indomethacin are effective in controlling diarrhea
|
True
|
|
|
This irritant is a laxative that increases peristalsis
|
Castor oil
|
|
|
These 2 irritants stimulate colonic activity
|
cascara and Senna
|
|
|
Bisacodyl belongs to this class of laxatives
|
Stimulant of the colon
|
|
|
Hydrophilic colloids belong to this class of laxatives
|
bulking agents
|
|
|
These drugs form gels in the large intestine causing water retention and intestinal distention, thereby increasing peristaltic activity
|
Bulking agents
|
|
|
Methylcellulose and bran have similar actions to this bulking agent
|
hydrophilic colloids
|
|
|
These drugs are nonabsorbable salts that hold water in the intestine by osmosis
|
Saline cathartics
|
|
|
This drug is a semisynthetic disaccharide that also acts as an osmotic laxative
|
Lactulose
|
|
|
Name 3 stool softeners that when emulsified with the stool, produce softer feces and ease passage
|
Docusate sodium
Mineral oil Glycerin suppositories |
|
|
What % of pts on chemotx will achieve a cure or prolonged remission
|
10%
|
|
|
What is the overall 5yr survival rate for CA pts
|
40%
|
|
|
T or F: CA chemotx acts to cause a lethal cytotoxic event in the cancer cell. This attack is generally directed against metabolic sites essential to cell replication
|
True
|
|
|
T or F: Ideally, anticancer drugs should interfere only with cellular processes that are unique to malignant cells
|
True
|
|
|
T or F: most currently available chemo drugs work only against malignant cells
|
False: against all proliferating cells
|
|
|
T or F: in CA treatment, the neoplastic cell burden is initially debulked either by surgery or radiation
|
True
|
|
|
When is chemo indicataed
|
When neoplasms are disseminated and are not amenable to surgery
|
|
|
What cell characteristic influences their susceptibility to chemotx
|
Growth factor
|
|
|
Are rapidly dividing cells more or less susceptible to chemotx
|
More
|
|
|
chemotx agents that are only effective against replicating cells are said to be...
|
cell-cycle specific
|
|
|
Are cell-cycle specific or nonspecific drugs useful against tumors that have low percentage of replicating cells
|
Nonspecific
|
|
|
Is the growth rate of most solid tumors initially slow or rapid
|
Rapid
|
|
|
T or F: growth rate increases as the tumor size gets bigger
|
False: decreases
|
|
|
T or F: reducing the tumor burden through surgery or radiation promotes the recruitment of the remaining cells into active proliferation and increases their susceptibility to chemotx agents
|
True
|
|
|
This is the term used to describe a given dose of a drug that destroys a constant fraction of cells
|
log kill
|
|
|
For most bacterial infx, what # of log reductions results in a cure
|
5-log
|
|
|
T or F: immune cells can destroy the remaining bacterial cells; however, the tumor cells are not as readily eliminated
|
True
|
|
|
is a single or a combination of chemo drugs more effective
|
Combo
|
|
|
What are 3 advantages of combination therapy
|
1. maximal cell killing within the range of tolerated toxicity
2. effective against a broader range of cell lines 3. Delay or prevent the development of resistant cell lines |
|
|
Does melanoma have inherent or acquired resistance to anticancer drugs
|
Inherent
|
|
|
T or F: some tumor types acquire resistance by mutating, esp after prolonged administration of low-dose drugs
|
True
|
|
|
How is chemo drug resistance minimized
|
By short-term, intensive, intermittant therapy with combinations of drugs
|
|
|
Therapy aimed at killing rapidly dividing cells also affects normal cells undergoing rapid proliferation, such as:
|
Buccal mucosa
Bone marrow GI mucosa Hair |
|
|
T or F: Most chemotx drugs have a narrow therapeutic index
|
True
|
|
|
What side effects, to a greater or lesser extent, are seen with all antineoplastic drugs
|
Vomiting
Stomatitis Alopecia |
|
|
T or F: myelosuppression predisposes to infection are common to many chemotx drugs
|
True
|
|
|
What adverse reaction is seen with doxorubicin
|
Cardiotoxicity
|
|
|
What adverse reaction is seen with bleomycin
|
pulmonary fibrosis
|
|
|
T or F: Some toxic reactions may be ameliorated by perfusing the tumor locally, removing some of the pt's marrow prior to intensive tx and then reimplanting it, or intenstive diuresis to prevent bladder toxicities
|
True
|
|
|
Megaloblastic anemia that occurs with this drug ___ can be counteracted by administering ____
|
Methotrexate
folinic acid (leucovorin) |
|
|
What drug is the human granulocyte stimulating factor
|
Filgrastim
|
|
|
What drug can partially reverse neutropenia caused by chemo drugs
|
Filgrastim
|
|
|
T or F: Antineoplastic agents are mutagens, neoplasms may arise 10 or more yrs after the original cancer was cured
|
True
|
|
|
Treatment induced neoplasia are esp a problem with these agents
|
Alkylating
|
|
|
This class of drugs is structurally related to normal compounds within the cell. They generally interfere with the availability of normal purine or pyrimidine nucleotide precursors either by inhibiting their synthesis, or by competing with them in DNA or RNA synthesis
|
Antimetabolites
|
|
|
Methotrexate belongs to what class of drugs
|
Antimetabolites
|
|
|
This drug is teratogenic and is an abortifacient, should be avoided in pregnancy
|
Methotrexate
|
|
|
This class of drugs owes its cytotoxic action to its interaction with DNA, leading to disruption of DNA function
|
Antibiotics
|
|
|
What drug is one of the most important and widely used anticancer drugs
|
Doxorubicin
|
|
|
What is an adverse side effect of doxorubicin
|
Irreversible, dose-dependent cardiotoxicity
|
|
|
Irreversible, dose dependent cardiotoxicity is more common in these two antibiotics
|
Daunorubicin
Doxorubicin |
|
|
What is the most serious adverse effect of Bleomycin
|
Pulmonary toxicity: progressing from rales, cough, and infiltrate to potentially fatal fibrosis
|
|
|
These drugs exert their cytotoxic activity by covalently binding to nucleophilic groups on various cell constituents
|
Alkylating agents
|
|
|
what is the most commonly used alkylating agent
|
Cyclophosphamide
|
|
|
Carmustine belongs to what class of drugs
|
Nitrosureas
|
|
|
Because of their ability to penetrate the CNS, nitrosureas are used primary in the treatment of ____
|
Brain tumors
|
|
|
Where are microtubule inhibitors derived from
|
Plants
|
|
|
Name 2 microtubule inhibitors
|
Vincristine
Vinblastine |
|
|
This chemo drug has shown good activity against advanced ovarian cancer and metastatic breast cancer
|
Paclitaxel (taxol)
|
|
|
This drug shows impressive benefits with fewer side effects
|
Docetaxel
|
|
|
This is a potent, anti-inflammatory corticosteroid with less mineralcorticoid activity than cortisol
|
Prednisone
|
|
|
This drug is used primarily to induce remission in pts with acute lymphocytic leukemia and in the treatment of Hodgkins and non-Hodgkins lymphoma
|
Prednisone
|
|
|
This drug can predispose to infx, hyperglycemia, cataract formation, osteoporosis, and change in mood (euphoria or psychosis)
|
Prednisone
|
|
|
These two drugs are analogs of GnRH and occupy the GnRH receptor in the pituitary which leads to desensitization, and inhibition of release of FSH and LH. Thus, both androgen and estrogen synthesis are reduced
|
Leuprolide and Goserelin
|
|
|
Response to this drug in prostatic cancer is equivalent to that of orchiectomy
|
Leuprolide
|
|
|
These drugs have some benefit in pre-menopausal women with advanced breast cancer
|
Leuprolide and Goserelin
|
|
|
T or F: with the use of GnRH analogs, levels of androgen may initially rise but then fall to castration levels
|
True
|
|
|
This drug is synthetic, nonsteroidal antiandrogen, used in the treatment of prostate cancer. It competes with the natural hormone for binding to the androgen receptor
|
Flutamide
|
|
|
T or F: introduction of an allograft can illilcit a damaging immune respone - rejection
|
True
|
|
|
Earlier immunosuppressive drugs were nonselective, and pts frequently succumbed to infection due to suppression of what part of the immune system
|
Humoral (antibody mediated)
Cell mediated |
|
|
Today, the principal approach to immunosuppressive tx is to alter the function of ____ using antibodies against immune proteins
|
lymphocyte
|
|
|
Name the 3 mechanisms of action by which immunosuppressive drugs are categorized
|
1. interfere w/ cytokine production
2. disrupt cell metabolism, preventing lymphocyte proliferation 3. mono-and polyclonal antibodies block T cell surface molecules |
|
|
T or F: Immunosuppresive tx is used in treatment of autoimmune disease
|
True
|
|
|
What is the name of signaling proteins that bind to cell surface receptors
|
Cytokines
|
|
|
What molecules are considered cytokines
|
Interleukins
Interferons TNFs Transforming growth factors Colony-stimulating factors |
|
|
Which cytokine stimulates proliferation of helper T cell
|
IL-2
|
|
|
What molecules do helper T cells produce, which in turn activate NK cells, macrophages, and cytotoxic T lymphocytes
|
IL-2
IFN gamma TNF-beta |
|
|
T or F: drugs that interfere with production or activity of IL-2 will significantly dampen the immune response
|
True
|
|
|
Cyclosporine can be used alone, but is more effective when what other drugs are administered
|
Glucocorticoids
|
|
|
Cyclosporine is an alternative to what drug for the treatment of severe, active rheumatoid arthritis, and recalcitrant psoriasis
|
Methotrexate
|
|
|
Cyclosporine preferentially suppresses cell mediated or humoral reactions?
|
Cell mediated
|
|
|
What is the end result of cell mediated suppression with cyclosporine
|
decreased IL-2
|
|
|
T or F: Infections in pts taking cyclosporine are common and may be life-threatening
|
True
|
|
|
What type of infections are prevalent in pts taking cyclosporine (CsA)
|
Viral infx due to herpes and CMV
|
|
|
An ointment preparation of cyclosporine has been approved for what condition
|
Atopic dermatitis
|
|
|
This macrolide is approved for use in renal transplantation
|
Sirolimus (SRL)
|
|
|
What drug coats stents, ultimately inhibiting restenosis of the blood vessels by reducing proliferation of endothelial cells
|
Sirolimus (SRL)
|
|
|
T or F: SRL inhibits proliferation of cells in the graft intimal areas and is effective in halting graft vascular disease
|
True
|
|
|
Antimetabolite agents are usually used in combination with what other drugs
|
Glucocorticoids
|
|
|
What drug has been the cornerstone of immunosuppressive therapy during the last several decades
|
Azathioprene
|
|
|
What cells are predominantly affected by cytotoxic effects of azathioprene
|
Lymphocytes
|
|
|
What is azathioprene's major non-immune toxicity
|
Bone marrow suppression
|
|
|
Azathioprene is being replaced by what drug
|
Mycophenolate Mofetil
|
|
|
T or F: Mofetil, like 6-MP, deprives the proliferating T and B cells of a key component of nucleic acids
|
True
|
|
|
These compounds are prepared either by immunization of rabbits or horses with human lymphoid cells (producing a mixture of polyclonal antibodies directed against a number of lymphocyte antigens)
|
Antibodies
|
|
|
What drugs were the first pharmacologic agents to be used as immunosuppressive in transplantation and in various autoimmune disorders
|
Glucocorticoids
|
|
|
These drugs are the mainstay for attenuating rejection episodes
|
Glucocorticoids
|
|
|
What are the most common agents for transplantation
|
Prednisone
Methylprednisone |
|
|
What drugs are employed for autoimmune conditions
|
Prednisone
Prednisolone |
|
|
Glucocorticoids mostly affect these cells
|
T cells
|
|
|
T or F: steroids rapidly reduce lymphocyte populations by lysis or redistribution
|
True
|
|
|
T or F: efforts are being made to reduce or eliminate the use of steroids in the maintanance of allografts
|
True
|
|
|
What method of GERD dx is superior to endoscopy
|
2 week course of PPI. This offers sensitivity and specificity equivalent to pH monitoring
|
|
|
T or F: doses of H-2 blocking agents may have to be doubled to be effective
|
True
|
|
|
Should PPIs be taken before or after meals
|
Before, to stimulate activation of proton pumps
|
|
|
What 2 anti-diarrheals are used for symptomatic tx of IBD
|
Loperamide
Diphenoxylate |
|
|
This drug is most useful in maintaining remissons of Crohn's and UC
|
Sulfasalazine
|
|
|
This drug is used in rectal or left sided disease, it's 5ASA coated in Eudragit resin
|
Mesalamine
|
|
|
This drug is effective in 1st 12 weeks of acute UC
|
Balsalazide
|
|
|
What antibiotic is the most extensively studied for tx of active Crohn's
|
Metronidazole
|
|
|
How is achalasia treated today
|
Botulinum toxin
|
|
|
Until recently, most cases of Achalasia were treated how
|
Dilation or surgical myotomy
|
|
|
These 3 class of drugs treat diffuse esophageal spasm
|
Long acting nitrates
CCB Balloon dilation |
|
|
What drugs should be avoided in someone w/ IBS and depression
|
Antidepressants with strong anti-cholinergic effects in pts w/ constipation
|
|
|
This drug is a 5HT-3 antagonist that delays colonic transit and reduces colonic sensation, useful in diarrhea predominant IBS
|
Alosetron (Lotronex)
|
|
|
This drug is a HT-4 agonist, that stimulates gastric emptying, approved for tx of constipation predominant IBS
|
Tegaserod (Zelnorm)
|
|
|
3 treatments of ascites
|
Sodium restriction
fluid restriction diuretic therapy -furosemide, amiloride, spironolactone |
|
|
This drug decreases ammonia diffusion across gut wall and may lead to increased utilization by gut bacteria, used in tx of encephalopathy
|
Lactulose
|
|
|
Combination tx of what 2 drugs is effective in tx encephalopathy in pts who fail to respond to either agent alone
|
Neomycin
Lactulose |
|
|
What drug is a sclerotherapeutic agent used in management of esophageal varicies
|
Sodium tetradecyl sulfate
|
|
|
This drug is a nonselective vasoconstrictor that reduces portal pressure by constriction of mesenteric and splanchnic arteries and portal veins, thus managing esophagesal varicies
|
Vasopressin
|
|
|
This drug is a long acting synthetic octapeptide analog of somatostatin, used in managing esophageal varicies
|
Octreotide
|
