Pharma- Heme-Onc

Front 1

Heparin's effect on:
Antithrombin
Thrombin
Xa

Back 1

Activates
Decreases
Decreases

Front 2

Why is heparin used in pregnancy instead of warfarin?

Back 2

Cannot cross placenta

Front 3

Test to monitor for pts on heparin?

Back 3

PTT

Front 4

Test to monitor for pts on warfarin?

Back 4

INR

Front 5

Rapid reversal of heparin with?

Back 5

Protamine sulfate (positively charged)

Front 6

4 advantages of LMWH?

Back 6

Better bioavailability
Longer half-life
Sub-Q administration
No need for lab monitoring

Front 7

Disadvantage of LMWH?

Back 7

Not easily reversible

Front 8

LMWHs have a greater effect on

Back 8

Xa

Front 9

Main toxicity of heparin?

Back 9

Heparin-induced thrombocytopenia (HIT)

Front 10

HIT ensues when heparin binds to ?

Back 10

Platelet factor IV

Front 11

Pathophys of HIT

Back 11

Heparin binds paltelet factor IV--> Ab production --> Abs bind and activate platelets --> platelets are cleared --> thrombocytopenic, hypercoagulable state

Front 12

Two direct thrombin inhibitors

Back 12

Lepirudin
Bivalirudin

Front 13

Clinical utility of direct thrombin inhibitors

Back 13

Pts with HIT

Front 14

Four toxicities of warfarin

Back 14

Bleeding
Teratogenic
Skin/ tissue necrosis
Drug-drug interactions

Front 15

Rapid reversal of warfarin overdose

Back 15

FFP

Front 16

Non-urgent reversal of warfarin overdose

Back 16

Vitamin K

Front 17

Advantage of warfarin administration over heparin?

Back 17

Available orally

Front 18

4 thrombolytics

Back 18

Streptokinase
Urokinase
tPA (alteplase)
APSAC (anistreplase)

Front 19

Main toxicity of thrombolytics

Back 19

Bleeding

Front 20

Thrombolytic toxicity treated with

Back 20

Aminocaproic acid (inhibitor of fibrinolysis)

Front 21

6 toxicities of aspirin

Back 21

Gastric ulceration
Bleeding
Hyperventilation
Reye's Syndrome
Tinnitus (CN VIII)
Interstitial nephritis/ acute renal failure

Front 22

Mechanism of ASA

Back 22

Acetylates and irreversibly inhibits cyclooxygenase to prevent conversion of arachidonic acid to TxA2

Front 23

Blood test affected by ASA

Back 23

Bleeding time

Front 24

2 mechanisms of clopidogrel and ticlopidine

Back 24

Irreversibly block ADP receptors --> inhibit platelet aggregation

Prevent glycoprotein IIb/IIIa expression --> inhibit fibrinogen binding

Front 25

Toxicity of ticlopidine

Back 25

Neutropenia

Front 26

Abciximab is a monoclonal Ab that binds to ______ to prevent platelet aggregation

Back 26

Glycoprotein receptor IIb/IIIa

Front 27

Antimetabolites work in this phase of the cell cycle

Back 27

S phase

Front 28

Vinca alkaloids and taxols work in this phase of the cell cycle

Back 28

M phase

Front 29

Etoposide works in these 2 phases of the cell cycle

Back 29

S and G2

Front 30

Bleomycin works in this phase of the cell cycle

Back 30

G2

Front 31

MTX inhibits

Back 31

dihydrofolate reductase --> dTMP

Front 32

Drug for leukemias, lymphomas, choriocarcinoma, and sarcomas

Back 32

MTX

Front 33

Non-neoplastic uses of MTX

Back 33

Abortion
Ectopic pregnancy
RA
Psoriasis

Front 34

Leucovorin rescue is used after toxicity from what drug?

Back 34

MTX

Front 35

Leucovorin rescue is used to decrease what toxicity of MTX?

Back 35

Myelosupression

Front 36

Another term for folinic acid

Back 36

Leucovorin

Front 37

Mechanism of leucovorin rescue

Back 37

Cofactor for thymidylate synthase (in lieu of THF)

Front 38

5 antimetabolites

Back 38

MTX, 5-FU, 6-MP, 6-TG, cytarabine (ara-C)

Front 39

4 toxicities of MTX

Back 39

Myelosuppression
Macrovesicular fatty change in liver
Mucositis
Teratogenic

Front 40

How is leucovorin used with 5-FU?

Back 40

To increase cell kill, rather than to decrease toxicity

Front 41

5-FU overdose can be rescued with?

Back 41

Thymidine

Front 42

2 toxicities of 5-FU

Back 42

Myelosuppression
Photosensitivity

Front 43

Mechanism of 5-FU

Back 43

Pyrimidine analog, bioactivated to 5F-dUMP, which complexes folic acid and inhibits thymidylate synthase

Front 44

MTX and 5-FU are

Back 44

Synergistic

Front 45

5-FU is used for

Back 45

Colon cancer and other solid tumors
Basal cell carcinoma (topical)

Front 46

6-MP decreases

Back 46

De novo purine synthesis (is a purine analog)

Front 47

6-MP is used for leukemias and lymphomas except

Back 47

CLL
Hodgkin's

Front 48

3 systems with toxicity from 6-MP

Back 48

BM
GI
Liver

Front 49

6-MP is metabolized by ?

Back 49

Xanthine oxidase (so toxicity is increased with allopurinol, which inhibits this enzyme)

Front 50

6-TG is used for

Back 50

ALL

Front 51

What distinguishes the drug interactions of 6-MP and 6-TG?

Back 51

6-TG can be given with allopurinol (and commonly is, to prevent uric acid stones from tumor lysis syndrome)

Front 52

Antimetabolite drug that is a pyrmidine analog

Back 52

Cytarabine (ara-C)

Front 53

Cytarabine inhibits ?

Back 53

DNA polymerase

Front 54

Another name for cytarabine?

Back 54

Ara-c

Front 55

Ara-C is used for

Back 55

AML
ALL
High-grade non-Hodgkin's lymphoma

Front 56

Toxicities of ara-C (3)

Back 56

Leukopenia
Thrombocytopenia
Megaloblastic anemia

Front 57

Drug used for childhood tumors

Back 57

Dactinomycin

Front 58

3 tumors treated with dactinomycin

Back 58

Ewing's sarcoma, Wilms' tumor, rhabdomyosarcoma

Front 59

Mechanism of dactinomycin

Back 59

Intercalates in DNA

Front 60

Toxicity of dactinomycin

Back 60

Myelosuppression

Front 61

Doxorubicin (adriamycin) and daunorubicin are in what class of antibiotics

Back 61

Anthracyclines

Front 62

Mechanism of anthracycline antibiotics

Back 62

Generate free radicals
Noncovalently intercalate in DNA

Front 63

Clinical use of doxorubicin and daunorubicin

Back 63

Hodgkin's lymphoomas
Myelomas, sarcomas, and solid tumors

Front 64

3 toxicities of doxorubicin and daunorubicin

Back 64

Cardiotoxicity
Myelosuppression
Alopecia

Front 65

Drug given to prevent cardiotoxicity from doxorubicin

Back 65

Dexrazoxane (iron-chelating agent)

Front 66

Mechanism of bleomycin

Back 66

Induces free radical formation --> breaks in DNA strands

Front 67

2 clinical uses of bleomycin

Back 67

Testicular cancer
Hodgkin's lymphoma

Front 68

Two toxicities of bleomycin

Back 68

Pulmonary fibrosis
Skin changes

Front 69

Mechanism of etoposide (and teniposide)

Back 69

Inhibits topoisomerase II --> DNA degradation

Front 70

Clinical use of etoposide

Back 70

Small cell carcinoma of lung and prostate

Testicular carcinoma

Front 71

3 toxicities of etoposide

Back 71

Myelosuppression
GI irritation
Alopecia

Front 72

Mechanism of cyclophosphamide and ifosfamide

Back 72

Covalently X-link (interstrand) DNA at guanine-7

Front 73

Cyclophosphamide and ifosfamide must be bioactivated by

Back 73

Liver

Front 74

Use of cyclophosphamide and ifosfamide

Back 74

Hon-Hodgkin's lymphoma
Breast and ovarian carcinomas

Front 75

2 toxicities of cyclophosphamide and ifosfamide

Back 75

Myelosuppression
Hemorrhagic cystitis

Front 76

Prevention of hemorrhagic cystitis in cyclophosphamide and ifosfamide treatment with?

Back 76

Mesna (thiol group binds toxic metabolite)

Front 77

Which alkylating agent can be used for brain tumors?

Back 77

Nitrosoureas (cross BBB)

Front 78

Toxicity of nitrosoureas

Back 78

CNS (dizziness, ataxia)

Front 79

Busulfan is used for

Back 79

CML

Front 80

Busulfan toxicity

Back 80

Pulmonary fibrosis, hyperpigmentation

Front 81

4 antitumor antibiotics

Back 81

Dactinomycin
Doxorubicin/ daunorubici
Bleomycin
Etoposide/ teniposide

Front 82

3 alkylating agents

Back 82

Cyclophosphamide/ ifosfamide
Nitrosoureas
Busulfan

Front 83

Mechanism of vincristine and vinblastine

Back 83

Bind tubulin and block polymerization of MTs so spindle cannot form

Front 84

Mechanism of paclitaxel and other taxols

Back 84

Hyperstabilize polymerized MTs in M-phase so mitotic spindle can't break down

Front 85

3 uses of vincristine/ vinblastine

Back 85

Hodgkin's lymphoma
Wilms' tumor
Choriocarcinoma

Front 86

2 uses of taxols

Back 86

Ovarian and breast carcinomas

Front 87

Toxicity of vincristine (2)

Back 87

Neurotoxicity (areflexia, peripheral neuritis)
Paralytic ileus

Front 88

Toxicity of vinblastine

Back 88

BM suppression

Front 89

Toxicity of taxols (2)

Back 89

Myelosuppression
Hypersensitivity

Front 90

Mechanism of cisplatin and carboplatin

Back 90

Cross-link DNA

Front 91

4 uses of cisplatin/ carboplatin

Back 91

Testicular, bladder, ovary, and lung carcinomas

Front 92

2 toxicities of cisplastin/ carboplatin

Back 92

Nephrotoxicity and acoustic nerve damage

Front 93

Prevent nephrotoxicity from cisplatin with

Back 93

Amifustine (thiol-based free radical scavenger) and hydration

Front 94

Hydroxyurea inhibits

Back 94

Ribonucleotide reductase

Front 95

Hydroxyurea is specific for

Back 95

(S-phase specific)

Front 96

3 uses for hydroxyurea

Back 96

Melanoma
CML
SCD (increases HbF)

Front 97

Toxicity of prednisone

Back 97

Cushing-like symptoms
Immunosuppression
Cataracts, acne, osteoporosis, HTN, PUD, hyperglycemia, psychosis

Front 98

2 SERMs

Back 98

Tamoxifen
Raloxifene

Front 99

SERMs are receptor antagonists in ____ and agonists in ____

Back 99

Breast, bone

Front 100

Why is raloxifene preferred over tamoxifene?

Back 100

No increase in endometrial carcinoma b/c is an antagonist (whereas tamoxifen is a partial agonist)

Front 101

Trastuzumab is a monoclonal Ab against ?

Back 101

HER-2 (erb-B2)

Front 102

Toxicity of trastuzumab

Back 102

Cardiotoxicity

Front 103

Imatinib is a

Back 103

bcr-abl tyrosine kinase inhibitor

Front 104

2 clinical uses of imatinib

Back 104

CML
GI stromal tumors

Front 105

Toxicity of imatinib

Back 105

Fluid retention

Front 106

Rituximab is a monoclonal Ab against ?

Back 106

CD20

Front 107

2 uses of rituximab

Back 107

Non-Hodgkin's lymphoma
RA (with MTX)