Therapeutics Hematology/oncology Exam 3 Final

Front 1

basic functions of blood (2)

Back 1

1. transportation
2. defense against infections and foreign materials

Front 2

what does blood transport? (5)

Back 2

1. oxygen and carbon dioxide
2. nutrients (glucose, lipids, amino acids)
3. waste products
4. hormones
5. heat

Front 3

WBC that contain granules (granulocytes) (3)

Back 3

1. neutrophils
2. eosinophils
3. basophils

Front 4

WBC without granules (2)

Back 4

1. lymphocytes
2. monocytes/ macrophages

Front 5

____ is the source for formation of all cell types

Back 5

bone marrow

Front 6

Development of stem cells involve ____ and ____ leading to development of progenitor or parent cells in each cell line

Back 6

cytokines and growth factors

Front 7

normal range for neutrophils

Back 7

4.4-11 thou/mcL

Front 8

average circulation time for neutrophils

Back 8

6-12 hours

Front 9

1. mild neutropenia ANC =
2. moderate neutropenia ANC =
3. severe neutropenia ANC =

Back 9

1. <1500 /mm3
2. 500-1500 / mm3
3. <500 /mm3

Front 10

treatment of neutropenia may include (2)

Back 10

1. filgastrim
2. pegfilgastrim

Front 11

____ granules are loaded with histamine which is released during allergic reactions

Back 11

eosinophils

Front 12

1. less effective but similar functions to that of neutrophils
2. primarily directed towards large invaders such as parasites
3. allergic reactions--will release histamines which induce vasodilation and pulmonary vasoconstriction (process prevents more antigens from entering the body)

Back 12

eosinophils

Front 13

1. in low numbers and their function is not well understood
2. they are involved in type I hypersensitivity responses and have high affinity to IgE leading to release of histamine
3. act in a similar fashion to mast cells with one difference being that these are located in the blood while mast cells are located in the tissue

Back 13

basophils

Front 14

once monocytes enter the tissue, they mature and become _____

Back 14

macrophages

Front 15

functions of?

1. initiation of immune responses especially fungal infections
2. regulation of immune response intensity
3. phagocytosis which engulf foreign matter as well as dead and dying cells in the body
4. secretion of monokines such as interferons, tumor necrosis factor, and interleukin-1

Back 15

monocytes

Front 16

1. responsible for making antibodies for humoral immunity
2. sometimes referred to as the memory cells since they produce immunoglublin type M (IgM); subsequent exposure to an antigen results in a quicker immun response

Back 16

B lymphocytes (B-cells)

Front 17

Go after intracellular pathogens and regulate the size and duration of the immune response; sometimes referred to as "suppressor T cells" since they help to down-regulate the immune system

Back 17

cytotoxic T cells (CD8)

Front 18

Help to regulate the inflammatory reactions through stimulation of B-cell maturation and antibody production; this essentially enhances the production of antibodies by the B cells

Back 18

Helper T cells (CD4)

Front 19

attacks and destroys tumor cells without prior sensitization

Back 19

natural killer cells

Front 20

lymphocytosis defined as ______ cells/L

Back 20

>4 x 10'9 cells/L

Front 21

normal values for platelets

Back 21

150,000-450,000

Front 22

normal lifespan of RBC

Back 22

120 days

Front 23

where is erythropoietin secreted from?

Back 23

kidneys

Front 24

1. a secretory anitbody found in all physiologic fluids including tears, saliva, GI fluids, milk, and mucus
2. neutralizes microorganisms/ toxins before these pathogens enter or cross the epithelium

Back 24

IgA

Front 25

1. predominately expressed on the surface of B cells
2. physiologic roll in the immune response is unclear

Back 25

IgD

Front 26

1. almost exclusively found on the surface of mast cells
2. when stimulated, this will cause the release of many allergic mediators and will be involved in parasitic infections

Back 26

IgE

Front 27

1. most abundant of the immunoglobulins in serum accounting for ~75% of all immunoglobulins in the serum
2. possesses high affinity for antigens and will help to eliminate antigen-bearing cells as well as facilitate natural killer cell activity
3. found in breast milk allowing passive immunity for newborns through breast-feeding

Back 27

IgG

Front 28

1. first antibody produced by the fetus and also the first antibody to respond to an antigen
2. primary exposure to an antigen leads to the appearance of this which will decrease as IgG synthesis increases

Back 28

IgM

Front 29

normal values for hemoglobin (Hgb)

male =
female=

Back 29

male = 14-17.5 g/dL
female = 12.3-15.3 g/dL

Front 30

normal values for hematocrit (Hct)

male =
female =

Back 30

male = 40.7- 50.3%
female = 36.1-44.3%

Front 31

represents the average volume of RBCs

Back 31

mean corpuscular volume (MCV)

normal = 80-100 fL

Front 32

average weight of hemoglobin per volume of cells and is independent of cell size

Back 32

Mean corpuscular hemoglobin concentration

normal = 31-37%

Front 33

percent volume of hemoglobin in a RBC

Back 33

mean corpuscular hemoglobin (MCH)

normal 26-34 pg

Front 34

factors that affect iron absorption (3)

Back 34

1. gastric acidity increases the absorption through ionization to the ferrous state
2. phytates (found in graines, brans, and some vegetables) can form insoluble complexes preventing iron absorption
3. situations such as achlorhydria will also prevent iron from being absorbed (state where gastric acid production is low/absent)

Front 35

transport protein which helps deliver iron to the bone marrow and to other organs for storage

Back 35

transferrin

Front 36

1. indirect measure of iron binding capacity and a very useful test
2. constant, thus one of the tests to determine if one has iron deficiency anemia

Back 36

total binding capacity (TBC)

Front 37

1. considered stored iron and is proportional to the total iron stores
2. low levels is almost diagnostic for iron deficiency anemia
3. normal to high levels dont really tell you much as this is an acute phase reactant meaning inflammatory responses may cause this to elevate

Back 37

serum ferritin

Front 38

common causes for decreased RBC production (4)

Back 38

1. lack of nutrients including iron, B12, and folate
2. problems involving the ability for bone marrow to produce RBCs including aplastic anemia, mylodysplasia, and red blood cell aplasia
3. suppression of bone marrow function due to drugs, chemo, and radiation
4. reductions in hormones which stimulate RBC production such as EPO, thyroid, and androgens

Front 39

s/s of anemia (8)

Back 39

1. fatigue
2. weakness
3. headache
4. faintness
5. loss of skin tone
6. tachycardia
7. breathlessness
8. lightheadedness

Front 40

s/s of iron deficiency anemia (6)

Back 40

1. fatigue
2. palpitations
3. tachypnea
4. spooning of the nails
5. brittle nails
6. pica (cravings to eat non-food items)

Front 41

characteristic labs of iron deficiency anemia (5)

Back 41

1. low serum iron (may be variable)
2. low ferritin
3. high TIBC
4. low MCV (initially normal but will drop)
5. hypochromic

Front 42

% of elemental iron in ferrous sulfate

Back 42

20% (65 mg per 325 mg tab)

Front 43

% of elemental iron in ferrous gluconate

Back 43

12% (39 mg per 325 mg tab)

Front 44

% of elemental iron in ferrous fumerate

Back 44

33% (33 mg per 100 mg tab

Front 45

% of elemental iron in poly sacharride complex

Back 45

150 mg per capsule or 50 mg per tablet (100% elemental iron)

Front 46

1. normal dosing for IDA for iron
2. dosing for pregnant women

Back 46

1. 200 mg elemental iron divided in 2-3 doses per day
2. 30 mg elemental iron per day

Front 47

SE of oral iron supplementation (5)

Back 47

1. nausea
2. constipation
3. epigastric pain/cramping
4. diarrhea
5. dark colored stools

Front 48

main drug interactions with iron (3)

Back 48

1. calcium
2. antacids
3. tetracyclines

Front 49

indications for using parenteral iron (5)

Back 49

1. noncompliance with oral therapy
2. inability to absorb oral iron
3. large iron boluses required to compensate for chronic blood loss
4. GI disorders which would be aggravated by oral therapy (ex: inflammatory bowel disease)
5. intolerance to oral therapy (fail at least 2 forms)

Front 50

equation for calculating iron deficit to determine how much parenteral iron is used?

Back 50

dose of iron (mg) = whole blood hemoglobin deficit (g/dL) x body weight (lb)

Front 51

which parenteral iron preparation is indicated for patients with chronic kidney disease (1)

Back 51

1. ferumoxytol

Front 52

characteristic labs associated with anemia of chronic disease (ACD) (3)

Back 52

1. low serum iron
2. normal to high ferritin levels
3. low TIBC

Front 53

when would you use EPO?

Back 53

do not initiate unless Hgb is <10 g/dL

Front 54

indications for EPO (4)

Back 54

1. anemia related to cancer
2. anemia secondary to CKD
3. anemia secondary to HIV
4. prophylaxis prior to surgery to reduce blood transfusions

Front 55

ADR with EPO (4)

Back 55

1. HTN
2. headache
3. arthralgias
4. nausea

Front 56

Hgb goal with EPO use

Back 56

should not exceed 11 g/dL or rise > 1 g/dL every 2 weeks due to increased mortality and cardiovascular events

Front 57

hemolytic anemias (5)

Back 57

1. sickle cell disease
2. glucose-6-phosphodiesterase deficiency
3. drug-induced (quinidine, high dose penicillin, methyldopa)
4. autoimmune disease
5. aplastic anemias

Front 58

macrocytic anemias are generally caused by an impairment of DNA synthesis which occurs mainly from deficiencies in ____ and ____ as these are cofactors for DNA synthesis

Back 58

1. folic acid
2. cobalamin

Front 59

symptoms of B12 deficiency (10)

Back 59

GI
1. glossitis
2. diarrhea
3. anorexia
4. gas
5. nausea
6. abdominal pain

neurologic
7. peripheral neuropathies
8. mild personality changes
9. depression
10. dementia/psychosis

Front 60

hypersegmented neutrophils are very sensitive and specific for which anemia?

Back 60

megaloblastic anemia

Front 61

dose for IM cyanocobalamin

Back 61

1000 mg IM weekly for 4-6 weeks then monthly

Front 62

Where do B lymphocytes mature?

Back 62

bone marrow

Front 63

where to T lymphocytes mature

Back 63

thymus gland

Front 64

general s/s of acute cellular rejection (3)

Back 64

1. pain over graft site
2. fever
3. lethargy

Front 65

treatment for acute cellular rejection (2)

Back 65

1. thymoglobulin: 1-2 mg/kg IV x 5-10 doses
2. corticosteroids: pulse dose (usually methylprednisolone 500 mg IV x 3-5 doses

Front 66

patients at increased risk for infection (8)

Back 66

1. younger patients
2. females > males
3. african americans
4. cadaveric grafts (from deceased patients)
5. donors > 50 yo
6. retransplantation
7. higher levels of preformed antibodies (panel reactive antibodies, PRA)
8. delayed graft function

Front 67

spotting rejection: kidney (2)

Back 67

1. increase in SCr
2. decrease in urine output

Front 68

spotting rejection: liver (2)

Back 68

1. increase in LFTs
2. serum bilirubin 1.5x ULN

Front 69

spotting rejection: pancreas (2)

Back 69

1. elevated blood sugars (need for insulin)
2. elevated amylase and lipase

Front 70

spotting rejection: lung (1)

Back 70

1. worsening spirometry parameters (esp FEV1)

Front 71

spotting rejection: heart (3)

Back 71

1. fatigue
2. shortness of breath
3. edema

Front 72

polyclonal antibodies (2)

Back 72

1. thymoglobulin (rabbit)
2. ATGAM (horse)

Front 73

monoclonal antibodies (2)

Back 73

1. basiliximab
2. alemtuzumab

Front 74

monitoring for thymoglobulin (3)

Back 74

1. absolute lymphocyte count
2. platelets
3. infectious complications

Front 75

blocks IL-2 receptors on activated T-cells, inhibiting the T-cell action against the transplant

Back 75

basiliximab

Front 76

i. Anti-CD 52 and B-cell depleting antibody

Back 76

alemtuzumab

Front 77

short term SE of steroids (7)

Back 77

1. Hyperglycemia
2. Increased appetite
3. Insomnia
4. Mental status changes
5. Hypernatremia
6. Hypocalcemia
7. Leukocytosis

Front 78

long term SE of steroids (8)

Back 78

1. Hypertension
2. Hyperlipidemia
3. Diabetes mellitus
4. Osteoporosis
5. Cataracts
6. Glaucoma
7. Impaired wound healing
8. Peptic ulcer disease

Front 79

calcineurin inhibitors (2)

Back 79

1. cyclosporine
2. tacrolimus

Front 80

antiproliferatives (3)

Back 80

1. azathioprine
2. mycophenolate/ myfortic
3. alefacept

Front 81

m-TOR inhibitors (2)

Back 81

1. sirolimus
2. everolimus

Front 82

binds to cyclophilin and this complex then inhibits calcineurin phosphatases and T-cell activation

Back 82

cyclosporine

Front 83

monitoring for cyclosporine (6)

Back 83

a. Trough
b. CBC
c. Electrolytes
d. Blood pressure
e. LFTs
f. Pregnancy category C

Front 84

binds to FKBP12 and this complex inhibits calcineurin phosphatases and T-cell activation

Back 84

tacrolamis

Front 85

CYP3A4 inhibitors (6)

Back 85

a. Azole antifungal
b. Macrolide antibiotics (erythromycin, clarithromycin)
c. CCB (diltiazem and verapamil; nifedipine and nicardipine)
d. Grapefruit juice
e. Statins
f. Ritonavir

Front 86

CYP3A4 inducers (5)

Back 86

a. Rifampin
b. Phenytoin
c. Phenobarbital
d. Carbamazepine
e. St. John’s wort

Front 87

what does azathioprine have a black box warning for?

Back 87

warning for malignancy (lymphoma)

Front 88

1. Antagonize purine metabolism

Back 88

azathioprine

Front 89

SE of azathioprine (5)

Back 89

1. Leukopenia
2. Bone marrow depression
3. N/V/D
4. Macrocytosis
5. Liver toxicity (uncommon)

Front 90

DDI with azathioprine (4)

Back 90

1. allpurinol--decrease azathioprine by 50-75%
2. 6-mercaptopurine
3. ace inhibitors--anemia, leukopenia
4. warfarin--increase warfarin dose

Front 91

reversible inhibitor of inosine monophosphate dehydrogenase (IMPDH)
a. Key rate limiting enzyme in de novo purine synthesis (i.e. inhibits purine production which is a key step in DNA/RNA synthesis

Back 91

mycophenolic acid

Front 92

SE of mycophenolic acid (5)

Back 92

1. GI--mainly diarrhea
2. nausea
3. neutropenia
4. anemia
5. hypertension

Front 93

DDI with mycophenolic acid (2)

Back 93

1. aluminum, magnesium, calcium, iron containing products--physically interact and reduce absorption (separate 2 hours before and after)
2. cholestyramine (same as above)