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52 Cards in this Set
- Front
- Back
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–Microcytic anemia
–HbH (ß4) disease –Found in Asia & Africa –HbBarts(g4)=hydrops fetalis (4 gene mutants) |
Alpha-thalassemia:
Decreased alpha-chain synthesis |
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–Microcytic anemia; MCV <80
–Decreased ferritin, MCHC,RBC |
Iron Deficiency Anemia
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What is Plummer Vinson Syndrome?
1.) ________________ 2.) ________________ 3.) ________________ |
Plummer Vinson Syndrome:
1.) Iron def. anemia 2.) Esophageal Webs 3.) Atrophic Glossitis |
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–Microcytic anemia; MCV <80
–Increased HbF (a2g2) –Prevalent in Mediterranean pop. –HbA2 >3.5 % is dgx |
ß-thalassemia (minor)
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–Microcytic anemia; MCV <80
–Increased HbF (a2g2) –"Crew cut" skull on Xray –Severe anemia requires transfusions |
ß-thalassemia (major)
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–Inhibition of rRNA degradation
–Abdominal colic, wrist drop, foot drop |
Lead poisoning
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–Aggregation of ribosomes within the RBC---> Basophilic stippling
–Also see ringed–sideroblasts –First line treatment is EDTA, dimercaprol, & succimer (peds) |
Lead poisoning
Inhibition of ∂-ALA-dehydratase Inhibtion of ferrochelatase |
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–Microcytic anemia; MCV <80
–Increased ferritin, [Fe+] –Ringed Sideroblasts –X-linked What is this disease and what is its MOA??? |
Siderblastic Anemia
defective ∂-ALA-synthase causes defective heme synthesis |
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HgA1c labs can appear falsely HIGH and falsely LOW.
What key feature causes them to be hi or lo? |
RBC turnover
Hi turnover = Falsely high A1c Low turnover = Falsely low A1c |
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What causes high RBC turnover?
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Fe+ Supplements
G6PD Hemolytic Anemias ALL LEAD TO FALSELY HIGH A1C LEVELS!!! |
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What causes falsely LOW RBC turnover?
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Folate def anemia
vB12 def anemia LOW RBC TURNOVER = FALSELY LOW A1C LEVELS ("you're not REALLY doing better on your diabetes vitamin deficiency") |
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–Normocytic anemia
–Low iron, TIBC –Increased ferritin, hepcidin –Can become microcytic over time |
Anemia of Chronic Disease
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–Folic Acid analog
–Blocks DHF reductase |
MTX
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SIDE FX:
–Restrictive lung dx –Macrovasicular fatty liver –Myelosuppression (reversible with folinic acid) |
MTX
Leucovorin Rescue!!! |
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SIDE FX:
–Photosensitivity –Irreversible Myelosuppression –"Rescue" OD w/thymidine |
5-FU
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–Pyrimidine analog
–Inhibits thymidylate synthase |
5-FU
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–Purine (thiol) analog
–Activated by HGPRTase –Metabolized by xanthine oxidase |
6-MP
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Should NEVER be given with allopurinol:
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6-MP
(6-TG is ok, since it's not metabolized by xanthine oxidase) |
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–Intercalates DNA
–used for childhood tumors –"Onion skin" growth |
Dactinomycin
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–Generates free radicals AND intercalates DNA
–used w/Hodgkin dx and solid organ tumors |
Doxorubicin
Daunorubicin |
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Cardiotoxic Chemo drugs?
How is cardiotoxicity prevented? |
Doxorubicin
Daunorubicin Prevented with Dexrazoxane |
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What specific cardiotoxic pathology is seen with doxorubicin/daunorubicin?
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Dilated cardiomyopathy
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Eradicate Ball Cancer
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Etoposide
Bleomycin Cisplatin |
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–Free radicals formed; DNA strand breaks
–used in testicular cancer/Hodgkin dx |
Bleomycin
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SIDE EFFECTS:
–Pulmonary Fibrosis –Hyperpigmentation |
Bleomycin
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–Inhibits Topoisomerase II
–used in SCCL and testicular cancer |
Etoposide
Teniposide |
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–Covalently X-links (interstrand) DNA at guanine N-7
–Requires liver activation –Immunosuppressant |
Cyclophosphamide
Ifosfamide |
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SIDE FX:
–Hemorrhagic cystitis –SIADH –Myelosuppression |
Cyclophosphamide
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What must be given to prevent hemorrhagic cystitis d.t. cyclophosphamide?
How does it work? |
MESNA
Has thiol that binds to acraline (toxic metabolite) |
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–Alkylates DNA
–crosses BBB (used for GBM) –Liver activation required |
Nitrosoureas
CarMUSTINE LoMUSTINE SeMUSTINE Streptozocin |
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–Alkyates DNA
–Good for CML –used to ablate host marrow in bone marrow transplant |
Busulfan
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SIDE FX:
–Pulmonary Fibrosis –Hyperpigmentation –Myelosuppression (severe) |
Busulfan
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–Inhibits microtubule polymerization
–Binds to tubulin in M phase |
Vincristine
Vinblastine |
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–Hyperstabilizes polymerized microtubules in M-phase
–Prevents breakdown of mitotic spindle –Cannot progress to anaphase |
Paclitaxel
(Taxols) |
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SIDE EFFECTS:
–Paralytic Ileus –Neurotoxic (areflexia; peripheral neuritis) |
Vincristine
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SIDE FX:
–blasts bone marrow |
vinBLASTine
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SIDE FX:
–Hypersensitivity rxn |
Paclitaxel
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–Cross links DNA
–used in testicular/ovary/bladder cancers |
CisPLATIN
CarboPLATIN OxaloPLATIN All contain PLATINUM |
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SIDE FX:
–Nephrotoxic; ototoxic How is this prevented |
Cisplatin (all PLATINs really)
Amifostine is used to prevent nephrotoxic effects (free radical scavenger) |
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–Inhibitis ribonucleotide reductase
–S-phase specific –used in melanoma, CML |
Hydroxyurea
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–S-phase specific drug used to increase [HgF] in sickle cell pts
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Hydroxyurea
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–SERM
–Increased risk of endometrial CA |
Tamoxifen
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–SERM
–No increase risk of endometrial CA |
Raloxifene
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–Anti-HER2 antibody
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Trastuzumab (Herceptin)
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Another name for an Anti-erb-B2 antibody?
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Trastuzumab (Herceptin)
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What do Herceptin and Gleevac have in common?
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They are antibodies against TYROSINE KINASES
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–Anti bcr-abl antiobdy
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Imatinib (Gleevac)
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SIDE FX:
–Cardiotoxic antibody |
Trastuzimab
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–Anti-CD20 antibody
–used for NHL/Rh arthritis (duh!) |
Rituximab
(anti B-cell antibody) used w/MTX in Rh arthritis |
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–Fever
–Neuro dfx –Renal failure –TTP –MAHA What is this classic pentad? |
HUS-TTP
Caused by what bug? |
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In HUS-TTP what symptoms classically dominate in both adults and kids?
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HUS-TTUP
Adults: Neuro dfx are often most severe Kids: Renal failure is often most severe |
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How does one differentiate leukemoid reaction to CML? to AML?
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CML = low alk phos
AML = >20% blasts Leuk. rxn = normal (or high alk phos) |
