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Details

Heme/Onc
Pharm
63
Medical
Graduate
04/03/2012

Additional Medical Flashcards

 


 

Cards

Term
heparin

mech/uses
Definition
immediate anticoagulation

cofactor to activate antithrombin
Term
heparin

tox
Definition
bleeding
thrombocytopenia
HIT - look for in first 4 days

rapid reversal with protamine sulfate
Term
HIT

heparin induced thrombocytopenia
Definition
+/- 4 days into treatment

heparin binds to platelet factor IV causing antibody production that binds to and activates platelets --> clearance of platelets - thrombocytopenia, hypercoagulable state

tx with direct thrombin inhibitors (hirudin derivatives)
Term
direct thrombin inhibitors
Definition
lepirudin
bilvalirudin
argatroban

--hirudin inhibitors
Term
direct thrombin inhibitors

mech/uses
Definition
lepirudin, bilvalirudin, argatroban

directly inhibit thrombin without the needing antithrombin

an alt to heparin for anticoagulating patients with HIT
Term
warfarin/coumadin

mech/uses
Definition
interferes with normal synthesis and gamma-carboxylations of vitamin K dependent clotting factors: II, VII, IX, X, protein C, protein S

used for chronic anticoagulation
Term
warfarin

tox
Definition
bleeding
teratogenic
skin/tissue necrosis (w/in 1st week, from inhibtion of prot C activity)

reverse toxity with vitamin K, rapid reversal with FFP
drug0drug interactions (P450)
Term
thrombolytics/fibrinolytics
Definition
streptokinase
urokinase
tPA (alteplase)
APSAC (antistreplase)
Term
thrombolytics

mech/uses
Definition
directly or indirectly help convert plasminogen-->plasmin to cleave thrombin and fibrin clots

increase clot lysis by increased formation of plasmin

used in early MI, early ischemic stroke
Term
thrombolytics

tox
Definition
bleeding...duh

reverse with aminocaproic acid, an inhibitor of fibrinolysis
Term
aspirin/ASA

mech
Definition
inhibits COX-1 and 2 to prevents conversion of arachidonic acid-->thromboxane A2
Term
aspirin

tox
Definition
gastric ulceration, bleeding, hyperventiliation, tinnitus

Reye's syn if given to kids with viral illness
Term
cilostazol, dipyridamole

mech, uses
Definition
phosphodiesterase III inhibitor
increases cAMP in platelets = inhibition of platelet aggregation

used in intermittent claud, coronary vasodilation, prevent stroke/TIAs, angina prophylax
Term
cilostazol, dipyridamole

tox
Definition
nausea, HA, facial flushing, hypotension, ab pain
Term
clopidogrel, ticlopidine

mech, use
Definition
inhibits platelet aggregation by irreversibly blocking ADP receptors

inhibits fibrinogen binding by blockingh expression of GPIIb/IIIa

can combine with aspirin to get an additive antiplatelet effect

used in acute coronary syndrome and coronary stenting
Term
clopidogrel, ticlopidine

tox
Definition
1% of ticlopidine patients may experience neutropenia, presenting as fevers and mouth sores
Term
abciximab

mech/uses
Definition
monoclonal antibody that binds to GPIIb/IIIa on activated platets thuis preventing aggregation

uaes in acute coronary syndromes, percutaneous transluminal coronary angioplasty
Term
abciximab

tox
Definition
bleeding
thrombocytopenia
Term
DDVAP-desmopressin acetate

mech/use
Definition
synthetic vasopressin analog that releases vWF and factor VIII from endothelium

used in the tx of mild-moderate hemophilia A
Term
antimetabolites

names and general mech
Definition
inhibit S phase = DNA synthesis

methotrexate (MTX)
5-flurouracil )5-FU)
6-mercaptopurine (6-MP)
6-thioguanine (6-TG)
cytarabine (ara-C)
Term
methotrexate

mech and use
Definition
FOLIC ACID ANALOG that inhibits dihydrofolate reductase --> inhibits DNA and protein synthesis

accumulation of dihydrofolic acid within treated cells

oncologic and non-neoplastic uses (ie abrotion/ectopic preg)
Term
methotrexate

tox
Definition
myelosuppression <-- reversible with LEUCOVORIN (folinic acid)

macrovesicular fatty change in liver

mucositits

teratogenic (duh, it's used to cause abortion!)
Term
5-FU

mech
Definition
pyrimidine analog that covalently bonds folic acid creating a complex that inhibits thymidylate synthase --> inhibit DNA and protein synthesis

synergy with MTX
Term
5-FU

tox
Definition
myelosuppression (NOT reversible with leucovorin)

phtosensitivity
Term
6-MP

mech
Definition
purine analog that decreases de novo purine synthesis

activated by HGPRTase
Term
6-MP

tox
Definition
bone marrow, liver, GI

increased toxicity with allopurinol because it is metabolized by xanthine oxidase
Term
cytarabine

mech
Definition
pyrimidine analog that inhibits DNA polymerase
Term
cytarabine

tox
Definition
leukopenia

thrombocytopenia

megaloblastic anemia
Term
antitumor antibiotics

names
Definition
dactinomycin
doxorubicin, daunorubicin
bleomycin
etoposide, teniposide
Term
dactinomycin

mech
Definition
intercalates in DNA

used for childhood tumors
Term
dactinomycin

tox
Definition
myelosuppression
Term
doxorubicin

daunorubicin

mech
Definition
generates free radicals

noncovalently intercalate in DNA causing breaks in DNA and thus decreasing replication
Term
doxorubicin

tox
Definition
cardiotoxicity (dilated cardiomyopathy)
myelosuppression
alopecia

iron chelation to prevent cardiotoxicity
Term
bleomycin

mech
Definition
induces free radical formation, causing breaks in DNA strands
Term
bleomycin

tox
Definition
pulmonary fibrosis

skin changes

(minimal myelosuppression)
Term
etoposide (VP-16)

teniposide

mech
Definition
inhibits topoisomerase II, decreasing DNA degradation
Term
etoposide

tox
Definition
myelosuppression

GI irritation

alopecia
Term
alkylating agents

names
Definition
cyclophosphamide, ifosamide
nitrosoureas
busulfan
Term
cyclophosphamide

ifosfamide

mech
Definition
covalently cross link (interstrand) DNA at guanine N-7

requires bioactivation by liver
Term
cyclophosphamide

tox
Definition
myelosuppression

hemorrhagic cystitis (partially prevented with mesna)
Term
nitrosoureas
(carmustine, lomustine, semustine, streptozocin)

mech
Definition
cross blood-brain barrier

require bioavtivation
Term
nitrosoureas

tox
Definition
CNS toxicity
(dizziness, ataxia)
Term
busulfan

mech
Definition
alkylates DNA
Term
busulfan

tox
Definition
pulmonary fibrosis

hyperpigmentation
Term
microtubule inhibitors

names and general mech
Definition
inhibit M phase of cell cycle = cellular division

vincristine, vinblastine

pacitaxel, other taxols
Term
vincristine
vinblastine

mech
Definition
block POLYMERIZATION of microtubules so that spindle cannot form

alkaloids that bind to tubulin in M-phase
Term
vincristine
vinblastine

tox
Definition
vincristine - neurotoxicity, paralytic ileus

vinblastine - bone marrow suppression
Term
taxols

mech
Definition
HYPERSTABILIZE polymerized microtubules in M-phase so that mitotic spindle cannot break down (aka anaphase can't occur)
Term
taxols

tox
Definition
myelosuppression

hypersensitivity
Term
cisplatin
carboplatin

mech
Definition
cross link DNA
Term
cisplatin
carboplatin

tox
Definition
nephrotoxicity

acoustic nerve damage
Term
hydroxyurea

mech
Definition
inhibits ribonucleotide reductase --> decreases DNA synthesis (S-phase specific)
Term
hydroxyurea

tox
Definition
bone marrow suppression

GI upset
Term
prednisone

mech
Definition
may trigger apoptosis

may even work on non-dividing cells
Term
prednisone

tox
Definition
Cushing-like symtoms

immunosuppression

cataracts, acne, osteoporosis, HTN, peptic ulcers, hyperglycemia, psychosis
Term
tamoxifen
raloxifene

mech
Definition
SERMs - receptor antagonists in breast and agonists in bone

block the binding of estrogen to estrogen-receptor-positive cells
Term
tamoxifen
raloxifene

tox
Definition
tamoxifen ONLY may increase risk of endometrial carcinoma via partial agonist effects

(ralox is an endometrial antagonist)
Term
trastuzumab
(Herceptin)

mech
Definition
monoclonal antibody against HER-2 (erb-B2), a tyrosine kinase

helps kill breast cancer cells that overexpress HER-2 (up to 30% of invasive cases), possibly through antibody-dependent cytotoxicity
Term
trastuzumab
(Herceptin)

tox
Definition
cardiotoxicity
Term
imatinib
(Gleevec)

mech
Definition
Philadelphia chromosome bcr-abl tyrosine kinase inhibitor
Term
imatinib
(Gleevec)

tox
Definition
fluid retention
Term
rituximab

mech
Definition
monoclonal antibody against CD20 - found on most B-cell neoplasms
Term
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Definition
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