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70 Cards in this Set
- Front
- Back
Mechanism and AEs of cisplatin and carboplatin?
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Cross-link DNA
AE: nephrotoxicity, acoustic nerve damage |
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Risk of endometrial carcinoma occurs with which SERMs?
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Tamoxifen: increases risk (partial agonist effects)
Raloxifene: no increased risk (endometrial antagonist) |
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Paclitaxel prevents progression to which phase of the cell cycle?
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Inhibits M phase: progression to anaphase
- hyperstabilizes polymerized microtubule so mitotic spindle can't break down |
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Microtubule inhibitors that block polymerization so mitotic spindles can't form?
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Vincristine and vinblastine
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Cytarabine mechanism and AEs?
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Pyrimidine analog --> inhibit DNA polymerase
- used for AML, ALL, non-Hodgkin's lymphoma AEs: leukopenia, thrombocytopenia, megaloblastic anemia |
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Relationship between 5-FU and methotrexate?
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Synergistic relationship
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AE of 5-FU?
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Myelosuppression (NOT reversible with leucovorin)
- Can "rescue" with thymidine Photosensitivity |
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Non-neoplastic uses of methotrexate?
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Abortion
Ectopic pregnancy Rheumatoid arthritis Psoriasis |
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Leucovorin is used to rescue what?
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Folinic acid that rescues myelosuppression as a result of methotrexate
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Drug similar to 6-MP that can be given with allopurinol?
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6-thioguanine (6-TG)
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Direct thrombin inhibitors and use?
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Lepirudin, Bivalirudin
Used as alternative to anticoagulation in patients with HIT. |
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Enoxaparin vs Heparin?
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Enoxaparin: low molecular weight heparin, acts more on Xa, better bioavailability, 2-4x longer half life
- administered subQ without lab monitoring |
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Mechanism of heparin induced thrombocytopenia (HIT)?
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Heparin binds platelet factor IV --> Ab production --> binds to/activates platelets --> clearance of platelets --> thrombocytopenic, hypercoagulable state
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RBC count vs mass?
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Count: RBCs/ul blood
Mass: total RBCs in body (ml/kg) RBC count = RBC mass / plasma volume |
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Key lab values to differentiate polycythemia vera from other forms of polycythemia?
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Increased plasma volume
Decreased EPO Significantly increased RBC mass |
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AE of ticlopidine (gpIIb/IIIa inhibitor)?
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Neutropenia
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What are auer rods?
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Peroxidase-positive cytoplasmic inclusions in granulocytes and myeloblasts
- commonly seen in AML M3 (APL) |
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S-100, CD1a, and Birbeck granules are characteristic of what?
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Langerhans cell histiocytosis (LCH)
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Mantle cell lymphoma translocation and gene?
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t(11;14)
Cyclin D activation |
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List 4 thrombolytics.
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Streptokinase
Urokinase tPA (alteplase) APSAC (anistreplase) |
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Toxicity of Trastuzumab? Imatinib?
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Trastuzumab (anti HER-2/erb-B2): cardiotoxicity
Imatinib (bcr-abl TKI): fluid retention |
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Alkylating agents?
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Cyclophosphamide, ifosfamide
Nitrosoureas (carmustine, lomustine, semustine, streptozocin) Busulfan |
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Toxicity of nitrosoureas?
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CNS toxicity (dizziness, ataxia)
- crosses BBB --> used for brain tumors (GBM, etc) |
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Mechanism of cyclophosphamide?
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Alkylating agent
- covalently cross link DNA at guanine N-7 - requires bioactivation by the liver |
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What mechanism do doxorubicin/daunorubicin and bleomycin have in common?
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Generate free radicals --> cause breaks in DNA strands
- Doxo/daunorubicin also noncovalently intercalate in DNA |
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Which chronic myeloproliferative disorders are JAK2 positive?
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Polycythemia vera
Essential thrombocytosis Myelofibrosis (all except CML) |
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Mechanism of bleomycin vs busulfan?
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Bleomycin: induces free radical formation --> breaks in DNA strands
Busulfan: alkylates DNA |
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What can happen with treatment of AML?
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Auer rods (peroxidase positive cytoplasmic inclusions) can be released and cause DIC
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What do defective cells in Langerhans cell histiocytosis (LCH) express?
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S-100 and CD1a
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Where are leukemic infiltrates often seen?
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Liver, spleen, and lymph nodes
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What are 3 common features of any leukemia?
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Anemia (decreased RBCs)
Infections (decreased mature WBCs) Hemorrhage (decreased platelets) |
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Which translocation confers a better prognosis in ALL?
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t(12;21)
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Most common cause of generalized lymphadenopathy > 60 yo?
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SLL/CLL
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TRAP positive leukemia?
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Hairy cell leukemia
Cells have filamentous, hairlike projections. |
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Most common adult non-Hodgkin's lymphoma?
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Diffuse large B cell
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CD5+ tumor?
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Mantle cell lymphoma
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Which type of lymphoma has more constitutional/B symptoms?
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Hodgkin's
- low grade fever, night sweats, weight loss |
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Spread of Hodgkin's vs non-Hodgkin's lymphoma?
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Hodgkin's: more localized, contiguous spread, extranodal is rare
Non-Hodgkin's: peripheral nodes, extranodal involvement, non-contiguous spread |
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Age distribution of Hodgkin's vs non-Hodgkin's lymphoma?
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Hodgkin's: bimodal distribution (and more common in men, except nodular sclerosing)
Non-Hodgkin's: ~20-40 yo |
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Lacunar cells are seen in which variant of Hodgkin's lymphoma?
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Nodular sclerosing
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Best to worse prognosis of Hodgkin's lymphoma?
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Excellent: nodular sclerosing & lymphocyte predominant
Intermediate: mixed cellularity Poor: lymphocyte depleted |
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Causes of DIC?
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Sepsis
Trauma Obstetric Pancreatitis (acute) Malignancy Nephrotic syndrome Transfusion |
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Receptor deficiency in Bernard-Soulier disease vs Glanzmann's thrombasthenia?
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Bernard-Soulier: Gp1b
Glanzmann's: Gp IIb/IIIa |
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Pentad of symptoms seen in TTP?
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Neurologic sx
Renal sx Fever Thrombocytopenia Microangiopathic hemolytic anemia |
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Enzyme deficient in acute intermittent porphyria?
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Porphobilinogen deaminase
Get buildup of porphobilinogen, d-ALA, and uroporphyrin |
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Enzyme deficient in porphyria cutanea tarda?
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Uroporphyrinogen decarboxylase.
Get buildup of uroporphyrin |
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1st reaction of heme synthesis?
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Glycine + succinyl CoA --> B6 + d-ALA synthase --> d-aminolevulinic acid (d-ALA)
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Warm agglutinins causing AIHA result from what?
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Chronic anemia in SLE
CLL Alpha-methyldopa, penicillin, Quinidine |
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Complications in sickle cell homozygotes?
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1. Aplastic crisis
2. Autosplenectomy 3. Salmonella osteomyelitis 4. Painful vaso-occlusive crisis 5. Renal papillary necrosis and microhematuria 6. Splenic sequestration crisis |
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What happens to glucose in RBCs?
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90% is anaerobically degraded to lactate
10% goes though HMP shunt |
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Different granules that platelets contain?
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Dense granules (ADP, Ca)
Alpha-granules (vWF, fibrinogen) |
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What do the large, spherical azurophilic granules in neutrophils contain?
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Hydrolytic enzymes
Lysozyme Myeloperoxidase Lactoferrin |
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Cells with frosted glass cytoplasm and kidney shaped nucleus?
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Monocytes
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2 things eosinophils produce and their function?
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Histaminase and Arylsulfatase
Help limit reaction following mast cell degranulation |
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Causes of eosinophilia?
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Neoplastic
Asthma Addison's Allergic processes Collagen vascular diseases (PAN) Parasites (invasive) |
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Degranulation of mast cells releases what?
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Histamine
Heparin Eosinophil chemotactic factors |
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Basophilic granules in basophils contain what?
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Heparin
Histamine Vasoactive amines Leukotrienes (LTD-4) |
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What activates factors VIIIa and Va?
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IIa (thrombin)
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What is kallikrein activated by and what does it do?
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Activated by XIIa
Converts HMWK to bradykinin |
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Acanthocytes are seen in what diseases?
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Liver disease & Abetalipoproteinemia
Echinocytes (more moderate): seen in uremia |
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Basophilic stippling?
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Thalassemias
Anemic of chronic disease Iron deficiency Lead poisoning |
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Target cells?
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HbC disease
Asplenia Liver disease Thalassemia |
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Heinz bodies?
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Oxidation of iron leads to denatured Hgb precipitation and damage to RBC membrane --> formation of bite cells
Alpha thalassemia, G6PD deficiency |
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Barts hemoglobin results from what?
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Deletion of 4 alpha genes
Barts: gamma4 - incompatible with life (hydrops fetalis) |
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HbH disease results from what?
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Deletion of 3 alpha genes
HbH = beta4 |
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Racial distribution of alpha vs beta thal?
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Alpha: Asia/Africa
Beta: Mediterranean |
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"Crew cut" on x-ray could mean what?
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Sickle cell disease or beta-thalassemia major
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Causes of aplastic anemia?
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Radiation/drugs (benzene, chloramphenicol, alkylating agents, antimetabolites)
Viral agents (B19, EBV, HIV, HCV, CMV) Fanconi's anemia (inherited DNA repair defect) Idiopathic (follows acute hepatitis) |
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Treatment of aplastic anemia?
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Immunosuppression (antithymocyte globulin, cyclosporine)
Allogeneic BM transplant Irradiated RBC, platelet transfusion G-CSF or GM-CSF |
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Mechanism that Dactinomycin and doxo/daunorubicin share?
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Both intercalate in DNA
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