Pharmacology Review – Hematology, Oncology, Immunology & GI

Vocabulary flashcards covering key drugs, mechanisms, and clinical pearls for hematology, oncology, immunosuppression, and gastrointestinal pharmacology.

Oral iron therapy

Replaces iron; take with food for tolerability (↓ absorption); causes dark stools & metallic taste; contraindicated in PUD, UC, or hemolytic anemia

Ferrous sulfate

325 mg tablet containing 65 mg elemental iron; most commonly used oral iron preparation

Ferrous gluconate

Oral iron salt alternative to ferrous sulfate

Ferrous fumarate

Oral iron salt with higher elemental iron content than ferrous gluconate

Carbonyl iron

100 % elemental iron by weight, but poorly absorbed

Parenteral iron

IV iron reserved for patients intolerant to oral iron or with chronic anemia; higher risk of hypersensitivity

Iron dextran (Infed)

IV iron with the highest risk of anaphylaxis; test dose required

Ferric gluconate complex (Ferrlecit)

Most commonly used IV iron; lower anaphylaxis risk than iron dextran

Iron sucrose

IV iron with moderate risk of hypersensitivity

Ferumoxytol (Feraheme)

IV iron; boxed warning for anaphylaxis

Deferoxamine (Desferal)

IV iron chelator used for acute iron toxicity

Deferasirox (Jadenu)

Oral iron chelator for chronic iron overload & hemochromatosis (second-line to phlebotomy)

Deferiprone (Ferriprox)

Oral iron chelator for chronic iron overload

Cyanocobalamin

Vitamin B12 salt used to correct B12 deficiency with neurologic symptoms

Hydroxocobalamin

Vitamin B12 salt converted to methylcobalamin; longer-acting than cyanocobalamin

Folic acid

Vitamin needed for DNA synthesis; corrects folate-deficiency anemia (no neurologic symptoms)

Leucovorin (Folinic acid)

Active folate form; rescues folate stores (e.g., after methotrexate); may cause flushing or allergy

Hydroxyurea

Inhibits ribonucleotide reductase; increases HbF in sickle-cell disease; myelosuppressive, embryo-fetal toxicity

Crizanlizumab (Adakveo)

Monoclonal antibody against P-selectin to reduce vaso-occlusive crises in SCD patients ≥16 yr

Epoetin alfa (Epogen, Procrit)

Recombinant erythropoietin; stimulates RBC production; raise Hgb slowly & supplement iron

Darbepoetin alfa (Aranesp)

Longer-acting EPO analog for anemia of chronic disease or chemotherapy

Filgrastim (Neupogen)

G-CSF that increases neutrophils; major side effect: bone pain

Sargramostim (Leukine)

GM-CSF with broad myeloid stimulation; bone pain, first-dose reaction, capillary leak syndrome

Oprelvekin (Neumega)

Recombinant IL-11; stimulates platelet production

Eltrombopag (Promacta)

Oral thrombopoietin-receptor agonist for chronic immune thrombocytopenia & Hep C; hepatotoxic; rebound thrombocytopenia on withdrawal

Romiplostim (Nplate)

Peptide TPO-receptor agonist for chronic ITP

Direct oral anticoagulants (DOACs)

Oral factor Xa inhibitors that require no routine monitoring; abrupt discontinuation ↑ stroke & spinal/epidural hematoma risk

Apixaban (Eliquis)

Most common DOAC; factor Xa inhibitor

Rivaroxaban (Xarelto)

Factor Xa inhibitor DOAC; once-daily dosing

Edoxaban (Savaysa)

Factor Xa inhibitor DOAC; less used due to rapid renal clearance

Argatroban (Acova)

IV direct thrombin inhibitor used in heparin-induced thrombocytopenia (HIT/HITT)

Low-molecular-weight heparins (LMWH)

Inhibit factor Xa > thrombin; preferred anticoagulant in pregnancy

Dalteparin (Fragmin)

LMWH for prophylaxis or treatment of thrombosis

Enoxaparin (Lovenox)

Most common LMWH; SC administration

Bivalirudin (Angiomax)

IV direct thrombin inhibitor used during PCI

Dabigatran (Pradaxa)

Oral direct thrombin inhibitor; reversal agent is idarucizumab

Heparin

Catalyzes antithrombin to inhibit multiple clotting factors; monitor aPTT; antidote protamine sulfate; risk of HIT/HITT

Warfarin (Coumadin)

Inhibits vitamin K–dependent clotting factor synthesis; monitor INR; pregnancy category X; many CYP450 interactions; reversed with vitamin K

Aspirin

Irreversible COX-1 inhibitor ↓ thromboxane A2; used for secondary prevention; bleeding risk

Dipyridamole (Persantine)

PDE inhibitor ↓ platelet Ca²⁺; used with aspirin

Clopidogrel (Plavix)

ADP-receptor (P2Y12) antagonist prodrug; ↓ effectiveness with CYP2C19 poor metabolizers

Prasugrel (Effient)

ADP-receptor antagonist with higher bleeding risk than clopidogrel

Ticlopidine (Ticlid)

Older ADP-receptor blocker; can cause neutropenia, TTP, agranulocytosis, aplastic anemia

Abciximab (Reopro)

Monoclonal antibody against GPIIb/IIIa; used with aspirin & heparin during PCI

Vorapaxar (Zonivity)

Protease-activated receptor-1 (PAR-1) antagonist; boxed warning for bleeding

Eptifibatide (Integrilin)

GPIIb/IIIa antagonist peptide; IV antiplatelet for ACS

Cangrelor (Kengreal)

IV reversible P2Y12 inhibitor with rapid onset/offset

Cilostazol (Pletal)

PDE-III inhibitor for intermittent claudication; antiplatelet & vasodilator

Ticagrelor (Brilinta)

Reversible oral P2Y12 inhibitor; dyspnea common

Tirofiban (Aggrastat)

Small-molecule GPIIb/IIIa inhibitor

Alteplase (tPA, Activase)

Recombinant tissue plasminogen activator; dissolves clots in stroke, MI, PE

Reteplase (Retavase)

Modified tPA with longer half-life for STEMI

Tenecteplase (TNKase)

tPA variant with highest fibrin specificity & single bolus dosing

Aminocaproic acid (Amicar)

Antifibrinolytic that inhibits plasminogen activation; treats bleeding

Andexanet alfa (Andexxa)

Factor Xa decoy protein reversing apixaban & rivaroxaban

Idarucizumab (Praxbind)

Monoclonal antibody fragment reversing dabigatran

Protamine sulfate

Heparin antidote (100 %), partial reversal of LMWH; none for synthetic heparins

Vitamin K (phytonadione)

Reverses warfarin-induced anticoagulation

Alkylating agents

Damage DNA to prevent cancer cell division; non-targeted chemo group

Cyclophosphamide (Cytoxan)

Nitrogen mustard; hemorrhagic cystitis risk (use mesna)

Chlorambucil

Alkylating agent; renal toxic metabolite

Carmustine (BiCNU)

Nitrosourea; crosses BBB; delayed myelosuppression

Lomustine (Gleostine)

Oral nitrosourea for brain tumors

Busulfan (Myleran)

Alkylating agent; causes pulmonary fibrosis & seizures

Procarbazine (Matulane)

Alkylating-like agent; MAOI properties

Dacarbazine (DTIC-Dome)

Triazene alkylating agent for melanoma, Hodgkin disease

Cisplatin

Platinum alkylator; dose-limiting nephrotoxicity, ototoxicity

Carboplatin

Platinum agent; dose-limiting bone marrow suppression

Oxaliplatin

Platinum agent; dose-limiting peripheral neuropathy

Ifosfamide

Nitrogen mustard; hemorrhagic cystitis & neurotoxicity

Methotrexate (Trexall)

Antimetabolite folate antagonist; pregnancy X; rescue with leucovorin

Pemetrexed (Alimta)

Antifolate similar to methotrexate

5-Fluorouracil (5-FU)

Pyrimidine analog inhibiting thymidylate synthase

Capecitabine (Xeloda)

Oral prodrug of 5-FU; boxed warning with warfarin (↑ bleeding)

6-Mercaptopurine (6-MP)

Purine analog; metabolized by xanthine oxidase (watch allopurinol)

Cytarabine (Ara-C)

Pyrimidine analog; boxed warning for myelosuppression

Gemcitabine

Pyrimidine analog for pancreatic & lung cancers

Topoisomerase inhibitors

Block topoisomerase enzymes, preventing DNA replication

Etoposide

Topoisomerase II inhibitor; risk of alopecia & hypotension

Irinotecan (Camptosar)

Topoisomerase I inhibitor; causes severe diarrhea

Topotecan (Hycamtin)

Topoisomerase I inhibitor used in ovarian & small-cell lung cancer

Anthracyclines

Antitumor antibiotics causing ROS & DNA intercalation; cardiotoxic

Doxorubicin (Adriamycin)

Anthracycline with dose-dependent cardiomyopathy

Daunorubicin

Anthracycline; boxed warning for myocardial toxicity

Mitoxantrone

Anthracenedione with less cardiotoxicity than doxorubicin

Bleomycin

Antitumor antibiotic causing pulmonary fibrosis

Vincristine (Oncovin)

Vinca alkaloid; neurotoxicity (peripheral neuropathy) dose-limiting

Vinblastine (Velban)

Vinca alkaloid; bone-marrow suppression dose-limiting

Paclitaxel (Taxol)

Taxane microtubule stabilizer; boxed warning for anaphylaxis (premedicate)

Docetaxel (Taxotere)

Taxane with similar hypersensitivity risk as paclitaxel

Asparaginase

Depletes asparagine; used in ALL; hypersensitivity reactions

Amifostine (Ethyol)

Cytoprotective agent reducing cisplatin nephrotoxicity

Palifermin (Kepivance)

Recombinant keratinocyte growth factor preventing chemo-induced mucositis

Rituximab (Rituxan)

Anti-CD20 mAb that depletes B-cells; infusion reactions & PML risk

Bevacizumab (Avastin)

VEGF inhibitor blocking angiogenesis; hypertension & bleeding

Trastuzumab (Herceptin)

Anti-HER2 mAb; cardiotoxicity risk

Pertuzumab (Perjeta)

HER2 dimerization inhibitor; used with trastuzumab

Cyclosporine (Neoral)

Calcineurin inhibitor; nephrotoxic, causes gingival hyperplasia, requires trough monitoring

Tacrolimus (Prograf)

Calcineurin inhibitor; higher incidence of post-transplant diabetes

Sirolimus (Rapamune)

mTOR inhibitor binding FKBP-12; avoid concurrent steroids; dyslipidemia