398 - 401 - Heme pharm

Question 1

What are two drugs that are derived from hirudin?

Answer 1

Argatroban

Bivalirudin

Question 2

What is the mechanism of action of hirudin and its derivatives?

Answer 2

inhibits thrombin directly

Question 3

When would you use a hirudin derivative?

Answer 3

instead of heparin for anticoagulating patients with HIT

Question 4

What are two direct factor Xa inhibitors?

Answer 4

Apaxiban

Rivaroxaban

Question 5

What are the applications of rivaroxaban?

Answer 5

1. DVT
2. PE
3. Stroke prophylaxis in patients with a. fib

Question 6

Do Xa factor inhibitors require coagulation monitoring?

Answer 6

Oral agents do not usually require monitoring

Question 7

What is the reversal agent for Xa inhibitors?

Answer 7

no specific reversal agents are available

Question 8

Name 3 thrombolytics

Answer 8

1. alteplase (tPA)
2. reteplase (rPA)
3. tenecteplase (TNK-tPA)

Question 9

What is the mechanism of thrombolytics?

Answer 9

Directly or indirectly aid conversion of

plasminogen → plasmin → cleaves thrombin and fibrin clots

Question 10

What effect do thrombolytics have on PT, PTT, and platelet count?

Answer 10

↑PT
↑↑PTT
no change in platelet count

Question 11

How do you treat toxicity of thrombolytics?

Answer 11

1. amniocaproic acid (an inhibitor of fibrinolysis)
2. fresh frozen plasma (replete factors)
3. cryoprecipitate (replete factors)

Question 12

Describe the effect of Asprin on:

• Bleeding time
• TXA2
• Prostaglandins
• PT
• PTT

Answer 12

• Bleeding time ↑
• TXA2 ↓
• Prostaglandins ↓
• PT - no change
• PTT - no change

Question 13

What are the toxicities of asprin?

Answer 13

1. Gastric ulceration
2. tinnitus (CN VIII)
   3 Acute renal failure
3. Interstitial nephritis
4. Upper GI bleeding
5. Reye syndrome in child w/ viral infection

Question 14

What happens to the blood acid/base levels with asprin overdose?

Answer 14

Initially respiratory alkalosis, then superimposed by metabolic acidosis

Question 15

What are 4 ADP receptor inhibitors?

Answer 15

1. Clopidogrel
2. Ticlopidine
3. Prasugrel
4. Ticagrelor

Question 16

What are the clinical uses of ADP receptor inhibitors?

Answer 16

1. Acute coronary syndrome

2. Coronary stenting

Question 17

What are 2 toxicities of ADP receptor inhibitors?

Answer 17

1. Neutropenia (ticlopidine)

2. TTP/HUS

Question 18

What are two phosphodiesterase III inhibitors used as antiplatelet aggregation agents?

Answer 18

1. Cilostazol

2. Dipyridamole

Question 19

How do cilostazol and dipyridamole twerk?

Answer 19

Inhibit phospodiesterase III → ↑ cAMP in platelets → inhibit platelet aggregation, vasodilation

Question 20

What are the clinical uses for cilostazol and dipyridamole?

Answer 20

1. Intermittent claudication
2. Coronary vasodilation
3. Prevention of stroke or TIAs (combined w/ asprin)
4. Angina prophylaxis

Question 21

Toxicities of cilostazol and dipyridamole?

Answer 21

1. Nausea
2. Headache
3. Facial flushing
4. Hypotension
5. Abdominal pain

Question 22

What are 3 GP IIb/IIIa inhibitors?

Answer 22

1. Abciximab
2. Eptifibatide
3. Tirofiban

Question 23

What is abciximab made from?

Answer 23

monoclonal antibody Fab fragments

Question 24

What are the uses for Gp IIb/IIIa inhibitors?

Answer 24

1. Unstable angina

2. percutaneous transluminal coronary angioplasty

Question 25

Toxicities of Gp IIb/IIIa inhibitors?

Answer 25

1. bleeding

2. thrombocytopenia