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pharmacology final ( 1st sem) > A: 16-19 > Flashcards

A: 16-19 Flashcards

1
Q

3 types of anti-PLT therapy

A

COX inhibitiors: Aspirin
Glycoprotein IIb/IIIa receptor inhibitor: Abciximab
ADP-R antagonists: Clopidogrel, Prasugrel, Ticagrelor

ADP זה כמו שהקלידו סתם במקלדת
כמו גרל
Clap your hand and pres on the tica

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2
Q

What is the result of blocking COX in PLT?

A

Decrease TXA2 –> Decrease stimulatory effect of PLT aggregation

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3
Q

Other name for Aspirin

A

Acetylsalicylic acid

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4
Q

Aspirin dosage amount: Anti-PLT vs. Anti-inflammatory

A

Anti-PLT(anti-thrombotic) requires lower dose than anti-inflammatory dose

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5
Q

Aspirin indications

A

Prevention and treatment of arterial thrombosis
Prevents MI, TIA, Ischemic stroke
Prophylaxis in arrhythmias

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6
Q

Aspirin side effects

A

GI toxicity
Nephrotoxicity Apirinnn=neprho

hypersensitivity rxn due to increased Leukotrienea
Hyperventilation metabolic acidosis A=A
Hyperthermia

Coma (overdose)

HSN
Tinnitus

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7
Q

Glycoprotein IIb/IIIa receptor inhibitor=

A

Abciximab

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8
Q

Abciximab

How to give and what is the molecule?

A

Parenteral

IgG Ab

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9
Q

Abciximab indications

A

Acute coronary syndrome (short period) - eg. unstable angina, MI
Used during PCI to prevent re-stenosis

Post angioplasty to prevent stenosis

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10
Q

Abciximab side effects

A

Bleeding

Thrombocytopenia with prolonged use

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11
Q

ADP-R antagonists

A

Clopidogrel
Prasugrel
Ticagrelor

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12
Q

Clopidogrel
Prasugrel

What are they as molecules?
Do they require activation?

A

Prodrugs
Activated by CYP450
Oral

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13
Q

What can block the activation of Clopidogrel, Prasugrel?

A

Omeprazole

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14
Q

Which ADP-R antagonists does not require activation?

A

Ticagrelor

יש לו שם קצת שונה אז בטח הוא תרופה חדשה

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15
Q

Clopidogrel
Prasugrel
Ticagrelor

Indications

A
  • Acute coronary syndrome
  • prevention of restenosis after PCI
  • prevention and treatment of arterial thrombosis

Post angioplasty to prevent stenosis
Prophylaxis in arrhythmias

  • from book table
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16
Q

Clopidogrel
Prasugrel
Ticagrelor

Side effects

A
  • Bleeding
  • GI disturbances
  • Neutropenia (hematologic abnormality) - clopidogrel less hematotoxic!

-TTP: disseminated formation of small thrombi, PLT consumption and
thrombocytopenia (very rare, by toclopidine)

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17
Q

Heparin inactivates

A
  • complexes with anti-thrombin-3
  • irreversibly inactivates : Thrombin and factor Xa

VII
IX
XI
XII

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18
Q

Heparin drugs

A

Unfractionated Heparin
Low Molecular Weight Heparin: Dalteparin, enoxaparin)
Fondaparinux (fond of the parinux) - similar to LMWH

Dalte is like smaller than alpha

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19
Q

Unfractionated Heparin

What is it
How to give it
How to monitor?

A

Acidic polysaccharide polymer
IV, SC. ( we dont use I.M because can cause hematoma!)
aPTT : activated partial thromboplastin time

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20
Q

Low Molecular Weight Heparin

Name of the drug

A

Dalteparin

enoxaparin

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21
Q

Low Molecular Weight Heparin

How is it different than Unfractionated Heparin?

A

Selective for Xa
Higher bioavailability
Longer duration of action
Renal metabolism

  • note: protamine sulfate reversal in only “partially effective “ with LMWH
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22
Q

Synthestic Heparin=

A

Fondaparinux

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23
Q

Fondaparinux target

A

More selective for Xa

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24
Q

Fondaparinux

How to give?

A

SC

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25
Q

Heparin indicactions

A

Acute and rapid anticoagulation

DIC

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26
Q

Which anticoagulation will we give during pregnancy?

A

LMWH

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27
Q

Heparin side effects

A

Bleeding (monitor with aPTT)
HIT “heparin induced thrombocytopenia”
Osteoporosis (chronic use)

heppaa
לחשוב על בהד 10 ועל הבחורה ששברה את הגב שזה מתקשר לאוסטאופורוסיס

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28
Q

Warfarin is a type of ______ anticoagulants

A

Coumarin

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29
Q

Warfarin MOA

A

Inhibit Vitamin K epoxidase reductase (VKOR)

Prevents post-trans. gamma carboxylation of factors II, VII, IX, X

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30
Q

Vit. K is important for which factors?

A 
II
VII
IX
X
Protein C, S
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31
Q

Complete theraputic effect with Warfarin is achieved after

A

2-3 days

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32
Q

Warfarin drug info

A

Lipid soluble
Oral
Highly bound to plasma proteins (albumin; NSAID can displace it )

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33
Q

Warfarin metabolism

A

CYP450

CYP450 inducers

  • reduce the anticoagulant, increase warfarin clearance
  • barbiturates
  • carbamazepine
  • phenytoin
  • rifampin,

Cytochrome P450 inhibitors (cg,
- amiodarone
-selective serotonin reuptake inhibitors,
- cimetidine
reduce warfarin’ s clearance and increase the anticoagulant

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34
Q

How should we monitor Warfarin use?

A

PT (INR)

35
Q

INR theraputic range using Warfarin

A

2-3

36
Q

Warfarin indications

A

Chronic anticoagulation

37
Q

Warfarin contraindication

A

Pregnancy

38
Q

Warfarin side effects

A
  • Skin vascular necrosis (thrombosis early in therapy due to defiency of Protein C)
  • Bleeding (monitor vitk1 & PT)
  • Teratogenic
  • Drug interactions

note: protein C= endogenous vit-k-dep anticogulant with short T1/2

39
Q

Direct acting Thrombin inhibitors

A

Bivalirudin
Dabigatran

ביווה ודבי חברות ממש טובות ושתיהן יחד מעקבות את טרומבין

40
Q

Bivalirudin
Dabigatran

How are they given?

A

Bivalirudin: Parenteral
Dabigatran: Oral

דבי היא זו שמדברת מלא
ביווה שקטה יותר

41
Q

Which Direct acting Thrombin inhibitors does not require monitoring by PT/PTT?

A

Dabigatran

כי היא מדברת כל כך הרבה ואף אחד לא רוצה להתקרב

42
Q

Bivalirudin indications

A
  • Anticoag. in patients with HIT

- In combination with Aspirin during PCI

43
Q

Dabigatran indications

A
  • prevention of stoke and systemic emboli in A. Fib (chronic therapy as an alternative therapy for Warfarin )
  • prophylaxis of venous thromboemboli (VTE) following hip/knee surgery
  • reduction of risk of recurrent VTE
44
Q

Which drug class are considered to be Noval Oral Anticoagulants?

A

Direct acting factor Xa inhibitors

45
Q

Direct acting factor Xa inhibitors:

A

Rivaroxaban
(apixaban, edoxaban)

לחשוב על הנהר בציור של סקצי
rivaroxxxxaban factor x

46
Q

Rivaroxanban indications

A

Prevention of :

  • venous thromboembolism after knee/hip surgery
  • pulmonary emboli
  • embolic stroke in A. Fib patients
47
Q

tPA drugs

A

Alteplase
Reteplase

אל תתקרב ראה- תה! פלס

48
Q

What is the difference btw. Alteplase and Reteplase?

A

Alteplase: Rebcombinant tPA
Reteplase: Modified Rebcombinant tPA

49
Q

Which has faster and longer duration of action?

Alteplase
Reteplase

A

Reteplase

rete is more rapid

50
Q

Alteplase
Reteplase

Indications

A

Short term management of thrombotic events (MI, PE…)

  • coronary a. thrombosis
  • Ischemic stroke
  • pulmonary embolism
51
Q

Alteplase
Reteplase

Side effects

A

Bleeding

Cerebral hemorrhage

52
Q

Alteplase
Reteplase

What is the drug group?

A

tPA (thrombolytics)

Direct conversion of plasminogen into Plasmin which degrades thrombi

53
Q

Thrombolytic therapy contraindications

A 
Active internal bleeding
Suspected aortic dissection
Recent head trauma
Previous hemorrhagic stroke
Trauma or surgery in the past 2 weeks
Previous ischemic stroke within the last 1 year
54
Q

Fibrin foam=

A

A spongy substance prepared from fibrinogen and thrombin from human blood plasma and

used especially after saturation with thrombin as an absorbable clotting agent in surgical wounds

55
Q

Vit. K indications

A

Vit. K deficiency

Reversal of excessive Warfarin anticlotting activity

56
Q

Who will likely have a Vit. K def.?

A

Patients with fat malabsorption

New borns

57
Q

Vit. K side effects

A

severe Infusion reaction when given IV or IM

**Can also be given orally

58
Q

Antiplasmin drugs

A

Aminocaproic acid ( competitively inhibit plasminogen activation)

tran-examic acid : analogue of aminocaproic a

59
Q

Aminocaproic acid

How to give?

A

Oral

Parenteral

60
Q

Aminocaproic acid indications

A
  • Management of acute beeding in patients with hemophilia or other bleeding disorders
  • Reverse the activity of fibrinolytic agents (excessive fibrinolysis)
61
Q

Aminocaproic acid side effects

A

Thrombosis
Hypotension
Myopathy
Diarrhea

62
Q

Aminocaproic acid

Contraindications

A

DIC

Bleeding of the upper urinary tract

63
Q

Iron drugs I should know for the test

A

Iron-hydroxide-polymaltose Complex

64
Q

Iron-hydroxide-polymaltose Complex

How is it given?

A

Oral

65
Q

Iron deficiency manifests as which anemia?

A

Hypochromic microcytic anemia

66
Q

Acute iron overdose

A 
Shock
Necrotizing gastroenteritis
Abdominal pain
Bloody diarrhea
Lethargy
Dysnea
67
Q

Chronic iron overdose

A

Hemochromatosis (Heart, liver, pancreas damage)

68
Q

Antitode for acute iron poisoning

A

Deferoxamine

69
Q

Vit. B12 preparations (2)

A

Methyl-cobalamin: Natural

Hydroxo-cobalamin: Synthetic

70
Q

Vit. B12 manifests as which anemia?

A

Megaloblastic anemia

71
Q

Which drug is used as Cyanide antidote?

A

Hydroxocobalamin

72
Q

Folic acid is given how?

A

Oral

73
Q

Folic acid indications

A

Folic acid deficiency

Prevention of congenital neural tube defects

74
Q

Erythropoiesis stimulating agent=

A

Epoetin alfa

75
Q

Epoetin alfa indications

A

Anemia of chronic renal disease, AIDS and cancer

Pre-operative

76
Q

Epoetin alfa side effects

A

HTN
Thrombotic complications
RBC aplasia

77
Q

In which case will we give Epoetin alfa?

A

Very severe anemias

78
Q

How and when to give Epoetin alfa?

A

IV or SC

1-3 times/week

79
Q

Myeloid growth factor=

A

Filgastrin

80
Q

Filgastrin MOA

A

Stimulates G-CSF receptors expressed on mature neutrphils and their progenitors

81
Q

G-CSF=

A

Granulocytes Colony Stimulating Factor

82
Q

How is Filgastrim given?

A

SC daily

83
Q

Filgastrin indications

A

Neutropenia assosiated with congenital neutropenia
Cyclic neutropenia
Myelodysplasia
Aplastic anemia
Mobilization of peripheral blood cells in preparation for stem cell transplantation

84
Q

Filgastrin side effects

A

Bone pain

Splenic rupture

pharmacology final ( 1st sem) (15 decks)

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