A: 16-19 Flashcards by shir nov

3 types of anti-PLT therapy

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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What is the result of blocking COX in PLT?

Decrease TXA2 –> Decrease stimulatory effect of PLT aggregation

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Other name for Aspirin

Acetylsalicylic acid

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

Anti-PLT requires lower dose

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Aspirin indications

Prevention and treatment of arterial thrombosis
Prevents MI
Prophylaxis in arrhythmias

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Aspirin side effects

GI toxicity
Nephrotoxicity Apirinnn=neprho
HSN
Tinnitus
Hyperventilation metabolic acidosis A=A
Hyperthermia
Coma

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Glycoprotein IIb/IIIa receptor inhibitor=

Abciximab

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Abciximab

How to give and what is the molecule?

Parenteral

IgG Ab

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Abciximab indications

Acute coronary syndrome

Post angioplasty to prevent stenosis

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Abciximab side effects

Bleeding

Thrombocytopenia with prolonged use

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ADP-R antagonists

Clopidogrel
Prasugrel
Ticagrelor

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Clopidogrel
Prasugrel

What are they as molecules?
Do they require activation?

Prodrugs
Activated by CYP450
Oral

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What can block the activation of Clopidogrel, Prasugrel?

Omeprazole

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Which ADP-R antagonists does not require activation?

Ticagrelor

יש לו שם קצת שונה אז בטח הוא תרופה חדשה

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Clopidogrel
Prasugrel
Ticagrelor

Indications

Acute coronary syndrome
Post angioplasty to prevent stenosis
Prophylaxis in arrhythmias

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Clopidogrel
Prasugrel
Ticagrelor

Side effects

Bleeding
Neutropenia
TTP

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Heparin inactivates

Thrombin and factor Xa
VII
IX
XI
XII

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Heparin drugs

Unfractionated Heparin
Low Molecular Weight Heparin: Dalteparin
Fondaparinux (fond of the parinux)

Dalte is like smaller than alpha

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Unfractionated Heparin

What is it
How to give it
How to monitor?

Acidic polysaccharide polymer
IV, SC
aPTT

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Low Molecular Weight Heparin

Name of the drug

Dalteparin

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Low Molecular Weight Heparin

How is it different than Unfractionated Heparin?

Selective for Xa
Higher bioavailability
Longer duration of action
Renal metabolism

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Synthestic Heparin=

Fondaparinux

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Fondaparinux target

More selective for Xa

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Fondaparinux

How to give?

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Heparin indicactions

Acute and rapid anticoagulation | DIC

Which anticoagulation will we give during pregnancy?

LMWH

Heparin side effects

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

Warfarin is a type of ______ anticoagulants

Coumarin

Warfarin MOA

Inhibit Vitamin K epoxidase reductase (VKOR) | Prevents post-trans. gamma carboxylation of factors II, VII, IX, X

Vit. K is important for which factors?

``` II VII IX X Protein C, S ```

Complete theraputic effect with Warfarin is achieved after

2-3 days

Warfarin drug info

Lipid soluble Oral Highly bound to plasma proteins

Warfarin metabolism

CYP450

How should we monitor Warfarin use?

PT (INR)

INR theraputic range using Warfarin

2-3

Warfarin indications

Chronic anticoagulation

Warfarin contraindication

Pregnancy

Warfarin side effects

Warfarin skin necrosis Bleeding Teratogenic Drug interactions

Direct acting Thrombin inhibitors

Bivalirudin Dabigatran ביווה ודבי חברות ממש טובות ושתיהן יחד מעקבות את טרומבין

Bivalirudin Dabigatran How are they given?

Bivalirudin: Parenteral Dabigatran: Oral דבי היא זו שמדברת מלא ביווה שקטה יותר

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

Dabigatran כי היא מדברת כל כך הרבה ואף אחד לא רוצה להתקרב

Bivalirudin indications

Anticoag. in patients with HIT | In combination with Aspirin during percutaneous coronary intervention

Dabigatran indications

A. Fib chronic therapy as an alternative therapy for Warfarin

Which drug class are considered to be Noval Oral Anticoagulants?

Direct acting factor Xa inhibitors

Direct acting factor Xa inhibitors:

Rivaroxaban (Dabigatran) לחשוב על הנהר בציור של סקצי rivaroxxxxaban factor x

Rivaroxanban indications

Prevention of venous thromboembolism after knee/hip surgery | Prevention of embolic stroke in A. Fib patients

tPA drugs

Alteplase Reteplase אל תתקרב ראה- תה! פלס

What is the difference btw. Alteplase and Reteplase?

Alteplase: Rebcombinant tPA Reteplase: Modified Rebcombinant tPA

Which has faster and longer duration of action? Alteplase Reteplase

Reteplase rete is more rapid

Alteplase Reteplase Indications

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

Alteplase Reteplase Side effects

Bleeding | Cerebral hemorrhage

Alteplase Reteplase What is the drug group?

tPA Direct conversion of plasminogen into Plasmin

Thrombolytic therapy contraindications

``` 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 ```

Fibrin foam=

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

Vit. K indications

Vit. K deficiency | Reversal of excessive Warfarin anticlotting activity

Who will likely have a Vit. K def.?

Patients with fat malabsorption | New borns

Vit. K side effects

Infusion reaction when given IV or IM **Can also be given orally

Antiplasmin drugs

Aminocaproic acid

Aminocaproic acid How to give?

Oral | Parenteral

Aminocaproic acid indications

Management of acute beeding in patients with hemophilia or other bleeding disorders Reverse the activity od fibrinolytic agents

Aminocaproic acid side effects

Thrombosis Hypotension Myopathy Diarrhea

Aminocaproic acid Contraindications

DIC | Bleeding of the upper urinary tract

Iron drugs I should know for the test

Iron-hydroxide-polymaltose Complex

Iron-hydroxide-polymaltose Complex How is it given?

Oral

Iron deficiency manifests as which anemia?

Hypochromic microcytic anemia

Acute iron overdose

``` Shock Necrotizing gastroenteritis Abdominal pain Bloody diarrhea Lethargy Dysnea ```

Chronic iron overdose

Hemochromatosis (Heart, live, pancreas damage)

Antitode for acute iron poisoning

Deferoxamine

Vit. B12 preparations (2)

Methyl-cobalamin: Natural | Hydroxo-cobalamin: Synthetic

Vit. B12 manifests as which anemia?

Megaloblastic anemia

Which drug is used as Cyanide antidote?

Hydroxocobalamin

Folic acid is given how?

Oral

Folic acid indications

Folic acid deficiency | Prevention of congenital neural tube defects

Erythropoiesis stimulating agent=

Epoetin alfa

Epoetin alfa indications

Anemia of chronic renal disease, AIDS and cancer | Pre-operative

Epoetin alfa side effects

HTN Thrombotic complications RBC aplasia

In which case will we give Epoetin alfa?

Very severe anemias

How and when to give Epoetin alfa?

IV or SC | 1-3 times/week

Myeloid growth factor=

Filgastrin

Filgastrin MOA

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

G-CSF=

Granulocytes Colony Stimulating Factor

How is Filgastrin given?

Filgastrin indications

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

Filgastrin side effects

Bone pain | Splenic rupture