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Block 3 - Fundamentals and Heme > Anemia Drugs and Anticoagulants > Flashcards

Anemia Drugs and Anticoagulants Flashcards

0
Q

Iron preparations - pharmacokinetics

A

Ferrous salts absorbed more rapidly than ferric
Parenteral administered IV if stores needed rapidly
Total IV dose of 1200-2000 mg usually needed

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1
Q

Iron preparations - mechanism

A

Oral prep are ferrous salts converted to ferric iron in body
Parenteral preps have ferric iron complexed with carbohydrates

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2
Q

Iron preparations - adverse side effects

A

Oral - heartburn, nausea, upper gastric discomfort, constipation, diarrhea
Oral-polysaccharide have fewer
Large amounts ferrous iron salts toxic - deferoxamine is chelator of choice for iron poisoning
Parenteral can cause allergic rxns

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3
Q

What can cause vitamin b12 deficiency (pernicious anemia)?

A

Absence of intrinsic factor secreted by parietal cells that helps absorb it
Dietary deficiency rare unless vegan

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4
Q

Cyanocobalamin and hydroxocobalamin - mechanism

A

Stable forms of b12 converted to active form in body
B12 enters cells, accepts methyl group from methyltetrahydrofolic acid to form tetrahydrofolic acid which participates in DNA synthesis

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5
Q

Cyanocobalamin and hydroxocobalamin - pharmacokinetics

A

Cobalamin - IM once a month
Hydroxocobalamin - IM once every 1-3 months
Intranasal preps for maintenance
Stored as b12 in the liver - enterohepatic cycle ensures constant availability to tissues

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6
Q

Cobalamin and hydroxocobalamin - adverse effects

A

Not toxic unless IV - then can cause anaphylaxis

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7
Q

Cobalamin and hydroxocobalamin - therapeutic uses

A

Oral admin ineffective since malabsorption is usually problem for deficiency in the first place

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8
Q

Folic acid - mechanism

A

Converted to methyltetrahydrofolic acid in GI tract and absorbed into blood then converted to tetrahydrofolic acid by vitamin b12 dependent mechanism

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9
Q

Folic acid - pharmacokinetics

A

Oral preferred but can be given parenterally in malabsorption syndromes
Stored mainly in liver
Enterohepatic circulation ensures small quantities constantly available to tissues

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10
Q

Folic acid - adverse effects

A

Not toxic
Therapy can mask b12 deficiency causing neurological damage which can then get worse - if unsure give both folic acid and hydroxocobalamin parenterally

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11
Q

Folic acid - therapeutic uses

A

Should be given prophylactically in pregnancy to prevent anemia
Decreases incidence of spinal cord malformations

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12
Q

Erythropoietins - pharmacokinetics

A

Epoetin alfa - Admin sc 1-3 times a week
Darbepoetin Alfa - admin sc every 1-3 weeks
CERA - admin sc once a month
Doses given to achieve hb of 10-12
Supplementary treatment with IV iron to support erythropoiesis

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13
Q

Erythropoietins - adverse reactions

A

Hypertension due to rapid rise in hematocrit
Elevated hb above 12 has risk of thromboembolic events
Can accelerate tumor growth and relapse in cancers

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14
Q

Eythropoietins - therapeutic uses

A

Anemias caused by renal failure or marrow depression
Anemia of prematurity
Admin before and after cardiac or orthopedic surgery to reduce need for transfusion
Darbopoietin and CERA have been misused by athletes

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15
Q

Aspirin - mechanism

A

Irreversibly inhibits COX blocking synthesis of thromboxane A2
PGI2 production less sensitive because endothelial cells have nuclei and can regenerate COX

16
Q

Aspirin - pharmacokinetics

A 
Maximal antithrombotic effect at 80-325 mg/day
Rapid action (2 hrs)
17
Q

Aspirin - adverse effects

A

Hemorrhage
Single dose doubles bleeding time for 4-7 days
Salicylate intoxication

18
Q

Aspirin - therapeutic uses

A

Several settings relevant to cardiovascular disease

More important in heart because platelets are more important in arterial thrombosis than venous

19
Q

Clopidogrel - mechanism

A

Inhibits ADP receptors which prevents activation of major platelet integrin
Reduces fibrinogen and vWF binding, platelet activation, and clot retraction in response to ADP

20
Q

Clopidogrel - pharmacokinetics

A

Prodrugs converted to metabolites that irreversibly binds receptor
Slow onset of action and prolonged action after discontinuation
Oral admin

21
Q

Clopidogrel - adverse effects

A

Rashes
Diarrhea
Neutropenia
Bleeding

22
Q

Clopidogrel - therapeutic uses

A

Helpful with acute coronary syndrome

Given with aspirin

23
Q

Heparin and LMWH - mechanism

A

Heparin Interacts with antithrombin III and increases ability to neutralize coagulation factors (esp factor Xa and thrombin)
No effect on non active precursors
LMWH - bind to antithrombin III and inactivate Xa but little effect on thrombin

24
Q

Heparin and LMWH - pharmacokinetics

A

Not absorbed from GI tract
Heparin - IV or SC
LMWH - SC and less often

25
Q

Heparin and LMWH - adverse effects

A

Hemorrhage
Bleeding can be reversed by protamine sulfate
Don’t give with a platelet inhibitor drug
Thrombocytopenia

26
Q

Heparin - therapeutic uses

A

Treat venous thrombosis and PE
Initial management of patients with heart problems and during bypass surgery
Anti coagulation during pregnancy - doesn’t cross placenta

27
Q

LMWH - therapeutic uses

A

Prevention and treatment of venous thromboembolism in hip replacement patients
Treatment of PE and deep venous thrombosis
Anticoagulant ion during pregnancy - doesn’t cross placenta

28
Q

Warfarin - mechanism

A

Vitamin k antagonist

29
Q

Warfarin - pharmacokinetics

A

Oral admin
48 hrs to achieve full effect because activated factors have to be depleted
Long duration of action

30
Q

Warfarin - adverse effects

A

Lots of drug drug interactions
Hemorrhage - reversed by admin of vitamin k or FFP
P450 metabolizes - there is polymorphism so some people more sensitive
Birth defects or abortion

31
Q

Warfarin - therapeutic uses

A

Prevention of venous thrombosis and PE after trauma, surgery or disease - heparin initial treatment but overlapped with warfarin for longer term protection
Treat thrombosis
Stop blood from coagulating in artificial surfaces

32
Q

TPA - mechanism

A

Stimulates plasminogen to plasmin which dissolves fibrin clot
More effective on newer clots - start therapy early

33
Q

TPA - pharmacokinetics

A

Protein not absorbed from GI tract

Infused or injected IV

34
Q

TPA - adverse effects

A

Bleeding

Restricted use to life threatening situations

35
Q

TPA - therapeutic uses

A

Treating acute MI
treating acute ischemic stroke
Treating massive PE
Treating severe acute arterial thromboses
Local instillation into occluded arteriovenous cannulae in patients on dialysis

Block 3 - Fundamentals and Heme (8 decks)

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