Blood 3: Drugs acting on the blood and blood elements

Question 1

Fibrinolysis represents the physiological converse of the ___________ process. It serves as a _______ mechanism against _______ of the coagulation mechanism

Answer 1

coagulation, defense, overactivity

Question 2

Pro-coagulants factors _______ coagulation. They include the following:

Answer 2

promote, XIIa; XIa; Xa, IXa and thrombin (IIa)

Question 3

Anti-coagulants ______ coagulation. They include the following:

Answer 3

inhibit, Fibrinolysis, antithrombin III (AT)

Question 4

Fibrinolysis is the ________ breakdown of the fibrin in blood _____.

Answer 4

enzymatic, clots

Question 5

When plasminogen is activated by local agents, such as tissue plasminogen activator, factors 11a and 12 a oplay a role in plasminogen becoming plasmin. Activated palsmin cuts polymerzied fibrin into fibrno degradation products.

Question 6

Pharmacological acceleration of fibrinolysis involves these drugs that enhance the conversion of ________ to the active _______ plasmin

Answer 6

plasminogen, fibrinolytic

Question 7

Fibrinolytic drugs are used as a form of emergency treatment in people for ______ ischemic ______, myocardial ________, deep vein ________, and pulmonary _________.

Answer 7

acute, strokes, infarction, thrombosis, thromboembolism

Question 8

Plasmin in _______ blood –> increase in systemic bleeding.

Answer 8

peripheral

Question 9

The use of Fibrinolytic drugs is not very successful in animals:
Used in these cases though:
▪ Feline arterial thromboembolism
▪ Canine pulmonary thromboembolism

Question 10

Two drugs that are fibrinolytic drugs are:

Answer 10

❑ Streptokinase
❑ Recombinant tissue plasminogen activator (rt-PA)

rt-PA binds to fibirn in clots ad converts local fibrinogen into fibrin?

Question 11

Fibrinolytic drugs actively reduce the ____ of a clot, as opposed to heparins, which inhibit the _____ of a clot

Answer 11

size, growth

Question 12

rt-PA = local (attractive property)

Question 13

Streptokinase is obtained from ?

Answer 13

β-hemolytic streptococci. often carried in intestines or lower intestinal tract. Generally unharmful in healthy adults.

Question 14

Streptokinase is classified as:
Classification:
Pharmacologic = _________ activator
Therapeutic = _________ medication and enzyme

Answer 14

plasminogen, thrombolytic

Question 15

Streptokinase MOA
Combines with ____________ to form ___________ complexes, then converts __________ to _________, which is then able to degrade clot-bound ___.

Answer 15

plasminogen, activator, plasminogen, plasmin, fibrin

Question 16

Streptokinase Therapeutic effects:
▪ Lysis of thrombi in ______ arteries (heart attack)(_____)
▪ Lysis of pulmonary ____ and subsequent _____ of blood flow (____)
▪ Deep venous ______ in dog

Answer 16

coronary, cats, emboli, restoration, dogs, thrombosis

Question 17

Streptokinase can be administered

Answer 17

IV

Question 18

The adverse effects of Streptokinase include:
▪ __________ fibrinolysis
▪ ________________
▪ Serious __________
▪Metabolic _______, ________ and other complications may lead to death.

Answer 18

Systemic, Coagulopathy, hemorrhage, acidosis, bleeding

Question 19

What can be seen here?

Answer 19

Streptokinase

Question 20

Recombinant tissue plasminogen activator (rt-PA)
Is a _______ chain polypeptide ____ _____ with a higher ______ for fibrin within _____ and low affinity for ______ plasminogen (______ fibrinolysis)

Answer 20

single, serine, protease, specificity, thrombi, circulating, local

Question 21

Pros of rt-PA ?

Answer 21

less systemic bleeding problems

Question 22

rt-PA
Experience in animals is ________ and the optimal dosage is not ____
Cats: high mortality rate with ___ administration
Dogs: ______ cases

Answer 22

limited, known, IV, isolated

Question 23

rt-PA
Adverse effects:
▪ Serious ______
▪ Potentially ______ in animals because it is a human protein

Answer 23

bleeding, antigenic

Question 24

Excessive fibrinolysis can lead to _________ ______ disorders. Antifibrinolytic drugs are used to promote ________ and ______ the need for RBC transfusion

Answer 24

excessive, bleeding, hemostasis, decrease

Question 25

Name two antifibrinolytic drugs used in veterinary medicine:

Answer 25

❑ Aminocaproic Acid ❑ Tranexamic Acid

Question 26

Both Aminocaproic Acid and Tranexamic Acid are _______ _____ compounds that ________ fibrinolysis by binding to ____.

Answer 26

Synthetic, lysine, decrease, fibrin

Question 27

What are the adverse effects of Antifibrinolytic drugs? ▪ __________ formation ▪ _____________ events (_________) in humans (___________ acid)

Answer 27

Thrombosis, Neurological, seizures, Tranexamic

Question 28

Red Blood Cells (RBCs) or Erythrocytes --> Structure: 1. _____-shaped 2. _____ surface area 3. Has no ______ 4. Contains ______ which carries oxygen

Answer 28

Disk, Large, nucleus, hemoglobin

Question 29

Site of RBC formation?

Answer 29

bone marrow

Question 30

RBC function

Answer 30

Function: ▪ Transport O2 from the lungs to the body and carbon dioxide from the body back to the lungs

Question 31

Anemia is defined as?

Answer 31

Deficiency of healthy RED BLOOD CELLs (RBCs)

Question 32

Causes of Anemia: ▪ Lack of production of _________ or ____ (______ _________ depression) ▪ Increased RBCs __________ (organs?) ▪ ________ deficiency (Examples?) ▪ ________ bleeding

Answer 32

hemoglobin, RBCs, bone marrow, destruction, spleen, liver, kidney, Nutrient, iron, folic acid, vitamin B12, Excessive

Question 33

Causes of Anemia in Dogs include

Answer 33

Causes of Anemia in Dogs: ✓ Cushing’s disease ✓ Chronic diseases suppressing RBC production *✓ Infectious diseases (canine distemper) *✓ Intestinal bleeding ✓ Medications that interfere with the production of RBC ✓ Poisons or toxins *✓ Cancer ✓ Tick-borne diseases ***✓ Poor nutrition ✓ Hypothyroidism *✓ Bone marrow disease *✓ Kidney disease ✓ Blood loss cause by parasites

Question 34

Causes of Anemia in Cats include

Answer 34

✓ Infection with a virus (more prevalent in cats than in dogs): Feline leukemia virus (FeLV) Feline immunodeficiency virus (FIV) Parasite (Mycoplasma hemophilus) ✓ Blood loss from severe flea infestations (especially in kittens) ✓ Immune-mediated disease

Question 35

Which canine breeds are at greater risk of developing anemia?

Answer 35

▪ Labrador Retrievers ▪ American Cocker Spaniels ▪ Miniature Schnauzers ▪ Shih Tzus

Question 36

List the symptoms of anemia in dogs

Answer 36

▪ Pale gums, eyes or ears ▪ Weakness or lethargy ▪ Black stools ▪ Fast pulse and rapid breathing ▪ Swelling of jaw or face ▪ Vomiting ▪ Loss of appetite ▪ Weight loss

Question 37

What can be seen in the image below?

Answer 37

Pale gums common sign of anemia in dogs

Question 38

How would you treat a patient with anemia?

Answer 38

▪ Intravenous fluids ▪ Deworming ▪ Parasite medications ▪ Gastrointestinal medication ▪ Chemotherapy ▪ Surgery ▪ Change in existing medications ▪ Antibiotics ▪ Immunosuppressive drugs ▪ Blood transfusion ▪ Bone marrow transfusion ▪ Potassium phosphate supplements

Question 39

What are the types of anemia in animals?

Answer 39

❑ Regenerative & Immune Mediated ❑ Non-regenerative (Aplastic Anemia)

Question 40

Regenerative Anemia: bone marrow is producing RBC ________ but other reasons that lead to blood loss include ▪ _______ disorder ▪ ________ ▪ ________ or __________ ▪ _______ bleeding: (3)

Answer 40

normally, Bleeding, Accident, Injury, surgery, Internal, parasites, ulcers, cancer

Question 41

Immune-Mediated Hemolytic Anemia: ______ produced but the RBCs are ________ _______ or ___________ of RBCs due to: ▪ _____ disease (_____ cell disease) ▪ __________ ▪ Conditions caused by ?

Answer 41

normally, broken down, destruction, Genetic, sickle, Autoimmunity, toxins, parasites, low phosphorus levels

Question 42

Non-regenerative or Aplastic Anemia: ___________ of production of ____ blood cells. If only RBCs it is called RBC ________.

Answer 42

deficiency, all, aplasia

Question 43

Non-regenerative or Aplastic Anemia can be caused by: ▪ Chronic diseases ▪ Bone marrow disease **▪ Kidney disease (a hormone produced by kidneys, called erythropoietin, is responsible for stimulating RBC production in bone marrow) ▪ Cancer (leukemia) ▪ Exposure to toxins ▪ Parvovirus ▪ Chemotherapeutic drugs and other medications ▪ Nutritional deficiencies ( iron, several Vit B, Vit E, copper, phosphorus)

Question 44

As with other anemias, __________ to determine underlying cause, as well as ruling out _______ health issues can determine if a chronic illness is to blame.

Answer 44

bloodwork, other

Question 45

Hemoglobin (Hb A) is a red-pigment protein in RBCs that contains ____ heme parts with iron (Fe++) ions and can carry ___ molecules of O2

Answer 45

4, 4

Question 46

Main function of Iron: to carry O2 from _____ to the _____ tissues, and to exchange the O2 for ____, and then carry the ___ back to the ____ where it is exchanged for O2.

Answer 46

lungs, body, CO2, CO2, lungs

Question 47

Iron deficiency caused anemia Most common in: ? Less common in: ?

Answer 47

dogs, piglets cats, horses, and ruminants

Question 48

Iron deficiency caused anemia is rarely _________, it most commonly occurs _______ to chronic blood loss

Answer 48

nutritional, secondary

Question 49

Sickle Cell Anemia is a hereditary genetic disorder that results in the production of abnormal _______.

Answer 49

hemoglobins

Question 50

In dogs, sickle cell anemia results in a deformity of the RBC --> causes restriction in ____-carrying capacity

Answer 50

O2

Question 51

Answer 51

Question 52

DONT HAVE TO KNOW? Sickle Cell Anemia is a result of: Point mutation (Val to Glu) in the Hemoglobin beta gene (located on chromosome 11) resulting in abnormal version of β-subunit

Question 53

No data on animals yet, but there is a drug called __________ inhibits HbS polymerazition and subsequent RBC sickling to reduce hemolysis and improve anemia

Answer 53

Oxbryta

Question 54

Vitamin B12 (_________) helps create the ____ portion of hemoglobin resulting in _____ RBCs

Answer 54

cobalamin, heme, functional

Question 55

Vitamin B12 can be found in ?

Answer 55

red meat, dairy, eggs (not in plants

Question 56

Vitamin B12 Interacts with factor produced in the ______ and necessary for the absorption of B12

Answer 56

stomach

Question 57

Vitamin B12 deficiency results in?

Answer 57

Deficiency results in low RBCs

Question 58

Vitamin B12 deficiency causes a?

Answer 58

Deficiency causes a wide range of hematological and neurological symptoms

Question 59

FERDEX B12: dextranic iron injectable solution for the prevention and treatment of ?

Answer 59

iron deficiency anemia in animals

Question 60

AutoImmune Hemolytic Anemia (AIHA) is an _______ system disease, in which the body attacks and destroys its ____ RBCs (______). What drugs can be used here to mitigate disease?

Answer 60

immune, own, hemolysis, immunosuppressants

Question 61

Immune-Mediated Hemolytic Anemia (IMHA) causes severe anemia in ____ and is associated with considerable ______ and ______

Answer 61

dogs, morbidity, mortality

Question 62

What is the most common autoimmune disease in what species?

Answer 62

IMHA is the most common autoimmune disease in dogs

Question 63

IMHA is associated with ?

Answer 63

Mortality

Question 64

FYI

Question 65

Describe the management of IMHA:

Answer 65

❑ Controlling the immune response: 1. Azathioprine (Imuran ): immunosuppressant (inhibits DNA and RNA synthesis) 2. Cyclophosphamide: anticancer drug, potent immunosuppressant (cytotoxic effects on B-cells and T-cells) 3. Cyclosporine: potent immunosuppressant (effects on T-cells, cytokines) *Pay attention to MOA of this drug per Dr. L* 4. Corticosteroids (prednisone): anti-inflammatory and immunosuppressive effects (used in combination with other drugs) *These drugs can be used in combination* ❑ Blood transfusions in severe cases ❑ Supportive care : IV fluids and medications ❑ Supplementation with glycoprotein erythropoietin to stimulate RBC production

Question 66

Azathioprine is an _________, decreases metabolism of __________, may inhibit ____/_____ synthesis, causes _______ acid malfunction

Answer 66

immunosuppressant, purines, DNA/RNA, nucleic

Question 67

Azathioprine is used to treat what clinical diseases?

Answer 67

Uses: Immune-mediated hemolytic anemia (IMHA) Immune-mediated thrombocytopenia (IMT)

Question 68

Azathioprine can be administered?

Answer 68

Administration: oral or IV

Question 69

Azathioprine Therapeutic effects in animals are __________ (3-5 weeks) vs in humans (~ 8 months) Animals should have their _______ __________ functions monitored

Answer 69

faster, bone marrow

Question 70

Azathioprine is ______ approved by the FDA but can be prescribed by a licensed DVM

Answer 70

not

Question 71

Azathioprine Adverse effects: ▪ Bone marrow __________ leading to __________ and _________ ▪ Transient __ toxicity (diarrhea, nausea) ▪ _____ toxicity ▪ Acute pancreatitis in ___ (?)

Answer 71

suppression, leukopenia, thrombocytopenia, CI, Liver, dogs

Question 72

Cyclophosphamide is a potent ________________ (cytotoxic effects on __-cells and also ___-cells) (anti-neoplastic drug with DNA damage ability)

Answer 72

immunosuppressant, B, T

Question 73

Cyclophosphamide Tablets: 25 and 50 mg for every-other-day regimen with corticosteroid on the alternate days

Question 74

Cyclophosphamide Toxic effects in dogs: a) bone marrow _______ leading to ______ **** (she said she is going to test on this***) b) _______ _______ mucosa (sterile hemorrhagic cystitis)

Answer 74

suppression, infections, urinary bladder

Question 75

Cyclophosphamide Toxic effects in cats: more resistant to the toxic effects on the _______.

Answer 75

bladder

Question 76

Cyclosporine: potent immunosuppressant: ▪ inhibits ___-cell receptor-activated signal transduction pathway ▪ Suppresses IL-___ and other cytokines ▪ Blocks proliferation of activated ___-lymphocytes activation ▪ Less ____ to B-cells ---- less ________ or ______ reactions

Answer 76

T, 2, T, specific, myelosuppression, nonspecific

Question 77

Cyclosporine is used to treat which diseases?

Answer 77

Immune-Mediated Hemolytic Anemia (IMHA) Immune-Mediated Thrombocytopenia (IMT)

Question 78

Cyclosporine dose adjustment and monitoring (PK & PD) is very important

Question 79

Cyclosporine Adverse effects: ▪ Transient ___ effects ▪ Some ______

Answer 79

GI, infections

Question 80

Hematopoietic Growth Agents can be very useful in treating anemia. Erythropoietic-Stimulating Agents (ESAs) used in Vet med include:

Answer 80

❖ Epoetin alfa (Procrit R; Epogen R) ❖ Darbepoetin (Aranesp R)

Question 81

Hematopoietic Growth agents MOA MOA: stimulate ___________ via _____ mechanism as endogenous _________

Answer 81

erythropoiesis, same, erythropoietin

Question 82

Hematopoietic Growth Agents Uses: a) ____________-induced anemia b) anemia due to ______ _____ disease

Answer 82

chemotherapy, chronic, renal ❖ Epoetin alfa (Procrit R; Epogen R) **Pay attention**❖ Darbepoetin (Aranesp R)

Question 83

Action of Endogenous Erythropoietin (know this)

Answer 83

Image = FYI

Question 84

Hematopoiesis: process of ______ cell formation Bone marrow: cells originate from one ______ ___ cell -progenitor Myeloid lineage: ______, ________ Lymphoid lineage: _____ cells

Answer 84

blood, pluripotent, stem, RBCs, Platelets, Immune

Question 85

Non-Regenerative Anemia aka

Answer 85

“Anemia of Chronic Disease”

Question 86

In cats: 1. non-regenerative anemia with low ________ count 2. chronic _____ disease is a very common in cats (~30% of _____ cats) 30-65% of affected cats will develop some degree of _____

Answer 86

reticulocyte, kidney, geriatric, anemia

Question 87

In cases of Non-regenerative anemia, Kidneys release less __________ leading to lowered ____ production by the bone marrow. To treat this, can prescribe: ___________ (Aranesp) - ______ injections - Close monitoring for _______ _____ --> Result: resolution of anemia in ___-____ % of cats with chronic kidney disease

Answer 87

erythropoietin, RBC, Darbepoetin, Weekly, side effects, 60, 65

Question 88

Hypovolemia is a condition in which the volume of blood ______ is too ____.

Answer 88

plasma, low

Question 89

Hypovolemia is caused by?

Answer 89

Caused by : Excessive bleeding Severe dehydration Bad burns

Question 90

Symptoms of Hypovolemia include?

Answer 90

▪ Rapid heartbeat ▪ Weak pulse ▪ Confusion and loss of consciousness ▪ Increased respiratory rate ▪ Hypovolemic shock

Question 91

SHE IS NOT ASKING QUESTIONS ON HYPOVOLEMIA 1. Determine primary cause (blood work, x-rays, coagulation tests) 2. Replacement fluid therapy by IV (electrolyte, glucose) 3. Nutritional support (rich in iron, vitamin B12, increased intake of fluids) 4. Blood plasma transfusion 5. Oxygen delivery 6. Intravenous, reversible agents such as butorphanol or fentanyl and benzodiazepines have limited adverse cardiovascular effects in the painful, hypovolemic animal. Their actions are also easily reversed with intravenous antidotes

Question 92

Add review slides

Question 93

Pay attention to preferential and selective for COX 1 and 2 Dual inhibitors --> pay attention Prostaglandins Endogenous and exogenous immuno Purine and promidine? Questions related to this Know where drugs target in bottom mechanisms UFH and LMWH and differences between them and what factors they inhibit Anticoags and the factors they act on Receptors in platele processes