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Intro to Pharmacology > Blood 3: Drugs acting on the blood and blood elements > Flashcards

Blood 3: Drugs acting on the blood and blood elements Flashcards

1
Q

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

A

coagulation, defense, overactivity

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2
Q

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

A

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

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3
Q

Anti-coagulants ______ coagulation. They include the following:

A

inhibit, Fibrinolysis, antithrombin III (AT)

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4
Q

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

A

enzymatic, clots

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5
Q

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.

A
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6
Q

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

A

plasminogen, fibrinolytic

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7
Q

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

A

acute, strokes, infarction, thrombosis, thromboembolism

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8
Q

Plasmin in _______ blood –> increase in systemic bleeding.

A

peripheral

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9
Q

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

A
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10
Q

Two drugs that are fibrinolytic drugs are:

A

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

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

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11
Q

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

A

size, growth

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12
Q

rt-PA = local (attractive property)

A
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13
Q

Streptokinase is obtained from ?

A

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

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14
Q

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

A

plasminogen, thrombolytic

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15
Q

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

A

plasminogen, activator, plasminogen, plasmin, fibrin

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16
Q

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

A

coronary, cats, emboli, restoration, dogs, thrombosis

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17
Q

Streptokinase can be administered

A

IV

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18
Q

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

A

Systemic, Coagulopathy, hemorrhage, acidosis, bleeding

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19
Q

What can be seen here?

A

Streptokinase

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20
Q

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

A

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

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21
Q

Pros of rt-PA ?

A

less systemic bleeding problems

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22
Q

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

A

limited, known, IV, isolated

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23
Q

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

A

bleeding, antigenic

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24
Q

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

A

excessive, bleeding, hemostasis, decrease

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25
Q

Name two antifibrinolytic drugs used in veterinary medicine:

A

❑ Aminocaproic Acid
❑ Tranexamic Acid

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26
Q

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

A

Synthetic, lysine, decrease, fibrin

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27
Q

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

A

Thrombosis, Neurological, seizures, Tranexamic

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28
Q

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

A

Disk, Large, nucleus, hemoglobin

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29
Q

Site of RBC formation?

A

bone marrow

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30
Q

RBC function

A

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

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31
Q

Anemia is defined as?

A

Deficiency of healthy RED BLOOD CELLs (RBCs)

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32
Q

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

A

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

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33
Q

Causes of Anemia in Dogs include

A

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

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34
Q

Causes of Anemia in Cats include

A

✓ 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

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35
Q

Which canine breeds are at greater risk of developing anemia?

A

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

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36
Q

List the symptoms of anemia in dogs

A

▪ 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

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37
Q

What can be seen in the image below?

A

Pale gums common sign of anemia in dogs

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38
Q

How would you treat a patient with anemia?

A

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

39
Q

What are the types of anemia in animals?

A

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

40
Q

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

A

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

41
Q

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

A

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

42
Q

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

A

deficiency, all, aplasia

43
Q

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)

A
44
Q

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

A

bloodwork, other

45
Q

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

A

4, 4

46
Q

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.

A

lungs, body, CO2, CO2, lungs

47
Q

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

A

dogs, piglets
cats, horses, and ruminants

48
Q

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

A

nutritional, secondary

49
Q

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

A

hemoglobins

50
Q

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

A

O2

51
Q
A
52
Q

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

A
53
Q

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

A

Oxbryta

54
Q

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

A

cobalamin, heme, functional

55
Q

Vitamin B12 can be found in ?

A

red meat, dairy, eggs (not in plants

56
Q

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

A

stomach

57
Q

Vitamin B12 deficiency results in?

A

Deficiency results in low RBCs

58
Q

Vitamin B12 deficiency causes a?

A

Deficiency causes a wide range of hematological and neurological symptoms

59
Q

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

A

iron deficiency anemia in animals

60
Q

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?

A

immune, own, hemolysis, immunosuppressants

61
Q

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

A

dogs, morbidity, mortality

62
Q

What is the most common autoimmune disease in what species?

A

IMHA is the most common autoimmune disease in dogs

63
Q

IMHA is associated with ?

A

Mortality

64
Q

FYI

A
65
Q

Describe the management of IMHA:

A

❑ 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

66
Q

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

A

immunosuppressant, purines, DNA/RNA, nucleic

67
Q

Azathioprine is used to treat what clinical diseases?

A

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

68
Q

Azathioprine can be administered?

A

Administration: oral or IV

69
Q

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

A

faster, bone marrow

70
Q

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

A

not

71
Q

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

A

suppression, leukopenia, thrombocytopenia, CI, Liver, dogs

72
Q

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

A

immunosuppressant, B, T

73
Q

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

A
74
Q

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

A

suppression, infections, urinary bladder

75
Q

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

A

bladder

76
Q

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

A

T, 2, T, specific, myelosuppression, nonspecific

77
Q

Cyclosporine is used to treat which diseases?

A

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

78
Q

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

A
79
Q

Cyclosporine
Adverse effects:
▪ Transient ___ effects
▪ Some ______

A

GI, infections

80
Q

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

A

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

81
Q

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

A

erythropoiesis, same, erythropoietin

82
Q

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

A

chemotherapy, chronic, renal

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

83
Q

Action of Endogenous Erythropoietin (know this)

A

Image = FYI

84
Q

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

A

blood, pluripotent, stem, RBCs, Platelets, Immune

85
Q

Non-Regenerative Anemia aka

A

“Anemia of Chronic Disease”

86
Q

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 _____

A

reticulocyte, kidney, geriatric, anemia

87
Q

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

A

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

88
Q

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

A

plasma, low

89
Q

Hypovolemia is caused by?

A

Caused by : Excessive bleeding
Severe dehydration
Bad burns

90
Q

Symptoms of Hypovolemia include?

A

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

91
Q

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

A
92
Q

Add review slides

A
93
Q

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

A

Intro to Pharmacology (31 decks)

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