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Top 100 Drugs > Blood > Flashcards

Blood Flashcards

1
Q

list three antiplatelet (ADP receptor) drugs

A

clopidogrel

ticagrelor

prasugrel

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2
Q

clopidogrel, ticagrelor and prasugrel belong to which drug class?

A

Antiplatelets (ADP-receptor agonists)

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3
Q

list three indicatiosn for prescription of antiplatelet drugs?

A
  1. treatment of ACS
  2. prevention of coronary artery stent occlusion
  3. long-term secondary prevention of thrombotic arterial events in pts w cardiovascular, cerebrovascular and peripheral arterial disease
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4
Q

antiplatelet drugs are commonly prescribed with which other drug?

A

aspirin

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5
Q

MOA of antiplatelets?

A

prevent platelet aggregation by binding to ADP receptors (P2Y12 subtype) on platelet surface.

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6
Q

The MOA of antiplatelets is synergistic/additive with that of aspirin?

A

synergistic: ADP binding process is independant of the COX pathway

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7
Q

what is the most common adverse effect of antiplatelets?

A

Bleeding

GI upset (common)

Thrombocytpenia (very rare)

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8
Q

list contraindications to prescribing antiplatelets

A

pts with active bleeding

elective surgeries (should be stopped 7 days prior)

renal and hepatic impairment should be used with caution

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9
Q

clopidogrel is a pro-drug which requires metabolism by which hepatic enzyme?

A

cytochrome P450 (CYP enzymes)

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10
Q

which class of drug may inhibit the efficacy of clopidogrel?

A

CYP inhibitors i.e. omeprazole, ciprofloxacin, erythromycin

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11
Q

are ticagrelor and prusagrel also pro-drugs?

A

prasugrel yes- less suceptible to interactions

ticagrelor no- but interacts with CYP inhibitors possibly inc risk of toxicity

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12
Q

available preparation of clopidogrel?

A

only oral preparaption

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13
Q

low doses of clopidogrel require how long to reach their full anitplatelet effect?

A

up to a week

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14
Q

if rapid effect required what loading dose of clopidogrel should be prescribed?

this is followed by what maintainence dose?

A

300mg orally for ACS

once only before commencing maintainence dose of 75mg orally daily

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15
Q

how should clopidogrel use be comunicated to the pt?

A

used to reduce risk of MI or strokes and ot prolong life

if treatment following stent insertion emphasise importance of continuing treatment and usually for 12 months

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16
Q

is clopidogrel a reversible drug?

A

NO it is irreversible- takes up to 7-10 days (lifetime of a platelet) for its antiplatelet effect to wear off

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17
Q

what kind of drug is aspirin?

A

antiplatelet

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18
Q

common indications for aspirin use?

A
  1. treatment of ACS and acute ischaemic stroke
  2. long-term secondary prevention of thrombotic aarterial events in pts with cardiovascular, cerebrovascular and peripheral arterial disease
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19
Q

what is the MOA of aspirin?

A

irreversibly inhibits cyclooxygenase (COX) reducing production of factor thromboxane

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20
Q

how long does the antiplatelet effect of aspirin last?

A

the lifetime of a platelet

(platelets do not have a nuclues to synthesis new COX)

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21
Q

what are the common adverse effects assoc with aspirin?

A

GI irritation

peptic ulceration, haemorrhage, bronchospasm (hypersensitivity)

*life threatening in overdose*

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22
Q

why can aspirin not be given to children under 16 years?

A

risk of Reyes syndrome

life threatening illness affecting liver and brain

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23
Q

who should not be prescribed aspirin?

A

those with aspirin hypersensitivity

third trimester of pregnancy (prosaglandin inhibition may lead to premature closure of ductus arteriousus)

those with peptic ulcers (prescibe gastroprotection)

gout- can trigger ana cute attack

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24
Q

what prepararions of aspirin are available?

A

oral and rectal

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25
Q

how should aspirin be prescribed for 1. ACS and 2. acute ischameic stroke?

A
  1. 300mg loading dose followed by 75mg daily
  2. 300mg daily for 2 weeks

(75mg daily for long-term prevention fo thrombosis)

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26
Q

why should aspirin be taken with or after food?

A

minimise gastric irritation

*those who are high risk for GI upset should be coprescribed gastric protection i.e. omeprazole 20mg daily

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27
Q

name the 4 most common direct oral anticoagulants or DOACs?

A

apixaban, dabigatran, edoxaban, rivaroxiban

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28
Q

list two common indications for DOACs

A
  1. venous thromboembolism (DVT and PE)
  2. AF (prevent stroke and sytemic embolism)
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29
Q

what is teh MOA of DOACs?

A

act on the final common pathway of coagulation cascade:

apixaban, endoxaban, rivaroxaban inhibit activated factor X (Xa)

dabigatran inhibits thrombin (inhibits conversion of fibrinogen to fibrin)

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30
Q

what are the common adverse effects of DOACs?

A

bleeding: greater GI bleed risk than warfarin but lower risk of major bleed or intracranial haemorrhage

others: anaemia, GI upset, dizzness, elevated liver enzymes

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31
Q

DOACs should be avoided in which groups of people?

A

active, clinically significant bleeding

those with risk factors for major bleeding i.e. peptic ulcers, cancer, recent surgery

hepatic/ renal disease- DOACs can be esxcreted using CYP enzymes

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32
Q

DOACs are contraindicated in which patient groups?

A

preganancy and breastfeeding

33
Q

what is the dosing regimen for DOACs?

A

varies by indication

duration also varies

34
Q

how are DOACs prepared?

A

oral preparation

advantage obver heparin in outpatient or prevention/treatment of VTE

35
Q

altepase and streptokinase belong to which class of drug?

A

fibrinolytic drugs

36
Q

when is the use of finbrinolytics indicated?

A
  1. acute ischaemic stroke
  2. acute st elevation MI
  3. massive PE with haemodynamic instability
37
Q

what is the MOA of fibrinolytics?

A

catalyse conversion of plasminogen to plasmin

*plasmin acts to dissolve fibrinous clots

38
Q

fibrinolyitcs are otherwise known as?

A

thrombolytic drugs

39
Q

list some adverse effects of fibrinolytics?

A

N&V, brusing, hypotension

serious bleeding, allergic reaction, cardiogenic shock and cardiac arrest require treatment to be stopped immediately

40
Q

contradindications to thrombolysis using fibrinolytics include?

A

bleeding (recent trauma/surgery, disorders)

intracranial haenorrhage (must undergo CT prior to treatment)

previous treatment with streptokinase

41
Q

risk of haemorrhage is increased in patients given fibrinolytics if they are also takin what drugs?

A

anticoagulants and antiplatelets

42
Q

how are fibrinolytics administered?

A

given IV as bolus or infusion

should only be prescribed and administered by clinicians with epertise in their use

43
Q

how can you describe fibrinolytics (thrombolyse) to patients and next of kin?

A

‘clot busting drug’ to dissolve clot and restore blood flow

44
Q

how should pts be monitored follwing fibrinolytic therapy (thrombolyses)?

A

pts should be in HDU with vital signs checked every 15 mins in first 2 hrs

45
Q

heparin is indicated for what (2)?

A
  1. primary prevention of DVT and PE (can also initially treat VTE until oral anticoag i.e. warfarin/DOAC)
  2. ACS - used with antiplatelet agents to reduce clot progression
46
Q

what is the MOA of heparin?

A

enhances anticoagulant effect of antithrombin (AT)

47
Q

what is the main adverse effect of heparin?

A

haemorrhage

hyperkalaemia occurs occasionally

48
Q

anticoagulants should be used with caution in which pt groups?

A

those at increased risk of bleeding

  • clotting disorders
  • recent surgery/trauma
  • severe uncontrolled HT
49
Q

anticoagulants i.e. heparin shoil dbe withheld immediatley before and after which procedures?

A

invasive procedures such as LP and spinal anaethesia

50
Q

combining heparins with other antithrombotic drugs i.e antiplatelets, warfarin has what effect?

A

additive effect

(can be desirable in ACS but otherwise assoc w inc risk of bleeding so should be avoided)

51
Q

protamine is a option to reverse which drug if major bleedign presents?

A

reverses heparin

52
Q

in renal impairment which anticoagulant is preffered due to risk of accumulation?

A

LMWH accumulates so lower dose of UFH should be used instead

53
Q

how are heparins commonly administered?

A

SC injection- abdo wall and not arm

54
Q

how could you explain heparin injections to a patient?

A

a daily injection to reduce risk of blood clots

55
Q

in special cases i.e. renal impairment, pregnancy how can heparin levels be monitored?

A

plasma antifactor Xa activity

in prolonged therapy >4days, platelet count and serum K+ conc should be measured

56
Q

when warfarin is used for VTE treatment why is antoher anticoagulant i.e. LMWH given alongside initially?

A

LMWH provides ‘bridging anticoagulation’ during the period where warfarin may be briefly pro-thrombotic before its effect on clotting factors

57
Q

common indications for prescribing iron? (2)

A
  1. treatment of iron-deficiency anaemia
  2. prophylaxis of iron-deficiency anaemia (those w risk factors- poor diet, malabsoprtion, menorrhagia)
58
Q

describe the MOA of iron and its absorption

A

essential for erythropoiesis and synthesis of haem

best asorbed in its ferrous state (Fe2+) in duodenum and jejunem

59
Q

most common adverse effect of iron?

A

GI upset- nausea, epigastric pain, constipationa and diarrhoea

(can have black bowel movements on treatment)

60
Q

iron should be used with caution in which patient groups?

A

atopic predisposition- risk of anaphylactic reaction

intestinal disease- exxacerbate symptoms

61
Q

iron reduces absorption of which drugs (2)?

A

levothyroxine and biphosphonates

(should be taken at least 2hrs before oral iron)

62
Q

how is iron available for prescription? (2)

A

oral and IV administration

63
Q

how should iron be administered?

A

oral iron on an empty stomach (or with food to reduce GI upset)

IV injection over 10mins or infusion

64
Q

how can you communicate the effects of iron to the patient?

A

used to top up iron stores to improve symtoms of anaemia- shoul dadvise it may take a few months to feel the full benefit

65
Q

how should iron administration be monitored?

A

FBC until haemoglobin has returned to normal

(should expect Hb rise by around 20g/L per month)

66
Q

people with iron deficiency often require a colonoscopy to investigate- what should be done with regards to iron therapy prior to scope?

A

iron treatment stopped 7 days before scope

(iron can make stool balck and sticky making it difficult to visualise anything)

67
Q

list some common vitamins and their indications (4)

A

Thiamine B1- Tx and prevention of Wernickes encephalopathy and Korsakoff’s psychosis

Folic acid- megaloblastic anaemia and 1st trimester to reduce risk of neural tube defects

Hydroxocobalamin B12- megaloblastic anaemia and subacute combined degeneration of the cord (from B12 deficiency)

Phytomenadine Vit K- newborns to prevent vit K deficiency bleeds and to reverse warfarin

68
Q

which two vitamins are important to give simultaneously if combined deficiency?

A

Vit B12 and folate

(replacing folate alone is assoc w neurological maifestations of B12 deficiency)

69
Q

pabrinex is given for which deficiency?

A

thiamine deficiency

70
Q

how is treatment with B12 and folate monitored?

A

FBC

71
Q

common indications for warfarin (2)?

A
  1. VTE (DVT and PE)
  2. prevention of arterial embolism in pts w AF or prosthetic valves
72
Q

MOA of warfarin?

A

inhibits vit K and in turn:

inhibits factors 2, 7, 9, 10 and proteins C and S

73
Q

main adverse effect of warfarin

A

bleeding

74
Q

warfarin should be used with caution in which pt groups?

A

risk of haemorrhage i.e. after surgery/trauma

liver disease (less able to metabolise drug)

1st trimester (teratogenicity risk)

75
Q

changes in which enzyme can significantly change the anticoagulation effect of warfarin?

A

cytochrome P450 (CYP)

76
Q

traditionally when is warfarin taken for consistent effects on the INR?

A

6 o’clock so consistent effect on INR the following morning

77
Q

how can you comunicate warfarin use to pts?

A

balance between preventing clots and bleeding

will recieve anticoagulant book ‘yellow book’ to record doses, test results

78
Q

what does the INR measure?

A

prothrombin time of a person

79
Q

what is important to consider when looking at INR following a dose change in warfarin?

A

changes in INR lag behind dosing changes- look back over last 48-72hrs to see what doses have led to the current INR

Top 100 Drugs (13 decks)

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