blood and cooagulation Flashcards
Required for the biosynthesis of heme and heme containing proteins, including hemoglobin and myoglobin; For Iron deficiency anmia, iron supplementation
Ferrous sulfate, Ferrous gluconate, Ferrous Fumarate, Iron dextran, Sodiun Ferric Gluconate complex, Iron sucrose (TOPNOTCH)
Chelates excess iron; For acute and chronic iron poisoning
Deferoxamine, Deferasirox (TOPNOTCH)
Cofactor required for essential enzymatic reactions that form tetrahydrofolate, convert homocysteine to methionine and metabolize methymalonyl-CoA; For vitamin B12 deficiency, megaloblastic anemia
Cyanocobalamin, Hydroxocobalamin (TOPNOTCH)
Precursor of an essential donor of methyl groups used for synthesis of amino acids, purines and deoxynucleotide; For Megaloblastic anemia, prevention of neutral tube defects(spina bifida), prevention of coronary artery disease
Folic acid (TOPNOTCH)
Agonist of erythropoietin receptors expressed by red cell progenitors; For Anemia, associated with chronic renal failure, cancer, HIV infection and prematurity
Epoetin Alfa, Darbepoetin alfa, Methoxy Polyethylene Glycol- Epoetin Beta (TOPNOTCH)
Binds receptors on myeloid progenitors and stimulates cell maturation and proliferation ; Accelerates neutrophil recovery and reduces incidence of infection; For neutrophenia associated with chemotheraphy, myelodysplasia, and aplastic anemia
(G-CSF) Filgrastim, Sargamostim (GM-CSF), Pegfilgrastim (TOPNOTCH)
Recombinant form of an endogenous cytokine; activates IL -11 receptors ; For secondary prevention of thrombocytopenia in patients undergoing chemotheraphy
Oprelvekin(IL-11),Thrombopoietin (TOPNOTCH)
nhibits rate-limit in enzyme in cholesterol biosynthesis (HMG-CoA reductase), Increased hepatic cholesterol uptake, Increased high affinity LDL receptors which leads to decreased LDL levels
Simvastatin, Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin, Cerivastatin (TOPNOTCH)
DOC for hypercholesterolemia(high LDL), decrease risk of acute coronary syndromes, ischemic stroke
Simvastatin, Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin, Lovastatin, Pitavastatin, Cerivastatin (TOPNOTCH)
Prominent SE of statins: ____
Hepatoxicity, Myopathy, Rhabdomyolysis (TOPNOTCH)
Increased risk of myopathy and rhabdomyolysis when statins are used with
Fibrates (TOPNOTCH)
non-absorbable polyemers that bind bile acids and similar steroids in the intestines preventing their reabsorption, increases cholesterol utilization for replacement, modestly lowers LDL levels by increasing hepatic LDL receptors
Bile Acid Binding Resin (TOPNOTCH)
Bile Acid Binding Resin
Colesevelam, Colestipol, Cholestyramine (TOPNOTCH)
SE: Constipation, Bloating, Gritty taste, Gallstone formation, steatorrhea, malabsortion of fat soluble substances (vitamin k, folate)
Colesevelam, Colestipol, Cholestyramine (TOPNOTCH)
Selective inhibitor of the NCP1L1 transporter decreasing intestinal absorption of cholesterol and other phytosterols, decreases cholesterol hepatic pool, increases hepatic LDL receptors
NPC1L1 transporter inhibitor (TOPNOTCH)
NPC1L1 transporter inhibitor
Ezetimibe (TOPNOTCH)
Cholesterol analog, takes the place of dietary and billiary cholesterol, decreasing intestinal absorption of cholesterol and other phytosterols
Sitosterol (TOPNOTCH)
Decreases VLDL synthesis and LDL cholesterol concentrations, decreases hormone-sensitive lipase activity leading to decreased LDL levels, Increases HDL cholesterol by decreasing its catabolism
Niacin (TOPNOTCH)
DOC for increasing HDL levels
Niacin (TOPNOTCH)
SE: Flushing, nausea, vomiting, Pruritus, Acanthosis nigricans, Rashes, Gastrointestinal irritation, Hepatoxicity (mild), Hyperuricemia, Impaired glucose tolerance, Arrythmias, Amyblopia
Niacin (TOPNOTCH)
Activates PPAR-_ and increases expression of lipoprotein lipase and apolipoproteins (apoA-I, apoA-II) leading to enhanced clearance of TG-rich lipoproteins, Lowers triglycerides, Increases HDL
Fibrates (TOPNOTCH)
DOC for hypertriglyceridemia
Fibrates (TOPNOTCH)
Fibrates
Gemfibrozil, Fenofibrate, Bezafibrate (TOPNOTCH)
Fibrates have higher risk of gallstone formation if given together with ____
resins (TOPNOTCH)
Nonselective, irreversible COX 1&2 inhibitor. Reduces platelet production of thromboxane A2, temporarily inhibit Prostacyclin synthesis
Aspirin (TOPNOTCH)
Uncoupler of oxidative phosphorylation, associated with Reye syndrome in children
Aspirin (TOPNOTCH)
Reversbily inhibits the binding of fibrin and other ligands to the platelet GPIIb-IIIa receptor
GPIIb-IIIa inhibitor: Abciximab, Eptifibatide,Tirofiban (TOPNOTCH)
For prevention or arterial thrombosis (MI, TIA, CVD), Inflammatory disorders (rheumatic fever, juvenile rheumatoid arthritis, kawasaki disease)
Aspirin (TOPNOTCH)
Inhibits phosphodiesterase III and increases cAMP in platelets and blood vessels, Inhibits platelet aggregation and causes vasolidation
PDE III inhibitor: Dipyridamole, Cilostazol (TOPNOTCH)
additional MOA: inhibit uptake of adenosine by endothelial cells and RBC, thus increasing adenosine levels leading to inhibition of platelet aggregation
PDE III inhibitor: Dipyridamole, Cilostazol (TOPNOTCH)
Irreversibly inhibits binding of ADP to platelet receptors,thus reducing platelet aggregation
ADP inhibitor: Clopidogrel,Ticlopidine, Prasugel (TOPNOTCH)
Activates antithrombin III which Inactivates thrombin or factor IIa, factor IXa & factor Xa by forming stable complexes with them
Heparin (TOPNOTCH)
SE: Bleeding, transient Heparin-induced thrombocytopenia, Osteoporosis with chronic use
Heparin (TOPNOTCH)
DOC for anticoagulation during pregnancy ; administered IV or SC ; Monitor with aPTT,
Heparin (TOPNOTCH)
Antidote for heparin toxicity
Protamine Sulfate (TOPNOTCH)
Binds and potentiates effect of antithrombin III on factor Xa (more selective for Xa)
LMWH (TOPNOTCH)
LMWH
Enoxaparin, Dalteparin, Tinzaparin, Danaparoid, Fondaparinux (TOPNOTCH)
Does not require aPTT monitoring, Protamine sulfate is only partially effective in reversing effects
LMWH: Enoxaparin, Dalteparin, Tinzaparin, Danaparoid, Fondaparinux (TOPNOTCH)
Binds to thrombin’s ative site and inhibits its enzymatic action
Direct Thrombin Inhibitors: Lepirudin, Desirudin, Bivalirudin, Argatroban, Dabigatran (TOPNOTCH)
bind to free and bound factor Xa
Direct Oral Factor Xa inhibitor: Rivaroxaban, Apixaban (TOPNOTCH)
Inhibits vitamin K epoxide reductase (responsible for y-carboxylation of the vitamin K- dependent clotting (factors II, VII, IX, X, Protein C & Protein S)
Warfarin (TOPNOTCH)
For chronic anticoagulation (DVT, atrial fibrillation, valve replacement)
Warfarin (TOPNOTCH)
SE: Bleeding, Teratogen (bone defects, hemorrhage), warfarin-induced skin necrosis (transient hypercoagulability)
Warfarin (TOPNOTCH)
Monitor effects with PT-INR
Warfarin (TOPNOTCH)
Antidote forwarfarin toxicity
Vitamin K or FFP (TOPNOTCH)
Chemical antagonist of heparin. Reverses excessive anticlotting activity of unfractionated heparin
Protamine Sulfate (TOPNOTCH)
Tissue plasminogen activator analog. Converts plasminogen to plasmin, which degrades the fibrin and fibrinogen, causing thrombolysis
Alteplase, Anistreplase, Reteplase, Streptokinase, Tenecteplase, Urokinase (TOPNOTCH)
Tx should be done within 6 hrs, better if within 3hrs ; Antidote is AMINOCAPROIC ACID
Alteplase, Anistreplase, Reteplase, Streptokinase, Tenecteplase, Urokinase (TOPNOTCH)
Competitively inhibits plasminogen activation thus inhibiting fibrinolysis
Tranexamic acid (TOPNOTCH)
For Vitamin K deficiency, Antidote to warfarin, prevention of hemorrhagic diatheses in newborns
Vitamin K1, K2 (Phytonadione, Menaquinone) (TOPNOTCH)
Vasopressin V2 receptor agonist, Increases factor VIII activity of patients with mild hemophilia A or VWD
Desmopressin (TOPNOTCH)
low doses undergo first order kinetics while high doses undergo zero order reaction ; Long term use reduces the risk of colon cancer
Aspirin (TOPNOTCH)
COX-2 > COX-1 inhibition
Meloxicam & Piroxicam (TOPNOTCH)
NSAIDs that can be used to close PDA
Ibuprofen and Indomethacin (TOPNOTCH)
has significant analgesic effect but not anti-inflammatory effect
Ketorolac (TOPNOTCH)
SE: Gastrointestinal toxicity, pancreatitis, Nephrotoxicity, Serious hematologic reactions, BM suppression
Indomethacin (TOPNOTCH)
Selective COX-2 inhibitor
Celecoxib, Etoricoxib, Parecoxib (TOPNOTCH)
Rofecoxib and Valdecoxib withdrawn due to
increased incidence of thrombosis (TOPNOTCH)
Selectively inhibits COX-3 in the CNS, Weak COX-1 and COX-2 inhibitor in the periphery, Inhibits prostaglandin synthesis
Paracetamol (Acetaminophen) (TOPNOTCH)
Inhibits AICAR transformylase and thymidylate snythetase, with secondary effects on polymorphonuclear chemotaxis
Methotrexate (TOPNOTCH)
DMARD of choice for Rheumatoid arthritis
Methotrexate (TOPNOTCH)
Rescue agent for Methotrexate toxicity
Leucovorin (Folinic acid) (TOPNOTCH)
Binds to TNF-a inhibitor
Infliximab, Adalimumab, Etanercept (TOPNOTCH)
SE: Bacterial infections (URTIs), reactivation of latent tuberculosis, lymphoma, Demyelination, Reactivation of Hepatitis B, Auto antibody formation (ANA, anti dsDNA), infusion reactions, hepatoxicity, hematotoxicity, cardiotoxicity
TNF-a inhibitor: Infliximab, Adalimumab, Etanercept (TOPNOTCH)