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Blood disorders 3 Flashcards

1
Q

Why are platelets important?

A

Platelets are vital components of hemostasis because they can adhere to injured blood vessels and accumulate at sites of injury

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2
Q

What does Collagen do?

A

Exposed by vascular injury, it activates the platelet cascade

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3
Q

What does ADP do?

A

Secreted from activated platelets, it promotes the release of thromboxane A2

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4
Q

What does thromboxane A2 do?

A

Induces platelet aggregation and vasoconstriction

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5
Q

What does thrombin do?

A

Formed from the coagulation cascade

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6
Q

When is dual antiplatelet therapy (DAPT) indicated?

A

In many patients with acute coronary syndromes and/or after coronary stent deployment

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7
Q

When starting DABT in pts 50 yrs or older without symptomatic CAD, what is the recommended med?

A

Aspirin 81 mg daily

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8
Q

When starting DABT in pts with established CAD, what is the recommended med?

A

Long-term single antiplatelet therapy with aspirin 81mg daily or clopidogrel 75 mg daily

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9
Q

When starting DABT in pts within the first year after ACS who have undergone PCI w/ stent, what is the appropriate regimen?

A

Ticagrelor 90 mg twice daily plus aspirin 81 mg daily
Clopidogrel 75 mg daily plus aspirin 81 mg daily
Prasugrel 10 mg daily plus aspirin 81 mg daily

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10
Q

DABT tx options for pts w/ history of noncardioembolic ischemic stroke or TIA?

A

Aspirin 81mg daily
Clopidogrel 75mg daily
Aspirin/extended-release dipyridamole (25mg/200mg) BID
Cilostazol 100mg BID

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11
Q

ASA MOA

A

Potent irreversible inhibitor of cyclooxygenase (COX-1), the rate-limiting enzyme in the production of prostaglandins

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12
Q

What does a single dose of ASA do to thromboxane A2?

A

Eliminates TXA2 production by the platelet

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13
Q

How quickly can platelet inhibition be detectable after taking ASA?

A

W/in 1 hr

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14
Q

What type of ASA should be used in cases of ACS?

A

If an acute effect is needed (in acute coronary syndrome), plain aspirin should be used (it should be chewed), not enteric-coated preparations (enteric coated take 3-4 hrs to reach peak effect)

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15
Q

How should ASA be taken in case of ACS?

A

Should be chewed

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16
Q

Plasma ASA levels dissipate quickly, however, its effect on platelets is?

A

platelet cyclooxygenase remains irreversibly acetylated (for the lifecycle of the platelet - 10 days)

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17
Q

Higher doses of ASA for the prevention of MI or stroke does what?

A

Not more effective but the pt is at higher risk of bleeding

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18
Q

ASA common doses and indications

A

A full-dose of 325 mg of aspirin is indicated in the acute treatment of MI and CVA
For most other indications, prescribe 81 mg daily

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19
Q

ASA use

A

Highly effective in reducing vascular endpoints in a wide range of clinical conditions
Patients who have undergone CABG/PCI or carotid endarterectomy are also candidates for aspirin treatment

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20
Q

ASA SE

A

tinnitus
ulcer bleeding (Co-administration of aspirin with a proton pump inhibitor may reduce GI complications by 50%)

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21
Q

Why should NSAIDs not be used w/ ASA?

A

Use of aspirin with a traditional NSAID not only increases the risk of GI toxicity, but also may negate aspirin’s cardioprotective effect

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22
Q

If a pt is allergic to ASA but needs prophylaxis, which med should be considered?

A

Clopidogrel

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23
Q

Contraindications to ASA

A

GI bleed - need compelling vascular indication

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24
Q

In which cases can ASA be given to kids?

A

Rarely, children are prescribed aspirin (Kawasaki disease)

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25
What is ASA resistance?
some patients do not have the expected inhibition of platelet aggregation with standard doses of aspirin
26
What is the max amount of EtOH that can be consumed by a pt on ASA and why?
More than 3 glasses of alcohol per day may increase the risk of GI bleeding
27
Why have P2Y12 inhibitors replaced ticlopidine?
Has greater effects on thrombosis Is safer, causing less neutropenia
28
P2Y12 Inhibitors MOA
Thienopyridine that blocks platelet activation by selectively and irreversibly blocking the binding of ADP to the platelet
29
P2Y12 Inhibitors examples
Clopidogrel Ticagrelor Prasugrel
30
How fast is the antiplatelet effect of P2Y12 Inhibitors seen?
Platelet inhibition is detectable 2 hours after a loading dose or during the second day of routine oral use, although peak platelet effect may take up to a week.
31
P2Y12 Inhibitors uses
ACS Ischemic stroke Peripheral atherosclerotic disease (clopidogrel only) Percutaneous coronary intervention
32
P2Y12 Inhibitors SE
Bleeding* Purpura, rash HA, dizziness
33
How do PPIs affect P2Y12 inhibitors?
Proton pump inhibitors interfere with the antiplatelet effects of clopidogrel and ticagrelor
34
In which pts should P2Y12 inhibitors NOT be used?
Active bleeding Prior episodes of severe bleeding Planned CABG within the next 5 days
35
Which P2Y12 inhibitor should not be used in pts > 75 yrs or < 60 kg in weight?
Prasugrel
36
Which P2Y12 inhibitor should not be used in pts w/ a hx of bleeding, stroke, or TIA?
Prasugrel
37
What is the black box warning on Prasugrel?
Increased risk of bleeding in certain pts
38
What is the black box warning on Ticagrelor?
ASA over 100 mg daily reduce the effectiveness of Ticagrelor
39
If a pt w/ ACS undergoes a coronary angioplasty, how should they be tx w/ ASA and clopidogrel?
All of these patients should take low- dose aspirin and clopidogrel 75 mg/day for at least a year After 1 year, if there was a stent and the patient has no bleeding or cost issues, consider continuing both After 1 year, if there was no stent, discontinue the clopidogrel.
40
Why is ASA + clopidogrel not recommended in pts w/ TIA?
efficacy doesn’t increase and there is just more bleeding
41
In pts w/ stable CAD, peripheral arterial dz, or those having undergone GABG, what is the recommendation for P2Y12 inhibitors?
prescribe low-dose aspirin alone If aspirin is not tolerated, then clopidogrel alone at 75 mg/day is reasonable.
42
Dipyridamole is used in IV formulation for what?
to dilate the coronary arteries during noninvasive testing for atherosclerotic CAD (stress testing)
43
Dipyridamole MOA
it inhibits platelet adenosine deaminase and phosphodiesterase, which causes an accumulation of adenosine, adenine nucleotides, and cyclic AMP
44
Dipyridamole use
prevent stroke
45
Oral dipyridamole dosing
only recommended product is a fixed combination with aspirin (a tablet that contains 50 mg of aspirin and 200 mg of extended-release dipyridamole, marketed as Aggrenox)
46
Why is clopidogrel preferred over dipyridamole in cases of recent ischemic stroke?
Causes less bleeding Is less expensive Is equally as effective as dipyridamole
47
Dipyridamole SE
Dizziness
48
Which drugs reduce the effect of dipyridamole?
Xanthines (caffeine, theophylline) reduce the effect of dipyridamole
49
Which antiplatelet drug should be avoided in pts w/ bronchospasm (Asthma or COPD)?
Dipyridamole
50
Glyocoprotein IIb/IIIa Inhibitors examples
Tirofiban Eptifibatide
51
Glyocoprotein IIb/IIIa Inhibitors MOA
Binds to platelet IIb/IIIa receptors, resulting in steric hindrance, thus inhibiting platelet aggregation
52
Glyocoprotein IIb/IIIa Inhibitors use
Non-ST elevation acute coronary syndrome Percutaneous coronary intervention (PCI)*
53
Glyocoprotein IIb/IIIa Inhibitors SE
Hypotension Hemorrhage
54
Contraindications for Glyocoprotein IIb/IIIa Inhibitors
Active abnormal bleeding within the previous 30 days or a history of bleeding diathesis History of stroke within 30 days or a history of hemorrhagic stroke Severe hypertension (>200/110) Major surgery within the preceding 6 weeks Dependency on hemodialysis
55
When using Glyocoprotein IIb/IIIa Inhibitors, what should be considered in regards to length of tx?
Not a long term treatment option - will need to be transitioned to oral therapy
56
Cilostazol MOA
Inhibitors of phosphodiesterase III
57
Cilostazol use
Intermittent claudication Second-line agent for PCI Secondary prevention of ischemic stroke or transient ischemic attack (TIA)
58
Cilostazol SE
Diarrhea HA Rhinitis
59
Why is ASA used more often than Cilostazol?
ASA has less SE but they have similar efficacy
60
How do fibrinolytic agents work?
A modified form of tPA, when given IV they bind to fibrin and convert plasminogen to plasmin -> fibrinolysis (clot dissolution)
61
Fibrinolytic (Thrombolytic) Agents examples
alteplase reteplase tenecteplase
62
Fibrinolytic (Thrombolytic) Agents use
Acute myocardial infarction Acute massive pulmonary embolism Acute ischemic stroke Alteplase is used in a special reduced dose to open clotted central venous access devices Used off label in cardiac arrest
63
What is the time limitation of Fibrinolytic (Thrombolytic) Agents use when tx acute ischemic stroke?
3-4.5 hrs after the initial sxs and w/ exclusion of intracranial hemorrhage
64
What is the time frame of Fibrinolytic (Thrombolytic) Agents use w/ acute MI?
Within 12 hrs
65
Fibrinolytic (Thrombolytic) Agents SE
Serious bleeding is the most common complication of fibrinolysis, especially ICH
66
Which pts are at an increased risk of bleeding from Fibrinolytic (Thrombolytic) Agents administration?
Risk factors for major bleeding include advanced age, low body weight, and female gender, prior cerebrovascular disease
67
What drug disqualifies a pt from being administered tPA?
Anticoagulants usually disqualify a patient from tPA use.

Pharm Exam 3 (7 decks)

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