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Pharm Exam 3 > Blood disorders 3 > Flashcards

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
Q

What is ASA resistance?

A

some patients do not have the expected inhibition of platelet aggregation with standard doses of aspirin

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26
Q

What is the max amount of EtOH that can be consumed by a pt on ASA and why?

A

More than 3 glasses of alcohol per day may increase the risk of GI bleeding

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27
Q

Why have P2Y12 inhibitors replaced ticlopidine?

A

Has greater effects on thrombosis
Is safer, causing less neutropenia

28
Q

P2Y12 Inhibitors MOA

A

Thienopyridine that blocks platelet activation by selectively and irreversibly blocking the binding of ADP to the platelet

29
Q

P2Y12 Inhibitors examples

A

Clopidogrel
Ticagrelor
Prasugrel

30
Q

How fast is the antiplatelet effect of P2Y12 Inhibitors seen?

A

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
Q

P2Y12 Inhibitors uses

A

ACS
Ischemic stroke
Peripheral atherosclerotic disease (clopidogrel only)
Percutaneous coronary intervention

32
Q

P2Y12 Inhibitors SE

A

Bleeding*
Purpura, rash
HA, dizziness

33
Q

How do PPIs affect P2Y12 inhibitors?

A

Proton pump inhibitors interfere with the antiplatelet effects of clopidogrel and ticagrelor

34
Q

In which pts should P2Y12 inhibitors NOT be used?

A

Active bleeding
Prior episodes of severe bleeding
Planned CABG within the next 5 days

35
Q

Which P2Y12 inhibitor should not be used in pts > 75 yrs or < 60 kg in weight?

A

Prasugrel

36
Q

Which P2Y12 inhibitor should not be used in pts w/ a hx of bleeding, stroke, or TIA?

A

Prasugrel

37
Q

What is the black box warning on Prasugrel?

A

Increased risk of bleeding in certain pts

38
Q

What is the black box warning on Ticagrelor?

A

ASA over 100 mg daily reduce the effectiveness of Ticagrelor

39
Q

If a pt w/ ACS undergoes a coronary angioplasty, how should they be tx w/ ASA and clopidogrel?

A

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
Q

Why is ASA + clopidogrel not recommended in pts w/ TIA?

A

efficacy doesn’t increase and there is just more bleeding

41
Q

In pts w/ stable CAD, peripheral arterial dz, or those having undergone GABG, what is the recommendation for P2Y12 inhibitors?

A

prescribe low-dose aspirin alone
If aspirin is not tolerated, then clopidogrel alone at 75 mg/day is reasonable.

42
Q

Dipyridamole is used in IV formulation for what?

A

to dilate the coronary arteries during noninvasive testing for atherosclerotic CAD (stress testing)

43
Q

Dipyridamole MOA

A

it inhibits platelet adenosine deaminase and phosphodiesterase, which causes an accumulation of adenosine, adenine nucleotides, and cyclic AMP

44
Q

Dipyridamole use

A

prevent stroke

45
Q

Oral dipyridamole dosing

A

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
Q

Why is clopidogrel preferred over dipyridamole in cases of recent ischemic stroke?

A

Causes less bleeding
Is less expensive
Is equally as effective as dipyridamole

47
Q

Dipyridamole SE

A

Dizziness

48
Q

Which drugs reduce the effect of dipyridamole?

A

Xanthines (caffeine, theophylline) reduce the effect of dipyridamole

49
Q

Which antiplatelet drug should be avoided in pts w/ bronchospasm (Asthma or COPD)?

A

Dipyridamole

50
Q

Glyocoprotein IIb/IIIa Inhibitors examples

A

Tirofiban
Eptifibatide

51
Q

Glyocoprotein IIb/IIIa Inhibitors MOA

A

Binds to platelet IIb/IIIa receptors, resulting in steric hindrance, thus inhibiting platelet aggregation

52
Q

Glyocoprotein IIb/IIIa Inhibitors use

A

Non-ST elevation acute coronary syndrome
Percutaneous coronary intervention (PCI)*

53
Q

Glyocoprotein IIb/IIIa Inhibitors SE

A

Hypotension
Hemorrhage

54
Q

Contraindications for Glyocoprotein IIb/IIIa Inhibitors

A

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
Q

When using Glyocoprotein IIb/IIIa Inhibitors, what should be considered in regards to length of tx?

A

Not a long term treatment option - will need to be transitioned to oral therapy

56
Q

Cilostazol MOA

A

Inhibitors of phosphodiesterase III

57
Q

Cilostazol use

A

Intermittent claudication
Second-line agent for PCI
Secondary prevention of ischemic stroke or transient ischemic attack (TIA)

58
Q

Cilostazol SE

A

Diarrhea
HA
Rhinitis

59
Q

Why is ASA used more often than Cilostazol?

A

ASA has less SE but they have similar efficacy

60
Q

How do fibrinolytic agents work?

A

A modified form of tPA, when given IV they bind to fibrin and convert plasminogen to plasmin -> fibrinolysis (clot dissolution)

61
Q

Fibrinolytic (Thrombolytic) Agents examples

A

alteplase
reteplase
tenecteplase

62
Q

Fibrinolytic (Thrombolytic) Agents use

A

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
Q

What is the time limitation of Fibrinolytic (Thrombolytic) Agents use when tx acute ischemic stroke?

A

3-4.5 hrs after the initial sxs and w/ exclusion of intracranial hemorrhage

64
Q

What is the time frame of Fibrinolytic (Thrombolytic) Agents use w/ acute MI?

A

Within 12 hrs

65
Q

Fibrinolytic (Thrombolytic) Agents SE

A

Serious bleeding is the most common complication of fibrinolysis, especially ICH

66
Q

Which pts are at an increased risk of bleeding from Fibrinolytic (Thrombolytic) Agents administration?

A

Risk factors for major bleeding include advanced age, low body weight, and female gender, prior cerebrovascular disease

67
Q

What drug disqualifies a pt from being administered tPA?

A

Anticoagulants usually disqualify a patient from tPA use.

Pharm Exam 3 (7 decks)

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