Blood drugs

Question 1

Aminocaprioic acid

Answer 1

Related drugs: Tranexamic acid

MOA:
Lysine analogue binds competitively to plasmin and inhibits fibrinolysis

Clinical uses:
pro-hemostatic agent used in various forms of bleeding

Major toxicity:
Thrombosis

Question 2

4-factor prothrombin complex concentrates

Answer 2

MOA:
Human blood coag factor replacement (F2, F7, F9, F10)

Clinical uses:
urgent reversal of acquired coag facto deficiency induced by warfarin

Major toxicity:
Thrombosis

Question 3

Acetylsalicylic acid

Answer 3

MOA:
non-selective, irreversible cox inhibitor

Clinical uses:
prevention and treatment of arterial thrombosis, anti-inflammatory

Major toxicity:
GI and nephro-toxic bleeding

Question 4

Alteplase

Answer 4

Related drugs:
Reteplase, tenecteplase, streptokinase

MOA:
stimulates the conversion of plasminogen to plasmin –> fibrinolysis

Clinical use:
Coronary artery thrombosis, pulmonary embolism, ischemic stroke

Question 5

Cyclosporine

Answer 5

MOA:
Calcineurin inhibitor
(activates T cells)

Assessment of effect:
cyclosporine level

Use:
Prevention and treatment of graft vs host disease in HSCT
idiopathic aplastic anemia

Major Toxicity:
HTN, electrolyte wasting, nephrotoxic

Question 6

Dabigatran

Answer 6

Related drugs:
lepirudin, desirudin, bivalirudin, argatroban

MOA:
Direct thrombin (F2) inhibitor 

Use:
Stroke prevention in A fib, DVT, and PE

Major toxicity:
bleeding, GI disturbances

Question 7

Desmopressin

Answer 7

MOA:
vasopressin analog selective for V2 receptors, stimulates release of von Willebrand factor

Use:
von Willebrand disease, qualitative platelet disorder

Toxicity:
hyponatremia

Question 8

Eltrombopag

Answer 8

MOA:
thrombopoietein (TpoR) receptor agonist (nonpeptide small molecule, transmembrain domain), stimulates megakaryocyte/platelet production and hematopoietic stem cells

Clinical assessment
Platelet Count

Use:
chronic idiopathic thrombocytopenia purpura, idiopathic acquired aplastic anemia

Question 9

Enoxaprin

Answer 9

Related names:
dalteparin

MOA:
indirect FXa inhibitor (complexes with antithrombin)

Use:
venous thrombosis prevention or treatment, acute coronary syndromes

Toxicity:
bleeding, thrombocytopenia (rare)

Question 10

Epoetin alfa

Answer 10

Other names:
darbepoetin alfa

MOA:
activate erythropoietin receptor to stimulate red blood cell production

Clinical assessment
Hgb

Use:
anemia secondary to cancer, renal disease, IBD

Toxicity:
hypertension, thrombosis

Question 11

Filgrastim

Answer 11

Related names:
Pegfilgrastim

MOA:
granulocyte colony-stimulating factor analog, stimulates neutrophil production

Clinical assessment
Abs Neutrophil Count

Use:
neutropenia secondary to chemotherapy or bone marrow transplantation

Toxicity:
bone pain

Question 12

Fondaparinux

Answer 12

MOA:
indirect FXa inhibitor (complexes with antithrombin)

Use:
venous thrombosis prevention or treatment, acute coronary syndromes

Toxicity:
bleeding

Question 13

Hydroxyurea

Answer 13

MOA:
inhibitor of ribonucleotide reductase which is required to convert ribonucleotides to deoxyribonucleotides

Use:
myeloproliferative disorders, sickle cell anemia

Toxicity:
cytopenias

Question 14

Imatinib

Answer 14

Other names:
dasatinib, nilotinib, ponatinib

MOA:
inhibitor of ABL, Kit, PDGF-R tyrosine kinases

Use:
chronic myelogenous leukemia, Ph+ ALL

Toxicity:
CHF, GI-upset

Question 15

Recombinant FVIIa

Answer 15

MOA:
recombinant factor VIIa

Use:
individuals with hemophilia who have antibody inhibitors to coagulation factors VIII or IX, patients with acquired hemophilia, and those with congenital factor VII deficiency

Toxicity:
thrombosis

Question 16

Rituximab

Answer 16

MOA:
binds to CD20 on the surface of B cells and leads to antibody dependent cellular cytotoxicity

Use
CD20 expressing hematopoietic malignancies, ITP

Toxicity:
infuional reactions, neutropenia

Question 17

Rivaroxaban

Answer 17

Other names
Rivaroxaban

MOA:
direct factor Xa inhibitor

Use:
stroke prevention in atrial fibrillation, DVT, pulmonary embolism

Toxicity:
bleeding

Question 18

Romiplostim

Answer 18

MOA:
thrombopoietein (TpoR) receptor agonist (peptibody, ligand-binding domain), stimulates megakaryocyte/platelet production

Clinical assessment
Platelet count

Use:
chronic idiopathic thrombocytopenia purpura

Question 19

Unfractionated heparin

Answer 19

MOA:
indirect FIIa and FXa inhibitor (complexes with antithrombin)

clinical assessment
PTT

Use:
venous thrombosis prevention or treatment, acute coronary syndromes

Toxicity:
bleeding, thrombocytopenia (rare), osteoporosis (with chronic use)

Question 20

vitamin K

Answer 20

MOA
activation of vitamin-K dependent clotting factors

Use:
“slow reversal of acquired coagulation factor
deficiency induced by Vitamin K antagonist ( e.g., warfarin) therapy”

Question 21

Warfarin

Answer 21

MOA:
inhibits vitamin K epoxide reductase blocking production of vit. K dependent clotting proteins (II, VII, IX, and X) and vit. K dependent anti-clotting proteins C and S

Clinical assessment
PT (INR)

Use:
stroke prevention in atrial fibrillation, DVT, pulmonary embolism, mechanical heart valves

Toxicity:
Bleeding