Drugs Flashcards
Xa reversal agent
Andexxa (recombinant Xa, very expensive)
Dabigatran reversal agent
Idarucizumab
Xa inhibitors
rivaroxaban, apixaban, betrixaban and edoxaban
warfarin onset
48 to 72 hours
how does heparin work
by activating antithrombin III, which blocks thrombin from clotting blood.
use of LMWH
does not require monitoring of the APTT coagulation parameter and has fewer side effects.
why are NOACs better than warfarn
relatively short half life + rapid onset
inherited thrombophilias
Lupus anticoagulant Prothrombin gene mutation Protein S Factor V Leiden Antithrombin 3 deficiency Protein C APS
Lovenox class
LMWH
LMWH drugs
dalteparin, fondaparinux, enoxaparin
fondaparinux trade name
Arixtra
direct thrombin inhibitors
argatroban, dabigatran
acquired VTE conditions
antiphospholipid syndrome, paroxysmal nocturnal hemoglobinuria (PNH), disseminated intravascular coagulation (DIC)
NOAC encompasses
Direct thrombin inhibitors + Xa inhibitors
cryoprecipitate
- FFP that is centrifuged, then you collect precipitate.
- fibrinogen (factor I), factor VIII, factor XIII, von Willebrand factor (VWF), and fibronectin derived from one unit of Fresh Frozen Plasma (FFP).
- Cryoprecipitate (cryo) contains a concentrated subset of FFP components including fibrinogen, factor VIII coagulant, vonWillebrand factor, and factor XIII. Cryo IS NOT just a concentrate of FFP. In fact, a unit of cryo contains only 40-50% of the coag factors found in a unit of FFP, but those factors are more concentrated in the cryo.
cryoprecipitate uses
hypofibrinogenemia, vonWillebrand disease, and in situations calling for a “fibrin glue.”
FFP clinical use
MULTIPLE factor deficiencies and active BLEEDING.
How does irradiation work for blood transfusions?
Irradiation is needed to destroy all living leukocytes (white blood cells), particularly lymphocytes that could cause transfusion associated graft versus host disease (TAGVD).
leukocyte reduction
Red blood cell and platelet units may be filtered to remove most of the leukocytes (white blood cells). This may reduce the risk for febrile transfusion reactions, may help prevent alloimmunizaton to MHC (HLA) donor antigens, and help reduce the risk for cytomegalovirus (CMV) infection.
washed RBCs
A unit of packed red blood cells (PRBCs) is washed to reduce plasma proteins. This reduces the risk for allergic transfusion reactions. Washing reduces immunoglobulins, such as anti-IgA that could cause anaphylactic transfusion reactions in persons with selective IgA deficiency.
Use of flow cytometry
evaluate for clonal populations of cells
What is a mixing study?
Test performed on blood plasma of patients or test subjects to distinguish factor deficiencies from factor inhibitors, such as lupus anticoagulant, or specific factor inhibitors, such as antibodies directed against factor VIII. The purpose is to determine the cause of prolongation of PT, Partial Thromboplastin Time, or sometimes of thrombin time (TT).
how a mixing study works
If the problem is a simple factor deficiency, mixing the patient plasma 1:1 with plasma that contains 100% of the normal factor level results in a level ≥50% in the mixture (say the patient has an activity of 0%; the average of 100% + 0% = 50%).[3] The PT or PTT will be normal (the mixing study shows correction). Correction with mixing indicates factor deficiency; failure to correct indicates an inhibitor.
colony stimulating factor medications + caveat
- GCSF
- Neupogen, Granix and Zarxio and trade names for G-CSF
- Can’t get neulasta inpatient, only granix
jadenu
deferasirox (treatment for iron overload)
function of PD-1
This receptor is generally responsible for preventing the immune system from attacking the body’s own tissues; it is a so-called immune checkpoint.
pembrolizumab mechanism
Blocks PD-1 located on lymphocytes. This receptor is generally responsible for preventing the immune system from attacking the body’s own tissues; it is a so-called immune checkpoint.
pembrolizumab trade name
keytruda
anastrozole trade name
arimidex
prolia generic name + use
- denosumab
- It can treat osteoporosis and hypercalcemia.
source of stem cells for nonmalignant HCT and why
Bone marrow - Contains a lower dose of T cells and confers a lower risk of graft-versus-host disease (GVHD).
cyclophosphamide trade name
cytoxin
cyclophosphamide chemo mechanism
crosslinking leading to apoptosis
adeno tumor markers
1) PD-L1
2) ROS-1
3) EGFR
4) ALK
5) BRAF
6) KRAS
TXA mechanism
antifibrinolytic
TXA use
heavy vaginal bleeding
vWF
blast crises in CML defined as any of the following…
≥20 percent peripheral blood or bone marrow blasts [3]
●Large foci or clusters of blasts on the bone marrow biopsy [4]
●Presence of extramedullary blastic infiltrates (eg, myeloid sarcoma also known as granulocytic sarcoma or chloroma)
AI’s
There are 3:
exemestine
anastrozole
lestrozole
tumors that metastasize to bone
prostate, breasts, lungs, thyroid, and kidneys
xgeva generic name
denosumab
capecitabine mechanism
metabolised to 5-FU which in turn is a thymidylate synthase inhibitor
HER2 directed drugs
trastuzumab, pertuzumabm lapatinib
perjeta generic name
pertuzumab
paclitaxel mechanism
microtubule inhibition
medication approved for breast cancer BRCA patients
olaparib
preferred endocrine therapy for postmenopausal women
aromatase inhibitor (AI) rather than tamoxifen.
NOAC with lowest GI bleed risk
eliquis
when NOAC’s can be restarted following bleed
2 weeks following resolution of bleed
sorafenib
protein kinase inhibitor
TKI’s approved for CML
imatinib, dasatinib, and nilotinib
vitamin k dependent clotting factors
II, VII, IX, and X.
Primary cisplatin contraindication
CKD
DOAC contraindications
1) elevated INR because of liver disease
2) severe renal impairment (CrCl <30)
3) BMI >40
risk of XRT to chest
CAD and LV dysfunction
difference in coverage between zosyn and cefepime
lose anaerobe coverage
pradaxa generic name
dabigatran
pradaxa problem
pH sensitive (problem with PPI's), which causes decreased GI absorption. Try to avoid using it.
interactions with NOACs
cyp450
intracranial hemorrhage and AC
NOACs as a class better than warfarin, but apixaban
GI bleed and AC
apixaban has less GI bleed risk, but other NOACs have the same or possibly slightly higher risk of GI bleed
AC and fall risk
It’s overblown, there’ve been studies looking in it, and there’s no significantly increased risk. Intracranial bleeds are rare and intracranial bleeds related to falls are even more rare.
definition of anemia in men and women
below 12 Hgb in women, 13.5 in men
therapeutic Xa level on heparin ggt
UH: 0.3-0.7 IU/mL
