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Drugs Acting on the Blood Flashcards

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1
Q

Name 4 types of drugs that act on the blood.

A

Antianemic drugs, Colony Stimulating Factors, Drugs affecting hemostasis (Tx hemorrhage), Treatment of thromboembolism in cats (antithrombotics)

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2
Q

What causes Microcytic anemia?

A

Iron deficiency

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3
Q

What causes Normocytic anemia?

A

Chronic diseases, endocrine anemia, bone marrow failure.

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4
Q

What causes Macrocytic (megaloblastic) anemia?

A

B12 deficiency, folic acid deficiency

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5
Q

What causes Hemolytic anemia?

A

Autoimmune diseases, drug-induced, hemoglobinopathies, membrane disorders, metabolic abnormalities, Glucose-6-phosphate dehydrogenase deficiency, infections.

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6
Q

What do you treat microcytic anemia with?

A

Iron Preparations or Copper preparations

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7
Q

How does iron deficiency cause anemia?

A

Because iron is a main component of RBCs.

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8
Q

What routes can we use to administer iron preparations?

A

Parenteral or oral.

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9
Q

Can we use IV iron preparations?

A

No because they are more likely to cause hypersensitivity.

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10
Q

What cause the GI side-effects of oral iron preparations?

A

Irritation and astringent properties (causes constipation).

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11
Q

What is a chelating complex?

A

An agent that is readily secreted in the urine and decreases toxic effects.

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12
Q

What is the order of preference for iron preparations?

DOUBLE CHECK WITH SHOCKRY.

A

Organic>Ferrous>Ferric

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13
Q

Why do we treat microcytic anemia with copper preparations?

A

Because Cu is important for the absorption of Fe AND Cu is a component is cytochrome oxidase which is important in oxidation of Fe.

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14
Q

What iron preparation would you administer parenterally?

A

Iron carbohydrate complexes

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15
Q

What iron preparation would you administer orally?

A

Ferrous chloride, Ferrous phosphate, Ferrous sulfate.

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16
Q

What copper preparation can you give orally?

A

Copper sulfate.

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17
Q

How do you give copper glycinate?

A

SQ or IM

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18
Q

Can you give cupper preparations IV?

A

No, it’s irritating.

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19
Q

What is another name for Macrocytic anemia?

A

Megaloblastic anemia

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20
Q

What is a common cause of macrocytic anemia in ruminants?

A

Cobalt deficiency.

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21
Q

What is a common cause of normocytic/normoplastic anema?

A

It is commonly a side effect of anti-cancer drugs because they target rapidly dividing cells (kills marrow before it kills the cancer cells).

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22
Q

How does EPO play a role in normocytic anemia?

A

EPO from the kidneys stimulates RBC production.

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23
Q

What can you do for immune mediated hemolytic anemia (IMHA)?

A

Supportive therapy (fluids, acid/base balance, etc), blood transfusions, immunosuppressives, IV gamma globulin.

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24
Q

Name 4 immunosuppressives.

A

Glucocorticoids (prednisone, prednisolone), cytotoxic drugs (azathioprine, cyclophosphamide), Danazol, Cyclosporin A.

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25
What are the two types of colony stimulating factors?
Granulocyte CSF (G-CSF) and Granulocyte-macrophage colony stimulating factor (GM-CSF).
26
What CSF type does Filgrastim fall under?
G-CSF
27
What CSF type does Sargramostim fall under?
GM-CSF
28
What is the use of CSF drugs?
Helps decrease the negative effects of cancer treatment by promoting growth of granulocytes.
29
What is the difference between G-CSF nd GM-CSF?
GM-CSF isn't as specific, it acts on granulocytes, platelets and RBCs. G-CSF only acts on granulocytes.
30
How does Filgrastim work at therapeutic doses?
Stimulates progenitors of neutrophils.
31
How does Sargramostim work?
Stimulates the growth and development of neutrophils, eosinophils, basophils, erythrocytes and macrophages.
32
What is the clinical use of a CSF?
To help treat anticancer chemotherapy-induced neutropenia.
33
What are the adverse effects of CSF use?
Bone pain, and Sargramostim can also cause fever and cardiopulmonary toxicity.
34
What are the two drug types that affect hemostasis?
Hemostatics and antithrombotics.
35
What are the 5 steps in hemostasis?
Vascular injury > contraction of the vessel > primary hemosstasis (platelet plug) > secondary hemostasis (protein plug) > fibrinolysis.
36
What are the two types of hemostatics?
Local (styptic) and systemic hemostatics.
37
What can happen if you use a local hemostatic systemically?
Can cause emboli.
38
What are the four types of local hemostatics?
Vasoconstrictors Astringents (tannic acid, ferric chloride) Surgical (oxidized cellulose, gelatin sponge, collagen) Physiological (thromboplastin, thrombin, fibrinogen, fibrin foam)
39
How can you tell if a drug is an amide or an ester?
If there's an "-i-" before "-caine" it's an amide.
40
What are the 5 types of systemic hemostatics?
Clotting factors (blood transfusion, fresh frozen plasma) Vitamin K Protamine sulfate Aminocaproic acid Desmopressin (DDAVP) - (synthetic analog of vasopressin)
41
Of the three types of vitamin K (K1, K2, K3) which are used clinically?
Vit. K1 and K3
42
What is Phytonadione?
Vit. K1
43
What is Menaquinone?
Vit. K2
44
What is Menadione?
Vit. K3
45
Where does Vit. K1 come from?
Plant origin.
46
Where does Vit. K2 come from?
Bacteria in the GIT.
47
Where does Vit. K3 come from?
Synthetic.
48
What is the mechanism of action for Vit. K1?
Stimulates the formation of prothrombin (Factor II), and factors VII, IX, and X in the liver.
49
How does Warfarin block clotting?
Warfarin blocks the reductase enzyme that reduces inactive Vitamin K epoxide to activated Vitamin K which is the cofactor required to activate factors II, VII, IX, and X.
50
How is Vit. K1 given?
Orally for maintenance or parenterally (IV, IM, SQ) in an emergency.
51
What are some considerations when giving Vit. K1 parenterally?
Use a small gauge needle (will bleed at site) IM=SQ>IV (causes hypersensitivity)
52
What are the 4 clinical uses of Vit. K1?
Warfarin poisoning Treatment of spoiled sweet clover poisoning in cattle Vit. K deficiency Combined with local hemostatics for treatment of epistaxis in dogs and horses.
53
Why is Vit. K deficiency so rare?
Food has lots of Vit. K
54
What are two things that can cause Vit. K deficiency?
Absorption problems, treatment with broad spectrum ABs ( affects gut flora), or liver disease.
55
What is a very important thing to remember when treating an animal with Vit. K1 for Warfarin poisoning?
Vit. K takes about a day to take effect, so animal will keep bleeding. Will need to give a transfusion to provide missing coag. factors immediately.
56
What is Protamine sulfate used for?
Specific antidote for heparin.
57
How does protamine sulfate work?
binds with heparin to form a salt.
58
How do you give protamine sulfate?
Given slowly IV.
59
Why can't protamine sulfate be given orally?
Has a short half-life and poor penetration of membranes.
60
Why must you be careful with your dose of protamine sulfate?
Has anticoagulant effect if given as an overdose.
61
How does aminocaproic acid work?
It inhibits the conversion of plasminogen to plasmin.
62
What are two clinical uses for aminocaproic acid?
To treat hemorrhage due to fibrinolysis | To treat degenerative myelopathy in GSD (peripheral neuronal degeneration.
63
What does desmopressin do?
Increases the vWF levels for about two hours in dogs.
64
What are 2 clinical uses for desmopressin?
Controlling bleeding in dogs with vWD | During surgery in dogs with vWD
65
What are the three classes of antithrombotic drugs?
Anticoagulants Thrombolytic agents Antiplatelet drugs
66
What are the two anticoagulants?
Warfarin | Heparin
67
What is Herparin's mechanism of action?
Activates antithrombin III, inhibiting thrombin and activated coag. factors IXa, Xa, XIa, and XIIa in the liver.
68
How is heparin absorbed?
IV or SQ NOT IM NOT absorbed orally
69
Is heparin absorbed orally?
No
70
Can heparin be given IM?
No
71
T/F: Heparin has a slow onset and short duration.
False. Heparin has a fast onset and short duration.
72
T/F: Heparin is rapidly metabolized in the liver.
True
73
T/F: Heparin does not cross the placenta and is not excreted in milk.
True.
74
What are 3 clinical uses of heparin?
Treatment of acute thromboembolism Anticoagulant in pregnant animals Anticoagulant in-vitro
75
T/F: Heparin has a wide safety margin.
False. Heparin has a short safety margin. So does Warfarin.
76
T/F: Heparin may cause allergic reaction.
True. However low molecular weight heparins (MWHs) are less antigenic.
77
What type of heparin is less antigenic?
Low molecular weight heparin (LMWHs)
78
How do you treat heparin toxicity?
Protamine sulfate, blood transfusion or fresh frozen plasma (FFP).
79
What are the pharmacokinetics of Warfarin?
Given orally. It's more lipid soluble, but not much better than heparin. Absorption is slow, but complete.
80
What must you be aware of when giving warfarin?
It CAN cross the placenta and cause fetal bleeding. It can also be excreted into the milk a little.
81
How long does Warfarin take to take effect?
A couple days, must first deplete the existing coag. factors. NOTE: This means you can treat warfarin poisoning preemptively.
82
T/F: Warfarin binds poorly to albumin.
False. Warfarin binds extensively (99%) to albumin giving it a longer half-life.
83
How long is the duration of action of warfarin?
2-5 days due to protein binding.
84
What are the two uses of warfarin?
Prevention in thromboembolic disease | Rodenticide
85
What must you be aware of with animals being treated with warfarin?
Protein binding is weak and so drug is easily displaced (eg. Phenylbutazone and horses).
86
Where is warfarin metabolized?
The liver
87
Does warfarin have a wide or narrow safety margin?
Narrow.
88
What are two toxic effects of warfarin?
Bleeding (this is number 1) and is also teratogenic (bone defects)
89
What is the specific antidote to warfarin toxicity?
Vitamin K1 Whole blood or fresh frozen plasma can be used in severe cases.
90
What 5 drugs increase response (displacement) of warfarin?
``` Phenylbutazone, salicylates Heparin Chloramphenicol Sulfonamides and broad-spectrum antibiotics Anabolic steroids ```
91
What 4 drugs are thrombolytic agents?
Streptokinase Urokinase Tissue plasminogen activator (tPA, alteplase) Anistreplase (APSAC)
92
What is the mechanism of action for thrombolytic agents?
Activate conversion of plasminogen to plasmin which causes fibrinolysis.
93
What must you be aware of with thrombolytic agents?
At low doses, they act on the clot. At high doses they can cause systemic bleeding.
94
What do you use thrombolytic agents to treat?
Acute thromboembolic disorders.
95
What toxic effects must you monitor for with thrombolytic treatment?
Narrow safety margin, must monitor hemodynamic and vital functions.
96
What do you treat thromboembolic toxicity with?
Aminocaproic acid
97
What drug is used as an antiplatelet drug?
Aspirin
98
What is Aspirin's mechanism of action?
Low doses inhibit synthesis of Thromboxane A2 by IRREVERSIBLY inhibiting cyclooxygenase (COX-1 and COX-2). Ultimately inhibiting platelet aggregation because TXA2 is the main proaggregant.
99
What is the clinical use of Aspirin?
Low doses used to prevent thrombotic disorders.
100
T/F: Large doses of Aspirin are more effective than low doses.
False. Low doses are more effective.
101
What other mechanisms of action are there with regards to antiplatelet drugs?
Inhibit phosphodiesterase and increase cAMP (Dipyridamole) | Block GPIIb/IIIa receptors (Abciximab)
102
What are two antiplatelet drugs?
Antithrombin = Lepirudin | Inhibition of ADP binding = Clopidogrel
103
How do you treat acute thromboembolism in cats?
Heparin, thrombolytic agents (Streptokinase) and vasodilators.
104
How do you prevent thromboembolism is cats?
Aspirin or Warfarin.

Pharmacology 2 (9 decks)

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