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Pharmacology 2 > Drugs Acting on the Blood > Flashcards

Drugs Acting on the Blood Flashcards

0
Q

Name 4 categories of anemia.

A
  • Microcytic
  • Normocytic
  • Macrocytic
  • Hemolytic
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1
Q

Name 4 categories of drugs that act on the blood.

A
  • Anti-anemic drugs
  • Colony stimulating factors
  • Drugs affecting homeostasis
  • Treatment of thromboembolism in cats
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2
Q

Name 3 causes of microcytic anemia.

A
  • Iron deficiency
  • Anemia of chronic disease
  • Sideroblastic anemia
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3
Q

Name 3 causes of normocytic anemia.

A
  • Anemia of chronic disease
  • Endocrine anemia
  • Bone marrow failure
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4
Q

Name 3 causes of macrocytic anemia.

A
  • Vitamin B12 deficiency
  • Folic acid deficiency
  • Myelodysplastic syndrome
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5
Q

Name 7 causes of hemolytic anemia.

A
  • Hemoglobinopathies
  • Autoimmune
  • Membrane disorder
  • Drug-induced
  • Metabolic abnormalities
  • Glucose-6-phosphate dehydrogenase deficiency
  • Infections
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6
Q

T/F: All anemias are treated the same.

A

False - treatment depends on type of anemia.

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7
Q

What can be seen with microcytic anemia?

A

Hypochromic anemia

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8
Q

What are two possible treatments for microcytic (hypochromic) anemia?

A
  • Iron preparations

- Copper preparations

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9
Q

Iron deficiencies are common in what 2 species?

A

Dogs and pigs

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10
Q

What is a potential complication of giving iron parenterally?

A

Formation of iron carbohydrate complexes.

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11
Q

What are 3 examples of oral iron preparations?

A
  • ferrous chloride
  • ferrous phosphate
  • ferrous sulfate
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12
Q

Which form of iron administration is less irritating, parental or oral?

A

Oral, parental is more likely to be astringent.

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13
Q

What is copper important for in relation to iron?

A

Copper is important for the absorption of iron.

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14
Q

T/F: Copper preparations can’t be given IV.

A

True

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15
Q

How is copper sulfate administered?

A

Orally

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16
Q

How is copper glycinate administered?

A

SC or IM

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17
Q

How does the body control its iron levels?

A

By controlling iron intake.

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18
Q

T/F: Too much iron in the body can cause shock.

A

True

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19
Q

How is iron dextran administered?

A

Parenterally

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20
Q

What is another name for macrocytic anemia?

A

Megaloblastic anemia

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21
Q

Name a treatment for macrocytic anemia and the species it is used in.

A

Cobalt in ruminants

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22
Q

What 3 things can be used to treat patients with anemia due to chronic renal failure or bone marrow suppression?

A
  • Erythropoeitin
  • Iron
  • Anabolic steroids
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23
Q

How is erythropoeitin administered?

A

Parenterally

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24
Q

What are 2 treatment options for immune-mediated hemolytic anemia?

A
  • Supportive therapy

- Blood transfusion

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25
Q

What are some examples of anti-anemic drugs that act as immunosuppressives?

A
  • Glucocorticoids (prednisone, prednisolone)
  • Cytotoxic drugs (azathioprine, cyclophosphamide)
  • Danazol
  • Cyclosporin A
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26
Q

What other category of drugs are colony stimulating factors used with?

A

Anti-cancer drugs

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27
Q

What does Filgrastim contain?

A

Granulocyte colony stimulating factor (G-CSF)

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28
Q

What does Sargramostim contain?

A

Granulocyte-macrophage colony stimulating factor (GM-CSF)

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29
Q

How are Filgrastim and Sargramostim administered?

A

Parenterally

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30
Q

Which only affects neutrophils, G-CSF or GM-CSF?

A

G-CSF

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31
Q

At therapeutic doses, Filgrastim stimulates the progenitor of which cells?

A

Neutrophils only

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32
Q

Sargramostim stimulates the growth and development of which cells?

A

Neutrophils, eosinophils, basophils, erythrocytes, macrophages

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33
Q

What is the clinical use of colony stimulating factors?

A

Anticancer chemotherapy-induced neutropenia

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34
Q

What are 2 adverse effects of colony stimulating factors?

A
  • Bone pain

- Sargramostim also causes fever and cardiopulmonary toxicity

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35
Q

What are 2 drugs that affect hemostasis?

A

Hemostatics, antithrombotic drugs

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36
Q

What is the pathway of hemostatic mechanisms?

A
  • Vascular injury
  • Contraction of the injured vessel
  • Primary hemostasis (platelet plug)
  • Secondary hemostasis (protein plug)
  • Fibrinolysis
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37
Q

What is expressed by the underlying collagen of damaged endothelial cells that attracts platelets?

A

von Willibrand factor

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38
Q

What are 2 types of hemostatics that affect homeostasis?

A
  • Local hemostatics

- Systemic hemostatics

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39
Q

What do local hemostatics treat?

A

External bleeding

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40
Q

What do systemic hemostatics treat?

A

Internal bleeding

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41
Q

What is another name for local hemostatics?

A

Styptics

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42
Q

What are 4 examples of types of local hemostatics?

A
  • Vasoconstrictors
  • Astringents
  • Surgical
  • Physiological
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43
Q

What is an example of a local hemostatic vasoconstrictor?

A

Epinephrine

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44
Q

What are 2 examples of astringent local hemostatics?

A
  • Tannic acid

- Ferric chloride

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45
Q

What are 3 examples of surgical local hemostatics?

A
  • Oxidized cellulose
  • Gelatin sponge
  • Collagen
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46
Q

What are 4 examples of physiological local hemostatics?

A
  • Thromboplastin
  • Thrombin
  • Fibrinogen
  • Fibrin
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47
Q

Can you use physiological local hemostatics for systemic bleeding?
Why?

A
  • No

- May cause an embolism

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48
Q

What is an example of a local anesthetic that can be added to local hemostatics?

A

Benzocaine

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49
Q

What are 5 examples of types of systemic hemostatics?

A
  • Clotting factors
  • Vitamin K
  • Protamine sulfate
  • Aminocaproic acid
  • Desmopressin
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50
Q

What is another name for Desmopressin?

A

DDAVP

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51
Q

What are 2 sources of clotting factors for systemic hemostatics?

A
  • Blood transfusion

- Fresh frozen plasma (FFP)

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52
Q

What are 3 classifications of Vitamin K?

A
  • Vitamin K1 (phytonadione)
  • Vitamin K2 (menaquinone)
  • Vitamin K3 (menadione)
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53
Q

What is another name for Vitamin K1?

A

Phytonadione

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54
Q

What is the source for Vitamin K1?

A

From plant origin.

55
Q

What is another name for Vitamin K2?

A

Menaquinone

56
Q

What is the source for Vitamin K2?

A

Formed by bacteria in the GI tract.

57
Q

T/F: If intestinal flora is inhibited, this can lead to a tendency to bleed.

A

True

58
Q

What is another name for Vitamin K3?

A

Menadione

59
Q

How is Vitamin K3 produced?

A

Synthetically

60
Q

What species can you not use Vitamin K3 in?

Why?

A
  • Horses

- Can cause renal failure/damage.

61
Q

Which of the 3 Vitamin Ks are available for clinical use?

A

Vitamin K1 and vitamin K3

62
Q

What is the mechanism of action for Vitamin K?

A

Stimulates formation of prothrombin (factor II) and factors VII, IX and X in the liver.

63
Q

How is Vitamin K administered?

A

Orally or parenterally

64
Q

Which form of administration of Vitamin K may cause hypersensitivity?

A

IV

65
Q

What are 4 clinical uses of Vitamin K?

A
  • As an antidote for warfarin poisoning.
  • Treatment of spoiled sweet clover (Melilotus spp.) poisoning in cattle.
  • Treatment of Vitamin K deficiency (rare).
  • Combined with local hemostatics for treatment of epistaxis in dogs and horses.
66
Q

What is Warfarin?

A

A rodenticide

67
Q

How long does Warfarin take to produce an effect?

Why?

A
  • About a day.

- Does not affect the current cascades.

68
Q

What can be done for immediate treatment of Warfarin poisoning?

A

Transfusion

69
Q

What 2 conditions may lead to Vitamin K deficiency?

A
  • Liver disease

- Long term treatment with antimicrobials

70
Q

What is protamine sulfate used for?

A

A specific antidote for heparin.

71
Q

What is protamine sulfate?

What is its action an example of?

A
  • A strongly basic drug that binds with acidic heparin to form a salt.
  • Chemical antagonism
72
Q

How is protamine sulfate administered?

A

Slowly IV

73
Q

Can protamine sulfate be given as an overdose?

Why?

A
  • No

- It has anticoagulant effect, will cause bleeding.

74
Q

What is the mechanism of action for Aminocaproic acid?

A

Inhibits conversion of plasminogen to plasmin.

75
Q

What are 3 clinical uses for aminocaproic acid?

A
  • Treatment of hemorrhage due to hyperfibrinolysis.
  • Antagonism of the fibrinolytic actions of thrombolytic agents.
  • Treatment of degenerative myelopathy in German Shepherds by anti-protease activity.
76
Q

What is the mechanism of action for Desmopressin (DDAVP)?

A
  • Increases von Willibrand’s factor levels for about 2 hours in dogs by causing releasee from endothelial cells and macrophages.
  • VWF is important for adherence of platelets to an injured vessel and to platelet aggregation in addition to stabilizing factor VIII.
77
Q

What is the most common inherited bleeding disorder in dogs?

A

von Willibrand disease

78
Q

What are 3 clinical uses for Desmopressin (DDAVP)?

A
  • Controlling bleeding in dogs with von Willibrand disease.
  • During surgery in dogs with von Willibrand disease.
  • In blood donor dogs with von Willibrand disease.
79
Q

What are 3 categories of antithrombotic drugs?

A
  • Anticoagulants
  • Thrombolytic agents
  • Antiplatelet drugs
80
Q

Thrombosis is most common in what species?

A

Cats

81
Q

What are 2 examples of anticoagulants?

A
  • Heparin

- Warfarin (coumarin)

82
Q

Does heparin have a very short or very long half life?

A

Very short half life.

83
Q

What is the mechanism of action for heparin?

A
  • Has anticoagulant effect.
  • Activates antithrombin III (ATIII) resulting in inhibition of thrombin (IIa) and activated coagulation factors IXa, Xa, XIa and XIIa in the liver.
84
Q

Is heparin a weak or strong acid?

A

Strong acid

85
Q

How is heparin administered?

How should it not be given?

A
  • IV

- IM or orally

86
Q

T/F: Heparin has a slow onset of action and long duration.

A

False - it has a fast onset of action and a short duration.

87
Q

How is heparin metabolized?

A

Rapidly in the liver.

88
Q

T/F: Heparin does not cross the placenta and is not excreted in milk.

A

True

89
Q

What are 3 clinical uses of heparin?

A
  • Treatment of acute thromboembolism.
  • The anticoagulant of choice during pregnancy.
  • Also used as anticoagulant in-vitro.
90
Q

Can heparin be used post-natal?

A

Yes, since it does not cross into the milk.

91
Q

What is the most commonly used in-vitro anticoagulant?

A

Heparin

92
Q

How big of a safety margin does Heparin have?

A

Narrow safety margin.

93
Q

T/F: All anticoagulants have a narrow safety margin.

A

True

94
Q

What is the main toxic effect of heparin?

A

Bleeding

95
Q

Can heparin cause an allergic hypersensitivity?

A

Yes

96
Q

What are 3 ways to treat heparin toxicity?

A
  • Protamine sulfate
  • Blood transfusion
  • Fresh frozen plasma (FFP)
97
Q

What is the mechanism of action for warfarin?

A
  • Inhibits vitamin K epoxide reductase.
  • Depletion of reduced vitamin K.
  • Inhibition of activation of the precursors of factors II, VII, IX, X.
98
Q

How long does it usually take for bleeding due to warfarin to start?
Why?

A
  • About 2 days.

- That’s when the first of the coagulation factors start to disappear.

99
Q

Can you treat warfarin before clinical signs appear?

A

Yes

100
Q

How is warfarin administered?

How is it absorbed?

A
  • Orally

- Slow but completely

101
Q

Does warfarin have a high bioavailability?

A

Yes

102
Q

Does warfarin cross the placenta?

Does it cross into milk?

A
  • Yes

- Yes

103
Q

Does warfarin bind to albumin?

A
  • Yes 99%
104
Q

What is the duration of action for warfarin?

A

2-3 days or more.

105
Q

T/F: Warfarin is not easily displaced from plasma proteins by other drugs.

A

False - it is easily displaced.

106
Q

Is warfarin metabolized by the liver?

A

Yes

107
Q

What are 2 clinical uses of warfarin?

A
  • Prevention in thromboembolic disease (long term use)

- Rodenticide

108
Q

Does warfarin have a wide or narrow safety margin?

A

Narrow

109
Q

What is the most important toxic effect of warfarin?

A

Bleeding

110
Q

Is Warfarin teratogenic?

A

Yes

111
Q

What is a specific antidote for warfarin?

A

Vitamin K1

112
Q

What 2 things can also be used to treat severe warfarin toxicity?

A
  • Whole blood

- Fresh frozen plasma (FFP)

113
Q

What are 5 examples of drugs that increase warfarin’s response?

A
  • Phenylbutazone/salicylates
  • Heparin
  • Chloramphenicol
  • Sulfonamides/broad-spectrum antibiotics
  • Anabolic steroids
114
Q

How do drugs that increase the response of warfarin do so?

A

By displacing it from plasma proteins.

115
Q

What is an example of drugs that decrease warfarin’s response?

A

Enzyme inducers (ex- phenobarbital)

116
Q

What are 4 examples of thrombolytic agents?

A
  • Streptokinase
  • Urokinase
  • Tissue plasminogen activator (tPA) - alteplase
  • Anistreplase
117
Q

What activate the conversion of plasminogen to plasmin?

A

Thrombolytic agents

118
Q

What causes fibrinolysis?

A

Plasmin

119
Q

Which thrombolytic agent, at therapeutic doses, binds specifically to plasminogen bound to fibrin (clot-specific)?

A

Alteplase (tPA)

120
Q

What is the clinical use for thrombolytic agents?

A

Acute thromboembolic disorders

121
Q

Do thrombolytic agents have a narrow or wide safety margin?

A

Narrow

122
Q

What 2 things must be monitored during the initial 48 hours of thrombolytic therapy?

A
  • Hemodynamic functions

- Vital functions

123
Q

What are 2 side effects that can be seen with the use of thrombolytic agents?

A
  • Bleeding

- Allergy

124
Q

What is an antagonist to thrombolytic agents?

A

Aminocaproic acid

125
Q

In low doses, aspirin inhibits what?

A

Synthesis of thromboxane A2 by irreversibly inhibiting cyclooxygenase.

126
Q

What is the main proaggregant?

A

Thromboxane A2 (TXA2)

127
Q

What does the mechanism of action of aspirin result in?

A

Inhibition of platelet aggregation.

128
Q

What are low doses of aspirin clinically used for?

A

Prevention of thrombotic disorders.

129
Q

What is more effective, a low dose of aspirin or a large dose?

A

A low dose.

130
Q

What is an Antiplatelet drug that inhibits phosphodiesterase and increases cAMP?

A

Dipyridamole

131
Q

What is an antiplatelet drug that blocks GPIIb/IIIa receptors?

A

Abciximab

132
Q

What is an antiplatelet drug that is antithrombin and binds to thrombin?

A

Lepirudin

133
Q

What is an antiplatelet drug that inhibits ADP binding?
What species is it given to?
Not given to?

A
  • Clopidogrel
  • Cats
  • Dogs
134
Q

What are 3 agents that can be used in the treatment of acute thromboembolism in cats?

A
  • Heparin
  • Thrombolytic agents (Streptokinase)
  • Vasodilators

Pharmacology 2 (10 decks)

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