Drugs for Week 5 and 6 Flashcards
Unfractioned Heparin: MOA + lab monitoring
- binds to antithrombin to increase it’s activity in inactivating factors II, IX, X, XI, and XII.
- Monitor PTT
Unfractioned Heparin + LMWH: Adverse Effect
- MOA of Adverse effect
Heparin Induced Thrombocytopenia: Decrease platelet count due to autoantibodies (IgG) to Platelet factor 4
LMWH: Specific name of drug + Difference with Heparin
Enoxaparin, inactivates Xa but less effective against thrombin itself.
- Usually no lab monitoring required.
Protamine MOA + Therapeutic Use.
Heparin/LMWH Reversal
- Note: When administered alone = anticoagulant effect
- Best Adjustment = tincture of time (don’t necessarily need protamine to reverse, just wait)
Direct Thrombin Inhibitor(s) = drug names + Therapeutic Use
Bilivarudin + Argatroban
- Used as an alternative anticoagulatnt for HIT patients.
Indirect Xa inhibitor = drug name + therapeutic use
Fondaparinux
- Used as an alternative anticoagulant for HIT patients
Treatment approach to DVT or PE
Warfarin + Anticoagulant (Enoxaparin or Fondaparinux, etc.) in the beginning, then take off Enoxaprin or Fondaparinux (heparin alternatives) when INR > 2.
Drug used for Immune Thrombocytopenia
IV Immune Globulin
IV IgG: Block Box Warning
- Acute Renal Failure due to high sucrose content
- Allergic reaction in individuals with IgA deficiency
Desmopressin
- Therapeutic Use
Increases serum levels of vWF and Clotting Factor VIII
- Note: Does not work for Hem B, do not increase Factor VIII high enough is bleeding episodes are severe.
Desmopressin
- Adverse effects
Risk of decreasing serum osmolarity (due to hyponatremia) with adverse CNS reactions
First line treatment for Hemophilia A and B
Recombinant DNA clotting factor products = doesn’t have risk of transmission of infectious disease compared to plasma derived products
Factor Replacement Therapy: Management + cornerstone of home-based treatment
- Comprehensive Hemophilia center
- self-infusion technique
Advantages of prophylactic treatment for Hemophilia A and B.
- Eliminate bleeding episodes + prevent join deterioration: Especially if started early in life. q
Hemophilia A and B: Factor doses are weight based. What are the recommended treatment goals (target %)
- Minor bleeding = 25-30%
- Severe bleeding = > 50%
- Surgical Procedure or Life Threatening = 75% to 100%
Best administrated strategy for Factor VIII and IX
Prophylactic treatment
Common presenting symptom of Hemophilias + treatment
Mucosal bleeding (nose and mouth) - antifibrinolytic agents (esp aminocaproic acid and tranexamic acid)
Alkylating agent: Specific drug name
Cyclophosphamide
Cyclophosphamide: MOA
Cross-linking of DNA via alkylation of N7 guanine, which leads to eventual DNA strand breakage.
Cyclophosamide: Main Adverse effect
Hemorrhagic Cystitis
Cyclophosamide: pharmacokinetics + Therapeutic Use
- Bioactivation by the liver
- Therapeutic Use: Solid Tumors, leukemia, lymphomas
Chemoprotectant of cyclophosphamide: Specific drug name
Mesna
Mesna: MOA + Therapeutic Use
- Binds to toxic metabolite of cyclophosphamide, protecting bladder
- Used as Adjuvant w/ alkylating agents
G2 phase specific: Drug name
Bleomycin
Bleomycin: MOA + Therapeutic Use
- Induce Free radicals to break DNA strands
- Used in Hodgkin and Non-Hodgkin Lymphoma
Bleomycin: Adverse Effects
Pulmonary Fibrosis and Minimal Myelosuppression (does this mean that it’s not really seen?)
S Phase specific: Drug Name
Methotrexate
Methotrexate: MOA + Therapeutic Use
- Competitively inhibits DFHR (Dihydrofolate reductase)
- ALL and Lymphomas
Methotrexate: Adverse Effect
Myelosuppression
Rescue drug for Methotrexate toxicity
Leucovorin
Leucovorin: Drug interaction
Enhance therapeutic and toxic effects of 5-FU (5-fluorouracil)
Mitosis (M) Phase Specific: Drug Name
Vinicristine
Vinicristine: MOA + Therapeutic Use
- Inhibits tubulin polymerization, which disrupts assembly of microtubules = inhibits mitotic spindle formation
- Versatile: Solid Tumors, Leukemias, Hodgkin’s and Non-Hodgkin’s Lymphoma
Vinicristine: Adverse Effects
Peripheral Neuropathy (Main), myelosuppression, Nausea and Vomiting
Drug(s) used for Hodgkin’s and Non Hodgkin’s Lymphoma
Vinicristine (Mitosis (M) phase specific) and Bleomycin (G2 phase specific)
