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Hematology > Episode 6-Blood DRUGS! > Flashcards

Episode 6-Blood DRUGS! Flashcards

1
Q

What are the for main classes of hemostasis that we will discuss in this deck?

A

1.Anti-coagulants 2. Thrombolytics/Fibrinolytics 3.Anti-Platelets 4.Anti-fibrinoytics

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2
Q

___________ are substances that prevent the synthesis of a fibrin network which inhibits coagulation and the formation of thrombi.

A

Anticoagulants

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3
Q

___________ are substances that promote the destruction of already formed blood clots or thrombi (i.e. – lyse thrombi) by disrupting the fibrin mesh

A

Thrombolytics/Fibrinolytics

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4
Q

___________ are drugs that reduce the adhesion and aggregation of platelets

A

Antiplatelets

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5
Q

___________ are drugs that promote the formation of clots and prevent excessive bleeding

A

Antifibrinolytics

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6
Q

____________ all inhibit the action or formation of one or more of the clotting factors.

A

Anticoagulants

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7
Q

Anticoagulants create an immediate defect (______ when given IV, ______ when given orally) in the clotting mechanism and should be treated with caution.

A

minutes….hours

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8
Q

What are the 4 categories of AntiCoagulants? (2 old, 2 new)

A

1.Indirect Thrombin Inhibitors (heparin)2.Coumarin Anticoagulants (warfarin) 3.Direct Thrombin Inhibitors 4.Direct Factor X Inhibitors

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9
Q

What are the two types of Heparin?

A

Unfractionated heparin (UFH)-c.1916 and Low-molecular-weight heparin-1990s

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10
Q

Heparin stimulates _________, which in turn, neutralizes the activity of factor __ (and other clotting factors as we’ll).

A

antithrombin- III…X

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11
Q

Heparin ALSO stimulates ____________, which inhibits thrombin.

A

heparin cofactor II

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12
Q

Unfractionated Heparin (UFH) is not absorbed if given _____. It is typically given _____.

A

orally…I.V.(bolus or infusion)

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13
Q

UFH also binds to _________ & _________ which further adds to its variability.

A

endothelial cells…..macrophages

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14
Q

Since the anti-coagulant response to UFH varies among patients, it is standard practice to adjust the dose of UFH and monitor its clinical effectiveness with the __________.

A

activated partial thromboplastin time (APTT)

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15
Q

Review from episode 5: What is the target APTT increase for treatment?

A

2-2.5 times the normal 25-36 seconds..about 1 min

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16
Q

What are the blood drugs that do not require blood monitoring?

A
  1. Low molecular weight Heparin 2. Oral Da-big-a-tran (DTI)
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17
Q

What is the unique way to administer Low Molecular Weight Heparin?

A

SubCutaneously with a needle

18
Q

The only major coumarin anticoagulant in the USA is _______.

A

warfarin (Coumadin)

19
Q

As a side note, warfarin is the main active ingredient in many _________.

A

rodent poisons

20
Q

How does Warfarin work?

A

Stops Liver synthesis of the Vitamin K dependent factors!!! (II, VII, IX, X)

21
Q

What are the 6 times you would treat with Warfarin?

A

1.Venous Thrombosis 2. Pulmonary Embolism 3.Post-M.I. 4.Post-Op 5.Prosth Heart Valves 6.Atrial Fib

22
Q

The therapeutic range for oral anticoagulation therapy (Warfarin) is defined in terms of the _________.

A

INR

23
Q

For most patients, therapeutic levels of warfarin should be adjusted to achieve an INR of _____.

A

2.0-3.0

24
Q

BOOM!!! What are the 4 common drugs and 4 antibiotics that INHIBIT wardarin metalolism? (can lead to SPONTANEOUS BLEEDING)

A

Commoners: 1.Cim-et-idine(heartburn) 2.Ace-ta-min-o-ohen 3.High dose, acute EtOH 4.Synthetic Thyroid Hormones Antibiotics: 1.Az-ithro-mycin 2.Cipro-flox-acin 3.Clar-ithro-mycin 4.Erythro-mycin

25
Q

What are the three drug interactions that can discount warfarin and therefore lead to clotting?

A

1.CHRONIC EtOH abuse 2.Phen-y-to-in(anti-epileptic) 3.Oral Contraceptives

26
Q

What dietary items can inhibit the effect of warfarin?

A

Green, leafy veggies rich in Vitamin K!! Just keep a CONSISTENT intake..

27
Q

In fact, warfarin overdoses are typically treated with ______ and _______.

A

vitamin K….transfusion

28
Q

________ is the most common side effect of warfarin and occurs most often from the mucous membranes of the ___________ and the _________.

A

Bleeding….gastrointestinal tract…..genitourinary tract

29
Q

Warfarin is contraindicated during pregnancy (category X) because it __________ and is ________. In the same theme, _________ should also be avoided during warfarin therapy.

A

crosses the placenta…..teratogenic…..Breast feeding

30
Q

The first oral direct thrombin inhibitor came to market in 2010 is _________.

A

Da-big-a-tran

31
Q

What is the unique class of hemostatic drugs that was first released in August 2011?

A

Direct Factor X Inhibitors!

32
Q

_________ rapidly lyse thrombi when administered intravenously by catalyzing the formation of ______ from ________.

A

Thrombolytics…..plasmin…..plasminogen

33
Q

What are the 3 examples of Thrombolytics?

A

1.StreptoKinase 2.Uro-kinase 3.Synthetic tPA (was $10K/dose!!!!)

34
Q

What are the 3 indications for the use of Thrombolytics? When should these drugs be administered?

A

1.Acute M.I. 2.Ischemic Stroke 3.Pulmonary Embolism…Within 3 hours!!

35
Q

What are the 3 classes of Anti-Platelet agents?

A

1.Cyclo-oxygen-ase (COX) Inhibitors (Aspirin) 2.Thi-eno-pyridines (ADP inhibitors) 3.GPIIb/IIIa Inhibitors (newest of the new)

36
Q

The synthesis of which platelet substance is inhibited by the COX inhibitor Aspirin?

A

TXA2

37
Q

What is the main Thi-eno-pyradine (ADP inhibitor)?

A

Clo-pid-o-grel (“Clow-ped-i-grill”)

38
Q

What is the main GP IIb/IIIa Inhibitor? How are they administered?

A

AB-cix-imab (“Ab-sicks-i-mab”)…Administered with IV and initial bolus THEN constant infusion.

39
Q

INTERESTING: What is the only drug we talked about that PROMOTES clotting?! (Reminds me of ANP and blood pressure!)

A

Antifibrinolytics

40
Q

The antifibrinolytic _________ inhibits the activation of ________ to ______.

A

Tran-ex-am-ic Acid….plasminogen….plasmin

41
Q

__________ is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time!!

A

Tran-ex-am-ic acid

42
Q

What are the Clot PROMOTERS? (4 endogenous, 2 exogenous)

A

Endogenous: 1.P.A.I. 1 2.P.A.I. 2 3.Alpha2-antiplasmin 4.alpha2-macroglobulin Exogenous: 1.Trans-ex-amic Acid 2.Amino-Cep-Ro-ic Acid

Hematology (8 decks)

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