Heart Failure, Diuretics, Hyperlipidemia, Allergy, Asthma, Anemia, Coagulation Flashcards
cardiac glycoside, inhibits Na/K ATPase, increases intracellular Ca, increasing cardiac contractility
digoxin
visual changes (yellow halos in vision)
digoxin
arrhythmogenesis in digoxin increased by
hypokalemia, hypomagnesemia, hypercalcemia
drugs with narrow therapeutic index
warfarin, aminoglycosides, lithium, ampho B, carbamazepine, phenobarbital, phenytoin, vanco, theophylline, digoxin (WALA na Cyang PaPa! VasTeD na!)
DOC antiarrhythmic drug in digitalis toxicity
lidocaine
digoxin antibodies
Fab fragments; Digibind
first line therapy for both systolic and diastolic failure
furosemide
aldosterone antagonist
eplerenone
first-line drugs for chronic heart failure, decrease ventricular remodeling (cardioprotective)
ARBs/ACEIs
reduce progression of CHRONIC heart failure, may be detrimental if systolic dysfunction is marked in acute failure
Carvedilol, Labetalol, Metoprolol
iminarone, milrinone
phosphodiesterase inhibitor
associated with increased morbidity and mortality in chronic heart failure
phosphodiesterase inhibitor
vasodilators for acute severe failure with congestion
nitroprusside or nitroglycerin
shown to reduce mortality in African-Americans with CHF
hydralazine, ISDN
class of drugs w/o value in CHF
CCB
improved survival in cases of heart failure
ACEIs, beta-blockers, aldosterone antagonists (ABA buhay ka pa!)
prolonged QT interval, polymorphic Vtach
Torsades de Pointes
anti-arrhythmics class 1; phase
sodium channel blockers; phase 0
anti-arrhythmics class 2; phase
beta-adrenoceptor blockers; phase 4
anti-arrhythmics class 3; phase
potassium channel blockers, phase 3
anti-arrhythmics class 4
calcium channel blockers
more selective anti-arrhythmic drug group (specific) with significant effects on ISCHEMIC tissue but negligible effects on NORMAL cells
group 1B
selectively depress tissue that are frequently depolarizing
use dependent anti-arrhythmic
selectively depress tissue that are relatively depolarized during rest
state dependent anti-arrhythmic
anti-arrhythmic which cuts across all classes, most efficacious, for refractory arrhythmia, causes microcrystalline deposits in cornea and skin, thyroid dysfunction, paresthesia, tremors, pulmonary fibrosis
amiodarone/ dronedarone
class 1a antiarrhythmic. lupus-like syndrome
procainamide
class 1a antiarrhythmic. marked antimuscarinic effects (atropine toxicity symptoms)
disopyramide
class 1a antiarrhythmic also used in malaria; but may cause torsades, cinchonism (headache, vertigo, tinnitus), autoimmune reactions (ITP), GI upset, reduced clearance of digoxin
quinidine
treatment of class 1A overdose: reverses drug-induced arrhythmias
sodium lactate
treatment of class 1A overdose: reverses drug-induced arrhythmias
pressor sympathomimetics
class 1b antiarrhythmic DOC for post MI ventricular arrhythmias, digoxin-induced arrhythmias; SE: CNS stimulation, agranulocytosis
lidocaine, mexiletine, phenytoin, tocainamide causes agranulocytosis
mnemonic for class 1a antiarrhythmics
I am the queen who proclaimed diso’s pyramids (quinidine, procainamide, disopyramide)
mnemonic for class 1b antiarrhythmics
I buy mexican tacos from lily (mexiletene, tocainide, lidocaine)
mnemonic for drugs that can cause agranulocytosis
agranulocytosis! CCCAPPIT (clozapine, cotri, colchicine, aminopyrine, phenylbutazone, PTU, indomethacin, tocainide)
class of antiarrhythmics that can be proarrhythmic, used as last resort for refractory arrhythmias
class 1c antiarrhythmics
class 1c antiarrhythmic, highest risk for Torsades, contraindicated for post MI arrhythmias
flecainide, propafenone, encainide, moricizine
mnemonic for class 1c antiarrhythmics
chicken ay pagkain for enrico mmm(propafenone, flecainamide, encainide, moricizine)
antiarrhythmic of choice for WPW
procainamide, amiodarone
antiarrhythmic of choice for acute ventricular arrhythmias, esp. post-MI, atrial arrhythmia due to digitalis
class 1b antiarrhythmic
nonselective B-blockers
propranolol, timolol
B1-selective B-blockers
Bet ko mag-ace sa ateneo si Esme (betaxolol, acebutolol, atenolol, esmolol, metoprolol)
B blockers with intrinsic sympathomimetic activity (partial agonist)
pindolol, acebutolol
B blocker lacking local anes effect, can be used for glaucoma
timolol, betaxolol
B blocker with low lipid solubility
atenolol
shortest and longest acting B blocker
esmolol, nadolol
B blocker with combined a and b blockade
carvedilol, labetalol
B blocker used for pheochromocytoma
labetalol
in CHF, this class 2 antiarrhythmic reduces progression and decreases incidence of potentially fatal arrhythmias
propranolol
B blocker for SVT, acute perioperative and thyrotoxic arrhythmias
esmolol
B blocker anti-arrhythmic with Class 3 properties
sotalol
anti-arrhythmic class with highest propensity to cause Torsades, prolongs AP duration increasing QT interval
Class 3
class 3 antiarrhythmic examples
AIDS (amiodarone, ibutilide, dofetilide, dronedarone, sotalol)
ECG morphology in class 4 antiarrhythmics
prolonged PR interval
type of CCB which are proarrhythmic; evokes compensatory sympathetic discharge
dihydropyridine CCBs
examples of class 4 antiarrhythmics; MC side effect
verapamil, diltiazem; flushing
miscellaneous antiarrhyhtmic; DOC for paroxysmal supraventricular tachycardia; SE: flushing, affects K channels prolonging hyperpolarization, reduces Ca channels
adenosine
ions with depressant effects on digitalis-induced arrhythmias
K, Mg (can be effective in Torsades)
carbonic anhydrase inhibitor acts on _____; example
PCT; acetazolamide, dorzolamide, brinzolamide, dichlorophenamide, methazolamide
uses of acetazolamide
diuretic, glaucoma, mountain sickness
NAGMA mnemonic
HARDUP (hyperalimentation, acetazolamide, RTA, diarrhea, ureteral diversion, pancreatic fistula)
loop diuretic toxicities mnemonic
OH DANG (ototoxicity-with aminoglycosides, hypoK, dehydration, allergy to sulfa, nephritis, gout-hyperuricemia)
____ decrease the efficacy of loop diuretics by inhibiting ______
NSAIDs (also decrease effect of thiazides), prostaglandins
Loop diuretics act on _____ at the ____; examples
Na-K-2Cl transporter; TAL, furosemide, bumetanide, torsemide, ethacrynic acid
thiazides act on___ transporter at the ____; examples
Na-Cl carrier; DCT; HCTZ, (padapain, itali, lasunin) indapamide, chlorthalidone,metolazone
Thiazide diuretic effects
HyperGLUC (gylcemia, lipidemia, uricemia, calcemia)
thiazides act on___ transporter at the ____; examples
Na-Cl carrier; DCT; HCTZ, (padapain, itali, lasunin) indapamide, chlorthalidone,metolazone
Thiazide diuretic effects
HyperGLUC (gylcemia, lipidemia, uricemia, calcemia)
primary site of acidification of urine; last site of Na reabsorption and K secretion
cortical collecting duct
use of spironolactone
hyperaldosteronism (Conn’s syndrome), hypertension, heart failure, hypokalemia
SE of spironolactone
gynecomastia, hyperchloremic metabolic acidosis, BPH
advantages of spironolactone (specifically eplerenone)
reduces progression of DM nephropathy, reduces mortality post-MI
mnemonic for K-sparing diuretics
The K STAEs with K-sparing diuretics (spironolactone, triamterene, amiloride, eplerenone)
drugs causing gynecomastia
Some drugs create awesome knockers (spironolactone, digoxin, cimetidine, alcohol, ketoconazole)
SE of amiloride
kidney stones, acute renal failure (with indomethacin)
mannitol is used for
rhabdomyolysis, hemolysis, inc ICP, acute glaucoma
osmotic diuretics
mannitol, glycerin, isosorbide, urea
ADH agonists act on ___ receptors at the _______;example
V1 and V2 ADH receptors; medullary collecting duct, ADH, desmopressin
ADH, desmopressin used for
central DI, nocturnal enuresis, hemophilia, von Willebrand’s dse
ADH antagonists act on ___ receptors at the _______;example
V1a and V2 ADH receptors; medullary collecting duct, conivaptan, tolvaptan, lixivaptan, demeclocycline, lithium
Conivaptan is used for
SIADH, hyponatremia
Conivaptan may cause
nephrogenic DI, renal failure, bone and teeth abnormalities
short acting benzodiazepines w/mnemonic
bro, try mo etox! (brotizolam, triazolam, midazolam, etizolam, oxazepam)
benzodiazepines cause ____ amnesia and ____ sedation
anterograde; unwanted daytime sedation
midazolam causes rebound _____
insomnia/anxiety
benzodiazepines increase the ____ of chloride channel opening while barbiturates incease the ______; which has more dependence liability?
frequency, duration; barbiturates
part of brain responsible for anterograde amnesia; retrograde
hippocampus (HATER), thalamus
intermediate acting benzodiazepines w/mnemonic
si ACE NaTaLo (alprazolam, clonazepam, estazolam, nitrazepam, lormetazepam, lorazepam, temazepam)
abnormal sleep pattern from benzodiazepine use?
decreased REM sleep
long-acting benzodiazepines
diazepam, quazepam, chlorazepate, chlordiazepoxide, flurazepam, flunitrazepam
special use of long-acting benzodiazepines
alcohol withdrawal
benzodiazepine used as a date-rape drug
flunitrazepam
benzodiazepines w/ longest half-life
chlordiazepoxide (longest spelling)
date-rape drugs
alcohol, flunitrazepam, gamma hydroxybutyrate
DOC for status epilepticus
lorazepam, diazepam
benzodiazepine also used for bipolar disorder
clonazepam
toxic dose of benzodiazepines; treatment
1000x therapeutic dose; flumazenil
with flumazenil, ____ and ____ may occur when administered in Pts who take both TCAs and benzodiazepines
seizures and arrhythmia
ultrashort acting barbiturates
may taya tayo (methohexital, thiamylal, thiopental)
thiopental
ultrashort acting (tayo agad!), acute intermittent porphyria, used for inc ICP
cyp450 inducers mnemonic
ethel booba takes phen-phen and refuses greasy carb shakes (ethanol, barbiturates, phenytoin, rifampicin, griseofulvin, carbamazepine, st. john’s wort/ smoking)
short and intermediate-acting barbiturates
pentobarbital (and all other barbitals except pheno and mephobarbital)
long-acting barbiturates
phenobarbital, mephobarbital, primidone
special use of long-acting barbiturates
hyperbilirubinemias (Gilbert syndrome)
enzyme deficient in acute intermittent porphyria
hmb synthase (porphobilinogen deaminase)
acts like benzodiazepine, used for sleep disorders only, effects reversed with___
zolpidem; flumazenil
partial agonist of 5-HT1a receptors and possibly D2 receptors used for generalized anxiety disorder
buspirone
enzyme used to metabolize low to moderate doses of ethanol
alcohol dehydrogenase
enzyme used to metabolize ethanol at blood levels higher than 100mg/dl
microsomal ethanol oxidizing system
blood alcohol concentration causing sedation, “high”, slow reaction times
50-100mg/dL
blood alcohol concentration causing impairment of drivinig ability
60-80mg/dL
blood alcohol concentration causing emesis, stupor
200-300mg/dL
blood alcohol concentration causing coma
300-400mg/dL
MC neurologic abnormality in chronic alcoholics
peripheral neuropathy
syndrome characterized by ataxia, confusion, paralysis of EOM; dreaded emergency of alcohol intoxication
Wernicke-Korsakoff syndrome (Weird ACO- ataxia, confusion, ophthalmoplegia; Korsakoff- confabulation, hallucination, amnesia)
Wernicke-Korsakoff syndrome: vitamin deficiency, CT scan findings
thamine; hemorrhagic necrosis of mamillary bodies
most catastrophic symptom of sedative-hypnotic withdrawal
rebound suicide
alcohol increases incidence of _____ cardiomyopathy; doxorubicin increases incidence of _____
reversible dilated; irreversible dilated
level of alcohol consumption increasing HDL levels
10-15 mg/dL
mental retardation, growth deficiencies, microcephaly, midfacial underdevelopment associated with heavy consumption of alcohol during T1 of pregnancy
fetal alcohol syndrome
microorganism associated with alcohol-induced infection
Klebsiella pneumoniae (currant jelly sputum)
HAD-48
delirium tremens (hallucinations, autonomic instability, delirium, 48-72 hours postdiscontinuation of alcohol)
scale used to monitor patients who are possibly having alcohol withdrawal
CIWA- Clinical institute withdrawal for alcohol
benzodiazepine with less complex metabolism for pts with compromised liver function exhibiting alcohol withdrawal
lorazepam
opioid receptor antagonist used for tx of alcoholism
naltrexone
NMDA receptor antagonist used for tx of alcoholism
acamprosate
these inhibit aldehyde dehydrogenase causing hang-over like sx
disulfiram, (Clara took the Pre-Medical Test in the PM) chlorpropamide, cefoperazone, cefomandaole, cefotetan, procarbazine, metronidazole)
distinct manifestation of methanol toxicity
visual dysfunction
electrolyte disturbance of methanol toxicity
acidosis (due to accumulation of formaldehyde and formic acid)
tx of methanol poisoning
ethanol, fomepizole (inhibitor of alcohol dehydrogenase)
manifestation of ethylene glycol toxicity
HAGMA (due to accumulation of oxalic acid), renal damage
tx of ethylene glycol poisoning
ethanol, fomepizole
hyper___ is associated with a high incidence of acute pancreatitis
chylomicronemia
MOA of statins
inhibit hepatic cholesterol synthesis by reversible competitive inhibition of Hmg-Coa reductase; liver compensates by increasing LDL receptors; plaque stabilization
notable SE of statins; especially when used with ____
myopathy, rhabdomyolysis; fibrates
MOA of resins
bind bile acids and prevent intestinal absorption, hepatic cholesterol is used to synthesize new bile acids, compensatory increase in LDL receptors
resin example; mnemonic
ang cholet, colet, colet mo! BAR this from people with high TGs! (cholestyramine, colesevalam, colestipol)
lipid-lowering drugs with GI SE
cholestyramine (BAR), sitosterol (sterol absorption blocker)
given at bedtime because cholesterol synthesis predominantly occurs at night
statins
notable SE of cholestyramine
GI sx, increases TG and VLDL
MOA of ezetimibe
cholesterol absorption blockers, inhibit NPC1L1 transporter in jejunal enterocyte which mediates cholesterol and phytosterol uptake, compensatory increase in LDL receptors
lipid lowering agent combination with synergistic LDL lowering effect but with increased hepatotoxicity.
statin + ezetimibe
MOA of sitosterol
cholesterol analog which decreases intestinal absorption of cholesterol
MOA of niacin
inhibits hormone sensitive lipase, reduces VLDL synthesis, increases clearance of VLDL by lipoprotein lipase, reduces catabolism of HDL, decreases fibrogen, increases tPA
most effective agent for increasing HDL
niacin
MC SE of niacin; reduced by
flushing; aspirin intake
lipid lowering agent which must be avoided in Pts with PUD; potentiates effects of antihypertensives (vasodilators, ganglion blockers)
niacin
drugs that cause flushing
(VANC) Vancomycin, adenocine, niacin, CCB
MOA of fibrates
ligand for PPAR-alpha protein–>inc synthesis of lipoprotein lipase, stimulate fatty acid oxidation, decrease expression of apo-CIII–>impeding clearance of VLDL and increasing apo A1 and A2 which increases HDL
DOC for hypertriglyceridemia/ high VLDL
fibrates
SE of gemfibrozil
cholesterol gallstone, nausea, rashes, leukopenia, hemoconcentration
best synergistic combination for hypercholesterolemia
statin + niacin (or ezetimibe but increased hepatotoxicity)
combination of lipid lowering agents which increases risk of cholelithiasis
fibrates + resin
endogenous molecules with powerful pharmacologic effects that do not fall into traditional autonomic groups
autacoids
histamine is from what amino acid?
histidine
enzymes metabolizing histamine
monoamine and diamine oxidase
excess production of histamine detected by
imidazole acetic acid in urine
classic demonstration of histamine effect
triple respones: wheal, flush, flare
first generation H1 receptor antagonist examples
MINE and ZINE (diphenhydramine, chlorpheniramine, cyclizine, meclizine, promethazine)
MOA of promethazine
competitive inhibition of peripheral and central H1 receptors+ alpha and M receptor, with anti-motion sickness effect
SE of cyclizine
drowsiness
2nd generation H1 receptor antagonist examples
cetirizine, loratadine, fexofenadine, desloratidine, terfenadine, astemizole
MOA of astemizole
competitive inhibition of peripheral H1 receptors; no anti-motion sickness effect
H2 receptor antagonist examples
ranitidine, famotidine, cimetidine, nizatidine
serotonin is produced from aa
tryptophan (5-hydroxytryptamine)
excess serotonin production is detected by ____ which is also a marker for
5-hydroxyindole acetic acid (5-HIAA); carcinoid tumor in GI tract
MOA of sumtriptan; DOC for
5-HT ID receptor agonist (brain), causes vasoconstriction; acute migraine, cluster headache
MOA of granisetron; DOC for
5-HT3 antagonist, blocks chemoreceptor trigger zone and enteric nervous system; chemo and postop vomiting
DOC for irritable bowel disease which may cause constipation
alosetron
5-HT3 antagonist wihich may cause QRS and QT prolongation
dolasetron
produced from a fungus in wet or spoiled grain, partial agonists at alpha-adrenoceptors and 5-HT receptors
ergot alkaloids
classification of ergot alkaloids with examples
vasoselective (ergotamine), uteroselective (ergonovine)
MOA of ergotamine
partial agonist of 5-HT and alpha adrenoceptors causing marked smooth muscle contraction but blocks alpha agonist vasoconstriction, used for migraine and cluster headache (vasoselective)
classification of methysergide; side effect
ergot alkaloids (vasoselective), retroperitoneal fibrosis
antidote of ergotamine
nitroprusside
MOA of ergonovine
partial agonist of 5-HT and alpha adrenoceptors causing marked smooth muscle contraction but blocks alpha agonist vasoconstriction, used for migraine and cluster headache (uteroselective)
partial agonist of 5-HT and alpha adrenoceptors used for postpartum bleeding, migraine
ergonovine, methylergonovine (methergine)
cyclooxygenase isoform found in normal physiologic processes
cox-1
cyclooxygenase isoform found in inflammatory cells
cox-2
endogenous fatty acid derivatives that are produced from arachidonic acid
eicosanoids
prostaglandin E1 analogue used for PUD, prevention of NSAID-induced gastric mucosal injury and abortifacient
misoprostol/gemeprost
SE of misoprostol
teratogenic (moebius sequence)
prostaglandin E1 analogue used for maintenance of PDA, erectile dysfunction; notable SE
alprostadil; priapism
prostaglandin E1 analogue used for maintenance of PDA, erectile dysfunction; notable SE
alprostadil; priapism
prostaglandin E2 analogue used induction of labor(cervical ripening) and abortifacient
dinoprostone/sulprostone
prostaglandin I2 analogue used for pulmonary HPN, reduced plt aggregation in dialysis
epoprostenol, beraptost, iloprost, treprostinil
prostaglandin F2A analogue used for glaucoma, causes permanent eye color change
latanoprost, bimatoprost, ravoprost, unoprostone
prostaglandin F2A analogue used for control of postpartum hemorrhage, abortifacient
carboprost, bimatoprost, ravoprost, unoprostone
prostaglandin F2A analogue used for glaucoma, causes permanent eye color change
latanoprost, bimatoprost, ravoprost, unoprostone
major risk factor of asthma
atopy
DOC for acute asthma attacks
SABA (Albuterol, salbutamol, levabuterol, terbutaline, metaprotenerol, pirbuterol, procaterol, fenoterol)
Seretide
Salmeterol+Fluticasone
Symbicort
Budesonide+Formoterol
for asthma prophylaxis which increases asthma mortality when used alone; may precipitate arrhythmias
LABA (Formoterol, Salmeterol, Cleneterol Bambuterol)
Ipatropium/Tiatropium MOA
muscarinic receptor antagonist preventing vagal-stimulated bronchoconstriction
more effective and less toxic for patients with COPD
Iatropium
drip used in status asthmaticus
aminophylline drip
MOA of theophylline/aminophylline/ pentoxifylline; use; SE
methylxantine; phosphodiesterase inhibition, adenosine receptor antagonist; prophylaxis against nocturnal attackes; may cause tremors, seizure, narrow therapeutic window
antidote in overdosage of B blockers
theophylline
MOA of cromolyn;use; similar drugs
mast cell stabilizer;causes ca influx, release of leukotrienes, histamine, and other mediators; asthma prophylaxis (not for acute control); nedocromil, lodoxamide
DOC for BA prophylaxis
ICS (fluticasone, beclomethasone, budesonide, ciclesonide, flunisolide, mometasone, triamcinolone)
MOA of mometasone; SE
corticosteroid, inhibitase phospholipase A2; oral candidiasis, mild growth retardation
can be used for severe refractory asthma (status asthmaticus)
IV hydrocortisone
ICS with lowest systemic steroid toxicity
Ciclesonide
MOA of zileuton; unique indication; SE
leukotriene synthesis inhibitor (specifically 5-lipoxygenase); BA prophylaxis, exercise, antigen and ASA-induced bronchospasm; elevation of liver enzymes
MOA of montelukast, unique indication, rare SE
leukotriene synthesis inhibitor (specifically cysteinyl leukotriene-1 receptor for SRSA, antigen and ASA-induced bronchospasm; Churg-strauss syndrome, neuropsych effects
MOA of omalizumab
anti-IgE antibody, binds IgE antibodies on mast cells; prophylaxis of severe, refractory asthma not responsive to other drugs
oral iron supplement with lowest elemental iron (36mg)
ferrous gluconate
oral iron supplement with highest elemental iron (106mg)
ferrous fumarate
triad of hemochromatosis; aka; tx
cirrhosis, DM, skin pigmentation; bronze diabetes; phlebotomy, deferoxamine or deferasirox
cause of megaloblastic anemia with neurologic defects; w/o neurologic defects
vitamin B12 deficiency; folic acid deficiency
neurologic defects of Vit B12 deficiency
ataxic gait, impaired position and vibratory sense, spasticity
reactions where vit B12 is essential
methylmalonyl CoA to succinyl CoA; homocysteine to methionine; folic acid metabolism, synthesis of deoxythmidylate (dTMP), a precursor for DNA synthesis
administration of ____ to patients with vit B12 deficiency helps refill tetrahydrofolate pool and corrects anemia but not neurologic defects
folic acid
vit B12 synthesis
cyanocobalamin, hydroxocobalamin
MOA of folic acid; similar drugs
precursor of essential donor of methyl groups used for synthesis of aa, purines and DNA
agonist of erythropoietin receptors; SE; associated with blood doping
epoietin alfa, darbepoietin alfa, methoxypolyethylene glycol-epoietin beta
myeloid growth factor; indication; SE
G-CSF, sargramostim (GM-CSF), Pegfilgrastim; neutropenia associated w/chemo, myelodysplasia, aplastic anemia, mobilization of peripheral blood cells for hematopoietic stem cell transplantation; bone pain
megakaryocyte growth factor; indication; SE
oprelvekin (IL-11) or thrombopoietin; prevention of thrombocytopenia in pts under chemo for nonmyeloid cancer; fluid accumulation, transient atrial arrhythmias
local autocoid factors responsible for vasoconstriction
TXA2, endothelin
causes platelet aggregation
adenosine diphosphate, serotonin (also causes vasoconstriction)
net result of coagulation pathways
prothrombin activator
arterial vs venous thrombosis
red and platelet rich; fibrin-rich
MOA of ASA; toxic dose, lethal dose, SE (regarding aerobic metab), associated syndrome
nonselective, irreversible cox1 and 2 inhibitor, reduces platelet production of TXA2; 150mg/kg; 500mg/kg; uncoupler of oxidative phosphorylation; Reye syndrome
indication for ASA in pedia
RF, Kawasaki dse, JRA
triad of aspirin hypersensitivity
SAMTER triad (asthma, aspirin sensitivity, nasal polyps)
salicylate intoxication acid-base abnormality in children; adults
HAGMA; respi alkalosis with HAGMA (lactic acidosis due to anaerobic metab)
MOA of abciximab; similar drugs; similar to this congenital deficiency
interferes with gpIIB/IIIa binding to fibrinogen; eptifibatide, tirofiban; Glanzmann’s thrombastenia
MOA of clopidogrel; similar drugs; SE
irreversibly inhibits binding of ADP to platelet receptors; ticlopidine, prasugel; TTP (more with ticlopidine)
inhibits phosphodiesterase III and inc cAMP in plt and BVs, used for prophylaxis in cardiac valve displacement; similar drug used for intermittent claudication (but contraindicated in heart failure)
dipyridamole; cilostazol
heparin is a (direct/indirect) thrombin inhibitor; activates ______, which complexes with Factors _____; most popular SE; monitor using; antidote
indirect; antithrombin III; IIa, IXa and Xa; heparin-induced thrombocytopenia; PTT; protamine
enoxaparin is a (direct/indirect) thrombin inhibitor; activates ______, which complexes with Factor _____; monitoring; antidote
indirect; antithrombin III; Xa; does NOT require PTT monitoring; protamine only partially effective
derived from saliva of medicinal leech
lepirudin
MOA of lepirudin; indication; monitoring; antidote
direct thrombin inhibitorl; binds to thrombin’s active site; HIT; PTT; no reversal agent
Warfarin is a (direct/indirect) thrombin inhibitor; activates ______; most popular SE; CI; monitor using; antidote
direct; vitamin K epoxide reductase (responsible for carboxylation of vit K dependent clotting factors [1972, protein C and S]); warfarin induced skin necrosis; pregnancy; PT; vit K (slow), FFP (fast)
MOA of alteplase, special note, allergy observed with ____, antidote
fibrinolytic, tPA analog; loses effectiveness on 2nd use; streptokinase; aminocaproic acid
MOA of aminocaproic acid; similar drug; CI (2)
competetive inhibitor of plasminogen activator; tranexamic acid; DIC and GU bleeding
names of vit K1, 2, 3; CI; among these, which must never be used as tx due to ineffectiveness?
phytonadione, menaquinone, menadione; severe infusion reaction when administered too fast (dyspnea, chest and back pain); vit K2
MOA of desmopressin
vasopressin V2 agonist; increases
FVIII activity for Hemophilia A, vW disease