hem-onc pharm Flashcards
(3) ways blood can dysfunction
- thrombosis
- bleeding
- anemia
Thromboxane A2 is:
It is produced by activated platelets and has prothrombotic properties: it stimulates activation of new platelets as well as increases platelet aggregation
at point of loose and TEMPORARY plug forms platelets bind to ________ and release (2) which activate other pltatelts in vicinty
collagen,
- thromboxane A2
- ADP
activated thrombin further activates (2)
- platelets
- proteins ZCS
- fibrin
dissolution of the clot is performed by
plasmin
________ ________ leading to activation of the extrinsic path is increased in atherosclerotic plaques
Tissue factor (present in subendothelial tissue and on activaed monocytes–binds to factor VII 7!)
body most reliant on _________ coag pathway
extrinsic
the extrinsic pathway requires _______ addition to blood
extrinsic (tissue factor + VIIa)
factor XIII 13 important for
crosslinking of fibrin
plasminogen ———–> plasmin (cofactor)
t-PA (therapeutically-break down existing clot)
protein C also a _____________, (in addition to a
cytoprotectant–protects surrounding cells from apoptosing
Warfarin inhibits synth of proteins ___ and ____
C and S – leading to necrosis!!!
Tx: (look at pics)
arterial thrombosis w/:
venous thrombosis:
- antiplatelet
- anticlot
both arterialand venous thrombosis grow toward
heart
IRREVERSIBLE COX 1&2 inhibitor
aspirin (Bayer)
RBC singaling of COX-1 –> synthesis of
TXA2 (thromboxane)
pt’s who can’t take aspirin for CV Dz should use (2)
- clopidogrel or
2. ticlopidine
after stent placement _______ used synergistically w/ _______
- aspirin
2. clopidogrel – Plavix
Aspirin ADRs (7) common vs. concerning
Common 1. GI bleeding, ulcer, dyspepsia 2. Asthma exacerbation (triad) 3. tinnitus 4. occult bleeding Concerning: 5. thrombocytopenia <150K *6. Reye syndrome (live vaccines) 7. AKI
ADP receptor inhibitors aka + example agent
theinopyridines,
clopidogrel
IRREVERSIBLE ANTAGONIST of P2Y12 receptor on platelet
clopidogrel–plavix (blocks platelet activation)
as adjunct to, or used when aspirin cannot be tollerated
clopidogrel–Plavix
STEMI
ST elevation MI (most fatal type of MI) Tx w/ antiplatelet
same MOA as clopidogrel, greater efficacy and faster onset + ^er risk of bleed
PrasuGREL
Clopidogrel is a ________, so must pass through liver for activation–problems w/ CYP450 inhibitors (PPIs, statins)
PRODRUG
Glycoprotein IIb/IIIa antagonists (3) – last step in platelet aggregation (stops aggregation) –very aggresive
- eptifibatide
- abciximab
- tirofiban
warfarin has a ______ _______, so can use ______ during interim. ___ days to return to normal clotting>
delayed onset (8-12 hours),
heparin,
4 days
Indication for Anti-coagulation (5)
- Atrial fibrillation
- ppl w/ low ejection fraction
- pulmonary emolu
- DVT
- Hypercoag states
- lupus, pt C or S deficiency, Anti thrombin III deficiency, Factor V Leiden
biggest ADR w/ warfarin–Coumadin
Bleeding (PT/ INR to monitor)
If bleeding caused by warfarin grows risky
- hold warfain
- give Vit K (reversal agent for warfarin)
severe - supplement prothrombin, FFP, factor VIIa
“blue-toe”/tissue necrotic ADR of warfarin due to:
prevent by:
- cytoprotectant ability of protein C (worse in pt’s w/ low ptC)
- Heparin bridge
Drugs that DON’T interact w/ warfarin (5)
- alcohol
- phenothiazines
- benzos
- acetaminophen
- opiodes
types of heparin (2)
- ungractionated heparin –
2. Low molecular weight haperin LMWH
Unfractionated heparin MOA
Helps ANTITHROMBIN by binding to and potentiating its actions
LMWHs MOA
PREFERENTIALLY helps antithrombin and inhibits factor 10a
heparins will prevent a clot but aren’t active against _, so they won’t _
fibrin-bound thrombin,
break down clots
black box for hypercoagulation w/ D/C
Rivaroxaban
fibrinolytics aka
examples (2)
- thrombolytics
1. streptokinase
2. tPA derivatives (alteplase, reteplase, tenecteplase)
desmopressin is ADH–treats
- hemophilia A
2. vDF Dz
