hem-onc pharm

Question 1

(3) ways blood can dysfunction

Answer 1

1. thrombosis
2. bleeding
3. anemia

Question 2

Thromboxane A2 is:

Answer 2

It is produced by activated platelets and has prothrombotic properties: it stimulates activation of new platelets as well as increases platelet aggregation

Question 3

at point of loose and TEMPORARY plug forms platelets bind to ________ and release (2) which activate other pltatelts in vicinty

Answer 3

collagen,

1. thromboxane A2
2. ADP

Question 4

activated thrombin further activates (2)

Answer 4

1. platelets
2. proteins ZCS
3. fibrin

Question 5

dissolution of the clot is performed by

Answer 5

plasmin

Question 6

________ ________ leading to activation of the extrinsic path is increased in atherosclerotic plaques

Answer 6

Tissue factor (present in subendothelial tissue and on activaed monocytes–binds to factor VII 7!)

Question 7

body most reliant on _________ coag pathway

Answer 7

extrinsic

Question 8

the extrinsic pathway requires _______ addition to blood

Answer 8

extrinsic (tissue factor + VIIa)

Question 9

factor XIII 13 important for

Answer 9

crosslinking of fibrin

Question 10

plasminogen ———–> plasmin (cofactor)

Answer 10

t-PA (therapeutically-break down existing clot)

Question 11

protein C also a _____________, (in addition to a

Answer 11

cytoprotectant–protects surrounding cells from apoptosing

Question 12

Warfarin inhibits synth of proteins ___ and ____

Answer 12

C and S – leading to necrosis!!!

Question 13

Tx: (look at pics)
arterial thrombosis w/:
venous thrombosis:

Answer 13

• antiplatelet

- anticlot

Question 14

both arterialand venous thrombosis grow toward

Answer 14

heart

Question 15

IRREVERSIBLE COX 1&2 inhibitor

Answer 15

aspirin (Bayer)

Question 16

RBC singaling of COX-1 –> synthesis of

Answer 16

TXA2 (thromboxane)

Question 17

pt’s who can’t take aspirin for CV Dz should use (2)

Answer 17

1. clopidogrel or

2. ticlopidine

Question 18

after stent placement _______ used synergistically w/ _______

Answer 18

1. aspirin

2. clopidogrel – Plavix

Question 19

Aspirin ADRs (7) common vs. concerning

Answer 19

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

Question 20

ADP receptor inhibitors aka + example agent

Answer 20

theinopyridines,

clopidogrel

Question 21

IRREVERSIBLE ANTAGONIST of P2Y12 receptor on platelet

Answer 21

clopidogrel–plavix (blocks platelet activation)

Question 22

as adjunct to, or used when aspirin cannot be tollerated

Answer 22

clopidogrel–Plavix

Question 23

STEMI

Answer 23

ST elevation MI (most fatal type of MI) Tx w/ antiplatelet

Question 24

same MOA as clopidogrel, greater efficacy and faster onset + ^er risk of bleed

Answer 24

PrasuGREL

Question 25

Clopidogrel is a ________, so must pass through liver for activation–problems w/ CYP450 inhibitors (PPIs, statins)

Answer 25

PRODRUG

Question 26

Glycoprotein IIb/IIIa antagonists (3) – last step in platelet aggregation (stops aggregation) –very aggresive

Answer 26

1. eptifibatide
2. abciximab
3. tirofiban

Question 27

warfarin has a ______ _______, so can use ______ during interim. ___ days to return to normal clotting>

Answer 27

delayed onset (8-12 hours),
heparin,
4 days

Question 28

Indication for Anti-coagulation (5)

Answer 28

1. Atrial fibrillation
2. ppl w/ low ejection fraction
3. pulmonary emolu
4. DVT
5. Hypercoag states
   - lupus, pt C or S deficiency, Anti thrombin III deficiency, Factor V Leiden

Question 29

biggest ADR w/ warfarin–Coumadin

Answer 29

Bleeding (PT/ INR to monitor)

Question 30

If bleeding caused by warfarin grows risky

Answer 30

1. hold warfain
2. give Vit K (reversal agent for warfarin)
   severe
3. supplement prothrombin, FFP, factor VIIa

Question 31

“blue-toe”/tissue necrotic ADR of warfarin due to:

prevent by:

Answer 31

• cytoprotectant ability of protein C (worse in pt’s w/ low ptC)
• Heparin bridge

Question 32

Drugs that DON’T interact w/ warfarin (5)

Answer 32

1. alcohol
2. phenothiazines
3. benzos
4. acetaminophen
5. opiodes

Question 33

types of heparin (2)

Answer 33

1. ungractionated heparin –

2. Low molecular weight haperin LMWH

Question 34

Unfractionated heparin MOA

Answer 34

Helps ANTITHROMBIN by binding to and potentiating its actions

Question 35

LMWHs MOA

Answer 35

PREFERENTIALLY helps antithrombin and inhibits factor 10a

Question 36

heparins will prevent a clot but aren’t active against _, so they won’t _

Answer 36

fibrin-bound thrombin,

break down clots

Question 37

black box for hypercoagulation w/ D/C

Answer 37

Rivaroxaban

Question 38

fibrinolytics aka

examples (2)

Answer 38

• thrombolytics
  1. streptokinase
  2. tPA derivatives (alteplase, reteplase, tenecteplase)

Question 39

desmopressin is ADH–treats

Answer 39

1. hemophilia A

2. vDF Dz