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Body Systems Pharmacology > Hemato > Flashcards

Hemato Flashcards

1
Q

P2Y12 receptor antagonist

A

Clopidogrel

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2
Q

Inhibition of which receptor ↓GP IIb/IIIa expression @Platlets

A

Clopidogrel

Irreversibly

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3
Q

Dual antiplatlet therapy

A

Clopidogrel + Aspirin

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4
Q

PPI + Clopidogrel

A

↓ conversion to active metabolite

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5
Q

Alternative antiagregant to Aspirin @cases of intolerance

A

Clopidogrel

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6
Q

Clinical use of monotherapy of Clopidogrel

A

Stroke

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7
Q

Contraindications Antiagregant use

A

Allergy
Active/recent bleeding <30days
Severe hypertension
Aortic dissection
Thrombocytopenia

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8
Q

Aspirin: onset & duration of therapeutic effect

A

minutes
7-10 days

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9
Q

Low dose of Aspirin

A

Antithrombotic (<300mg/day)

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10
Q

Intermediate dose of Aspirin

A

Antipyretic + Analgesic
300-2400 mg/day

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11
Q

High dose of Aspirin

A

Anti-inflammatory
2400-4000 mg/day

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12
Q

Most common adverse effect of Acetylsalicylc Acid

A

GI effect

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13
Q

Adverse effects of Aspirin

A

GI effect
Coagulopathy → ↑ bleeding time
Tinnitus
Renal @chronic use
Salicylate poisoning
Allergic runs

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14
Q

Antiaggregant contraindicated in febrile illness <19yo

A

Aspirin

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15
Q

Is contraindicated @Acute Gout attacks bc it competes with uric acid for renal excretion

A

Aspirin

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16
Q

____ is associates with Aspirin use for viral febrile illness @Px <19yo

A

Reye Syndrome

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17
Q

T or F: There is NO effect in the concomitant use of Aspirin + Alcohol

A

F
it ↑ bleeding time

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18
Q

Which NSAIDs ↓ Aspirins cardio protective function when used together

A

Ibuprofen
Naproxen

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19
Q

GpIIa/IIIa inhibitors

A

Abcximab
Tirofiban

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20
Q

Prevents platelets from binding to fibrinogen GpIIa/IIIa receptor and blocking them

A

Abcximab
Tirofiban

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21
Q

Antiaggregant used to prevent thrombotic complications @HIGH risk Px with unstable angina and/or NSTEMI (non-ST-segment elevation myocardial infraction)

A

Abcximab
Tirofiban

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22
Q

Adverse effects of GpIIb/IIIa inhibitors

A

Severe Thrombocytopenia

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23
Q

Monoclonal antibody with antiaggregant properties

A

Ancximab

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24
Q

Fibynolytics // Thrombolytics

A

Alteplase
Tenecteplasa
Streptokinase

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25
Q

Antiaggregants

A

Clopidogrel
Aspirin
Abcximab
Tirofiban

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26
Q

Fibrin specific agents (Fibrinolytics)

A

Alteplase
Tenecteplasa

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27
Q

Non fibrin specific agents

A

Streptokinase

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28
Q

Are recombinant variants of t-PA

A

Alteplase
Tenecteplasa

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29
Q

MOA of Fibrinolytics/Thrombolytics

A

Directly or Indirectly ↑ concentration of Plasmin → Cleavage of Thrombin and Fibrin

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30
Q

Which Fibrinolytic has HIGHER fibrin selectivity + Resistance to Plasminogen Activator inhibitors

A

Tenecteplasa

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31
Q

Greater Thrombolytic effect

A

Tenecteplasa

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32
Q

Thrombolytic that has NO effect in circulating plasminogen

A

Alteplase

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33
Q

First line tx for Pulmonary Embolism

A

Tenecteplase

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34
Q

Enzyme produced by group A Streptococci that catalyzes the conversion of Plasminogen to Plasmin

A

Streptokinase

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35
Q

Themolytic tha binds specifically to Plasminogen the is already bound to Fibrin

A

Alteplase

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36
Q

Fibrinolytic that affects both circulating and bound Plasminogen

A

Streptokinase

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37
Q

Thrombolytic indicated for Early STEMI (<12hrs)

A

Streptokinase

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38
Q

Adverse effect of Fibrinolytics

A

Bleeding
ex. Intracranial Hemorrhage

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39
Q

Intrcranial hemorrhage

A

Fibrinolytics

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40
Q

Thrombolytic who causes Hypersensitivity most commonly

A

Streptokinase
bc its antigenic

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41
Q

Thrombolytic related to endocarditis, and pericarditis as adverse effects

A

Tenectplasa

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42
Q

Tx of Adverse Effects of Fibrinolytics

A

Antifibrinolytics (Tranexami acid & Aminocaproic acid)
Fresh Frozen Plasma or Crypto-precipitate
Platelet transfusion

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43
Q

Prior intracranial hemorrhage is considered an ____ contraidication

A

Absolute

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44
Q

Clinical Use of Thrombolytics

A

Thrmbolysis @
Acute Ischemic Stroke
Pulmonary Embolism
Myocardial infraction

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45
Q

Known malignant intracranial neoplasm, _____ contraindication of Fibrinolytics

A

Absolute

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46
Q

Ischemis Stroke ≤3months ago, is an______ contraindication

A

Absolute

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47
Q

Suspected aortic dissection is an ______ contraindication of Fibrinolytics

A

Absolute

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48
Q

Uncontrolled hypertension is a ______ contraindication of Fibrinolytics

A

Relative

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49
Q

Recent (2-4 weeks) internal bleeding is a ______ contraindication of Fibrinolytics

A

Relative

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50
Q

Active bleeding is a ______ contraindication of Fibrinolytics

A

Absolute

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51
Q

Traumatic or Prolonged CPR or Major Surgery ≤3 months is ______ contraindication of Fibrinolytics

A

absolute

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52
Q

Pregnancy is a ______ contraindication of Fibrinolytics

A

Relative

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53
Q

Active Peptic Ulcer is ______ contraindication of Fibrinolytics

A

Relative

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54
Q

Current use of Warfarin + INR >1.7 is a ______ contraindication of Fibrinolytics

A

Relative

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55
Q

What is a relative contraindication unique to Streptokinase

A

Prior exposure (≥5 days ago) or Prior allergic reaction to Streptokinase

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56
Q

Thrombolytic that is resistant to inhibition by PAI-1 inhibitor of plasminogen activator

A

Tenectplase

57
Q

Vitamin K Antagonist

A

Warfarin
Acenocumarol

58
Q

Inhibits hepatic vit.K epoxide reductase

A

Warfarin
Acenocumarol

59
Q

Px takes warfarin starts presenting small wounds that cease to bleed spontaneously….. what do we do?

A

STOP warfarin

60
Q

Anticoagulant that can induce Skin Necrosis

A

Warfarin
After 3-10 days of tx with high doses

61
Q

Purple Toe Syndrome

A

Warfarin

62
Q

Anticoagulant that can cause abdominal cramps

A

Warfarin

63
Q

Warfarin induced Skin Necrosis Tx

A

STOP warfarin
administer IV Vitamin K, Protein C concentrate or FFP

64
Q

Prevention of skin induced necrosis by warfarin

A

temporary bridging anticoagulation with Heparin

65
Q

T or F: Protein C and S have a shorter life, and are depletes more quickly Annan procoagulants → vascular occlusion, tissue infraction, blood extravasation

A

T

66
Q

Contraindication for anticoagulants

A

Hepatic dysfunction ( due to impaired hepatic production of coagulation factors)

67
Q

Vit.K dependent Coagulation factors

A

2,7,9,10

68
Q

T or F: Warfarin + Other Anticoagulant to have better tx

A

F

69
Q

Contraindications Warfarin

A

Coagulopathies
Acute bleeding
Suspected vascular lesions ( hypertension, anuerism, endocarditis, GI bleeding, surgery, tendency to fall)
Severe renal insufficiency
Pregnancy
Concurrent admin of several anticoagulants

70
Q

Warfarin + Rifampicin

A

↓ Effect
due to CYP460 induction

71
Q

Warfarin + Food rich in Vit.K

A

↓ Effect

72
Q

Warfarin + PPIs

A

↓ effect
due to impaired uptake of warfarin

73
Q

Warfarin + Metronidazole

A

↑ Effect
due to CYP460 inhibition

74
Q

Warfarin + Acetaminophen

A

↑ Effect
bc interrupts bit.k cycle

75
Q

Warfarin + Sulfonamides

A

↑ Effect
completely blocks/displaces Warfarin at plasma protein binding sites

76
Q

Vit K. antagonists affect ____ coagulation pathway

A

Extrinsic
Warfarin Extrinsic Pathway PT = WEPT

77
Q

Mutation and polymorphisms @___ gene alter the effect of Vit.K antagonists

A

VKORC1

78
Q

Cerebral Embolism Anticogulant

A

Acenocumarol

79
Q

Prophylaxis of thromboembolism following knee or hip replacement

A

Warfarin

80
Q

Prophylaxis of thromboembolism following valvular atrial fibrillation

A

Warfarin

81
Q

Prophylaxis of thromboembolism following heart valve replacement

A

Warfarin

82
Q

Prophylaxis of thromboembolism following heart valve replacement

A

Warfarin

83
Q

Low molecular weight heparin

A

Nadroparin
Enoxaparin

84
Q

T or F: Heparin affects intrinsic pathway

A

F

85
Q

Admin of therapeutic and prophylaxis Heparin

A

t = IV
p = SC

86
Q

Preferred anticoagulant for px with renal insufficiency

A

Heparin

87
Q

Anticoagulant safe to use during pregnancy

A

Heparin
Nadroparin
Enoxaparin

88
Q

T or F: Low molecular weight heparin is indicated to use in px with renal insufficiency

A

F
due to its greater bioavailability compared to unfractioned heparin (high molecular heparin)

89
Q

Out of hospital tx for px with DVT or Pulmonary embolism

A

Low molecular weight hepain

90
Q

HIGH dose Heparin

A

immediate anticoagulation effect for:
atrial fibrillation
DVT
pulmonary embolism
acute coronary synd
myocardial infraction
unstable angina
mechanical heart valve replacement

91
Q

Anticoagulant of choice for surgery requiring cardiopulmonary bypass

A

Heparin

92
Q

Anticoagulant for Px with disseminated intravascular coagulation

A

Heparin

93
Q

Goal of Heparin

A

Prevent reformation and extension of thrombin and fibrin

94
Q

Antidote for Heparin

A

Protamine Sulfate

95
Q

Heparin induced Thrombocytopenia

A
  • usually if tx is >7 days
    - UFH > LMW
    - W > M
96
Q

Side effects of high and low weight heparin

A

Bleeding
Allergic reaction (IgG)
Heparin induced Thrombocytopenia
Osteoporosis
Hypoaldosenorism → Hyperkalemia

97
Q

Contraindication of Heparin

A

recent stroke
uncontrolled hypertension
active bleeding

98
Q

How is Heparin tx monitored

A

by measuring aPTT

99
Q

Nicotine/Tetracyclines + Heparin

A

Risk of bleeding complications

100
Q

Dextran + Heparin

A

risk of hemorrhage

101
Q

Heparin binds reversibly to …

A

Antithrombin III (ATIII)
causing its potentiation

102
Q

Heparin caused indirect inhibition of:

A

Factor Xa = ↓activation of prothrombin
Thrombin (Factor IIa) = ↑ thrombin inhibition
= ↓Fibrin

103
Q

Phytomenadione

A

Vitamin K

104
Q

Cofactor for y-carboxylation of glutamate residues @vit.K dependent proteins involved in coagulation and bone formation

A

Phytomenadione

105
Q

Postnatal injection of Vit.K

A

Phytomenadione
to prevent Vit.K deficiency in the New born (VKDB)

106
Q

T or F: IV admin of Phytomenadione carries major risk of anaphylactoid reactions

A

T

107
Q

Toxicity of Phytomenadione causes…

A

Oversupplementation of Vit.K
= hemolytic anemia, hyperbilirubinemia, jaundice, kernicterus

108
Q

T or F: IV admin of Phytomenadione must be given at a normal velocity rate

A

F, SLOWLY

109
Q

Indications of Phytomenadione

A

Postnatal Vit.K injection (prevent vit.K defieciency in the new born)
Coagulopathy (disorders of the EXTRINSIC pathway)
Reversal of Warfarin
Billiary obstruction

110
Q

Stimulates CFU-E units promoting erythropoiesis @BM

A

Erythropoyetin

111
Q

Anemia in AIDs px is induced by ______ and tx with

A

Zivudine
Erythropoyetin

112
Q

MOST common sude effect of Erythoproyetin

A

Hypertension aggravation
due to rapid rise of hematocrit

113
Q

Adverse Effect of Erytopoyetin

A

GI effect
Flu-like symptoms
Hypertension aggravation
Thromboembolism

114
Q

Contraindication of Erythropoyetin

A

uncontrolled Hypertension

115
Q

Growth factors used for Chronic Bone Marrow Failure

A

Methenolone

116
Q

Admin of Methenolone Acetate

A

Oral

117
Q

Admin of Methenolen Enathate

A

IM

118
Q

Antianemic that can cause masculinization

A

Methenolone

119
Q

Precursor of Vit.B

A

Hydroxocobalamin

120
Q

Tx for Vit.B12 deficiency

A

Hydroxocobalamin

121
Q

Megaloblastic anemia caused by folate deficiency

A

Folic Acids
CANNOT cure B12 deficiency

122
Q

which body store is bigger: Folic Acid or Vit.B12?

A

Vit.B12 (3-4 years)

123
Q

Most common cause of Macrocytic anemia

A

Folate deficiency
bc of low body stores (3 weeks-4 months)

124
Q

T or F: For Vit.B12 deficiency the admin of Folic Acid also helps in the tx

A

T

125
Q

Which deficiency accuses neurological symptoms

A

Vit.B12

126
Q

Prevention of neural tue defects

A

Folic acid
begin 1M before pregnancy

127
Q

Dietary defieicny of Vit.B12

A

strict vegetarian
gastrectomy

128
Q

Oral iron tharpy

A

Ferrous Sulfate

129
Q

Used when oral iron therapy fails

A

Iron Dextran

130
Q

Type of Iron the can be given to iron deficiency px and pregnant women, to create iron stores

A

Parenteral Iron
- Iron Dextran
- Ferric Fumarate

since oral route would take months to achieve it

131
Q

Tx of Choice for Iron deficiency

A

Ferrous Sulfate

132
Q

Parenteral Iron with less adverse effects

A

Ferric Saccrate

133
Q

Chronic use of Ferric Saccrate

A

Renal Tubulointestinal damage

134
Q

Contraindications of Iron Dextran

A

RA
Hypersensitivity

135
Q

Anticoagulants MOA

A

Prevent blood clots from forming
Interfere with coagulation factors, affecting secondary hemostasis

136
Q

Warfarin blocks _____ enzyme that inhibits Vit.K recycling

A

Vitamin K Epoxide Reductase

137
Q

Montoring of Heparin with

A

INR
Goal (1-3 INR)

138
Q

How is Heparin tx monitored?

A

aPTT (intrinsic pathway)
50-90 sec @Heparin
aprox 1.5-2.5x

Body Systems Pharmacology (6 decks)

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