Hemato Flashcards
P2Y12 receptor antagonist
Clopidogrel
Inhibition of which receptor ↓GP IIb/IIIa expression @Platlets
Clopidogrel
Irreversibly
Dual antiplatlet therapy
Clopidogrel + Aspirin
PPI + Clopidogrel
↓ conversion to active metabolite
Alternative antiagregant to Aspirin @cases of intolerance
Clopidogrel
Clinical use of monotherapy of Clopidogrel
Stroke
Contraindications Antiagregant use
Allergy
Active/recent bleeding <30days
Severe hypertension
Aortic dissection
Thrombocytopenia
Aspirin: onset & duration of therapeutic effect
minutes
7-10 days
Low dose of Aspirin
Antithrombotic (<300mg/day)
Intermediate dose of Aspirin
Antipyretic + Analgesic
300-2400 mg/day
High dose of Aspirin
Anti-inflammatory
2400-4000 mg/day
Most common adverse effect of Acetylsalicylc Acid
GI effect
Adverse effects of Aspirin
GI effect
Coagulopathy → ↑ bleeding time
Tinnitus
Renal @chronic use
Salicylate poisoning
Allergic runs
Antiaggregant contraindicated in febrile illness <19yo
Aspirin
Is contraindicated @Acute Gout attacks bc it competes with uric acid for renal excretion
Aspirin
____ is associates with Aspirin use for viral febrile illness @Px <19yo
Reye Syndrome
T or F: There is NO effect in the concomitant use of Aspirin + Alcohol
F
it ↑ bleeding time
Which NSAIDs ↓ Aspirins cardio protective function when used together
Ibuprofen
Naproxen
GpIIa/IIIa inhibitors
Abcximab
Tirofiban
Prevents platelets from binding to fibrinogen GpIIa/IIIa receptor and blocking them
Abcximab
Tirofiban
Antiaggregant used to prevent thrombotic complications @HIGH risk Px with unstable angina and/or NSTEMI (non-ST-segment elevation myocardial infraction)
Abcximab
Tirofiban
Adverse effects of GpIIb/IIIa inhibitors
Severe Thrombocytopenia
Monoclonal antibody with antiaggregant properties
Ancximab
Fibynolytics // Thrombolytics
Alteplase
Tenecteplasa
Streptokinase
Antiaggregants
Clopidogrel
Aspirin
Abcximab
Tirofiban
Fibrin specific agents (Fibrinolytics)
Alteplase
Tenecteplasa
Non fibrin specific agents
Streptokinase
Are recombinant variants of t-PA
Alteplase
Tenecteplasa
MOA of Fibrinolytics/Thrombolytics
Directly or Indirectly ↑ concentration of Plasmin → Cleavage of Thrombin and Fibrin
Which Fibrinolytic has HIGHER fibrin selectivity + Resistance to Plasminogen Activator inhibitors
Tenecteplasa
Greater Thrombolytic effect
Tenecteplasa
Thrombolytic that has NO effect in circulating plasminogen
Alteplase
First line tx for Pulmonary Embolism
Tenecteplase
Enzyme produced by group A Streptococci that catalyzes the conversion of Plasminogen to Plasmin
Streptokinase
Themolytic tha binds specifically to Plasminogen the is already bound to Fibrin
Alteplase
Fibrinolytic that affects both circulating and bound Plasminogen
Streptokinase
Thrombolytic indicated for Early STEMI (<12hrs)
Streptokinase
Adverse effect of Fibrinolytics
Bleeding
ex. Intracranial Hemorrhage
Intrcranial hemorrhage
Fibrinolytics
Thrombolytic who causes Hypersensitivity most commonly
Streptokinase
bc its antigenic
Thrombolytic related to endocarditis, and pericarditis as adverse effects
Tenectplasa
Tx of Adverse Effects of Fibrinolytics
Antifibrinolytics (Tranexami acid & Aminocaproic acid)
Fresh Frozen Plasma or Crypto-precipitate
Platelet transfusion
Prior intracranial hemorrhage is considered an ____ contraidication
Absolute
Clinical Use of Thrombolytics
Thrmbolysis @
Acute Ischemic Stroke
Pulmonary Embolism
Myocardial infraction
Known malignant intracranial neoplasm, _____ contraindication of Fibrinolytics
Absolute
Ischemis Stroke ≤3months ago, is an______ contraindication
Absolute
Suspected aortic dissection is an ______ contraindication of Fibrinolytics
Absolute
Uncontrolled hypertension is a ______ contraindication of Fibrinolytics
Relative
Recent (2-4 weeks) internal bleeding is a ______ contraindication of Fibrinolytics
Relative
Active bleeding is a ______ contraindication of Fibrinolytics
Absolute
Traumatic or Prolonged CPR or Major Surgery ≤3 months is ______ contraindication of Fibrinolytics
absolute
Pregnancy is a ______ contraindication of Fibrinolytics
Relative
Active Peptic Ulcer is ______ contraindication of Fibrinolytics
Relative
Current use of Warfarin + INR >1.7 is a ______ contraindication of Fibrinolytics
Relative
What is a relative contraindication unique to Streptokinase
Prior exposure (≥5 days ago) or Prior allergic reaction to Streptokinase
Thrombolytic that is resistant to inhibition by PAI-1 inhibitor of plasminogen activator
Tenectplase
Vitamin K Antagonist
Warfarin
Acenocumarol
Inhibits hepatic vit.K epoxide reductase
Warfarin
Acenocumarol
Px takes warfarin starts presenting small wounds that cease to bleed spontaneously….. what do we do?
STOP warfarin
Anticoagulant that can induce Skin Necrosis
Warfarin
After 3-10 days of tx with high doses
Purple Toe Syndrome
Warfarin
Anticoagulant that can cause abdominal cramps
Warfarin
Warfarin induced Skin Necrosis Tx
STOP warfarin
administer IV Vitamin K, Protein C concentrate or FFP
Prevention of skin induced necrosis by warfarin
temporary bridging anticoagulation with Heparin
T or F: Protein C and S have a shorter life, and are depletes more quickly Annan procoagulants → vascular occlusion, tissue infraction, blood extravasation
T
Contraindication for anticoagulants
Hepatic dysfunction ( due to impaired hepatic production of coagulation factors)
Vit.K dependent Coagulation factors
2,7,9,10
T or F: Warfarin + Other Anticoagulant to have better tx
F
Contraindications Warfarin
Coagulopathies
Acute bleeding
Suspected vascular lesions ( hypertension, anuerism, endocarditis, GI bleeding, surgery, tendency to fall)
Severe renal insufficiency
Pregnancy
Concurrent admin of several anticoagulants
Warfarin + Rifampicin
↓ Effect
due to CYP460 induction
Warfarin + Food rich in Vit.K
↓ Effect
Warfarin + PPIs
↓ effect
due to impaired uptake of warfarin
Warfarin + Metronidazole
↑ Effect
due to CYP460 inhibition
Warfarin + Acetaminophen
↑ Effect
bc interrupts bit.k cycle
Warfarin + Sulfonamides
↑ Effect
completely blocks/displaces Warfarin at plasma protein binding sites
Vit K. antagonists affect ____ coagulation pathway
Extrinsic
Warfarin Extrinsic Pathway PT = WEPT
Mutation and polymorphisms @___ gene alter the effect of Vit.K antagonists
VKORC1
Cerebral Embolism Anticogulant
Acenocumarol
Prophylaxis of thromboembolism following knee or hip replacement
Warfarin
Prophylaxis of thromboembolism following valvular atrial fibrillation
Warfarin
Prophylaxis of thromboembolism following heart valve replacement
Warfarin
Prophylaxis of thromboembolism following heart valve replacement
Warfarin
Low molecular weight heparin
Nadroparin
Enoxaparin
T or F: Heparin affects intrinsic pathway
F
Admin of therapeutic and prophylaxis Heparin
t = IV
p = SC
Preferred anticoagulant for px with renal insufficiency
Heparin
Anticoagulant safe to use during pregnancy
Heparin
Nadroparin
Enoxaparin
T or F: Low molecular weight heparin is indicated to use in px with renal insufficiency
F
due to its greater bioavailability compared to unfractioned heparin (high molecular heparin)
Out of hospital tx for px with DVT or Pulmonary embolism
Low molecular weight hepain
HIGH dose Heparin
immediate anticoagulation effect for:
atrial fibrillation
DVT
pulmonary embolism
acute coronary synd
myocardial infraction
unstable angina
mechanical heart valve replacement
Anticoagulant of choice for surgery requiring cardiopulmonary bypass
Heparin
Anticoagulant for Px with disseminated intravascular coagulation
Heparin
Goal of Heparin
Prevent reformation and extension of thrombin and fibrin
Antidote for Heparin
Protamine Sulfate
Heparin induced Thrombocytopenia
- usually if tx is >7 days
- UFH > LMW
- W > M
Side effects of high and low weight heparin
Bleeding
Allergic reaction (IgG)
Heparin induced Thrombocytopenia
Osteoporosis
Hypoaldosenorism → Hyperkalemia
Contraindication of Heparin
recent stroke
uncontrolled hypertension
active bleeding
How is Heparin tx monitored
by measuring aPTT
Nicotine/Tetracyclines + Heparin
Risk of bleeding complications
Dextran + Heparin
risk of hemorrhage
Heparin binds reversibly to …
Antithrombin III (ATIII)
causing its potentiation
Heparin caused indirect inhibition of:
Factor Xa = ↓activation of prothrombin
Thrombin (Factor IIa) = ↑ thrombin inhibition
= ↓Fibrin
Phytomenadione
Vitamin K
Cofactor for y-carboxylation of glutamate residues @vit.K dependent proteins involved in coagulation and bone formation
Phytomenadione
Postnatal injection of Vit.K
Phytomenadione
to prevent Vit.K deficiency in the New born (VKDB)
T or F: IV admin of Phytomenadione carries major risk of anaphylactoid reactions
T
Toxicity of Phytomenadione causes…
Oversupplementation of Vit.K
= hemolytic anemia, hyperbilirubinemia, jaundice, kernicterus
T or F: IV admin of Phytomenadione must be given at a normal velocity rate
F, SLOWLY
Indications of Phytomenadione
Postnatal Vit.K injection (prevent vit.K defieciency in the new born)
Coagulopathy (disorders of the EXTRINSIC pathway)
Reversal of Warfarin
Billiary obstruction
Stimulates CFU-E units promoting erythropoiesis @BM
Erythropoyetin
Anemia in AIDs px is induced by ______ and tx with
Zivudine
Erythropoyetin
MOST common sude effect of Erythoproyetin
Hypertension aggravation
due to rapid rise of hematocrit
Adverse Effect of Erytopoyetin
GI effect
Flu-like symptoms
Hypertension aggravation
Thromboembolism
Contraindication of Erythropoyetin
uncontrolled Hypertension
Growth factors used for Chronic Bone Marrow Failure
Methenolone
Admin of Methenolone Acetate
Oral
Admin of Methenolen Enathate
IM
Antianemic that can cause masculinization
Methenolone
Precursor of Vit.B
Hydroxocobalamin
Tx for Vit.B12 deficiency
Hydroxocobalamin
Megaloblastic anemia caused by folate deficiency
Folic Acids
CANNOT cure B12 deficiency
which body store is bigger: Folic Acid or Vit.B12?
Vit.B12 (3-4 years)
Most common cause of Macrocytic anemia
Folate deficiency
bc of low body stores (3 weeks-4 months)
T or F: For Vit.B12 deficiency the admin of Folic Acid also helps in the tx
T
Which deficiency accuses neurological symptoms
Vit.B12
Prevention of neural tue defects
Folic acid
begin 1M before pregnancy
Dietary defieicny of Vit.B12
strict vegetarian
gastrectomy
Oral iron tharpy
Ferrous Sulfate
Used when oral iron therapy fails
Iron Dextran
Type of Iron the can be given to iron deficiency px and pregnant women, to create iron stores
Parenteral Iron
- Iron Dextran
- Ferric Fumarate
since oral route would take months to achieve it
Tx of Choice for Iron deficiency
Ferrous Sulfate
Parenteral Iron with less adverse effects
Ferric Saccrate
Chronic use of Ferric Saccrate
Renal Tubulointestinal damage
Contraindications of Iron Dextran
RA
Hypersensitivity
Anticoagulants MOA
Prevent blood clots from forming
Interfere with coagulation factors, affecting secondary hemostasis
Warfarin blocks _____ enzyme that inhibits Vit.K recycling
Vitamin K Epoxide Reductase
Montoring of Heparin with
INR
Goal (1-3 INR)
How is Heparin tx monitored?
aPTT (intrinsic pathway)
50-90 sec @Heparin
aprox 1.5-2.5x