Hematologic Lesson 1 - DRUGS Flashcards
What is the therapeutic range/ heparin level for aPTT (acitivated partial thrombosplatin time)
1.5 to 2.5 times the control value (about 30-80 seconds)
What is the therapeutic range/heparin level for Protamine titration?
0.2 to 0.4 unit/mL
What is the therapeutic range/heparin level for Anti-Xa units?
0.3 to 0.7 unit/mL
What is the INR range for DVT/PE?
2.0 to 3.0
What is the INR range for Atrial Fibrillation?
2.0 to 3.0
What is the INR range for Myocardial Infraction?
2.0 to 3.0
What is the INR range for Mechanical Heart Valves?
2.5 to 3.5
Drugs for Enzyme induction in pharmacokinetic effects
- Barbiturate
- Rifampin
Drugs for Enzyme inhibition in pharmacokinetic effecrts
- Cimetidine
Drugs for reduced plasma protein binding in pharmacokinetic effects
- Phenylbutazone
Impaired hemostasis,
reduced clotting factor synthesis, as in
hepatic disease
Synergism
Vitamin K
Competitive antagonism
Hereditary resistance to oral anticoagulants
An altered physiologic control loop for
vitamin K
What are the drugs under the prevention of embolic stroke in patients with nonvalvular atrial fibrilation
- Apixaban
- Edoxaban
- Rivaroxaban
What are the drugs under the prevention of venous thromboembolism followwing hip or knee surgery
- Apixaban
- Rivaroxaban
What are the drugs under the treatment of venous thromboembolic disease (VTE)
- Apixaban
- Edoxaban
- Rivaroxaban
First antidote approved
for use in patients treated with anti-Xa
agents who require rapid reversal for
surgery or uncontrolled bleeding
Andexanet alfa
Drugs under Parenteral Direct Thrombon Inhibitors
- Hirudin
- Lepirudin
- Bivalirudin
- Argatroban
Irreversible thrombin inhibitor
from leech saliva
Hirudin
Recombinant form of Hirudin
Lepirudin
With a rapid onset and offset of action
Bivalirudin
Given by continuous IV
infusion due to short half-lifeaPTT
Argatroban
Drugs under Oral Direct Thrombin Inhibitor
Dabigatran etexilate mesylate
Rapid onset and offset of action allow
immediate anticoagulation
Dabigatran etexilate mesylate
Use in patients with thrombosis
related to heparin-induced thrombocytopenia
Lepirudin
FDA-approved for use in percutaneous coronary angioplasty
Bivalirudin
FDA-approved for use in patients with HIT with or without thrombosis and coronary angioplasty in patients with HIT
Argatroban
Approved for use in Europe for prevention of venous thromboembolism in patients who have
undergone hip or knee replacement surgery
Dabigatran
Monitored by
aPTT
- Lepirudin
- Argatroban
PTT, thrombin time, and ecarin clotting time [(ECT)
Dabigatran
Clotting test
based on the use of a protein isolated
from viper venom] can be use to estimate
drug effect
Dabigatran
Humanized monoclonal
antibody Fab fragment binds to dabigatran and reverses the anticoagulant effect
Idarucizumab
Approved for use in situations requiring
emergent surgery or for life-threatening
bleeding
Idarucizumab
Drugs under GP IIb/IIIa receptor antagonist
- Abciximab
- Eptifibatide
- Tirofiban
Drugs under ADP receptor antagonist
- Ticlopidine
- Clopidogrel
- Prasugrel
Drugs under TXA2 (COX) inhibitor
Aspirin
Drugs under PDE/ adenosin uptake inhibitor
- Dipyridamole
- Cilostazol
What is the mechanism of action of aspirin under Antithrombotic?
Inhibits COX, thus prevents TXA2 (a potent platelet aggregating substance) and PGs formation
What is the mechanism of action of Clopidogrel and Ticlopidine under Antithrombotic?
Inhibit ADP pathway of platelet formation
What is the mechanism of action of Dipyridamole under Antithrombotic?
Inhibits platelet function by inhibiting adenosine uptake and cGMP phosphodiesterare (PDE) activity
What is the mechanism of action of Cilostazol under Antithrombotic?
Phosphodiesterase (PDE) inhibitor that promotes vasodilation and inhibition of platelet aggregation
What is the mechanism of action of Abciximab, Eptifibatide and Tirofiban under Antitrombotic?
Inhibit GP IIb/IIIa, a glycoprotein receptor molecule necessary for platelet aggregation
A fat-soluble substance
found primarily in leafy green vegetables
Vitamin K
A drug found in
food
Vitamin K1 (Phytonadione)
A drug found in
human tissues and is synthesized by
intestinal bacteria
Vitamin K2 (Menaquinone)
It is currently administered to all newborns to prevent the hemorrhagic disease
Vitamin K1
How many hours does vitamin K1 can delayed onset effect
6 hours
How many hours is the complete effect of Vitami K1 when treating depression of prothrombin activity caused by excess warfarin or vitamin K deficiency
24 hours
What are the available administration for vitamin K1?
Oral adn parenteral forms
Intravenous administration of vitamin K1 should be slow, if rapid infusion occurs it can produce what?
- Dyspnea
- Chest pain
- Back pain
- Death
It is best achieved with
intravenous or oral administration
because its bioavailability after
subcutaneous administration is erratic
Vitamin K repletion
It is used for the treatment of Warfarin overdosage and Vitamin K deficiency
Vitamin K
Water soluble; ineffective in warfarin overdosage
Vitamine K3 (Menadione)
It is frequently occurs in
hospitalized patients in intensive care units because of poor diet, parenteral nutrition, recent surgery, multiple
antibiotic therapy, and uremia
Vitamin K deficiency
Used as a treatment of blood clotting factors
deficiencies
Plasma Fractions
Factor VIII deficiency
- Classic hemophilia
- Hemophilia A
Factor IX deficiency
- Christmas disease
- Hemophilia B
Factors under plasma fractions
- Factor VIII deficiency
- Factor IX deficiency
- Lyophilized factor VIII
A factor VIII-Fc domain conjugate that prolongs the factor VIII half-life and allows twice-weekly dosing
Eloctate
A factor IX-albumin conjugate with a
half-life of 100 hours
Idelvion
FDA-approved for prophylaxis or treatment of
bleeding in hemophilia B patients
Idelvion
A factor VIII concentrate approved by the FDA for the treatment of bleeding associated
with von Willebrand disease
Humate-P
A recombinant von Willebrand factor
product approved for treatment and control of bleeding in adults with von Willebrand disease
Vonicog alfa
Used for factor deficiencies for which no recombinant form of the protein is available
Fresh frozen plasma
A four-factor plasma replacement preparation containing vitamin K–dependent factors II VII, IX, and X
4F PCC (Kcentra)
For rapid reversal of warfarin in bleeding
patients
4F PCC (Kcentra)
Increases the factor VIII activity of patients
with mild hemophilia A or von Willebrand
disease
DESMOPRESSIN ACETATE
Can be used in preparation for minor
surgery such as tooth extraction and available in high-dose intranasal
desmopressin
DESMOPRESSIN ACETATE
Can be used in preparation for minor
surgery such as tooth extraction and available in high-dose intranasal
desmopressin
DESMOPRESSIN ACETATE
Plasma protein fraction obtainable from
whole blood
CRYOPRECIPITATE
Used to treat deficiencies or qualitative abnormalities of fibrinogen
CRYOPRECIPITATE
