Hematologic Pharm

Question 1

2 ways to treat IDA anemia

Answer 1

1. oral iron

2. IV iron sucrose

Question 2

oral iron

Answer 2

can be either ferrous sulfate (preferred) or ferrous gluconate

best if taken with vitamin C or other acid (soda, orange juice) to improve absorption

avoid taking with food

may cause constipation and gastric mucosal irritation

Question 3

IV iron sucrose

Answer 3

Venofer

new, helps with pts who don’t tolerate oral iron

low risk of anaphylaxis, goes right to the blood

more expensive, req. monitoring bc can cause hypotension n

Question 4

anti platelet agents

Answer 4

prevent platelet activation and clot formation

1. asprin
2. theinopyridines (clopidigrel/Plavix)

Question 5

Asprin

Answer 5

irreversible inhibition of COX-1 (so can’t synthesize thromboxane A2)

Question 6

thromboxane A2

Answer 6

chemical responsible for calling platelets to the party

Question 7

Plevex

Answer 7

class: thienopyridines
generic: clopidigrel

inhibits activation of GP2a/3b receptor

platelets can’t bind to one another

Question 8

anticoagulant drugs

Answer 8

NOACs

1. direct thrombin inhibitors
2. Xa inhibitors
3. heparin
4. Warfarin( Coumadin)

Question 9

Direct thrombin inhibitors

Answer 9

dabigatran/Pradaxa

inhibit thrombin, which prevents conversion of fibrinogen to fibrin

minimal effect on platelets (can’t stick together)

availably orally and in weight based dosage

Question 10

Xa inhibitors

Answer 10

Apixaban (Eliquis)

inactivate factor 10 without direct effect on platelets

available orally in weight based dose

safe for CKD

Question 11

heparins

Answer 11

accelerates anti-thrombin III ability to inactivate thrombin and clotting factors

prevents conversion of fibrinogen to fibrin, minimal effect on platelets

1. Unfractionated (given as a drip)
2. Enoxaparin (Lovenox) (weight based, subQ, lower molecular weight)

Question 12

Warfarin

Answer 12

Coumadin

vitamin K antagonist that decreases ability of liver to synthesize vitamin K dependent clotting factors

narrow therapeutic index, multiple drug drug interactions

Question 13

how do we dose coumadin?

Answer 13

monitor and pick the middle dose

check PT to inhibit production (INR of 2-3)

req. frequent blood tests and dietary restrictions to control vitamin K levels

tough to use by cheap

Question 14

arterial side of clotting

Answer 14

occurs when platelets are activated

must give anti-platelet agent (aspirin, Plavix)

ex. CVA, MI

Question 15

venous side of clotting

Answer 15

clotting here is bc of coagulation factor activation

must give anti coagulant (warfarin, heparin, NOACs)

ex. PE, DVT, AFib