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Pharm > Hematological agents II > Flashcards

Hematological agents II Flashcards

1
Q

What is type I heparin induced thrombocytopenia? What is the consequence of this?

A

Heparin can increase platelet aggregation which causes a decrease in circulation platelet numbers

Little clinical consequence

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2
Q

What is type II heparine induced thrombocytopenia?

A

Heparine can bind platelet factor 4, which some pts develop antibodies against. This causes thrombosis

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3
Q

Which type of heparin causes HIT: fractionated or unfractionated?

A

unfractionated

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4
Q

Which are more common in HIT: venous or arterial thromboses?

A

Venous

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5
Q

Who are more affected by HIT: men or women?

A

Women

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6
Q

How long does it take platelet counts to fall following heparin administration?

A

5-10 days

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7
Q

What is enoxaparin?

A

Lower molecular weight heparin

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8
Q

What is low molecular weight heparin called?

A

Enoxaparin

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9
Q

What is the major disadvantage to low molecular weight heparin? (2)

A

Cannot deactiveate thrombin

Protamine only partially reverses it

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10
Q

What are the advantages to low molecular weight heparin? (2)

A

Easier to dose

Lower risk for HIT

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11
Q

What disease contraindicates low molecular weight heparin?

A

Renal insufficiency

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12
Q

What is fondaparinux?

A

Synthetic analog of AT binding pentasaccharide sequence

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13
Q

What is the MOA of fondaparinux?

A

Binds to antithrombin and increases rate of factor X inhibition

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14
Q

True or false: protamine is only partially effectie against fondaparinux

A

False–not at all effective

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15
Q

What is the major contraidication with fondaparinux?

A

Renal disease

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16
Q

What is the monitoring assay for fondaparinux?

A

anti-factor Xa assay

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17
Q

True or false: monitoring of fondaparinux and LMWH is not as intensive as monitoring regular heparin

A

True

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18
Q

What is the MOA of hirudin?

A

Direct thrombin inhibitor at both active sites

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19
Q

Do direct thrombin inhibitors inhibit factor 10?

A

no

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20
Q

How do you administer hirudin?

A

parenterally

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21
Q

What is the MOA of lepirudin?

A

Direct thrombin inhibitor at both active sites

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22
Q

How do direct thrombin inhibitors work?

A

Directly binding to the active site in thrombin that cleaves fibrinogen into fibrin

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23
Q

What is the MOA of argatroban?

A

Direct thrombin inhibitor at the active site

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24
Q

What is the MOA of dabigitran?

A

Direct thrombin inhibitor at the active site

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25
Q

Which direct thrombin inhibitor is given orally?

A

Dabigitran

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26
Q

What is the major advantage of DTIs vs heparin?

A

can inhibit thrombin bound to fibrin

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27
Q

What type of drug should you use instead of heparin in cases of HIT?

A

Direct thrombin inhibitor

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28
Q

What is the MOA of bivalirudin?

A

Inhibits thrombin by binding directly to active site (direct thrombin inhibitor)

29
Q

What is the drug used to reverse direct thrombin inhibitors

A

There is none

30
Q

What is the MOA of warfarin?

A

Competes with Vit K for Vit K reductase

31
Q

What are the factors that need vitamin K?

A

10 9 7 and 2 (and protein C and S)

32
Q

What does vitamin K reductase do?

A

Reduces the oxidized form of Vit K, that is used in factor activation

33
Q

How long does it take for warfarin to take full effect? Why?

A

3-5 days

Only affects new factors

34
Q

What is the enzyme that degrades warfarin? What is the significance of this?

A

CYP2C9

pts with polymorphisms need lower dose

35
Q

Why does warfarin have such a high Vd?

A

Plasma protein bound

36
Q

What is the test to monitor warfarin?

A

PT

37
Q

What are the general steps of performing a PT?

A
  • blood collected in Ca free tube
  • thromboplastin added
  • Ca added
  • time
38
Q

Generally, what types of drugs are contraindicated with warfarin?

A

Any drug that interferes with Vit K absorption

39
Q

Where does Vit K come from? What drugs, then, have to be carefully used when a pt is on warfarin?

A

Gut bacteria

Abx

40
Q

Potentiate or reduce the anticoagulant effect of warfarin: NSAIDs. Why?

A

Potentiate

Interfere with primary hemostasis

41
Q

Potentiate or reduce the anticoagulant effect of warfarin: SSRIs

A

Potentiate

42
Q

Potentiate or reduce the anticoagulant effect of warfarin: anti-platelet drugs

A

Potentiate

43
Q

Potentiate or reduce the anticoagulant effect of warfarin: drugs that decrease hepatic metabolism

A

potentiate

44
Q

Potentiate or reduce the anticoagulant effect of warfarin: statins . Why?

A

Potentiate

Use same CYP enzyme, and saturate it

45
Q

Potentiate or reduce the anticoagulant effect of warfarin: rifampin. Why?

A

Reduce

46
Q

Potentiate or reduce the anticoagulant effect of warfarin: carbamazepine. Why?

A

reduce

Increase hepatic elimination of the drug

47
Q

Potentiate or reduce the anticoagulant effect of warfarin: renal insufficiency. Why?

A

Potentiate since hypoalbuemia

48
Q

Potentiate or reduce the anticoagulant effect of warfarin: decreased hepatic function

A

Reduce

49
Q

What is the severe adverse side effect of warfarin use? What causes this?

A

Necrosis

Precipitous fall in vitamin C

50
Q

What is the therapeutic INR range for warfarin?

A

2-3

51
Q

What are the two things to administer a pt with too high of an INR d/t warfarin use?

A

Vit K

Administer fresh plasma

52
Q

What is the MOA of rivaroxaban?

A

Direct inhibitor of factor X

53
Q

What is the MOA of apixaban?

A

Directly inhibits factor X

54
Q

What are the benefits of the newer oral anticoagulants like rivaroxaban, apixaban, and dabigatran?

A
  • Faster onset
  • Low food/drug interactions
  • Predictable effect
55
Q

IS warfarin or heparin safe to take during pregnancy?

A

Warfarin, no

Heparin, yes

56
Q

What is the main protein involved in the fibrinolytic system? What activates it?

A

Plasmin

tPA

57
Q

Why isn’t there much activation of plasminogen in the plasma if there’s tPA?

A

Both have higher affinity when bound to fibrin

58
Q

What is the inhibitor in the plasma that will inhiit plasmi?

A

Alpha2 plasma inhibitor

59
Q

How, generally, do the fibrinolytic drugs work?

A

Activate plasmin from plasminogen

60
Q

What is the MOA of steptokinase?

A

forms a complex with plasminogen

61
Q

What is the MOA of urokinase?

A

Natrual activator of plasmin, produced by the kidney

62
Q

What are the two tPA agents used in clinic?

A

Alteplase

Reteplase

63
Q

What are the adverse effects of streptokinase?

A

anaphylaxis

64
Q

When are fibrinolytic drugs used?

A

STEMI or new LBBB

65
Q

Should you use thrombolytics in NSTEMIs?

A

No

66
Q

What is the MOA of aminocaproic acid?

A

Blocks interaction of plasmin with fibrin, thus preventing fibrin degradation

67
Q

What is the MOA of tranexamic acid?

A

Blocks interaction of plasmin with fibrin, thus preventing fibrin degradation

68
Q

What are aminocaproic acid and tranexamic acid used for?

A

Hemophila treatment

Pharm (73 decks)

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