Hematology Rx Flashcards
Heparin
1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe) 2) Anti-thrombin: antithrombin cofactor –> decr thrombin* + decr factor Xa 3) toxicity: bleeding, HIT, osteoporosis, Rx interactions; protamine sulfate antidote (pos charge molec that binds neg charge heparin) 4) short 1/2 life
Enoxaparin
1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe) 2) LMWH antithrombin: act more on factor Xa 3) toxicity but less risk than heparin: bleeding, HIT, osteoporosis, Rx interactions; no antidote 4) compared to heparin: better bioavail, 2~4x longer 1/2 life; sub-Q; no need to monitor
Dalteparin
1) immediate anticoag for PE, ACS, MI, DVT (pregnancy safe) 2) LMWH antithrombin: act more on factor Xa 3) toxicity but less risk than heparin: bleeding, HIT, osteoporosis, Rx interactions; no antidote 4) compared to heparin: better bioavail, 2~4x longer 1/2 life; sub-Q; no need to monitor
Lepirudin
1) immediate anticoag for pts w/ HIT 2) antithrombin 3) N/A 4) deriv of hirudin (leeches)
Bivalirudin
1) immediate anticoag for pts w/ HIT 2) antithrombin 3) N/A 4) deriv of hirudin (leeches)
Warfarin (Coumadin)
1) chronic anticoag: post STEMI, VTE prophylaxis, prevent stroke in afib (teratogenic) 2) antiplt: interfere w/ nl syn + carboyxlation of vit-K clotting factors (1972: X, IX, VII, II) + proteins C, S 3) bleeding, teratogenic, skin/tissue necrosis*, Rx interactions; give vit K for OD, give FFP for severe OD 4) cyt P450 met; incr PT (extrinsic path); long 1/2 life; follow PT/INR; PO
Alteplase (tPA)
1) early MI, early ischemic stroke, direct thrombolysis of severe PE 2) thrombolytic: aid plasminogen –> plasmin to cleave thrombin + fibrin clots 3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis) 4) incr PT, PTT; no change in plt ct
Reteplase (rPA)
1) early MI, early ischemic stroke, direct thrombolysis of severe PE 2) thrombolytic: aid plasminogen –> plasmin to cleave thrombin + fibrin clots 3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis) 4) incr PT, PTT; no change in plt ct
Tenecteplase (TNK-tPA)
1) early MI, early ischemic stroke, direct thrombolysis of severe PE 2) thrombolytic: aid plasminogen –> plasmin to cleave thrombin + fibrin clots 3) bleeding (contraindicate in active bleed, intracranial bleed hx, recent sx, known bleed diathese, severe HTN); tx toxicity w/ aminocaproic acid (inhibits fibrinolysis) 4) incr PT, PTT; no change in plt ct
Aspirin (ASA)
1) antipyretic, analgesic, anti-infl, anti-plt (decr aggregation) 2) irreversibly inhibits COX-1 (and -2) via covalent acetylation –> decr TxA2 + prostaglandins 3) gastric ulcer, tinnitus (CN VIII); chronic use: acute renal failure, interstitial nephritis, upper GI bleed; Reye’s syn in kids w/ viral infct; OD: respir alkalosis + met acidosis 4) plts can’t syn new COX so effect lasts until new plts made; incr bleeding time; no effect on PT, PTT
Clopidogrel
1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke 2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa 3) N/A 4) N/A
Ticlopidine
1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke 2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa 3) neutropenia (unique) 4) N/A
Prasugrel
1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke 2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa 3) N/A 4) N/A
Ticagrelor
1) ACS, coronary stenting, decr incidence + recurr of thrombotic stroke 2) ADP R inhibitor: inhibit plt aggregation by irreversibly blocking ADP R; inhibit fibrinogen binding via Gp IIb/IIIa 3) N/A 4) N/A
Cilostazol
1) intermittent claudication, coronary vasodilation, prevent stroke/TIAs (w/ ASA), angina prophylaxis 2) PDE III inhibitor –> incr cAMP in plts –> inhibit plt aggregation; vasodilator 3) nausea, HA, facial flush, hypotension, ab pain 4) N/A