Heme Meds and treatments

Question 1

Mechanism, uses, and important adverse effects of aspirin

Answer 1

Irreversibly inhibits cyclooxygenase -> blocks production of thromboxane A2 -> blocks platelet aggregation

Uses: ASCVD (CAD, MI, Stroke)

S/E:
G.I. hemorrhage - PUD
Hyperventilation -> respiratory alkalosis
Tinnitus
Reye syndrome - hepatoencephalopathy

Question 2

Mechanism, uses, and important adverse effects of ADP receptor blockers

Answer 2

Clopidogrel
Ticlopidine
Prasugrel
Ticagrelor
Cangrelor

Inhibit platelet ADP receptors -> Block expression of GpIIb/IIIa -> block platelet aggregation

uses: recent MI/PCI, PVD, prevention of recurrent stroke/TIA

no S/E

Question 3

Mechanism, uses, and important adverse effects of GpIIb/IIIa inhibitors

Answer 3

Abciximab
Eptifibatide
Tirofiban

Bind platelets Gp IIb/IIIa -> block platelet aggregation

Uses: recent PCI, NSTEMI

Question 4

Mechanism, uses, and important adverse effects of Dipyridamole

Answer 4

Inhibits adenosine deaminase and phosphodiesterase -> increased adenosine and cAMP -> vasodilation and inhibition of platelet aggregation

uses: prevention of recurrent stroke/TIA

S/E: headache

Question 5

Mechanism, uses, and important adverse effects of heparin

Answer 5

Finds anti-thrombin (makes 1000x more active) -> inactivates thrombin and factorXa -> inhibits coagulation

Uses:
DVT prophylaxis
Acute MI
Acute PE
Anticoagulation pregnancy

Monitor PPT
Overdose - protamine sulfate

S/E: heparin induced thrombocytopenia (HIT)

Question 6

Mechanism, uses, and important adverse effects of LMWH

Answer 6

Enoxaparin
Dalteparin
Tinzaparin
Nadroparin

Find anti-thrombin -> efficiently inactivate factor Xa -> inhibit coagulation

Uses:
DVT prophylaxis
Acute MI
Acute PE
Anticoagulation pregnancy

Safest during pregnancy
Monitor anti-factor Xa activity

S/E HIT

Question 7

Mechanism, uses, and important adverse effects of fondaparinux

Answer 7

Bind antithrombin -> factor Xa -> inhibits coagulation
-does not bind platelet factor 4 - no risk of HIT

Uses:
Treatment of DVT and PE
DVT prophylaxis in surgical patients

Question 8

Mechanism, uses, and important adverse effects of Diret factor Xa inhibitors

Answer 8

Rivaroxaban
Apixaban
Edoxaban

Bind factor Xa -> inhibit conversion of prothrombin to thrombin

Uses:
Oral anticoagulation - afib, post-op DVT ppx

Question 9

Mechanism, uses, and important adverse effects of Direct thrombin inhibitors

Answer 9

Dabigatran (PO)
Argatroban
Bivalirudin
Desirudin

Bind thrombin -> inhibit coagulation

Uses:
Atrial fibrillation
DVT prophylaxis/treatment
Recent PCI
HIT

Question 10

Mechanism, uses, and important adverse effects of warfarin

Answer 10

Inhibits epoxide reductase -> inhibits synthesis of vitamin K dependent clotting factors (factors 10, 9, 2, 7 + protein C and S)

Uses:
Atrial fibrillation
Mechanical heart valves
Hypercoagulable states
DVT
PE

Check PT/INR

S/E: teratogenic, drug-drug interactions

OD: vit K
Acute bleeding - FFP

Question 11

Malaria prophylaxis regimens

Answer 11

Start 1-2 days before travel, take daily:
atovaquone - proguanil
Doxycycline

Start 2-3 weeks before and continue for weeks after return
-Mefloquine

Question 12

Drug use in the treatment malaria

Answer 12

Atovaquone-proguanil
Mefloquine
Chloroquine (vivax resistant)
Primaquine
Quinine + doxycycline
Artemisinin combination therapy - artesnuate + mefloquin - first line for falciparum