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Heme Pharm > Heme Pharm > Flashcards

Heme Pharm Flashcards

1
Q

What class or drugs does Iron belong to?

A

Hematinic

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2
Q

When should we prescribe iron?

A

Iron deficiency

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3
Q

MoA for iron?

A

Supplement

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4
Q

SE/ADRs to iron?

A

Nausea/vomiting, constipation, diarrhea, abdominal cramps, black stools, anaphylaxis (IV)

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5
Q

Contraindications for iron?

A

Anaphylaxis, hemochromatosis, hemolytic anemia

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6
Q

Dx-Dx interactions for iron?

A

Antacids, Phenytoin, Quinolone, Tetracycline antibiotics bind Fe

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7
Q

What should we monitor in patients taking iron?

A

Serum ferratin, transferrin saturation, Hgb, reticulocytes

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8
Q

What class of drugs does Deferoxamine belong to?

A

Iron Chelator

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9
Q

When should we prescribe Deferoxamine?

A

Excess serum iron levels

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10
Q

MoA for Deferoxamine?

A

Chelates iron from hemosiderin, ferratin, transferrin (not from hemoglobin or cytochromes)

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11
Q

SE/ADRs to Deferoxamine?

A

fever, leg cramps, tachycardia, hypotension (IV), allergic drug reactions, pulmonary syndrome, neurotoxicity

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12
Q

Contraindications for Deferoxamine?

A

Prior anaphylaxis with drug, renal insufficiency

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13
Q

Dx-Dx interactions for Deferoxamine?

A

None! (Well that we need to know of anyway)

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14
Q

What should we monitor in patients taking Deferoxamine?

A

Hemoglobin, serum iron

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15
Q

How is Deferoxamine administered?

A

Usually IV

Can be IM, SQ

Seldom PO

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16
Q

What class of drugs does Cyanacobalamin belong to?

A

B-Vitamin

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17
Q

When do we prescribe Cyanacobalamin?

A

B-12 deficiency (megaloblastic anemia, peripheral neuropathy, depression, CVD)

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18
Q

What is the MoA for Cyanacobalamin?

A

Rate limiting cofactor in conversion folate to active form, and DNA synthesis

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19
Q

SE/ADRs to Cyanacobalamin?

A

Painful by injection

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20
Q

Contraindications for Cyanacobalamin?

A

None!

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21
Q

Dx-Dx interactions for Cyanacobalamin?

A

Long term acid suppression therapy, metformin, phenytoin

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22
Q

What should we monitor in patients on Cyanacobalamin?

A

B12, folate, homocysteine, methylmalonic acid levels, replenishment regimens: IM 1,000mcg daily for 1-2 weeks, then 1,000 mcg weekly, then 1,000 mcg monthly; PO 1,000 mcg daily

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23
Q

What class of drugs does Folic Acid belong to?

A

Hematopoetic agents-Nutritional

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24
Q

When should we prescribe folic acid?

A

Folate deficiency (megaloblastic anemia, prevention of neural tube defects, CVD)

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25
Q

MoA for folic acid?

A

Cofactor in DNA synthesis

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26
Q

SE/ADRs to folic acid?

A

bronchospasm, flushing, pruritis (rare)

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27
Q

Contraindications for folic acid?

A

Hypersensitivity

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28
Q

Dx-Dx interactions for folic acid?

A

Phenobarbitol, phenytoin, primidone levels decreased by folic acid; phenytoin, trimethoprim, methotrexate deplete folic acid levels

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29
Q

What class of drugs does Epoetin alfa belong to?

A

Erythrocytosis stimulator

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30
Q

When should we prescribe Epoetin alfa?

A

low RBC secondary to ESRD, HIV, antineoplastic therapy, RA

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31
Q

MoA for Epoetin alfa?

A

Stimulates erythroid proliferation and differentiation, induces release of reticulocytes

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32
Q

SE/ADRs to Epoetin alfa?

A

Secondary impact on iron deficiency, clotting; hypertension, thrombosis, seizures

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33
Q

Contraindications for Epoetin alfa?

A

Hypersensitivity

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34
Q

Dx-Dx interactions for Epoetin alfa?

A

anti-coagulants, iron

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35
Q

What should we monitor in patients taking Epoetin alfa?

A

Retic count, Hgb/Hct, serum ferritin

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36
Q

What class of drug does Filgrastim belong ton?

A

Myeloid growth factor

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37
Q

Indications for Filgrastim?

A

neutropenia secondary to chemotherapy

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38
Q

MoA for Filgrastim?

A

(a) stimulates proliferation and differentiation of myeloid cells
(b) increased phagocytic capacity and prolongs survival of mature neutrophils
(c) mobilizes peripheral neutrophils

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39
Q

SE/ADRs to Filgrastim?

A

Fever, petechia, bone pain, splenomegally

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40
Q

Contraindications for Filgrastim?

A

Hypersensitivity

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41
Q

Dx-Dx interactions for Filgrastim?

A

None!

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42
Q

What should we monitor in patients taking Filgrastim?

A

CBC

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43
Q

What else is important to monitor in patients taking Filgrastim?

A

GM-CSF

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44
Q

What class of drug does Heparin belong to?

A

Indirect Thrombin Inhibitors

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45
Q

Indications for Heparin?

A

Thrombotic disorders

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46
Q

MoA for Heparin?

A

accelerates degradation of Xa, and thrombin (lla)

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47
Q

SE/ADRs to Heparin?

A

bleeding, allergic reaction, alopecia; long-term use: osteoporosis; HIT (after 7 days); skin necrosis

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48
Q

Contraindications for Heparin?

A

prior HIT, pre-existing severe thrombocytopenia, intra-cranial bleeding

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49
Q

Dx-Dx interactions for Heparin?

A

other anticoagulants, tNSAIDs; NTG decreases effectiveness

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50
Q

What should we monitor in patients on Heparin?

A

aPTT, platelet counts, H&H, fecal occult blood

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51
Q

What class of drugs does Enoxeparin belong to?

A

Anticoagulant

Low-Molecular Weight Heparin

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52
Q

Indications for Enoxeparin?

A

Acute coronary syndrome, DVT prevent and treatment

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53
Q

MoA for Enoxeparin?

A

increased degradation of Xa

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54
Q

SE/ADRs to Enoxeparin?

A

injection site hematoma, fever, increased AST/ALT, bleeding, hypersensitivity reaction

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55
Q

Contraindications for Enoxeparin?

A

Active major bleeding, hypersensitivity to pork, heparin, thrombocytopenia

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56
Q

Dx-Dx interactions for Enoxeparin?

A

None

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57
Q

What should we monitor in patients taking Enoxeparin?

A

Platelet count, CrCl

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58
Q

What class of drug does Protamine sulfate belong to?

A

Indirect thrombin inhibitor antagonist

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59
Q

When should we use Protamine sulfate?

A

Excess heparin impact

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60
Q

MoA for Protamine sulfate?

A

Binds to heparin and neutralizes its anticoag effect

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61
Q

How is Protamine sulfate administered?

A

IV

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62
Q

What class of drugs does Fondaparinux belong to?

A

Indirect Thrombin Inhibitor

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63
Q

Indications for Fondaparinux?

A

DVT prophylaxis, Tx acute PE, Tx acute DVT without PE

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64
Q

MoA for Fondaparinux?

A

Accelerates factor Xa degraddation

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65
Q

SE/ADRs to Fondaparinux?

A

Moderate thrombocytopenia, bleeding, rash, fever, nausea, anemia, edema

66
Q

Contraindications for Fondaparinux?

A

Hypersensitivity, CrCL

67
Q

Dx-Dx interactions for Fondaparinux?

A

tNSAID, o/w minimal

68
Q

What should we monitor in patients taking Fondaparinux?

A

CBC, CrCl, fecal occult blood

69
Q

How is Fondaparinux administered?

A

Sub-q only

70
Q

What class of drugs does Dabigatran belong to?

A

Direct thrombin inhibitor–oral

71
Q

Indications for Dabigatran?

A

Prevent stroke in non-valvular a fib

72
Q

MoA for Dabigatran?

A

Directly inhibits thrombin (lla) action to convert fibrinogen to fibrin; inhibits platelet aggregation

73
Q

SE/ADRs to Dabigatran?

A

Bleeding (17%/3%), gastric irritation, gastritis

74
Q

Contraindications for Dabigatran?

A

severe renal disease (CrCL

75
Q

Dx-Dx interactions for Dabigatran?

A

P-gp inducers antagonize (rifampin); P-gp inhibitors (clopidogrel, amiodarone) increase levels

76
Q

What should we monitor in patients taking Dabigatran?

A

H&H, ECT (ecarine clotting time); aPTT; CrCl

77
Q

What pregnancy category is Dabigatran?

A

C

78
Q

What is the shelf life of Dabigatran?

A

30 days.

Also very moisture sensitive

79
Q

What class of drug is Rivaroxaban?

A

Oral direct factor Xa inhibitor

80
Q

Indications for Rivaroxaban?

A

To reduce risk of clots with knee and hip replacement, non-valvular atrial fibrilation, DVT/PE

81
Q

MoA for Rivaroxaban?

A

Directly and selectively inhibits factor Xa

82
Q

SE/ADRs to Rivaroxaban?

A

Bleeding, peripheral edema, diarrhea, dizzyness

83
Q

Contraindications for Rivaroxaban?

A

Active pathological bleeding, hypersensitivity, mod-severe liver disease, coagulopathy

84
Q

Dx-Dx interactions of Rivaroxaban?

A

CYP3A4/P-gp inhibitors (clarithromycin, fluconazole).

Increased drug concentrations.

CYP3A4/P-gp inducers (carbamazepine, phenoytoin, rifampin, St. John’s Wart).

Decreased drug concentrations.

85
Q

What should we monitor in patients taking Rivaroxaban?

A

Initially CBC, CrCl, LFT

Nothing for chronic

86
Q

What class of drug does Warfarin belong to?

A

Coumarin Anticoagulants

87
Q

Indications for Warfarin?

A

Prevention and treatment of venous thrombosis

88
Q

MoA for Warfarin?

A

block vitamin K mediated carboxylation of clotting factors 7, 9, 10, 11 and proteins C and S

89
Q

SE/ADRs to Warfarin?

A

easy bruising, skin/tissue necrosis, hypersensitvity reactions, vasculitis

90
Q

Contraindications for Warfarin?

A

Active bleeding, prior history skin necrosis

91
Q

Dx-Dx interactions for Warfarin?

A

Other anticoagulants, ginkgo biloba

92
Q

What should we monitor in patients taking Warfarin?

A

PT/INR, H&H

93
Q

What counteracts warfarin?

A

Vitamin K

94
Q

What class of drug does Vitamin K, Phytonadine belong to?

A

Warfarin anticoagulant inhibitor

95
Q

Indications for Phytonadine?

A

counteract excess warfarin anticoagulation or Vitamin K deficiency

96
Q

MoA for Phytonadine?

A

Promotes liver synthesis of factors 2, 7, 9, 10

97
Q

SE/ADRS to Phytonadine?

A

Primarily with IV dosing–flushing, hypotension, cyanosis, rash

98
Q

Contraindications for Phytonadine?

A

Hypersensitivity to Vitamin K

99
Q

Dx-Dx interactions for Phytonadine?

A

Decreases coumarin anticoagulation; Orlistat decreases PO absorption

100
Q

What should we monitor in patients taking Phytonadine?

A

PT/INR, H&H

101
Q

What class of drug does Streptokinase belong to?

A

Fibrinolytic, Thrombolytic

102
Q

Indications for Streptokinase?

A

Severe DVT, PE, AMI, occluded AV cannulas

103
Q

MoA for Streptokinase?

A

Activates the conversion of plasminogen to plasmin which degrades fibrin, fibrinogen to lyse clot (both physiologic and pathologic thrombi)

104
Q

SE/ADRs to Streptokinase?

A

Bleeding, fever, pruritis

ADR: Bleeding, reperfusion arrhythmias, hypotension

105
Q

Contraindications for Streptokinase?

A

Active bleeding, Hx CVA, uncontrolled HTN

106
Q

Dx-Dx interactions for Streptokinase?

A

Other anticoagulants or anti-platelet drugs

107
Q

What should we monitor in patients taking Streptokinase?

A

H&H, platelets, PT, aPTT, Thrombin time (baseline and serial every 4H)

108
Q

How is Streptokinase administered?

A

IV, intracoronary admin only

109
Q

What class of drug does Alteplase belong to?

A

Tissue plasminogen activator, thrombolytic

110
Q

Indications for Alteplase?

A

Thrombus lysis in AMI, PE

111
Q

MoA for Alteplase?

A

Preferentially activates plasminogen bound to fibrin (theory–confines thrombolysis to formed thrombus)

112
Q

SE/ADRs to Alteplase?

A

Bruising, fever, bleeding, hypotension, fever, reperfusion arrhythmias

113
Q

Contraindications for Alteplase?

A

Hypersensitivity, active bleeding

114
Q

Dx-Dx interactions for Alteplase?

A

Other anticoagulants, nitroglycerin, aminocaproic acid

115
Q

How is Alteplase manufactured?

A

Manufactured via recombinant DNA technology

116
Q

How is Alteplase administered?

A

IV

117
Q

What kind of drug is Aminocaproic Acid?

A

Fibrinolysis Inhibitor

118
Q

Indications for Aminocaproic Acid?

A

States of excess fibrinolysis

119
Q

MoA for Aminocaproic Acid?

A

Binds to plasminogen and plasmin and blocks plasmin lysis of fibrin (but some thrombi continue to form)

120
Q

SE/ADRs to Aminocaproic Acid?

A

Hypotension, abdominal discomfort, diarrhea; myopathy, muscle necrosis (rare)

121
Q

Contraindications for Aminocaproic Acid?

A

DIC, upper GU tract bleeding

122
Q

Dx-Dx interactions for Aminocaproic Acid?

A

None

123
Q

What should we monitor in patients taking Aminocaproic Acid?

A

H&H

124
Q

How is Aminocaproic Acid administered?

A

IV

125
Q

What class of drug does Aspirin belong to?

A

Anti-platelet aggregation drug (COX-1, COX-2 inhibitor)….but COX-1 is bolded so??

126
Q

Indications for Aspirin?

A

Secondary prophylaxis s/p MI, CVA

127
Q

MoA for Aspirin?

A

Irreversible inactivation (via acetylation) of cyclo-oxygenase

Inhibits synthesis of thromboxane A2

Prevents platelet aggregation and vasoconstriction by thromboxane A2

128
Q

SE/ADRs to Aspirin?

A

30% gastritis, dyspepsia; Bleeding, tinnitus (high dose)

129
Q

Contraindications for Aspirin?

A

Hypersensitivity, nasal polyposis, and bronchospasm

130
Q

Dx-Dx interactions for Aspirin?

A

Other anticoagulants, NSAIDs

131
Q

What class of drug does Clopidogrel belong to?

A

Platelet ADP inhibitor

132
Q

Indications for Clopidogrel?

A

Secondary prevention AMI, CVA, PAD

133
Q

MoA for Clopidogrel?

A

Irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation

134
Q

SE/ADRs to Clopidogrel?

A

27% gastritis, abdominal pain, dyspepsia; thrombocytopenia, leukopenia (rare)

135
Q

Contraindications for Clopidogrel?

A

Active bleeding, hypersensitivity

136
Q

Dx-Dx interactions for Clopidogrel?

A

Other antiplatelet or anticoagulant drugs, ginko biloba (increased effect); atorvastatin, macrolide ABT’s (decrease)

137
Q

What should we monitor in patients taking Clopidogrel?

A

H&H

138
Q

Is Clopidogrel a pro-drug?

A

Yes

139
Q

What class of drug does Abciximab belong to?

A

Glycoprotein IIB/IIIA Inhibitor

140
Q

Indications for Abciximab?

A

Coronary artery stent surgery, Acute Coronary Syndrome

141
Q

MoA for Abciximab?

A

Blocks platelet GBIIb/IIIa receptors for Thromboxane A2, thrombin, collagen and prevents platelet aggregation

142
Q

SE/ADRs to Abciximab?

A

Bleeding

143
Q

Contraindications for Abciximab?

A

Bleeding

144
Q

Dx-Dx interactions for Abciximab?

A

Anticoagulants

145
Q

How is Abciximab administered?

A

IV

146
Q

What class of drug does Dipyridamole + ASA belong to?

A

Phosphodiesterase inhibitor (and vascular dilator)

147
Q

Indications for Dipyridamole + ASA?

A

Post-op primary prophylaxis s/p prosthetic heart valves; prophylaxis after CVA

148
Q

MoA for Dipyridamole + ASA?

A

Increases platelet concentration of AMP decreasing platelet aggregation

149
Q

SE/ADRs to Dipyridamole + ASA?

A

Dizziness, headache, abdominal discomfort, blurred vision; 38% headache, dyspepsia, hypotension

150
Q

Contraindications for Dipyridamole + ASA?

A

Hypersensitivity, severe hepatic or renal impairment

151
Q

Dx-Dx interactions for Dipyridamole + ASA?

A

Aspirin

152
Q

What should we monitor in patients in taking Dipyridamole + ASA?

A

CrCl, H&H

153
Q

Is Dipyridamole effective but itself?

A

Questionable effects orally, adding ASA is thought to increase effectiveness, not for use with ASA hypersensitivity

154
Q

What class of drug does Cilostazol belong to?

A

Peripheral arterial disease (intermittent claudication)

155
Q

MoA for Cilostazol?

A

Inhibits platelet phosphodiesterase thus preventing aggregation

156
Q

SE/ADRs to Cilostazol?

A

Rhinitis, 27-34% headache, 12-15% abnormal stools

157
Q

Contraindications for Cilostazol?

A

Thrombocytopenia, heart failure or severe renal or hepatic impairment

158
Q

Dx-Dx interactions for Cilostazol?

A

CYP3A4 inhibitors–macrolide ABTs (increase effect); NSAIDs and Omeprazole (increase); anticoagulants (increase)

159
Q

What should we monitor in patients taking Cilostazol?

A

CrCl; walking distance

160
Q

What should we avoid when taking Cilostazol?

A

Grapefruit juice, avoid taking with high fat meals

Heme Pharm (1 decks)

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