Heme Pharm Flashcards
1
Q
What class or drugs does Iron belong to?
A
Hematinic
2
Q
When should we prescribe iron?
A
Iron deficiency
3
Q
MoA for iron?
A
Supplement
4
Q
SE/ADRs to iron?
A
Nausea/vomiting, constipation, diarrhea, abdominal cramps, black stools, anaphylaxis (IV)
5
Q
Contraindications for iron?
A
Anaphylaxis, hemochromatosis, hemolytic anemia
6
Q
Dx-Dx interactions for iron?
A
Antacids, Phenytoin, Quinolone, Tetracycline antibiotics bind Fe
7
Q
What should we monitor in patients taking iron?
A
Serum ferratin, transferrin saturation, Hgb, reticulocytes
8
Q
What class of drugs does Deferoxamine belong to?
A
Iron Chelator
9
Q
When should we prescribe Deferoxamine?
A
Excess serum iron levels
10
Q
MoA for Deferoxamine?
A
Chelates iron from hemosiderin, ferratin, transferrin (not from hemoglobin or cytochromes)
11
Q
SE/ADRs to Deferoxamine?
A
fever, leg cramps, tachycardia, hypotension (IV), allergic drug reactions, pulmonary syndrome, neurotoxicity
12
Q
Contraindications for Deferoxamine?
A
Prior anaphylaxis with drug, renal insufficiency
13
Q
Dx-Dx interactions for Deferoxamine?
A
None! (Well that we need to know of anyway)
14
Q
What should we monitor in patients taking Deferoxamine?
A
Hemoglobin, serum iron
15
Q
How is Deferoxamine administered?
A
Usually IV
Can be IM, SQ
Seldom PO
16
Q
What class of drugs does Cyanacobalamin belong to?
A
B-Vitamin
17
Q
When do we prescribe Cyanacobalamin?
A
B-12 deficiency (megaloblastic anemia, peripheral neuropathy, depression, CVD)
18
Q
What is the MoA for Cyanacobalamin?
A
Rate limiting cofactor in conversion folate to active form, and DNA synthesis
19
Q
SE/ADRs to Cyanacobalamin?
A
Painful by injection
20
Q
Contraindications for Cyanacobalamin?
A
None!
21
Q
Dx-Dx interactions for Cyanacobalamin?
A
Long term acid suppression therapy, metformin, phenytoin
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
23
Q
What class of drugs does Folic Acid belong to?
A
Hematopoetic agents-Nutritional
24
Q
When should we prescribe folic acid?
A
Folate deficiency (megaloblastic anemia, prevention of neural tube defects, CVD)
25
MoA for folic acid?
Cofactor in DNA synthesis
26
SE/ADRs to folic acid?
bronchospasm, flushing, pruritis (rare)
27
Contraindications for folic acid?
Hypersensitivity
28
Dx-Dx interactions for folic acid?
Phenobarbitol, phenytoin, primidone levels decreased by folic acid; phenytoin, trimethoprim, methotrexate deplete folic acid levels
29
What class of drugs does Epoetin alfa belong to?
Erythrocytosis stimulator
30
When should we prescribe Epoetin alfa?
low RBC secondary to ESRD, HIV, antineoplastic therapy, RA
31
MoA for Epoetin alfa?
Stimulates erythroid proliferation and differentiation, induces release of reticulocytes
32
SE/ADRs to Epoetin alfa?
Secondary impact on iron deficiency, clotting; hypertension, thrombosis, seizures
33
Contraindications for Epoetin alfa?
Hypersensitivity
34
Dx-Dx interactions for Epoetin alfa?
anti-coagulants, iron
35
What should we monitor in patients taking Epoetin alfa?
Retic count, Hgb/Hct, serum ferritin
36
What class of drug does Filgrastim belong ton?
Myeloid growth factor
37
Indications for Filgrastim?
neutropenia secondary to chemotherapy
38
MoA for Filgrastim?
(a) stimulates proliferation and differentiation of myeloid cells
(b) increased phagocytic capacity and prolongs survival of mature neutrophils
(c) mobilizes peripheral neutrophils
39
SE/ADRs to Filgrastim?
Fever, petechia, bone pain, splenomegally
40
Contraindications for Filgrastim?
Hypersensitivity
41
Dx-Dx interactions for Filgrastim?
None!
42
What should we monitor in patients taking Filgrastim?
CBC
43
What else is important to monitor in patients taking Filgrastim?
GM-CSF
44
What class of drug does Heparin belong to?
Indirect Thrombin Inhibitors
45
Indications for Heparin?
Thrombotic disorders
46
MoA for Heparin?
accelerates degradation of Xa, and thrombin (lla)
47
SE/ADRs to Heparin?
bleeding, allergic reaction, alopecia; long-term use: osteoporosis; HIT (after 7 days); skin necrosis
48
Contraindications for Heparin?
prior HIT, pre-existing severe thrombocytopenia, intra-cranial bleeding
49
Dx-Dx interactions for Heparin?
other anticoagulants, tNSAIDs; NTG decreases effectiveness
50
What should we monitor in patients on Heparin?
aPTT, platelet counts, H&H, fecal occult blood
51
What class of drugs does Enoxeparin belong to?
Anticoagulant
Low-Molecular Weight Heparin
52
Indications for Enoxeparin?
Acute coronary syndrome, DVT prevent and treatment
53
MoA for Enoxeparin?
increased degradation of Xa
54
SE/ADRs to Enoxeparin?
injection site hematoma, fever, increased AST/ALT, bleeding, hypersensitivity reaction
55
Contraindications for Enoxeparin?
Active major bleeding, hypersensitivity to pork, heparin, thrombocytopenia
56
Dx-Dx interactions for Enoxeparin?
None
57
What should we monitor in patients taking Enoxeparin?
Platelet count, CrCl
58
What class of drug does Protamine sulfate belong to?
Indirect thrombin inhibitor antagonist
59
When should we use Protamine sulfate?
Excess heparin impact
60
MoA for Protamine sulfate?
Binds to heparin and neutralizes its anticoag effect
61
How is Protamine sulfate administered?
IV
62
What class of drugs does Fondaparinux belong to?
Indirect Thrombin Inhibitor
63
Indications for Fondaparinux?
DVT prophylaxis, Tx acute PE, Tx acute DVT without PE
64
MoA for Fondaparinux?
Accelerates factor Xa degraddation
65
SE/ADRs to Fondaparinux?
Moderate thrombocytopenia, bleeding, rash, fever, nausea, anemia, edema
66
Contraindications for Fondaparinux?
Hypersensitivity, CrCL
67
Dx-Dx interactions for Fondaparinux?
tNSAID, o/w minimal
68
What should we monitor in patients taking Fondaparinux?
CBC, CrCl, fecal occult blood
69
How is Fondaparinux administered?
Sub-q only
70
What class of drugs does Dabigatran belong to?
Direct thrombin inhibitor--oral
71
Indications for Dabigatran?
Prevent stroke in non-valvular a fib
72
MoA for Dabigatran?
Directly inhibits thrombin (lla) action to convert fibrinogen to fibrin; inhibits platelet aggregation
73
SE/ADRs to Dabigatran?
Bleeding (17%/3%), gastric irritation, gastritis
74
Contraindications for Dabigatran?
severe renal disease (CrCL
75
Dx-Dx interactions for Dabigatran?
P-gp inducers antagonize (rifampin); P-gp inhibitors (clopidogrel, amiodarone) increase levels
76
What should we monitor in patients taking Dabigatran?
H&H, ECT (ecarine clotting time); aPTT; CrCl
77
What pregnancy category is Dabigatran?
C
78
What is the shelf life of Dabigatran?
30 days.
Also very moisture sensitive
79
What class of drug is Rivaroxaban?
Oral direct factor Xa inhibitor
80
Indications for Rivaroxaban?
To reduce risk of clots with knee and hip replacement, non-valvular atrial fibrilation, DVT/PE
81
MoA for Rivaroxaban?
Directly and selectively inhibits factor Xa
82
SE/ADRs to Rivaroxaban?
Bleeding, peripheral edema, diarrhea, dizzyness
83
Contraindications for Rivaroxaban?
Active pathological bleeding, hypersensitivity, mod-severe liver disease, coagulopathy
84
Dx-Dx interactions of Rivaroxaban?
CYP3A4/P-gp inhibitors (clarithromycin, fluconazole).
Increased drug concentrations.
CYP3A4/P-gp inducers (carbamazepine, phenoytoin, rifampin, St. John's Wart).
Decreased drug concentrations.
85
What should we monitor in patients taking Rivaroxaban?
Initially CBC, CrCl, LFT
Nothing for chronic
86
What class of drug does Warfarin belong to?
Coumarin Anticoagulants
87
Indications for Warfarin?
Prevention and treatment of venous thrombosis
88
MoA for Warfarin?
block vitamin K mediated carboxylation of clotting factors 7, 9, 10, 11 and proteins C and S
89
SE/ADRs to Warfarin?
easy bruising, skin/tissue necrosis, hypersensitvity reactions, vasculitis
90
Contraindications for Warfarin?
Active bleeding, prior history skin necrosis
91
Dx-Dx interactions for Warfarin?
Other anticoagulants, ginkgo biloba
92
What should we monitor in patients taking Warfarin?
PT/INR, H&H
93
What counteracts warfarin?
Vitamin K
94
What class of drug does Vitamin K, Phytonadine belong to?
Warfarin anticoagulant inhibitor
95
Indications for Phytonadine?
counteract excess warfarin anticoagulation or Vitamin K deficiency
96
MoA for Phytonadine?
Promotes liver synthesis of factors 2, 7, 9, 10
97
SE/ADRS to Phytonadine?
Primarily with IV dosing--flushing, hypotension, cyanosis, rash
98
Contraindications for Phytonadine?
Hypersensitivity to Vitamin K
99
Dx-Dx interactions for Phytonadine?
Decreases coumarin anticoagulation; Orlistat decreases PO absorption
100
What should we monitor in patients taking Phytonadine?
PT/INR, H&H
101
What class of drug does Streptokinase belong to?
Fibrinolytic, Thrombolytic
102
Indications for Streptokinase?
Severe DVT, PE, AMI, occluded AV cannulas
103
MoA for Streptokinase?
Activates the conversion of plasminogen to plasmin which degrades fibrin, fibrinogen to lyse clot (both physiologic and pathologic thrombi)
104
SE/ADRs to Streptokinase?
Bleeding, fever, pruritis
ADR: Bleeding, reperfusion arrhythmias, hypotension
105
Contraindications for Streptokinase?
Active bleeding, Hx CVA, uncontrolled HTN
106
Dx-Dx interactions for Streptokinase?
Other anticoagulants or anti-platelet drugs
107
What should we monitor in patients taking Streptokinase?
H&H, platelets, PT, aPTT, Thrombin time (baseline and serial every 4H)
108
How is Streptokinase administered?
IV, intracoronary admin only
109
What class of drug does Alteplase belong to?
Tissue plasminogen activator, thrombolytic
110
Indications for Alteplase?
Thrombus lysis in AMI, PE
111
MoA for Alteplase?
Preferentially activates plasminogen bound to fibrin (theory--confines thrombolysis to formed thrombus)
112
SE/ADRs to Alteplase?
Bruising, fever, bleeding, hypotension, fever, reperfusion arrhythmias
113
Contraindications for Alteplase?
Hypersensitivity, active bleeding
114
Dx-Dx interactions for Alteplase?
Other anticoagulants, nitroglycerin, aminocaproic acid
115
How is Alteplase manufactured?
Manufactured via recombinant DNA technology
116
How is Alteplase administered?
IV
117
What kind of drug is Aminocaproic Acid?
Fibrinolysis Inhibitor
118
Indications for Aminocaproic Acid?
States of excess fibrinolysis
119
MoA for Aminocaproic Acid?
Binds to plasminogen and plasmin and blocks plasmin lysis of fibrin (but some thrombi continue to form)
120
SE/ADRs to Aminocaproic Acid?
Hypotension, abdominal discomfort, diarrhea; myopathy, muscle necrosis (rare)
121
Contraindications for Aminocaproic Acid?
DIC, upper GU tract bleeding
122
Dx-Dx interactions for Aminocaproic Acid?
None
123
What should we monitor in patients taking Aminocaproic Acid?
H&H
124
How is Aminocaproic Acid administered?
IV
125
What class of drug does Aspirin belong to?
Anti-platelet aggregation drug (COX-1, COX-2 inhibitor)....but COX-1 is bolded so??
126
Indications for Aspirin?
Secondary prophylaxis s/p MI, CVA
127
MoA for Aspirin?
Irreversible inactivation (via acetylation) of cyclo-oxygenase
Inhibits synthesis of thromboxane A2
Prevents platelet aggregation and vasoconstriction by thromboxane A2
128
SE/ADRs to Aspirin?
30% gastritis, dyspepsia; Bleeding, tinnitus (high dose)
129
Contraindications for Aspirin?
Hypersensitivity, nasal polyposis, and bronchospasm
130
Dx-Dx interactions for Aspirin?
Other anticoagulants, NSAIDs
131
What class of drug does Clopidogrel belong to?
Platelet ADP inhibitor
132
Indications for Clopidogrel?
Secondary prevention AMI, CVA, PAD
133
MoA for Clopidogrel?
Irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation
134
SE/ADRs to Clopidogrel?
27% gastritis, abdominal pain, dyspepsia; thrombocytopenia, leukopenia (rare)
135
Contraindications for Clopidogrel?
Active bleeding, hypersensitivity
136
Dx-Dx interactions for Clopidogrel?
Other antiplatelet or anticoagulant drugs, ginko biloba (increased effect); atorvastatin, macrolide ABT's (decrease)
137
What should we monitor in patients taking Clopidogrel?
H&H
138
Is Clopidogrel a pro-drug?
Yes
139
What class of drug does Abciximab belong to?
Glycoprotein IIB/IIIA Inhibitor
140
Indications for Abciximab?
Coronary artery stent surgery, Acute Coronary Syndrome
141
MoA for Abciximab?
Blocks platelet GBIIb/IIIa receptors for Thromboxane A2, thrombin, collagen and prevents platelet aggregation
142
SE/ADRs to Abciximab?
Bleeding
143
Contraindications for Abciximab?
Bleeding
144
Dx-Dx interactions for Abciximab?
Anticoagulants
145
How is Abciximab administered?
IV
146
What class of drug does Dipyridamole + ASA belong to?
Phosphodiesterase inhibitor (and vascular dilator)
147
Indications for Dipyridamole + ASA?
Post-op primary prophylaxis s/p prosthetic heart valves; prophylaxis after CVA
148
MoA for Dipyridamole + ASA?
Increases platelet concentration of AMP decreasing platelet aggregation
149
SE/ADRs to Dipyridamole + ASA?
Dizziness, headache, abdominal discomfort, blurred vision; 38% headache, dyspepsia, hypotension
150
Contraindications for Dipyridamole + ASA?
Hypersensitivity, severe hepatic or renal impairment
151
Dx-Dx interactions for Dipyridamole + ASA?
Aspirin
152
What should we monitor in patients in taking Dipyridamole + ASA?
CrCl, H&H
153
Is Dipyridamole effective but itself?
Questionable effects orally, adding ASA is thought to increase effectiveness, not for use with ASA hypersensitivity
154
What class of drug does Cilostazol belong to?
Peripheral arterial disease (intermittent claudication)
155
MoA for Cilostazol?
Inhibits platelet phosphodiesterase thus preventing aggregation
156
SE/ADRs to Cilostazol?
Rhinitis, 27-34% headache, 12-15% abnormal stools
157
Contraindications for Cilostazol?
Thrombocytopenia, heart failure or severe renal or hepatic impairment
158
Dx-Dx interactions for Cilostazol?
CYP3A4 inhibitors--macrolide ABTs (increase effect); NSAIDs and Omeprazole (increase); anticoagulants (increase)
159
What should we monitor in patients taking Cilostazol?
CrCl; walking distance
160
What should we avoid when taking Cilostazol?
Grapefruit juice, avoid taking with high fat meals
