Heme Pharm

Question 1

MOA of heparin?

Answer 1

Binds to antithrombin, enhancing activity (reducing thrombin and Factor Xa activity)

Question 2

Clinical use of heparin?

Answer 2

Immediate anticoagulation for PE, ACS, MI, DVT. PREGNANCY

Question 3

How do you test for heparin tox?

Answer 3

PTT

Question 4

Toxicity of heparin?

Answer 4

Bleeding, thrombocytopenia (HIT), osteoporosis, drug-drug interactions.

Question 5

Antidote to heparin?

Answer 5

Protamine sulfate

Question 6

What is LMW heparin?

Answer 6

Heparins that act more on Xa and havd better bioavailability and longer half life. Can be administered without lab monitoring; not easily reversible.

Question 7

Examples of LMW Heparin?

Answer 7

Enoxaparin, dalteparin

Question 8

What is HIT?

Answer 8

Heparin-induced thrombocytopenia - development of IgG antibodies against heparin bound to PF4. Immune complex activates platelets - thrombosis and thrombocytopenia

Question 9

What are argatroban and bivalirudin?

Answer 9

Direct thrombin inhibitors. Use instead of heparin for anticoagulating pts with HIT

Question 10

What is the MOA of warfarin?

Answer 10

Blocks Vitamin K epoxide reductase, preventing synthesis of II, VII, IX, and X as well as protein C and S

Question 11

How to check for warfarin tox?

Answer 11

PT

Question 12

Clinical use of heparin?

Answer 12

Chronic anticoagulation - STEMI, VTE, and prevention of stroke in a-fib. NOT FOR PREGNANT WOMEN.

Question 13

Warfarin toxicity?

Answer 13

Bleeding, teratogenic, skin necrosis, drug-drug interactions

Question 14

Antidote of warfarin?

Answer 14

Vitamin K or fresh frozen plasma if severe

Question 15

What are apixaban and ravaroxaban?

Answer 15

Direct factor Xa inhibitors

Question 16

What are Xa inhibitors used for?

Answer 16

Treatment and prophylaxis of DVT and PE, a-fib stroke prophylaxis

Question 17

How is heparin administered?

Answer 17

IV

Question 18

What are alteplase, reteplase, and tenecteplase?

Answer 18

Thrombolytics

Question 19

MOA of thrombolytics?

Answer 19

Aids conversion of plasminogen to plasmin; Increases both PT and PTT.

Question 20

Clinical use of thrombolytics?

Answer 20

Early MI, early ischemic stroke, direct thrombolysis of severe PE.

Question 21

Toxicity of thrombolytics?

Answer 21

Bleeding

Question 22

Antidote to thrombolytics?

Answer 22

Aminocaproic acid

Question 23

Aspirin MOA?

Answer 23

Irreversible inhibition of COX (both 1 and 2) enzyme by covalent acetylation. Lasts until new platelets are produced.

Question 24

Effects of aspirin?

Answer 24

Increased BT, decreased TXA2 and prostaglandins. NO effect on PT or PTT

Question 25

Clinical use of aspirin?

Answer 25

Antipyretic, analgesic, anti-inflammatory, anti-platelet

Question 26

Aspirin toxicity?

Answer 26

Gastric ulceration, tnnitus. Chronic use can lead to acute renal failure, interstitial nephritis, and upper GI bleeding.

Question 27

What is the MOA of clopidogel, ticlopidine, prasugrel, and ticagrelor?

Answer 27

ADP receptor inhibitors - prevent platelet aggregation by blocking ADP receptors on platelet surfaces. Inhibition of fibrinogen binding by preventing GP IIb/IIIa from binding fibrinogen.

Question 28

Clinical use of ADP receptor inhibitors?

Answer 28

Coronary stenting; decrease incidence or recurrence of thrombotic stroke

Question 29

Toxicity of ADP receptor inhibitors?

Answer 29

Neutropenia; TTP/HUS

Question 30

What are cliostazol and dipyridamole?

Answer 30

PDEIII inhibitors. Increase cAMP in platelets, whihc inhibits platelet aggregation; vasodilators

Question 31

Clinical use of PDEIII inhibitors?

Answer 31

Intermittent claudication, coronary vasodilation, prevention of stroke or TIAs, angina prophylaxis

Question 32

Toxicity of PDEIII inhibitors?

Answer 32

Nausea, headache, facial flushing, hypotension, abdominal pain

Question 33

What are abciximab, eptifibatide, tirofiban?

Answer 33

GP IIb/IIIa inhibitors - prevent platelet aggregation

Question 34

Clinical use of GP IIb/IIIa inhibitors

Answer 34

Unstable angina, PCTA

Question 35

Tox of GPIIb/IIIa inhibitors?

Answer 35

Bleeding, thrombocytopenia