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FU17 Hematology > Heme Pharm > Flashcards

Heme Pharm Flashcards

1
Q

Formulations of Iron

A

Oral and IV

  1. Ferrous sulfate (DOC)
  2. Ferrous glucosamine
  3. Ferrous fumarate
  • IV: Venofer
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2
Q

Oral iron patient instruction

A

Avoid enteric coated bc of poor absorption

Take with vitamin C (oral or OJ) and on empty stomach

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3
Q

IDA treatment

A

Iron is continued until anemia is resolved and iron stores are replenished (6-8 months)

HgB slowly rises 1-2 weeks after start, but should return by 6-8 weeks

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4
Q

ADRs to Oral Iron

A

GI problems (metallic taste, n/v, constipation/diarrhea, gastritis)

Black/green tools

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5
Q

Who should receive IV iron?

A

Patients who can’t tolerate GI side effects

Need to grow stores in 1-2 visits

Ongoing blood loss > iron absorption

Co existing inflammatory condition

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6
Q

IV iron

A

Iron sucrose (venofer)

Given 5-10 doses per day

Low anaphylactic risk

can cause Hypotension (esp. in hemodialysis patients)

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7
Q

What might cause no response to iron supplementation

A

Not taking iron

Reduced absorption

Blood loss/re-bleeding

Wrong diagnosis, more than one cause

Inflammation

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8
Q

What to do if someone doesn’t respond do iron

A

Confirm they are taking and no more blood loss

Look for inflammation

Might be a malabsorption issue – Celiac or H. Pylori

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9
Q

ESAs used

A 
Epoetin Alfa (Epogen, Procrit) 
Darbepoetin Alfa (aranesp)

ALFA

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10
Q

ESA indications

A

Anemia of CKD (3b+)

Concurrent with chemo therapy that IS NOT curative (to avoid transfusions)

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11
Q

ESA dosage

A

Given enough to control HgB levels

If levels fall below 10 but alter dosage if getting close to 11

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12
Q

who should NOT use ESA

A

Those with chemotherapy that intends to be curative (can cause tumor growth)

Palliative care

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13
Q

ESA precaution

A

Increases BP – caution with uncontrolled HTN

Increased risk of seizures

Can cause Pure red cell aplasia – now CI

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14
Q

ESA BBW

A
  1. Increased risk of serious cardio events if HgB is elevated above 11g/dL
  2. Shortened survival, increased risk of tumor progression or recurrence
  3. Death, CV, stroke in CKD
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15
Q

Indications for G-CSF

A

Prophylaxis - in anticipation of heavy chemo, during retreatment after neutropenia fever

Afebrile neutropenia

NOT given to febrile bc of serious allergic reactions

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16
Q

GSFs available

A

Filtration (Neupogen, Granix)

Pegfilgrastam (Neulasta)

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17
Q

Aspirin MOA

A

Irreversible inhibits COX-1 and COX-2 decreased Thromboxane A2

NO platelet aggregation

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18
Q

Aspirin ADRs

A

GI ulcers/gastritis

Hypersensitivity reactions (asthma and polyps)

Bleeding

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19
Q

ASA Contraindications

A
  1. Use with alcohol increases bleeding
  2. High dose is CI in pts with CKD
  3. Children and teens (Reye’s syndrome)
  4. 3rd trimester/Pregnancy
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20
Q

Commonly used oral thienopyridines

A

Plavix (Clopidigrel)

Prasurgrel (Effient)

Ticagrelor (Brilinta)

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21
Q

Thienopyridine MOA

A

Blocks GP IIb/IIIa activation, reducing aggregation

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22
Q

Clopidogril/Plavix indications (3)

A

Heart attacks

STROKE

Peripheral artery disease

23
Q

Clopidogril/Plavix ADRs

A

Bleeding (esp. if old or underweight)

TTP - usually happens quickly)

Higher concentration in patients w/CKD

Can have poor metabolizers - still clot despite taking drug

24
Q

Prasugrel/Effient

Indications

A

Acute coronary syndrome

CAD

25
Q

Prasugrel/Effient CI

A

Patients with history of stroke/TIA

26
Q

Prasugrel/Effient BBW

A

Pts 75+ – dont use bc will cause increased risk of bleeding

Avoid taking 7+ days before surgery

27
Q

Ticagrelor/Brilinta

Indications

A

Acute coronary

CAD

28
Q

Ticagrelor/Brilinta

ADRs

A

Increased bleeding

dyspnea

Gout - uric acid

29
Q

Ticagrelor/Brilinta

BBW

A

Won’t work with >100 mg ASA

DC before surgery

Metabolized in liver- dont use if liver problems present

30
Q

IV GP IIb/IIIa

A

Used briefly during PCI procedures to quickly block platelet activity

Short half life

31
Q

Warfarin indications

A

Venous thrombosis
Cardoembolic thrombi with VALVULAR dz
Prophylaxis in Afib, severe VALVE dz, or cardiac function issue

32
Q

Warfarin dosing

A

Start at middle dose and see where therapeutic level is (2-3)

Lower starting dose (liver dz, poor nutrition, CHF, elderly)

HIgher starting dose (low risk of bleeding on inducing agents – need a lot drug interactions)

33
Q

Warfarin MOA

A

Blocks the production of vitamin K dependent clotting factors and protein C and S

34
Q

Warfarin ADRs

A

BLEEDING

Cold intolerance

Multiple drug interactions

Warfarin skin necrosis

35
Q

Warfarin Skin necrosis

A

Develops during first few days of starting warfarin and stopped heparin

Must administer warfarin and heparin simultaneously for 5 days (INR must be therapeutic 2 days)

36
Q

Warfarin dietary considerations

A

Patients must consume consistent amounts of food high in Vitamin K

37
Q

Unfractionated Heparin

MOA

A

Potentiates action of anti-thrombin III to inactivate thrombin

Prevents conversion of fibrinogen and fibrin

38
Q

Unfractionated Heparin dosage

A

Prophylaxis: against DVT (5000 units SQ/8hrs)

IV bolus based on weight

39
Q

Unfractionated Heparin ADRs

A

Thrombocytopenia

HIT

Hyperkalemia (suppresses aldosterone release)

Reverses Protamine

40
Q

LMWH dosage

A

Therapeutic: 1 mg/kg twice daily

prophylaxis: 30-40mg SQ daily

41
Q

LMWH ADRs

A

Bleeding
Hyperkalemia
Thrombocytopenia

42
Q

LMWH precautions

A

Not used in late state CKD

Dose adjust if GFR <30

43
Q

LMWH drugs

A

Enoxaprin (Lovenox)

Dalteparin (Fragmin)

44
Q

Direct Thrombin Inhibitors (list)

A

Dabigitran (Pradaxa)

45
Q

Dabigitran (Pradaxa)

MOA

A

Reversible direct thrombin inhibitor

Blocks coagulation by preventing cleavage of fibrinogen to fibrin, activation of clotting factors, and inhibition of aggregation

46
Q

Dabigitran (Pradaxa)

Indications

A

DVT

NON VALVE Afib

47
Q

Dabigitran (Pradaxa)

ADRs

A

Bleeding
Use with caution in patients >75 due to increased bleed risk

Premature stopping could cause clot formation

Drug available to reverse effects if necessary

48
Q

Rivaroxaban (Xarelto)

MOA

A

Xa inhibitor

Inhibits platelet activation and fibrin clot formation

49
Q

Rivaroxaban (Xarelto)

Indications

A

DVT/PE treatment and prevention

Non-valvular aFib

50
Q

Rivaroxaban (Xarelto)

ADR

A

Bleeding
Use caution if giving to elderly
Clot formation if stopped

51
Q

List of Xa inhibitor

A

Rivaroxaban (Xarelto)
Apixaban (Eliquis)
Edoxaban (savaysa)

52
Q

Apixaban (Eliquis)

ADR

A

Bleeding

Use caution in elderly – may need to adjust if weight or creatinine meet criteria

Clot formation

53
Q

Apixaban (Eliquis)

MOA
, Indications

A

MOA: inhibits platelet activation and clot formation by inhibition of Xa

Indication: DVT/PE treatment, non valvular aFib

54
Q

Parenteral Xa inhibitor

A

Fondaparinux (Arixtra)

Indicated for DVT/PE treatment and prophylaxis
NOT AFIB

FU17 Hematology (10 decks)

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