hemeagents2pharm

Question 1

what is lepirudin

Answer 1

a recombinant form of hiruden is a direct thrombin inhibitor DTI

Question 2

what is hirudin

Answer 2

isolated from the leach first DTI direct thrombin inhibitor

Question 3

name some direct thrombin inhibitors

Answer 3

hirudin lepirudin, bivalrudin, and argatroban all the parental orally is only dabigatran

Question 4

what can inhibit thrombin when its bound to fibrin

Answer 4

only the direct thrombin inhibitors or DTI

Question 5

what drug would you use with a patient with a history of thrombocytopinea

Answer 5

you would use a DTI because it does not cause thrombocytopinea

Question 6

what DTI would you use with a PCI in patients with HIT

Answer 6

bivalirudin

Question 7

what DTI would you use with a stroke prevention patient

Answer 7

Dabigatran

Question 8

what is a drawback on DTI

Answer 8

we do not currently have a direct antidote

Question 9

what are some clinical uses of warfarin

Answer 9

prevent progression of venous thrombosis and thromboembolism and MI and can be used orally

Question 10

tell me about the warfarin mechanism of action

Answer 10

it will compete with vitamin k for binding sites and will prevent clotting faxtors 2,7,9, and 10 by preventing the vit k reduction.

Question 11

tell me about the pharmacokinetics of warfarin

Answer 11

Almost 100% bioavaliibility F, but its highly bound to serum albumin but only the unbound is active. Half life 48 hours so theraputic after 3-5 days and takes 5-7 days to leave system after stopping the dosafe

Question 12

tell me about the warfarin clearance

Answer 12

liver metabolized by the p450 complex, know that some patients will need less because of a common genetic variat that clears it slower.

Question 13

what assay would you use to monitor warfarin

Answer 13

prothrombin time assay is generally used. The normal INR is 2.0-3.0 can be higher with mechanical heart valves.

Question 14

tell me about the drug interaction with warfarin

Answer 14

broad spectrum antibiotics will increase the effect of warfarin, nonsteroidal anti-inflammatory drugs increase effect, certain SSRI can increase, certain statins can increase, rifampin barbiturates anc carbamazepine all decrease the effects of warfarin.

Question 15

tell me about other factors that effect warfarin

Answer 15

lower liver function will increase warfarin, disease of intestine like crohns will increase effects, renal insufficiency can cause hyoalbuminimen will increase warfarin.

Question 16

what are some adverse effects of warfarin

Answer 16

hemorrhage, placental transfer, birth defects, necrosis,

Question 17

what can reverse the effects of warfarin

Answer 17

vitamin K can be used but is slow otherwise you have to use fresh plasma.

Question 18

what are the new oral anticoagulants

Answer 18

rivaroxaban, apixaban, dabigatran.

Question 19

what are the benefits of the new oral over warfarin

Answer 19

faster onset longer indow low potential for interactions, less monitering, lower risk of intracranera or intecerebral bleeding

Question 20

tell me about rivaroxaban

Answer 20

oral direct factor of Xa inhibitor,

Question 21

what is the major antiplatelet drug

Answer 21

aspirin,

Question 22

how does aspirin work to reduce platelets

Answer 22

reduces thrombane A2 production which leads to a reduced platelets activation and aggregation and is an irreversible blocker.

Question 23

how does dipyridamole work

Answer 23

blocks cAMP reduction leading to higher levels of cAMP and and leads to less activation of platelets, not as good by itself but combined with asparin

Question 24

name some P2Y12 antagonists

Answer 24

clopidogrel and prasurgrel irreversible inhibitors and are prodrugs that need to be metabolized ticagrelor is reversible and does not need to be metabolized.

Question 25

what is an FDA precation with clopidogrel

Answer 25

get the enzyme sequnced so you know what dosage to use.

Question 26

what p2y212 could you use with a prevouis history of intracranil bleeding

Answer 26

clopidogrel

Question 27

tell me about abciximab

Answer 27

GP2b/3a antagonists, prevents platelet aggregation, can cause thrombocytopenia and bleeding.

Question 28

tell me about vorapaxar

Answer 28

protease activated receptor antagonis, used for prevention of thrombotic events in MI patents,

Question 29

what are the main fibrinilytic drugs

Answer 29

streptokinase and tissue plaminogen activators

Question 30

when are fibrinolytic drugs used.

Answer 30

acute MI main reasons, also for thromobotic stroke.

Question 31

give me some examples of fibrinolytic drugs

Answer 31

streptokinase, unrokinase, Tissue plaminogen acivators such as alteplase reteplawe and tenecteplase