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Pharm > Hemotologic > Flashcards

Hemotologic Flashcards

1
Q

Platelet Aggregation Inhibitor Classes

A

PG synth inhibitors
Anti-platelets
P2Y12 inhibitors
GP IIb/IIIa Inhibitors

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2
Q

PG Synth Inhibitor

A

Aspirin (ASA - Acetylsalicylic Acid)

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3
Q

PGA Synth Inhib:

Aspirin - MOA

A

Irreversible inhibition of COX-1/2 enzymes:

Results in decrease TXA2 synth (from arachidonic acid)

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4
Q

PGA Synth Inhib:

Aspirin - Clinical Use

A 
Primary prevention of CV events:
•  50-69 yo (60+ consider age) w/ 10-year CV risk > 10%:
Primary prevention of stroke in women
AFIB
STEMI
UA/NSTEMI
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5
Q

PGA Synth Inhib:

Aspirin - Adverse Effects

A

GI (most common)
Increased risk in bleeding (possible surgery complication)
Reye’s Syndrome
Hypersensitivity

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6
Q

PGA Synth Inhib:

Aspirin - Dose

A

50-160mg
81mg for 50-59yo
No more than 160mg

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7
Q

PGA Synth Inhib:

Aspirin - Notes

A

Pregnancy: C/D (3rd trimester - premature closure of Ductus Arteriosus)
Antidote: Platelet Transfusion
Washout: 7-10 Days

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8
Q

Anti-platelets

A

Dipyridamole
ASA/Dipyridamole (Aggrenox)
Cilostazol
Vorapaxar

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9
Q

Anti-Platelet:

Dipyridamole - MOA

A

Stimulates prostacyclin synth:

Inhibits adenosine uptake = Inhibiting platelet aggregation

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10
Q

Anti-Platelet:

Dipyridamole - Clin Use

A

Combined w/ ASA (little use on its own)

Stroke ischemia prevention

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11
Q

Anti-Platelet:

Dipyridamole - Adverse Effects

A

Flushing
Dizziness
HA
Coronary steal phenomenon (in unstable angina Pts)

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12
Q

Anti-Platelet:

Dipyridamole - Drug Interactions

A

Caution with anti-coags:

May aggravate MG

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13
Q

Anti-Platelet:

Dipyridamole - Dose

A

Oral (w/ warfarin): Prevention of thromboembolism POST heart valve replacement
IV: Alternative to exercise in thallium myocardial perfusion imaging

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14
Q

Anti-Platelet:

Dipyridamole - Notes

A

No antidote

Washout: 2-3 Days

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15
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - MOA

A

Inhibit COX-1/2

Stimulate prostacyclin synth

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16
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - Clin Use

A

Secondary prevention of stroke POST ischemic stroke or TIA

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17
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - Adverse Effects

A

Do not use in children/teens w/ viral syndrome:

Linked to Reye’s syndrome

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18
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - Drug interactions

A

Caution with anti-coags

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19
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - Dose

A

Oral: BID

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20
Q

Anti-Platelet:

ASA/Dipyridamole (Aggrenox) - Notes

A

Must be protected from moisture

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21
Q

Anti-Platelet:

Cilostazol - MOA

A

PDE3 inhibitor:
Inhibits cAMP (vasodilator) breakdown
Reversibly inhibits platelet aggregation induced by ADP

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22
Q

Anti-Platelet:

Cilostazol - Clin Use

A

Redux of sxs of intermittent claudication

Use w/ ASA enhances platelet inhibition vs ASA alone

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23
Q

Anti-Platelet:

Cilostazol - Adverse Effects

A 
CV effects
HA
Diarrhea 
Infx
Rhinitis
Thrombocytopenia (possible)
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24
Q

Anti-Platelet:

Cilostazol - Drug Interactions

A

CYP3A4 and CYP2C19 substrates

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25
Q

Anti-Platelet:

Cilostazol - Notes

A

BLACK BOX: Do not use in HF of any severity
No antidote
Washout: 2-13 days

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26
Q

Anti-Platelet:

Vorapaxar - MOA

A

PAR1 Antagonist (Protease-activated receptor 1)
Does not inhibit platelet aggregation by ADP
Does not affect coag parameters

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27
Q

Anti-Platelet:

Vorapaxar - Clin Use

A

Prevention of thrombotic CV events in Pts with MI history or PVD/PAD

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28
Q

Anti-Platelet:

Vorapaxar - Drug Interactions

A

Avoid w/ strong CYP3A4 inhibitors/inducers
Active metabolite M20
Avoid w/ Anti-coags

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29
Q

P2Y12 Inhibitors

A

“-grel-”

Clopidogrel
Prasugrel
Ticagrelor
Cangrelor

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30
Q

P2Y12 Inhibitors:

Clopidogrel/Prasugrel - MOA

A

Irreversible inhibits binding of ADP to P2Y12 receptors:

Inhibition of GPIIb/IIIa receptors (needed for platelet aggregation)

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31
Q

P2Y12 Inhibitors:

Clopidogrel - Clin Use

A

Prevention of atherosclerotic events
Prophylaxis of thrombotic events of UA
Combo w/ ASA to reduce: MI, Stroke, Death

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32
Q

P2Y12 Inhibitors:

Clopidogrel - Adverse Effects

A

Bleeding Risk

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33
Q

P2Y12 Inhibitors:

Clopidogrel - Drug Interactions

A

Prodrug: Activated by CYP2C19, 3A4, 2B6, 1A2, 2C9 enzymes
Avoid 2C19 inhibitors
Avoid anticoagulants and other anti-platelets

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34
Q

P2Y12 Inhibitors:

Clopidogrel/Pasugrel - Notes

A

Washout: 5-7 days

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35
Q

P2Y12 Inhibitors:

Pasugrel - Clin Use

A

W/ ASA: CV prevention post PCI in ACS Pts

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36
Q

P2Y12 Inhibitors:

Pasugrel - Adverse Effects

A

Bleeding risk if >75 yo

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37
Q

P2Y12 Inhibitors:

Prasugrel

A

Prodrug: Activated by CYP23A4, 2B6 enzymes

Least amount of DI

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38
Q

P2Y12 Inhibitors:

Ticagrelor - MOA

A

Reversible inhibits binding of ADP to P2Y12 receptors:

Inhibition of GPIIb/IIIa receptors (needed for platelet aggregation)

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39
Q

P2Y12 Inhibitors:

Ticagrelor - Clin Use

A

Reduce rate of thrombotic CV Events in Pts w/ ACS

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40
Q

P2Y12 Inhibitors:

Ticagrelor - Adverse Effects

A

Dypsnea
Careful w/ asthma
Bradycardia

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41
Q

P2Y12 Inhibitors:

Ticagrelor - Drug Interactions

A

3A4 substrate

ASA (high dose) decreases effectiveness

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42
Q

P2Y12 Inhibitors:

Ticagrelor - Notes

A

BLACK BOX: Decreased effectiveness with ASA dose >100mg

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43
Q

P2Y12 Inhibitors:

Cangrelor - MOA

A

Inhibits binding of ADP to P2Y12 receptor (not a prodrug)

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44
Q

P2Y12 Inhibitors:

Cangrelor - Clin Use

A

IV: Adjunct to PCI in Pts who have not been tx w/ P2Y12 inhibitor

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45
Q

P2Y12 Inhibitors:

Cangrelor - Adverse Effects

A

Bleeding risk

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46
Q

P2Y12 Inhibitors:

Cangrelor - Notes

A

IV - Very short t1/2

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47
Q

GP IIb/IIIa Inhibitors

A

Abciximab
Eptifibratide
Tirofiban

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48
Q

GP IIb/IIIa Inhibitors:

Adverse Effects

A

BLEEDING

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49
Q

Anti-Platelet:

Vorapaxar - Notes

A

Not for use in ACS
Limited use as mono therapy
No antidote
Washout: May not be feasible (Long t1/2 - may take up to 4 weeks)

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50
Q

GP IIb/IIIa Inhibitors:

Abciximab - MOA

A

Monoclonal Ab fragment:

Steric hindrance near active GP IIb/IIIa binding site - prevents fibrin, vWF from binding to platelets

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51
Q

GP IIb/IIIa Inhibitors:

Abciximab - Clin Use

A

Adjunct to PCI for prevention of ischemic complications:

Pts not responding to conventional therapy when PCI is planned w/n 24 hrs

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52
Q

GP IIb/IIIa Inhibitors:

Eptifibatide/Tirofiban - MOA

A

Reversibly inhibit binding of fibrin to the GP IIb/IIIa receptor
Not monoclonal Ab

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53
Q

GP IIb/IIIa Inhibitors:

Eptifibatide/Tirofiban - Clin Use

A

W/ Heparin and ASA: In ACS and PCI to reduce thrombotic cardiac events

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54
Q

GP IIb/IIIa Inhibitors:

Eptifibatide/Tirofiban - Notes

A

Special dosing required for those with reduced renal function

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55
Q

GP IIb/IIIa Inhibitors:

Abciximab - Notes

A

Anti-platelet effect: 24-48 hrs

Renal adjustment not necessary

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56
Q

Anti Coagulant Classes

A

Indirect Thrombin Inhibitors
Direct Thrombin Inhibitors
Direct Factor-Xa Inhibitors (Oral)

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57
Q

Indirect Thrombin Inhibitors

A 
“-parin-“:
Unfractioned Heparin
Enoxaparin (LMWH)
Dalteparin (LMWH)
Tinzaparin (LMWH)
Fondaparinux

Other:
Protamine Sulfate
Warfarin
Phytonadione (Vit K)

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58
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - MOA

A

Binds to ATIII and speeds its ability to inhibit coag factors (IIa and Xa)

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59
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - Clin Use

A

Reduce thrombi propagation/formation

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60
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - Adverse Effects

A

Bleeding
Heparin induced thrombocytopenia (50% decrease in platelets)
Osteoporosis
Hyperkalemia

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61
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - Dose

A

Sub Q/IV - Acts in minutes
Not absorbed orally
Tx is indication specific

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62
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - Note

A

Antidote: Protamine Sulfate
Prep Cat: C (Does not bind to protein, not secreted in breast milk, doesn’t cross placenta)
Must monitor aPTT (Intrinsic pathway)

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63
Q

Indirect Thrombin Inhibitors:

Unfractioned Heparin - Contraindications

A 
PROPURA!
h/o HIT/active thrombocytopenia
Hypersensitivity 
Active bleeding
HTN
IC hemorrhage/recent brain surgery
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64
Q

Indirect Thrombin Inhibitors:

Protamine Sulfate - MOA

A

Forms table salt complex in presence of heparin
Derived from fish sperm
High in arginine (alkaline)

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65
Q

Indirect Thrombin Inhibitors:

Protamine Sulfate - Clin Use

A

Reverse heparin anticoagulation

Will not completely convert LMWH

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66
Q

Indirect Thrombin Inhibitors:

Protamine Sulfate - Adverse Effects

A

Allergies: Fish component
Caution: Infusion reaction (Sudden BP drop or bradycardia)

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67
Q

Indirect Thrombin Inhibitors:

Protamine Sulfate - Drug Interactions

A

Certain Antibiotics:
Cephalosporins
Penicillins

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68
Q

Indirect Thrombin Inhibitors:

Protamine Sulfate - Dose

A

IV: Admin very slowly over 10 min period

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69
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Enoxaparin, Dalteparin, Tinzaparin)

A

Binds ATIII (lower affinity than heparin):
Inactivates Factor Xa
Does not affect aPTT

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70
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Clin Use
(Enoxaparin specific)

A

Tx/prophylaxis of DVT
W/ Warfarin for PE
Tx of STEMI

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71
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Dalteparin Specific)

A

Prophylaxis of DVT

Extended/Recurrent Tx of VET in CANCER PTs

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72
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Tinzaparin specific)

A

W/ Warfarin: Tx of acute DVT +/- PE

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73
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Adverse Effects
(Enoxaparin, Dalteparin, Tinzaparin)

A

Less risk of HIT

74
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Dose
(Enoxaparin, Dalteparin, Tinzaparin)

A

SubQ

Longer t1/2 than Unfractioned Heparin

75
Q

Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Notes
(Enoxaparin, Dalteparin, Tinzaparin)

A

PROTAMINE SULFATE DOESN’T FULLY REVERSE LMWH OD
BLACK BOX: MAY CAUSE SPINAL/EPIDURAL HEMATOMA
Preferred analog in pregnancy (Cat B)
Not necessary to monitor aPTT

76
Q

Indirect Thrombin Inhibitors:

Fondaparinux - MOA

A

Binds ATIII: Selectively inhibits Factor Xa

77
Q

Indirect Thrombin Inhibitors:

Fondaparinux - Clin Use

A

Prophylaxis of DVT

W/ Warfarin: Tx of acute DVT/PE

78
Q

Indirect Thrombin Inhibitors:

Fondaparinux - Adverse Effects

A

Bleeding (<100k platelets)

May still cause HIT (less likely)

79
Q

Indirect Thrombin Inhibitors:

Fondaparinux - Dose

A

SubQ

80
Q

Indirect Thrombin Inhibitors:

Fondaparinux - Note

A

BLACK BOX: May cause spinal/epidural hematoma

Less likely to cause HIT

81
Q

Indirect Thrombin Inhibitors:

Warfarin - MOA

A

Inhibits Vit-K cofactors (II, VII, IX, X, Proteins C & S)

82
Q

Indirect Thrombin Inhibitors:

Warfarin - Clin Use

A

Prophylaxis and Tx of DVT/PE
Secondary prevention in risk of death, recurrent MI/stroke
Protein C & S deficiency

83
Q

Indirect Thrombin Inhibitors:

Warfarin - Adverse Effects

A

PURPLE TOE SYNDROME
Common: Bleeding/Bruising
Rare: Skin necrosis (related to C/S proteins)

84
Q

Indirect Thrombin Inhibitors:

Warfarin - Drug Interactions

A

99% protein bound
Avoid NSAIDs
Metabolized by CYP2C9: Easily altered by dark leafy greens (high Vit-K)

85
Q

Indirect Thrombin Inhibitors:

Warfarin - Dose

A

Rapid Effect req’d: Gove w/ heparin or LMWH

Adjust per INR

86
Q

Indirect Thrombin Inhibitors:

Warfarin - Notes

A

Anticoagulation is based on t1/2 of factors:
Factors (hrs): II = 60, VII = 6, IX = 24, X = 48-72
Proteins (hrs): C = 6, S = 10

Monitored w/ INR:
Normal 0.8-1.2, DVT prophylaxis 2-3, Artificial valves 2.5-3.5

87
Q

Indirect Thrombin Inhibitors:

Warfarin - Contraindicated

A

Preg Cat: X

88
Q

Indirect Thrombin Inhibitors:

Phytonadione - MOA

A

Fat soluble vitamin K

89
Q

Indirect Thrombin Inhibitors:

Phytonadione (Vit-K) - Clin Use

A

Reversal agent for Warfarin

90
Q

Indirect Thrombin Inhibitors:

Phytonadione (Vit-K) - Dose

A

PO (Mephyton): Preferred

IV(Aquamephyton): Given slowly to avoid anaphylaxis

91
Q

Direct Thrombin Inhibitors

A

Bivalirudin
Argatroban
Dabigatran
Idarucizamab IV

92
Q

Direct Thrombin Inhibitors:

Bivalirudin/Argatroban - MOA

A

Binds to active site of Thrombin:
Prevents conversion of I to Ia
No cofactor needed

93
Q

Direct Thrombin Inhibitors:

Bivalirudin/Argatroban - Adverse Effects

A

Major/Minor bleeding
Caution w/ anti-coag’s
Allergic reactions

94
Q

Direct Thrombin Inhibitors:

Bivalirudin - Clin Use

A

PCI
Pts w/ or at risk of HIT
HIT and thrombosis syndrome undergoing PCI

95
Q

Direct Thrombin Inhibitors:

Argatroban - Clin Use

A

Prophylaxis or Tx for Pts with HIT w/ or w/o thrombosis

In adults w/ or at risk for HIT while undergoing PCI

96
Q

Direct Thrombin Inhibitors:

Bivalirudin - Dose

A

Adjust dose with CrCl

97
Q

Direct Thrombin Inhibitors:

Argatroban - Dose

A

Adjust for liver impairment

Must obtain INR and aPTT prior to first dose

98
Q

Direct Thrombin Inhibitors:

Bivalirudin - Notes

A

Cleared by kidneys
Maintain aPTT 1.5-2.5 times baseline aPTT
Activated clotting time (ACT) is also monitored

99
Q

Direct Thrombin Inhibitors:

Argatroban - Notes

A

Metabolized by liver

aPTT range = 1.5-3 times initial baseline

100
Q

Direct Thrombin Inhibitors:

Dabigatran - MOA

A

Direct thrombin inhibitor prodrug

101
Q

Direct Thrombin Inhibitors:

Dabigatran - Clin Use

A

Stroke/embolism prevention in Pt with non-valvular a-fib DVT/PE
Tx/prevention of recurrence

102
Q

Direct Thrombin Inhibitors:

Dabigatran - Adverse Effect

A

Bleeding (IDARUCIZUMAB ANTIDOTE)

Contraindicated in mechanical heart valves, concomitant use of ketoconazole and other P-GP inhibitors

103
Q

Direct Thrombin Inhibitors:

Dabigatran - Drug Interactions

A

W/ ASA or clopidogrel bleeding risk doubled
Avoid Ticagrelor
P-GP inhibitors may increase levels
Take 24hrs before antacids

104
Q

Direct Thrombin Inhibitors:

Dabigatran - Dose

A

Stop warfarin/start Dabigatran when the INR <2.0

Not recommended for CrCl <15ml/min

105
Q

Direct Thrombin Inhibitors:

Dabigatran - Notes

A

Pregnancy Cat C

Better than warfarin: more effective at prevention of stroke and embolism in a-fib, lower risk of IC bleeding, fewer drug rxns, monitoring not required

Worse than Warfarin: Renal elimination, Not for use with prosthetic valves, risk of dyspepsia, BID, $$$;

aPTT is used to approximate risk, Activated charcoal can be used and diuresis promotes excretion

106
Q

Direct Thrombin Inhibitors:

Idarucizumab IV - MOA

A

Humanized monoclonal Ab fragment:
Binds to Dabigatran and its metabolites with higher affinity then the binding affinity of Dabigatran to Thrombin.

Neutralizes anticoag effect

107
Q

Direct Thrombin Inhibitors:

Idarucizumab IV - Clin Use

A

Reverse Dabigatran anticoagulant effects

Will NOT work for factor Xa inhibitors

108
Q

Direct Thrombin Inhibitors:

Idarucizumab IV - Notes

A

Very expensive

109
Q

Direct Factor Xa Inhibitors (Oral)

A

“ -xaban”

Aphixaban
Rivaroxaban
Edoxaban

110
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban, Rivaroxaban, Edoxaban - MOA

A

Selectively blocks Xa:
Prevents the conversion of prothrombin to thrombin; no direct effect on platelets

Does NOT require a co-factor

111
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban - Clin Use

A

DVT prophylaxis in knee or hip replacement Pts

Stroke prevention in Pts with non-valvular A-fib

112
Q

Direct Factor Xa Inhibitors (Oral):

Rivaroxaban - Clin Use

A

Redux of risk of stroke/embolism in non-valvular A-fib

Prophylaxis of DVT post surgery

DVT/PE treatment/recurrence

113
Q

Direct Factor Xa Inhibitors (Oral):

Edoxaban -

A

Thromboembolism prevention

DVT/PE treatment

114
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban, Rivaroxaban, Edoxaban - Adverse Effects

A

Bleeding: No antidote available

Activated Charcoal may reduce absorption if needed

115
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban, Rivaroxaban, Edoxaban - Drug Interactions

A

Avoid use w/ P-GP and strong CYP3A4 inducers/inhibitors

116
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban, Edoxaban - Dose

A

Stop 24hrs prior to surgery

117
Q

Direct Factor Xa Inhibitors (Oral):

Rivaroxaban - Dose

A

Stop prior to Surgery

Moderate/high risk of bleeding

118
Q

Direct Factor Xa Inhibitors (Oral):

Aphixaban - Notes

A

Avoid in pt with Liver disease

Pregnancy Cat C

May prolong PT; aPTT is less sensitive”

119
Q

Direct Factor Xa Inhibitors (Oral):

Rivaroxaban - Notes

A

Not recommended in severe liver impairment

Pregnancy Cat B

May prolong PT; aPTT is less sensitive”

120
Q

Direct Factor Xa Inhibitors (Oral):

Edoxaban - Notes

A

Pregnancy Cat C

May prolong PT; aPTT is less sensitive”

121
Q

Fibrinolytic/Thrombolytic Classes

A

Thrombolytic Enzymes

Tissue Plasminogen activators

122
Q

Thrombolytic Enzymes

A

Streptokinase

Urokinase

123
Q

Thrombolytic Enzymes:

Streptokinase, Urokinase - MOA

A

Enzyme synth’d by kidney:
Directly converts plasminogen to plasmin;
Degrades fibrin and clotting factors V & VII

Streptokinase not available in USA

124
Q

Thrombolytic Enzymes:

Streptokinase, Urokinase - Dose

A

IV infusion

125
Q

Thrombolytic Enzymes:

Streptokinase - Notes

A

Not available in USA

Derived from culture broths of Group C Beta hemolytic strep

126
Q

Tissue Plasminogen Activators

A

“-eplase”

Alteplase
Reteplase
Tenecteplase

127
Q

Tissue Plasminogen Activators:

Alteplase, Reteplase, Tenecteplase - MOA

A

Activates fibrin bound plasminogen in thrombi:

Initiating fibrinolysis

128
Q

Tissue Plasminogen Activators:

Alteplase - Clin Use

A

Tx of STEMI, submassive/massive PE, acute ischemic stroke (<3hrs), catheter clearance

129
Q

Tissue Plasminogen Activators:

Reteplase - Clin Use

A

ONLY approved for acute STEMI

OFF LABEL: DVT and massive PE

130
Q

Tissue Plasminogen Activators:

Tenecteplase - Clin Use

A

ONLY approved for acute STEMI

131
Q

Tissue Plasminogen Activators:

Tenecteplase - Dose

A

Longer t1/2

132
Q

Tissue Plasminogen Activators:

Alteplase, Reteplase - Notes

A

Human tPA

133
Q

Tissue Plasminogen Activators:

Tenecteplase - Notes

A

Mutant form of tPA

Longer t1/2

134
Q

Fibrinolytics -

Absolute Contraindications

A 
h/o IC hemorrhage 
h/o Cerebrovascular lesion
Known IC neoplasm 
Ischemic stroke <3mo 
Aortic dissection 
h/o Head/facial trauma (<3mo) 
Active bleeding/bleeding diathesis"
135
Q

Fibrinolytics -

Relative Contraindications

A 
Pregnancy 
h/o chronic severe uncontrolled HTN 
Systolic BP >180 or diastolic BP >110 
Ischemic stroke > 3 months 
IC pathologies 
Prolonged (≥ 10 min ) CPR w/n 3 wks 
Major surgery w/n 3 wks 
h/o internal bleeding w/n 2-4 wks 
Noncompressible vascular puncture 
Active peptic ulcer 
Active use of anti-coag’s
136
Q

Blood Control Classes

A

Blood Transfusion (IV)
CRYO (IV)
Prothrombin Complex Concentrates (IV)
Tranexamic Acid (PO/IV)

137
Q

Prothrombin Complex Concentrates (IV)

A

Kcentra

Profilnine

138
Q

Prothrombin Complex Concentrate (IV):

Kcentra - MOA

A

Mixture of prothrombin; factors VII, IX, and X; and protein C and S 4- factor

139
Q

Prothrombin Complex Concentrate (IV):

Profilnine - MOA

A

Vit-K dependent factors II, IX, X w/ low levels of VII

140
Q

Prothrombin Complex Concentrate (IV):

Kcentra, Profilnine - Clin Use

A

Reserving as last line effort:

Reversing of newer anticoags (apixaban, dabigatran, rivaroxaban, edoxaban)

141
Q

Tranexamic Acids

A

Lasteda (PO)

Cyklokapron (IV)

142
Q

Tranexamic Acid:

Lasteda (PO), Cyklokapron (IV) - MOA

A

Reversible: Forms complex that displaces plasminogen from fibrin: Inhibition of fibrinolysis; also inhibits proteolytic activity of plasmin

143
Q

Tranexamic Acid:

Lasteda (PO), Cyklokapron (IV) - Clin Use

A

Cyclic heavy menstural bleeding (oral)

Tooth extraction in pts with hemophilia (Inj)

Unlabeled: traumatic bleed, perioperative bleeding

144
Q

Tranexamic Acid:

Lasteda (PO), Cyklokapron (IV) - Adverse Effects

A

Severe: thrombotic events
Common: HA, abdominal pain, and back pain

145
Q

Tranexamic Acid:

Lasteda (PO), Cyklokapron (IV) - Notes

A

Eliminated by the kidneys Precautions: h/o thrombotic events, renal dysfx

146
Q

Anemia Drug Classes

A

Iron Supplement (PO/IV)
Vitamin B12
Folate
Growth Factors

147
Q

Iron Supplements (PO)

A

“Ferrous -“
Ferrous Gluconate
Ferrous Sulfate
Ferrous Fumarate

148
Q

Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - MOA

A

Ferrous Gluconate - 12% Fe

Ferrous Sulfate - 20% Fe

Ferrous Fumarate - 33% Fe

149
Q

Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Clin Use

A

Iron Deficiency Anemia’s

150
Q

Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Adverse Effects

A

Constipation

Stool discoloration (Black)

151
Q

Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Dose

A

Approx 25% of PO Iron is absorbed

Ferrous Sulfate (20% Fe) is best absorbed

152
Q

Iron Supplements (IV)

A 
Iron Dectrane
Sodium Ferric Gluconate Complex
Iron Sucrose 
Ferumoxutol 
Ferric Carboxymaltose
153
Q

Iron Supplements (IV) - Clin Use

A

Documented IDA unable to tolerate PO option

Chronic anemia who cannot use oral alone

Severe conditions requiring rapid correction of iron

154
Q

Iron Supplements (IV) - Adverse Affects

A

GI upset

Hypersensitivity rxns (most common with parenteral)

Fatal OD (1-10g)

155
Q

Iron Supplements (IV) - Notes

A

Antidote: Deferoxamine (Desferal); iron chelating agent for iron toxicity

Fatal Overdose 1-10g

156
Q

Vitamin B12 Supplements

A

“-ocobalmin”

Hydroxyocobalmin
Cyanocobalmin

157
Q

Vit B-12:

Hydroxyocobalamin, Cyanocobalamin - Clin Use

A

Insufficient dietary intake of B12

Replace B12 caused by dysfx of distal ileum w/ defective absorption of IF

After total gastrectomy

Pernicious Anemia

158
Q

Vit B-12:

Hydroxyocobalamin, Cyanocobalamin - Adverse Reactions

A 
Anaphylacsis 
Death
PE 
CHF
PVT
itching/exanthema/feeling of swelling
159
Q

Vit B-12:

Hydroxyocobalamin - Notes

A

Preferred:
Highly protein bound
Remains in circulation longer

160
Q

Folates

A

Folic Acid

Leucovorin (reduced folic acid)

161
Q

Folate:

Folic Acid - MOA

A

Dietary insufficiency

162
Q

Folate:

Leucovorin - Clin Use

A

Folic acid antagonist

OD

163
Q

Growth Factors

A

“-poetin”
Epoetin Alfa (IV)
Darbapoetin (IV)

“-stim”
Filgrastim (IV)
Sargramostim

164
Q

Growth Factors:

Epoetin Alfa, Darbapoetin - MOA

A

Increase proliferation/differentiation of erythroid cells:
Increases release of reticulocytes

Requires adequate iron stores

165
Q

Growth Factors:

Epoetin Alfa, Darbapoetin - Clin Use

A

RBC production in anemia of CKD

Chemotherapy induced anemia

Surgery prep

166
Q

Growth Factors:

Epoetin Alfa, Darbapoetin - Adverse Effects

A 
Risk evaluation and mitigation strategies (REMS) program 
Increase risk of death/CV events, 
HTN 
Seizures 
HA
167
Q

Growth Factors:

Epoetin Alfa, Darbapoetin - Contraindications

A

Do not give if Hgb >10g/dL

168
Q

Growth Factors:

Darbapoetin - Dose

A

Less frequent dosing:

3x longer t1/2 than EPO alfa

169
Q

Growth Factors:

Epoetin Alfa - Notes

A

No value in treating acute anemia

170
Q

Growth Factor:

Filgrastim (IV) - MOA

A

Granulocyte colony stim factor:

Stim neutrophil production/activation

171
Q

Growth Factor:

Filgrastim (IV) - Clin Use

A

Chemotherapy recipients w/ nonmyeloid malignancies

Hematopoietic radiation

172
Q

Growth Factor:

Filgrastim (IV) - Adverse Effects

A

Alveolar hemorrhage
Nephrotoxicity
ARDS

173
Q

Growth Factor:

Filgrastim (IV) - Dose

A

Discontinue when neutrophils are >10K

174
Q

Growth Factors:

Sargramostim - MOA

A

Granulocyte macrophage colony stim factor:

Stims neutrophils, eosinophils, monocytes and macrophages

175
Q

Growth Factors:

Sargramostim - Clin Use

A

AML
Bone marrow transplant
Stem cell transplant

176
Q

Growth Factors:

Sargramostim - Adverse Effects

A

First dose effect: Hypoxia, flushing, hotn, tachy, syncope

Fluid retention

Pulmonary sx

177
Q

Growth Factors:

Sargramostim - Notes

A

Hematologic effect:

If there is a rapid increase in blood/platelet count - decrease the dose by 50%

178
Q

Pulmonary Emobolism Diagnostic

A

Pulmonary angiography = Gold Std

D-Dimer: high neg predictive value
Elevated troponins
Elevated natriuretic peptides
ECG (tachy, arrhythmias, RBBB etc

179
Q

Pulmonary Emobolism Diagnostic:

Massive PE

A

Acute PE w/ sustained HOTN Sysolic <90 for 15min,
Loss of pulse

Acute PE with Persistent Brady HR <40bpm
S/S of shock

180
Q

Pulmonary Emobolism Diagnostic:

Submassive PE

A

Acute PE without systemic HOTN

RV dysfunction Myocardial necrosis

181
Q

Pulmonary Emobolism Diagnostic:

Low-Risk PE

A

Acute PE w/ absence of clinical markers of adverse prognosis that define massive/submassive PE

Pharm (5 decks)

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