Hemotologic Flashcards
1
Q
Platelet Aggregation Inhibitor Classes
A
PG synth inhibitors
Anti-platelets
P2Y12 inhibitors
GP IIb/IIIa Inhibitors
2
Q
PG Synth Inhibitor
A
Aspirin (ASA - Acetylsalicylic Acid)
3
Q
PGA Synth Inhib:
Aspirin - MOA
A
Irreversible inhibition of COX-1/2 enzymes:
Results in decrease TXA2 synth (from arachidonic acid)
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
5
Q
PGA Synth Inhib:
Aspirin - Adverse Effects
A
GI (most common)
Increased risk in bleeding (possible surgery complication)
Reye’s Syndrome
Hypersensitivity
6
Q
PGA Synth Inhib:
Aspirin - Dose
A
50-160mg
81mg for 50-59yo
No more than 160mg
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
8
Q
Anti-platelets
A
Dipyridamole
ASA/Dipyridamole (Aggrenox)
Cilostazol
Vorapaxar
9
Q
Anti-Platelet:
Dipyridamole - MOA
A
Stimulates prostacyclin synth:
Inhibits adenosine uptake = Inhibiting platelet aggregation
10
Q
Anti-Platelet:
Dipyridamole - Clin Use
A
Combined w/ ASA (little use on its own)
Stroke ischemia prevention
11
Q
Anti-Platelet:
Dipyridamole - Adverse Effects
A
Flushing
Dizziness
HA
Coronary steal phenomenon (in unstable angina Pts)
12
Q
Anti-Platelet:
Dipyridamole - Drug Interactions
A
Caution with anti-coags:
May aggravate MG
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
14
Q
Anti-Platelet:
Dipyridamole - Notes
A
No antidote
Washout: 2-3 Days
15
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - MOA
A
Inhibit COX-1/2
Stimulate prostacyclin synth
16
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - Clin Use
A
Secondary prevention of stroke POST ischemic stroke or TIA
17
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - Adverse Effects
A
Do not use in children/teens w/ viral syndrome:
Linked to Reye’s syndrome
18
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - Drug interactions
A
Caution with anti-coags
19
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - Dose
A
Oral: BID
20
Q
Anti-Platelet:
ASA/Dipyridamole (Aggrenox) - Notes
A
Must be protected from moisture
21
Q
Anti-Platelet:
Cilostazol - MOA
A
PDE3 inhibitor:
Inhibits cAMP (vasodilator) breakdown
Reversibly inhibits platelet aggregation induced by ADP
22
Q
Anti-Platelet:
Cilostazol - Clin Use
A
Redux of sxs of intermittent claudication
Use w/ ASA enhances platelet inhibition vs ASA alone
23
Q
Anti-Platelet:
Cilostazol - Adverse Effects
A
CV effects HA Diarrhea Infx Rhinitis Thrombocytopenia (possible)
24
Q
Anti-Platelet:
Cilostazol - Drug Interactions
A
CYP3A4 and CYP2C19 substrates
25
Anti-Platelet:
| Cilostazol - Notes
BLACK BOX: Do not use in HF of any severity
No antidote
Washout: 2-13 days
26
Anti-Platelet:
| Vorapaxar - MOA
PAR1 Antagonist (Protease-activated receptor 1)
Does not inhibit platelet aggregation by ADP
Does not affect coag parameters
27
Anti-Platelet:
| Vorapaxar - Clin Use
Prevention of thrombotic CV events in Pts with MI history or PVD/PAD
28
Anti-Platelet:
| Vorapaxar - Drug Interactions
Avoid w/ strong CYP3A4 inhibitors/inducers
Active metabolite M20
Avoid w/ Anti-coags
29
P2Y12 Inhibitors
“-grel-”
Clopidogrel
Prasugrel
Ticagrelor
Cangrelor
30
P2Y12 Inhibitors:
| Clopidogrel/Prasugrel - MOA
Irreversible inhibits binding of ADP to P2Y12 receptors:
| Inhibition of GPIIb/IIIa receptors (needed for platelet aggregation)
31
P2Y12 Inhibitors:
| Clopidogrel - Clin Use
Prevention of atherosclerotic events
Prophylaxis of thrombotic events of UA
Combo w/ ASA to reduce: MI, Stroke, Death
32
P2Y12 Inhibitors:
| Clopidogrel - Adverse Effects
Bleeding Risk
33
P2Y12 Inhibitors:
| Clopidogrel - Drug Interactions
Prodrug: Activated by CYP2C19, 3A4, 2B6, 1A2, 2C9 enzymes
Avoid 2C19 inhibitors
Avoid anticoagulants and other anti-platelets
34
P2Y12 Inhibitors:
| Clopidogrel/Pasugrel - Notes
Washout: 5-7 days
35
P2Y12 Inhibitors:
| Pasugrel - Clin Use
W/ ASA: CV prevention post PCI in ACS Pts
36
P2Y12 Inhibitors:
| Pasugrel - Adverse Effects
Bleeding risk if >75 yo
37
P2Y12 Inhibitors:
| Prasugrel
Prodrug: Activated by CYP23A4, 2B6 enzymes
| Least amount of DI
38
P2Y12 Inhibitors:
| Ticagrelor - MOA
Reversible inhibits binding of ADP to P2Y12 receptors:
| Inhibition of GPIIb/IIIa receptors (needed for platelet aggregation)
39
P2Y12 Inhibitors:
| Ticagrelor - Clin Use
Reduce rate of thrombotic CV Events in Pts w/ ACS
40
P2Y12 Inhibitors:
| Ticagrelor - Adverse Effects
Dypsnea
Careful w/ asthma
Bradycardia
41
P2Y12 Inhibitors:
| Ticagrelor - Drug Interactions
3A4 substrate
| ASA (high dose) decreases effectiveness
42
P2Y12 Inhibitors:
| Ticagrelor - Notes
BLACK BOX: Decreased effectiveness with ASA dose >100mg
43
P2Y12 Inhibitors:
| Cangrelor - MOA
Inhibits binding of ADP to P2Y12 receptor (not a prodrug)
44
P2Y12 Inhibitors:
| Cangrelor - Clin Use
IV: Adjunct to PCI in Pts who have not been tx w/ P2Y12 inhibitor
45
P2Y12 Inhibitors:
| Cangrelor - Adverse Effects
Bleeding risk
46
P2Y12 Inhibitors:
| Cangrelor - Notes
IV - Very short t1/2
47
GP IIb/IIIa Inhibitors
Abciximab
Eptifibratide
Tirofiban
48
GP IIb/IIIa Inhibitors:
| Adverse Effects
BLEEDING
49
Anti-Platelet:
| Vorapaxar - Notes
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)
50
GP IIb/IIIa Inhibitors:
| Abciximab - MOA
Monoclonal Ab fragment:
| Steric hindrance near active GP IIb/IIIa binding site - prevents fibrin, vWF from binding to platelets
51
GP IIb/IIIa Inhibitors:
| Abciximab - Clin Use
Adjunct to PCI for prevention of ischemic complications:
| Pts not responding to conventional therapy when PCI is planned w/n 24 hrs
52
GP IIb/IIIa Inhibitors:
| Eptifibatide/Tirofiban - MOA
Reversibly inhibit binding of fibrin to the GP IIb/IIIa receptor
Not monoclonal Ab
53
GP IIb/IIIa Inhibitors:
| Eptifibatide/Tirofiban - Clin Use
W/ Heparin and ASA: In ACS and PCI to reduce thrombotic cardiac events
54
GP IIb/IIIa Inhibitors:
| Eptifibatide/Tirofiban - Notes
Special dosing required for those with reduced renal function
55
GP IIb/IIIa Inhibitors:
| Abciximab - Notes
Anti-platelet effect: 24-48 hrs
| Renal adjustment not necessary
56
Anti Coagulant Classes
Indirect Thrombin Inhibitors
Direct Thrombin Inhibitors
Direct Factor-Xa Inhibitors (Oral)
57
Indirect Thrombin Inhibitors
```
“-parin-“:
Unfractioned Heparin
Enoxaparin (LMWH)
Dalteparin (LMWH)
Tinzaparin (LMWH)
Fondaparinux
```
Other:
Protamine Sulfate
Warfarin
Phytonadione (Vit K)
58
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - MOA
Binds to ATIII and speeds its ability to inhibit coag factors (IIa and Xa)
59
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - Clin Use
Reduce thrombi propagation/formation
60
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - Adverse Effects
Bleeding
Heparin induced thrombocytopenia (50% decrease in platelets)
Osteoporosis
Hyperkalemia
61
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - Dose
Sub Q/IV - Acts in minutes
Not absorbed orally
Tx is indication specific
62
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - Note
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)
63
Indirect Thrombin Inhibitors:
| Unfractioned Heparin - Contraindications
```
PROPURA!
h/o HIT/active thrombocytopenia
Hypersensitivity
Active bleeding
HTN
IC hemorrhage/recent brain surgery
```
64
Indirect Thrombin Inhibitors:
| Protamine Sulfate - MOA
Forms table salt complex in presence of heparin
Derived from fish sperm
High in arginine (alkaline)
65
Indirect Thrombin Inhibitors:
| Protamine Sulfate - Clin Use
Reverse heparin anticoagulation
| Will not completely convert LMWH
66
Indirect Thrombin Inhibitors:
| Protamine Sulfate - Adverse Effects
Allergies: Fish component
Caution: Infusion reaction (Sudden BP drop or bradycardia)
67
Indirect Thrombin Inhibitors:
| Protamine Sulfate - Drug Interactions
Certain Antibiotics:
Cephalosporins
Penicillins
68
Indirect Thrombin Inhibitors:
| Protamine Sulfate - Dose
IV: Admin very slowly over 10 min period
69
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Enoxaparin, Dalteparin, Tinzaparin)
Binds ATIII (lower affinity than heparin):
Inactivates Factor Xa
Does not affect aPTT
70
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Clin Use
(Enoxaparin specific)
Tx/prophylaxis of DVT
W/ Warfarin for PE
Tx of STEMI
71
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Dalteparin Specific)
Prophylaxis of DVT
| Extended/Recurrent Tx of VET in CANCER PTs
72
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - MOA
(Tinzaparin specific)
W/ Warfarin: Tx of acute DVT +/- PE
73
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Adverse Effects
(Enoxaparin, Dalteparin, Tinzaparin)
Less risk of HIT
74
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Dose
(Enoxaparin, Dalteparin, Tinzaparin)
SubQ
| Longer t1/2 than Unfractioned Heparin
75
Indirect Thrombin Inhibitors:
Low Molecular Weight Heparins - Notes
(Enoxaparin, Dalteparin, Tinzaparin)
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
Indirect Thrombin Inhibitors:
| Fondaparinux - MOA
Binds ATIII: Selectively inhibits Factor Xa
77
Indirect Thrombin Inhibitors:
| Fondaparinux - Clin Use
Prophylaxis of DVT
| W/ Warfarin: Tx of acute DVT/PE
78
Indirect Thrombin Inhibitors:
| Fondaparinux - Adverse Effects
Bleeding (<100k platelets)
| May still cause HIT (less likely)
79
Indirect Thrombin Inhibitors:
| Fondaparinux - Dose
SubQ
80
Indirect Thrombin Inhibitors:
| Fondaparinux - Note
BLACK BOX: May cause spinal/epidural hematoma
| Less likely to cause HIT
81
Indirect Thrombin Inhibitors:
| Warfarin - MOA
Inhibits Vit-K cofactors (II, VII, IX, X, Proteins C & S)
82
Indirect Thrombin Inhibitors:
| Warfarin - Clin Use
Prophylaxis and Tx of DVT/PE
Secondary prevention in risk of death, recurrent MI/stroke
Protein C & S deficiency
83
Indirect Thrombin Inhibitors:
| Warfarin - Adverse Effects
PURPLE TOE SYNDROME
Common: Bleeding/Bruising
Rare: Skin necrosis (related to C/S proteins)
84
Indirect Thrombin Inhibitors:
| Warfarin - Drug Interactions
99% protein bound
Avoid NSAIDs
Metabolized by CYP2C9: Easily altered by dark leafy greens (high Vit-K)
85
Indirect Thrombin Inhibitors:
| Warfarin - Dose
Rapid Effect req’d: Gove w/ heparin or LMWH
| Adjust per INR
86
Indirect Thrombin Inhibitors:
| Warfarin - Notes
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
Indirect Thrombin Inhibitors:
| Warfarin - Contraindicated
Preg Cat: X
88
Indirect Thrombin Inhibitors:
| Phytonadione - MOA
Fat soluble vitamin K
89
Indirect Thrombin Inhibitors:
| Phytonadione (Vit-K) - Clin Use
Reversal agent for Warfarin
90
Indirect Thrombin Inhibitors:
| Phytonadione (Vit-K) - Dose
PO (Mephyton): Preferred
| IV(Aquamephyton): Given slowly to avoid anaphylaxis
91
Direct Thrombin Inhibitors
Bivalirudin
Argatroban
Dabigatran
Idarucizamab IV
92
Direct Thrombin Inhibitors:
| Bivalirudin/Argatroban - MOA
Binds to active site of Thrombin:
Prevents conversion of I to Ia
No cofactor needed
93
Direct Thrombin Inhibitors:
| Bivalirudin/Argatroban - Adverse Effects
Major/Minor bleeding
Caution w/ anti-coag’s
Allergic reactions
94
Direct Thrombin Inhibitors:
| Bivalirudin - Clin Use
PCI
Pts w/ or at risk of HIT
HIT and thrombosis syndrome undergoing PCI
95
Direct Thrombin Inhibitors:
| Argatroban - Clin Use
Prophylaxis or Tx for Pts with HIT w/ or w/o thrombosis
| In adults w/ or at risk for HIT while undergoing PCI
96
Direct Thrombin Inhibitors:
| Bivalirudin - Dose
Adjust dose with CrCl
97
Direct Thrombin Inhibitors:
| Argatroban - Dose
Adjust for liver impairment
| Must obtain INR and aPTT prior to first dose
98
Direct Thrombin Inhibitors:
| Bivalirudin - Notes
Cleared by kidneys
Maintain aPTT 1.5-2.5 times baseline aPTT
Activated clotting time (ACT) is also monitored
99
Direct Thrombin Inhibitors:
| Argatroban - Notes
Metabolized by liver
| aPTT range = 1.5-3 times initial baseline
100
Direct Thrombin Inhibitors:
| Dabigatran - MOA
Direct thrombin inhibitor prodrug
101
Direct Thrombin Inhibitors:
| Dabigatran - Clin Use
Stroke/embolism prevention in Pt with non-valvular a-fib DVT/PE
Tx/prevention of recurrence
102
Direct Thrombin Inhibitors:
| Dabigatran - Adverse Effect
Bleeding (IDARUCIZUMAB ANTIDOTE)
| Contraindicated in mechanical heart valves, concomitant use of ketoconazole and other P-GP inhibitors
103
Direct Thrombin Inhibitors:
| Dabigatran - Drug Interactions
W/ ASA or clopidogrel bleeding risk doubled
Avoid Ticagrelor
P-GP inhibitors may increase levels
Take 24hrs before antacids
104
Direct Thrombin Inhibitors:
| Dabigatran - Dose
Stop warfarin/start Dabigatran when the INR <2.0
| Not recommended for CrCl <15ml/min
105
Direct Thrombin Inhibitors:
| Dabigatran - Notes
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
Direct Thrombin Inhibitors:
| Idarucizumab IV - MOA
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
Direct Thrombin Inhibitors:
| Idarucizumab IV - Clin Use
Reverse Dabigatran anticoagulant effects
Will NOT work for factor Xa inhibitors
108
Direct Thrombin Inhibitors:
| Idarucizumab IV - Notes
Very expensive
109
Direct Factor Xa Inhibitors (Oral)
“ -xaban”
Aphixaban
Rivaroxaban
Edoxaban
110
Direct Factor Xa Inhibitors (Oral):
| Aphixaban, Rivaroxaban, Edoxaban - MOA
Selectively blocks Xa:
Prevents the conversion of prothrombin to thrombin; no direct effect on platelets
Does NOT require a co-factor
111
Direct Factor Xa Inhibitors (Oral):
| Aphixaban - Clin Use
DVT prophylaxis in knee or hip replacement Pts
Stroke prevention in Pts with non-valvular A-fib
112
Direct Factor Xa Inhibitors (Oral):
| Rivaroxaban - Clin Use
Redux of risk of stroke/embolism in non-valvular A-fib
Prophylaxis of DVT post surgery
DVT/PE treatment/recurrence
113
Direct Factor Xa Inhibitors (Oral):
| Edoxaban -
Thromboembolism prevention
| DVT/PE treatment
114
Direct Factor Xa Inhibitors (Oral):
| Aphixaban, Rivaroxaban, Edoxaban - Adverse Effects
Bleeding: No antidote available
Activated Charcoal may reduce absorption if needed
115
Direct Factor Xa Inhibitors (Oral):
| Aphixaban, Rivaroxaban, Edoxaban - Drug Interactions
Avoid use w/ P-GP and strong CYP3A4 inducers/inhibitors
116
Direct Factor Xa Inhibitors (Oral):
| Aphixaban, Edoxaban - Dose
Stop 24hrs prior to surgery
117
Direct Factor Xa Inhibitors (Oral):
| Rivaroxaban - Dose
Stop prior to Surgery
Moderate/high risk of bleeding
118
Direct Factor Xa Inhibitors (Oral):
| Aphixaban - Notes
Avoid in pt with Liver disease
Pregnancy Cat C
May prolong PT; aPTT is less sensitive"
119
Direct Factor Xa Inhibitors (Oral):
| Rivaroxaban - Notes
Not recommended in severe liver impairment
Pregnancy Cat B
May prolong PT; aPTT is less sensitive"
120
Direct Factor Xa Inhibitors (Oral):
| Edoxaban - Notes
Pregnancy Cat C
May prolong PT; aPTT is less sensitive"
121
Fibrinolytic/Thrombolytic Classes
Thrombolytic Enzymes
| Tissue Plasminogen activators
122
Thrombolytic Enzymes
Streptokinase
| Urokinase
123
Thrombolytic Enzymes:
| Streptokinase, Urokinase - MOA
Enzyme synth’d by kidney:
Directly converts plasminogen to plasmin;
Degrades fibrin and clotting factors V & VII
Streptokinase not available in USA
124
Thrombolytic Enzymes:
| Streptokinase, Urokinase - Dose
IV infusion
125
Thrombolytic Enzymes:
| Streptokinase - Notes
Not available in USA
Derived from culture broths of Group C Beta hemolytic strep
126
Tissue Plasminogen Activators
“-eplase”
Alteplase
Reteplase
Tenecteplase
127
Tissue Plasminogen Activators:
| Alteplase, Reteplase, Tenecteplase - MOA
Activates fibrin bound plasminogen in thrombi:
| Initiating fibrinolysis
128
Tissue Plasminogen Activators:
| Alteplase - Clin Use
Tx of STEMI, submassive/massive PE, acute ischemic stroke (<3hrs), catheter clearance
129
Tissue Plasminogen Activators:
| Reteplase - Clin Use
ONLY approved for acute STEMI
OFF LABEL: DVT and massive PE
130
Tissue Plasminogen Activators:
| Tenecteplase - Clin Use
ONLY approved for acute STEMI
131
Tissue Plasminogen Activators:
| Tenecteplase - Dose
Longer t1/2
132
Tissue Plasminogen Activators:
| Alteplase, Reteplase - Notes
Human tPA
133
Tissue Plasminogen Activators:
| Tenecteplase - Notes
Mutant form of tPA
Longer t1/2
134
Fibrinolytics -
| Absolute Contraindications
```
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
Fibrinolytics -
| Relative Contraindications
```
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
Blood Control Classes
Blood Transfusion (IV)
CRYO (IV)
Prothrombin Complex Concentrates (IV)
Tranexamic Acid (PO/IV)
137
Prothrombin Complex Concentrates (IV)
Kcentra
| Profilnine
138
Prothrombin Complex Concentrate (IV):
| Kcentra - MOA
Mixture of prothrombin; factors VII, IX, and X; and protein C and S 4- factor
139
Prothrombin Complex Concentrate (IV):
| Profilnine - MOA
Vit-K dependent factors II, IX, X w/ low levels of VII
140
Prothrombin Complex Concentrate (IV):
| Kcentra, Profilnine - Clin Use
Reserving as last line effort:
| Reversing of newer anticoags (apixaban, dabigatran, rivaroxaban, edoxaban)
141
Tranexamic Acids
Lasteda (PO)
| Cyklokapron (IV)
142
Tranexamic Acid:
| Lasteda (PO), Cyklokapron (IV) - MOA
Reversible: Forms complex that displaces plasminogen from fibrin: Inhibition of fibrinolysis; also inhibits proteolytic activity of plasmin
143
Tranexamic Acid:
| Lasteda (PO), Cyklokapron (IV) - Clin Use
Cyclic heavy menstural bleeding (oral)
Tooth extraction in pts with hemophilia (Inj)
Unlabeled: traumatic bleed, perioperative bleeding
144
Tranexamic Acid:
| Lasteda (PO), Cyklokapron (IV) - Adverse Effects
Severe: thrombotic events
Common: HA, abdominal pain, and back pain
145
Tranexamic Acid:
| Lasteda (PO), Cyklokapron (IV) - Notes
Eliminated by the kidneys Precautions: h/o thrombotic events, renal dysfx
146
Anemia Drug Classes
Iron Supplement (PO/IV)
Vitamin B12
Folate
Growth Factors
147
Iron Supplements (PO)
“Ferrous -“
Ferrous Gluconate
Ferrous Sulfate
Ferrous Fumarate
148
Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - MOA
Ferrous Gluconate - 12% Fe
Ferrous Sulfate - 20% Fe
Ferrous Fumarate - 33% Fe
149
Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Clin Use
Iron Deficiency Anemia’s
150
Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Adverse Effects
Constipation
Stool discoloration (Black)
151
Iron Supplements (PO) Ferrous Gluconate, Sulfate, Fumarate - Dose
Approx 25% of PO Iron is absorbed
Ferrous Sulfate (20% Fe) is best absorbed
152
Iron Supplements (IV)
```
Iron Dectrane
Sodium Ferric Gluconate Complex
Iron Sucrose
Ferumoxutol
Ferric Carboxymaltose
```
153
Iron Supplements (IV) - Clin Use
Documented IDA unable to tolerate PO option
Chronic anemia who cannot use oral alone
Severe conditions requiring rapid correction of iron
154
Iron Supplements (IV) - Adverse Affects
GI upset
Hypersensitivity rxns (most common with parenteral)
Fatal OD (1-10g)
155
Iron Supplements (IV) - Notes
Antidote: Deferoxamine (Desferal); iron chelating agent for iron toxicity
Fatal Overdose 1-10g
156
Vitamin B12 Supplements
“-ocobalmin”
Hydroxyocobalmin
Cyanocobalmin
157
Vit B-12:
| Hydroxyocobalamin, Cyanocobalamin - Clin Use
Insufficient dietary intake of B12
Replace B12 caused by dysfx of distal ileum w/ defective absorption of IF
After total gastrectomy
Pernicious Anemia
158
Vit B-12:
| Hydroxyocobalamin, Cyanocobalamin - Adverse Reactions
```
Anaphylacsis
Death
PE
CHF
PVT
itching/exanthema/feeling of swelling
```
159
Vit B-12:
| Hydroxyocobalamin - Notes
Preferred:
Highly protein bound
Remains in circulation longer
160
Folates
Folic Acid
| Leucovorin (reduced folic acid)
161
Folate:
| Folic Acid - MOA
Dietary insufficiency
162
Folate:
| Leucovorin - Clin Use
Folic acid antagonist
OD
163
Growth Factors
“-poetin”
Epoetin Alfa (IV)
Darbapoetin (IV)
“-stim”
Filgrastim (IV)
Sargramostim
164
Growth Factors:
| Epoetin Alfa, Darbapoetin - MOA
Increase proliferation/differentiation of erythroid cells:
Increases release of reticulocytes
Requires adequate iron stores
165
Growth Factors:
| Epoetin Alfa, Darbapoetin - Clin Use
RBC production in anemia of CKD
Chemotherapy induced anemia
Surgery prep
166
Growth Factors:
| Epoetin Alfa, Darbapoetin - Adverse Effects
```
Risk evaluation and mitigation strategies (REMS) program
Increase risk of death/CV events,
HTN
Seizures
HA
```
167
Growth Factors:
| Epoetin Alfa, Darbapoetin - Contraindications
Do not give if Hgb >10g/dL
168
Growth Factors:
| Darbapoetin - Dose
Less frequent dosing:
| 3x longer t1/2 than EPO alfa
169
Growth Factors:
| Epoetin Alfa - Notes
No value in treating acute anemia
170
Growth Factor:
| Filgrastim (IV) - MOA
Granulocyte colony stim factor:
| Stim neutrophil production/activation
171
Growth Factor:
| Filgrastim (IV) - Clin Use
Chemotherapy recipients w/ nonmyeloid malignancies
Hematopoietic radiation
172
Growth Factor:
| Filgrastim (IV) - Adverse Effects
Alveolar hemorrhage
Nephrotoxicity
ARDS
173
Growth Factor:
| Filgrastim (IV) - Dose
Discontinue when neutrophils are >10K
174
Growth Factors:
| Sargramostim - MOA
Granulocyte macrophage colony stim factor:
| Stims neutrophils, eosinophils, monocytes and macrophages
175
Growth Factors:
| Sargramostim - Clin Use
AML
Bone marrow transplant
Stem cell transplant
176
Growth Factors:
| Sargramostim - Adverse Effects
First dose effect: Hypoxia, flushing, hotn, tachy, syncope
Fluid retention
Pulmonary sx
177
Growth Factors:
| Sargramostim - Notes
Hematologic effect:
| If there is a rapid increase in blood/platelet count - decrease the dose by 50%
178
Pulmonary Emobolism Diagnostic
Pulmonary angiography = Gold Std
D-Dimer: high neg predictive value
Elevated troponins
Elevated natriuretic peptides
ECG (tachy, arrhythmias, RBBB etc
179
Pulmonary Emobolism Diagnostic:
| Massive PE
Acute PE w/ sustained HOTN Sysolic <90 for 15min,
Loss of pulse
Acute PE with Persistent Brady HR <40bpm
S/S of shock
180
Pulmonary Emobolism Diagnostic:
| Submassive PE
Acute PE without systemic HOTN
| RV dysfunction Myocardial necrosis
181
Pulmonary Emobolism Diagnostic:
| Low-Risk PE
Acute PE w/ absence of clinical markers of adverse prognosis that define massive/submassive PE
