pharm

Question 1

what do three drugs can you give for iron deficiency and how?

Answer 1

ferrous sulfate and gluconate-oral
iron dextran (ferric gluconate)-parenteral

Question 2

what is given for acute iron toxicity? what is its other use?

Answer 2

deferoxamine

prevent transfusional iron overload

Question 3

what are the three B12 drugs and how are they give?

which is preferred and why?

Answer 3

cobalamin
cyanocobalamin
hydroxycobalamin* (more protein-bound, longer lasting)
-parenteral injection

Question 4

name the two erythropoietic drugs and contrast them

Answer 4

epoietin alfa-recombinant human Epo

darbopoietin alfa-longer-acting glycosylated form

Question 5

what drug is used to stimulate granulocyte (neutrophil) growth, activate neutrophils, and mobilize HSC to peripheral blood? what does it mimic?

Answer 5

filgrastim/pegfilgrastim

G-CSF

Question 6

what drug is used to stimulate myeloid (granulocyte, erythroid, and Meg) growth? what does it mimic?

Answer 6

sarograstim

GM-CSF

Question 7

what drug stimulates Meg maturation and thrombopoiesis? what does it mimic?

Answer 7

oprelvekin

IL-12

Question 8

what drug mimics thrombopoietin?

Answer 8

romiplastin

Question 9

clopidogrel: what does it do? what is it metabolized by?

Answer 9

P2Y12 inhibitor

• blocks ADP receptor to prevent platelet aggregation
• CYP2C19

Question 10

ticlopidine: what does it do? when is it used and why?

Answer 10

P2Y12 inhibitor

• blocks ADP receptor to prevent platelet aggregtion
• only used as second line treatment due to severe toxicities:
• agranulocytosis, neutropenia, thrombocytopenia, anemia
• TTP

Question 11

prasugrel: what does it do?

Answer 11

P2Y12 inhibitor

-blocks ADP receptor to prevent platelet aggregation

Question 12

dipyridamole: action

Answer 12

phosphodiesterase inhibitor

• inhibits enzyme that degrades cAMP/cGMP
• prevents platelet activation/aggregation and release of TxA2
• stimulates release of prostacylin to induce adenylate cyclase activity

Question 13

abciximab: action and structure and how that affects it

Answer 13

GpIIb/IIIa inhibitor
-inhibits platelet binding to fibrinogen
monoclonal antibody
-irreversibly binds platelet, can persist up to 2 weeks, causing thrombocytopenia

Question 14

eftifibatide: action

Answer 14

GpIIb/IIIa inhibitor

-inhibits platelet binding to fibrinogen

Question 15

tirofiban: action

Answer 15

GpIIb/IIIa inhibitor

-inhibits platelet binding to fibrinogen

Question 16

vorapaxar: action and metabolism

Answer 16

PAR-1 inhibitor
-blocks thrombin-induced platelet aggregation
CYP3A4

Question 17

what herbal products affect coagulation and how?

Answer 17

gingko biloba and garlic: antiplatelet properties

ginger: inhibits TxA2 synthesis

Question 18

heparin: action, how it causes heparin-induced thrombocytopenia, what test does it affect and why

Answer 18

• binds and activates antithrombin to inactivate thrombin, Xa and IXa
• antibodies to heparin-platelet factor 4 activate platelets incorrectly, causing their depletion
• prolonged aPTT because reduced thrombin

Question 19

what drug is give as an antidote to heparin? how does it work? what is the risk?

Answer 19

protamine sulfate

• binds and neutralizes heparin
• protamine reaction: like anaphylactic shock

Question 20

what can be given for the reaction to the antidote to heparin?

Answer 20

protamine reaction: morphine, diphenhydramine (counteract anaphylaxis), saline (to counteract hypotension/reduced blood volume)

Question 21

what drug interacts with P-Gp inhibitors/inducers?

Answer 21

dabigatran

Question 22

what three drugs directly inhibit thrombin? what’s their risk

Answer 22

dabigatran
bivalirudin
lepirudin
-bleeding with no reversal agents available

Question 23

enoxaparin: structure and function, advantage, how it shows up on tests

Answer 23

low molecular weight heparin: only induces antithrombin to inactivate Xa

• less frequent bleeding due to less frequent thrombocytopenia than heparin
• doesn’t affect aPTT because doesn’t inhibit thrombin

Question 24

dalteparin: what does it do?

Answer 24

just another form of low molecular weight heparin, like enoxaparin

Question 25

apixaban: action, risk

Answer 25

directly inhibits factor Xa, free or bound | -bleeding with no reversal agent available

Question 26

rivaroxaban: action, risk

Answer 26

directly inhibits factor Xa, free or bound | -bleeding with no reversal agent available

Question 27

fondaparinux: action and risks (2)

Answer 27

indirectly inhibits Xa by mimicking antithrombin binding site of heparin-so binds and inactivates Xa - bleeding with no reversal agent available - CYP metabolism: drug-drug interaction

Question 28

warfarin: specific action and effects, what test does it affect?

Answer 28

blocks Vit-K epoxide reductase (VKORC1) - reduced synthesis of functional II, VII, IX, and X, proteins C and S - prolonged PT, because affects VII

Question 29

what two general factors affect warfarin action and what four things interact with it? how do they affect warfarin?

Answer 29

``` VKORC1 genotype CYP2C9 metabolism cimetidine (CYP inhibitor): prolonged PT rifampin (CYP inducer): reduced PT aspirin (depletes Vit K at high doses): prolongs PT Vit K: reduces PT ```

Question 30

what are two antidotes to warfarin and how do they work? which works faster and why?

Answer 30

prothrombin complex: contains factors II, VII, IX and X and proteins C and S phytonadione Vit-K1: Vit-K analog -prothrombin complex faster b/c phytonadione requires liver metabolism to work

Question 31

what are the four plasminogen activators? what are the differences?

Answer 31

alteplase: recombinant human tPA reteplase: r-PA=longer half-life tenecteplase: TNK-tPA=longer half-life streptokinase: bacterial strep product

Question 32

what drug inhibits fibrinolysis and how does it work?

Answer 32

aminocaproic acid | -inhibits activation of plasminogen to plasmin