pharm Flashcards
what do three drugs can you give for iron deficiency and how?
ferrous sulfate and gluconate-oral iron dextran (ferric gluconate)-parenteral
what is given for acute iron toxicity? what is its other use?
deferoxamine
prevent transfusional iron overload
what are the three B12 drugs and how are they give?
which is preferred and why?
cobalamin
cyanocobalamin
hydroxycobalamin* (more protein-bound, longer lasting)
-parenteral injection
name the two erythropoietic drugs and contrast them
epoietin alfa-recombinant human Epo
darbopoietin alfa-longer-acting glycosylated form
what drug is used to stimulate granulocyte (neutrophil) growth, activate neutrophils, and mobilize HSC to peripheral blood? what does it mimic?
filgrastim/pegfilgrastim
G-CSF
what drug is used to stimulate myeloid (granulocyte, erythroid, and Meg) growth? what does it mimic?
sarograstim
GM-CSF
what drug stimulates Meg maturation and thrombopoiesis? what does it mimic?
oprelvekin
IL-12
what drug mimics thrombopoietin?
romiplastin
clopidogrel: what does it do? what is it metabolized by?
P2Y12 inhibitor
- blocks ADP receptor to prevent platelet aggregation
- CYP2C19
ticlopidine: what does it do? when is it used and why?
P2Y12 inhibitor
- blocks ADP receptor to prevent platelet aggregtion
- only used as second line treatment due to severe toxicities:
- agranulocytosis, neutropenia, thrombocytopenia, anemia
- TTP
prasugrel: what does it do?
P2Y12 inhibitor
-blocks ADP receptor to prevent platelet aggregation
dipyridamole: action
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
abciximab: action and structure and how that affects it
GpIIb/IIIa inhibitor
-inhibits platelet binding to fibrinogen
monoclonal antibody
-irreversibly binds platelet, can persist up to 2 weeks, causing thrombocytopenia
eftifibatide: action
GpIIb/IIIa inhibitor
-inhibits platelet binding to fibrinogen
tirofiban: action
GpIIb/IIIa inhibitor
-inhibits platelet binding to fibrinogen
vorapaxar: action and metabolism
PAR-1 inhibitor
-blocks thrombin-induced platelet aggregation
CYP3A4
what herbal products affect coagulation and how?
gingko biloba and garlic: antiplatelet properties
ginger: inhibits TxA2 synthesis
heparin: action, how it causes heparin-induced thrombocytopenia, what test does it affect and why
- 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
what drug is give as an antidote to heparin? how does it work? what is the risk?
protamine sulfate
- binds and neutralizes heparin
- protamine reaction: like anaphylactic shock
what can be given for the reaction to the antidote to heparin?
protamine reaction: morphine, diphenhydramine (counteract anaphylaxis), saline (to counteract hypotension/reduced blood volume)
what drug interacts with P-Gp inhibitors/inducers?
dabigatran
what three drugs directly inhibit thrombin? what’s their risk
dabigatran
bivalirudin
lepirudin
-bleeding with no reversal agents available
enoxaparin: structure and function, advantage, how it shows up on tests
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
dalteparin: what does it do?
just another form of low molecular weight heparin, like enoxaparin
apixaban: action, risk
directly inhibits factor Xa, free or bound
-bleeding with no reversal agent available
rivaroxaban: action, risk
directly inhibits factor Xa, free or bound
-bleeding with no reversal agent available
fondaparinux: action and risks (2)
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
warfarin: specific action and effects, what test does it affect?
blocks Vit-K epoxide reductase (VKORC1)
- reduced synthesis of functional II, VII, IX, and X, proteins C and S
- prolonged PT, because affects VII
what two general factors affect warfarin action and what four things interact with it? how do they affect warfarin?
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
what are two antidotes to warfarin and how do they work? which works faster and why?
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
what are the four plasminogen activators? what are the differences?
alteplase: recombinant human tPA
reteplase: r-PA=longer half-life
tenecteplase: TNK-tPA=longer half-life
streptokinase: bacterial strep product
what drug inhibits fibrinolysis and how does it work?
aminocaproic acid
-inhibits activation of plasminogen to plasmin
