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