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Block 3: Hem/Onc > Pharm: Hem/Onc I > Flashcards

Pharm: Hem/Onc I Flashcards

1
Q

Describe antiplatelet drugs

A

decr platelet aggregation (suppress platelets) & inhibit thrombus formation.
effective in arterial circulation

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2
Q

Antiplatelet drugs are also known as…

A
  • platelet agglutination inhibitor
  • platelet aggregation inhibitor
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3
Q

Examples of antiplatelet drugs

A
  • Aspirin
  • Clopidogrel (Plavix)
  • Ticagrelor (Brilinta)
  • Dipyridamole (Persantine)
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4
Q

Describe anticoagulants drugs

A
  • prevent the formation of blood clots by suppressing the synthesis or function of various clotting factors in the blood
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5
Q

Examples of anticoagulants drugs

A
  • Heparin
  • Warfarin (Coumadin)
  • Enoxaparin (Lovenox)
  • Argatroban
  • Apixaban
  • Rivaroxaban
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6
Q

Describe Fibrinolytic

A

stimulate breakdown of the blood clot

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7
Q

Fibrinolytic drugs are also known as…

A
  • thrombolytic drugs
  • “Clot busters”
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8
Q

Example of Fibrinolytics

A
  • Alteplase (tPA)
  • Streptokinase
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9
Q

Describe Heparin antagonist

A
  • inhibit the anticoag action of heparin
  • used for tx of severe heparin OD. reversal agen
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10
Q

Examples of Heparin Antagonist

A

Protamine Sulfate

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11
Q

Describe Prothrombin complex concentrate (Human)

A
  • Prothrombin complex concentrates supply factors II, VII, IX, X and Proteins C & S
  • promote coagulation
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12
Q

Examples of Prothrombin complex concentrate (Human)

A

Kcentra**

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13
Q

Describe Coagulation factor Xa (recombinant)

A

Binds & sequesters factor Xa inhibitor & inhibits tissue factor pathway inhibitor (TFPI), reversing anti-Xa activity & restoring thrombin generation

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14
Q

Examples of Coagulation factor Xa (recombinant)

A

Andexxa**

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15
Q

Describe blood products

A
  • any substance made from human blood
  • whole blood, blood components & plasma derivatives.
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16
Q

Example of Blood products

A
  • Fresh Frozen Plasma [Octaplas]
  • Platelets
  • Packed Red Blood Cells
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17
Q

Describe Colony Stimulating Factors

A

secreted glycoPROs that bind to receptor PROs on the surfaces of hemopoietic stem cells, thereby activating intracellular signaling pathways that can cause cells to proliferate & differentiate into a specific kind of blood cell.

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18
Q

Examples of Colony Stimulating Factors

A
  • Epoetin Alfa (Epogen)
  • Filagrastim (Neupogen)
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19
Q

Describe Vitamins

A

an organic molecule that is an essential for organisms in small quantities for the proper functioning of its metabolism.

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20
Q

Examples of Vitamins

A
  • Vitamin K
  • Iron (Ferrous Sulfate)
  • Folic Acid (Vit B9)
  • Cyanocobalamin (Vit B12)
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21
Q

Describe antimetabolites

A

inhibits a metabolite

  • these are needed as a part of metabolism of another substance
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22
Q

Examples antimetabolites

A

Hydroxyurea

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23
Q

Describe Chemotherapy

A

type of cancer tx that can use multiple anti cancer drugs

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24
Q

Examples of Chemotherapy meds

A

5-Fluorouricil (Efudex)
6-Mecaptopurine (Purinethol)
Cisplatin
Cyclophosphamide (Cytoxan)
Dactinomycin (Cosmegen)
Doxorubicin (Adriamycin)
Goserelin (Zoladax)
Interferon Alfa 2B (Interferon A)
Rituximab (Rituxan)
Methotrexate
Tamoxifen (Soltamox)
Vincristine (Oncovin)

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25
Q

What does ASA reduce?

A
  • risk of MIs & stroke
  • risk of cancer
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26
Q

What does ASA increase?

A
  • risk of tinnitus
  • risk of Reye’s Syndrome
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27
Q

What other problems can ASA cause?

A
  • pregnancy problems
  • permanent inhibiting of platelet aggregation
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28
Q

ASA dosage:

A

81 mg/day

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29
Q

ASA: Uses

A
  • acute coronary syndrome
  • MI prevention TIA/thromboembolic stroke prevention
  • pain/fever
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30
Q

ASA: MOA

A

non-selectively & reversibly inhibits cyclooxygenase, reducing prostaglandin & thromboxane A2 synthesis, producing analgesic, anti-inflammatory, & antipyretic effects & reducing platelet aggregation

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31
Q

ASA: Common Rxns

A
  • dyspepsia, N/V, abdom pain
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32
Q

ASA: Serious Rxns

A
  • anaphylaxis/anaphylactoid rxn
  • angioedema
  • bronchospasm
  • bleeding
  • GI perf/ulcer
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33
Q

ASA: Safety

A
  • Pregnancy: May use low dose but avoid full dose in 3rd trimester
  • Lactation: Consider alternatives
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34
Q

Clopidogrel Dosage

A

75mg /day

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35
Q

How is Clopidogrel used in clinical practice?

A

used with or instead of ASA

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36
Q

Clopidogrel [Plavix]: Uses

A
  • acute coronary syndrome
    –> STEMI or NSTEMI
  • thrombotic event prevention
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37
Q

Clopidogrel [Plavix]: MOA

A

irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation

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38
Q

Clopidogrel [Plavix]: Serious Rxns

A

bleeding, severe
hemorrhage
TTP
agranulocytosis
aplastic anemia

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39
Q

When should you stop Clopidogrel?

A

Stop 5 days before elective surg to reduce bleeding risk

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40
Q

Clopidogrel: BBW

A

Diminished Antiplatelet Effect in CYP2C19 Poor Metabolizers (There is a CYP2C19 test available)

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41
Q

Ticagrelor [Brilinta]: Uses

A
  • acute coronary syndrome
  • CV & cerebrovascular event risk reduction
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42
Q

Ticagrelor [Brilinta]: MOA

A

reversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation & aggregation

43
Q

Ticagrelor: Serious Rxns

A

bleeding, severe
syncope
TTP
Bradyarrhythmia
AV block
Central sleep apnea

44
Q

Ticagrelor: BBW

A
  • Significant bleeding risk.
  • Contraindicated in intracranial hemorrhage. Manage bleeding w/o stopping med if possible.
45
Q

Dipyridamole: Uses

A
  • cardiac stress test
  • thromboembolism prevention adjunct, cardiac valve-assoc.
  • Stroke prevention when combined with aspirin (Aggrenox)
46
Q

Dipyridamole: MOA

A

Inhibits platelet adenosine uptake, reducing platelet aggregation; augments cGMP production, dilating coronary arteries

47
Q

Dipyridamole: Serious Rxns

A
  • severe hypotension
48
Q

Dipyridamole is usually used in combo with…

A

Warfarin or ASA

49
Q

What is the most potent for of Heparin?

A

Unfractionated Heparin (UFH)

50
Q

Which form of Heparin is used most in surgery?

A

UFH,
but as the most SEs

51
Q

Describe Type 2 HITT?

A

most concerning (risk of major clots)

  • immune-mediated disorder that occurs 4-10 days after exposure & has life & limb-threatening thrombotic complications.
52
Q

How does HITT manifest?

A

skin lesions at injection site
systemic rxns: (chills, fever, dyspnea, chest pain)

53
Q

Heparin: Uses

A

thromboembolism prophylaxis
Percutaneous coronary intervention (prior to initiation)
acute coronary syndrome, adjunct tx

54
Q

Heparin: MOA

A

acts at multiple sites in coagulation process; binds to antithrombin III, catalyzing inactivation of thrombin & other clotting factors

55
Q

Heparin: Common Rxns

A

bleeding
thrombocytopenia
prolonged clotting time
local injection site rxn

56
Q

Heparin: Serious Rxns

A

hemorrhage
thrombocytopenia, severe
Heparin-induced thrombocytopenia (HITT) incl. delayed onset

57
Q

Advantages of LMWH

A
  • Less potent so safer
  • More predictable effect
  • Less pharmacokinetic Limitations
  • No monitoring
  • Lower incidence of HIT
  • Can be given subcu
  • Longer half life
58
Q

Enoxaparin [Lovenox/LMWH]: Uses

A
  • DVT
  • angina
  • non-Q wave MI
  • STEMI
59
Q

Enoxaparin [Lovenox/LMWH]: MOA

A

binds to antithrombin III and accelerates activity, inhibiting thrombin and factor Xa (low-molecular weight heparin)

60
Q

Enoxaparin [Lovenox/LMWH]: Serious Rxns

A

hemorrhage, major
prosthetic heart valve thrombosis
anemia
thrombocytopenia

61
Q

Enoxaparin [Lovenox/LMWH]: BBW

A

Spinal/Epidural Hematomas may occur in anticoagulated pts receiving neuraxial anesthesia or spinal puncture

62
Q

Protamine Sulfate: Uses

A
  • Heparin reversal
  • LMWH reversal
63
Q

Protamine Sulfate: MOA

A

ionically binds heparin, forming a stable complex which neutralizes anticoagulant effects

64
Q

Protamine Sulfate: Serious Rxns

A

anaphylaxis
anaphylactoid rxn
bronchospasm
angioedema
circulatory collapse
bradycardia, severe
hypotension, severe

65
Q

Protamine Sulfate: BBW

A

severe hypoTN, CV collapse, noncardiogenic pulm edema, catastrophic pulm vasoconstriction, & pulm HTN

66
Q

Warfarin: Uses

A

DVT/PE tx
DVT/PE prophylaxis, postpartum
Thromboembolism/ stroke prophylaxis LV thrombus

67
Q

Warfarin: MOA

A

inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)

68
Q

Warfarin: Serious Rxns

A

hemorrhage
skin/tissue necrosis
Some foods and herbal teas interfere with Warfarin

69
Q

Warfarin: Safety

A
  • NO PREGNANCY
70
Q

Warfarin: BBW

A

Bleeding Risk - major or fatal bleeding; more likely during starting period, w/ higher dose; risk factors incl. high intensity anticoagulation (INR >4.0), pts 65 yo

71
Q

Human prothrombin complex concentrate [Kcenctra]: Uses

A

Vitamin K antagonist reversal

72
Q

Human prothrombin complex concentrate [Kcenctra]: MOA

A

Supplies factors II, VII, IX, X, and proteins C and S, promoting coagulation

73
Q

Human prothrombin complex concentrate [Kcenctra]: Serious Rxns

A

anaphylaxis
anaphylactoid rxn
hypoxia
Arterial thromboembolism
Sudden death
PE/DVT

74
Q

Human prothrombin complex concentrate [Kcenctra]: Safety

A
  • Incr risk of thromboembolic events.
  • Weigh acute bleeding reversal indication carefully before administering.
75
Q

Apixaban (Eliquis): Uses

A
  • Thromboembolism/stroke prophylaxis
  • DVT txt/prophylaxis
75
Q

Argatroban: MOA

A

selectively inhibits free and clot-bound thrombin (direct thrombin inhibitor)

75
Q

Argatroban: Serious Rxns

A

hemorrhage, severe
intracranial bleeding
cardiac arrest
ventricular tachycardia
MI

75
Q

Argatroban: Uses

A
  • Anticoag prophylaxis & tx of thrombosis in pts w/ HIT
  • PCI adjunct
76
Q

Apixaban (Eliquis): MOA

A

selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor)

77
Q

Apixaban (Eliquis): Serious Rxns

A
  • bleeding
  • thrombocytopenia
78
Q

Apixaban (Eliquis): Safety

A
  • Use alt in pregnancy
  • may drug interactions
79
Q

Apixaban (Eliquis): BBW

A
  • Premature Tx Discontinuation – consider an alt when D/C’ing
  • Epidural/Spinal Hematoma Risk
80
Q

Rivaroxaban (Xarelto): Uses

A

Thromboembolism/ stroke prophylaxis
DVT treatment DVT prophylaxis cardiovascular
event risk reduction

81
Q

Rivaroxaban (Xarelto): MOA

A

selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor)

82
Q

Rivaroxaban (Xarelto): Serious Rxns

A

bleeding, severe
thrombocytopenia
agranulocytosis
hypersensitivity rxn
Stevens-Johnson syndrome

83
Q

Rivaroxaban (Xarelto): Safety

A
  • Use alt in pregnancy
  • many drug interactions
84
Q

Rivaroxaban (Xarelto): BBW

A
  • Premature Tx Discontinuation – consider an alt when D/C’ing
  • Epidural/Spinal Hematoma Risk
85
Q

Recombinant coagulation factor Xa
[Andexxa]: Uses

A

Apixaban & rivaroxaban reversal

86
Q

Recombinant coagulation factor Xa
[Andexxa]: : MOA

A

Binds and sequesters factor Xa inhibitor and inhibits tissue factor pathway inhibitor (TFPI), reversing anti-factor Xa activity and restoring thrombin generation

87
Q

Recombinant coagulation factor Xa
[Andexxa]: : Serious Rxns

A

thrombosis
thromboembolism
Ischemic stroke
MI

infusion rxn

88
Q

Recombinant coagulation factor Xa
[Andexxa]: BBW

A
  • Incr risk of life-threatening thromboembolic events.
  • Cardiac arrest & sudden death
89
Q

Currently available thrombolytic agents include:

A
  • Alteplase (t-PA or Activase)
  • Reteplase (r-PA or Retavase)
  • Tenectaplase (TNKase)**
  • Urokinase (Abbokinase)
  • Streptokinase (not used)
90
Q

What does t-PA mean?

A

tissue Plasminogen Activator

91
Q

Absolute Contraindications in general for Thrombolytics

A

Risk of bleeding so don’t give if pt is bleeding or a risk of bleeding in places that are dangerous

92
Q

What is the half-life of Alteplase (Activase, t-PA) & why is this important?

A
  • 5 minutes
  • critical to start another agent - Heparin in another IV
93
Q

Alteplase [Activase, t-PA): Uses

A

acute MI (STEMI)
- acute ischemic stroke
- acute massive PE

94
Q

Alteplase [Activase, t-PA): MOA

A

binds to fibrin and converts tissue plasminogen to plasmin, promoting fibrinolysis

95
Q

Alteplase [Activase, t-PA): Common Rxns

A

bleeding

96
Q

Alteplase [Activase, t-PA): Serious Rxns

A
  • intracranial hemorrhage
  • Bleeding, severe
  • Thromboembolism
  • Cholesterol embolism
97
Q

Tenectaplase (TNKase): Uses

A

acute myocardial infarction (STEMI)
acute ischemic stroke

** easier to dose via IV push

98
Q

Tenectaplase (TNKase): MOA

A

binds to fibrin and converts tissue plasminogen to plasmin, promoting fibrinolysis

99
Q

Tenectaplase (TNKase): Serious Rxns

A

bleeding, severe
intracranial hemorrhage
Reperfusion arrythmia
Cholesterol embolism

100
Q

Which thrombolytic is no longer used in the US?

A

Streptokinase

101
Q

Why is Streptokinase no longer used

A
  • produced by streptococci bacteria & causes febrile rxns & allergic rxns
  • can’t be administered safely a 2nd time w/n 6 months

Block 3: Hem/Onc (6 decks)

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