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Pharmacology > Pharm III Hematology > Flashcards

Pharm III Hematology Flashcards

1
Q

Aspirin

A

Anti-platelet Prostaglandin COX 1 and 2 irrversible Inhibitor. Preg: C/D

Results in decreased production of TXA2 from Arachidonic acid. Stop 7-10 days prior to Sx

Primary prevention of stroke and CA, Stemi/UNSTEMI
Reye’s Syndrome w/ tx Chicken pox or Inluenza

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2
Q

Dipyridamole

A

Stimulates prostacyclin synth.; inhibits the uptake of Adenosine into platelets; inhibits platelet aggregation

Combo w/ Aspirin for Cerebral Ischemia; Alone no beneficial effect; worsens ischemia (Steal phenomen)

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3
Q

Cilostazol

A

Phosphodiesterase III Inhibitor; Inhibits cAMP breakdown reversibly inhibits platelet aggregation

Intermittent Claudication; Enhances Aspirin platelet inhibition. CI; Heart Failure any severity

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4
Q

Vorapaxar

A

Protease-activated receptor-1 Antagonist expressed on platelet;

Antithrombotic; MI, PAD, w/ Aspirin or Clopidrogel.
Not for ACS

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5
Q

Cangrelor (P2y12)

A

Inhibits binding of ADP to P2Y12 Rec. Indications: Periprocedural MI and Coronary revascul., stent thrombosis

Adjunct to percutaneous Coronary Intervention. For Patients not on P2Y12 or GP IIb/IIIa

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6
Q

Clopidogrel (P2y12)

A

Irreversible Inhibits binding of ADP to P2Y12–> Inhibition of GPIIb/IIIa Rec. required for platelet aggreg.

Use: Prevents Atherosclerotic events; Recent stroke, MI, Peripheral Artery Disease; Prophylaxis U-Angina; Reduce HA, stroke and CV death

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7
Q

Prasugrel (P2y12)

A

Irreversible Inhibits binding of ADP to P2Y12–> Inhibition of GPIIb/IIIa Rec. required for platelet aggreg.

Use; Prevent CV event post PCI in ACS along w Aspirin
CI: > 75 y/o

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8
Q

Ticagrelor

A

Reversibly inhibits the binding of ADP to its P2Y12 Rec.
–> Inhibition of GPIIb/IIIa Rec. required for platelet aggreg

Use: Reduce rate of Thrombotic cardiovascular events in Pts w/ ACS, U-Angina, NSTEMI, STEMI, MI
CI: Decrease effectiveness w/ Aspirin >100mg

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9
Q

ABciximab (GPIIb/IIIa Inhibitor)

A

Fragment of a monoclonal Ab. causes stearic hindrance near the GP binding site. Prevents adhesion

Use: Adjunct to PCI prevention of Cardiac Ischemic complications in Pts undergoing PCI; None responding U-Angina to conventional therapy;Adjust not necessary

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10
Q

Eptifibatide (GPIIb/IIIa Inhibitor)

A

Reversibly inhibit binding of fibrin to the GP IIb-IIIa Rec.
Not Monoclonal Antibodies (Ab) Less immunogenic

Use; With Heparin and Aspirin in ACS and PCI to reduce thrombotic events. Special dose for Renal Pts

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11
Q

Heparin UFH (Anticoagulant) Indirect Inhibitor

A

Indirect Thrombin; Binds to Anti-Thrombin III and speed its ability Coagulation factors (Thrombin). Natural Occur.
Less HIT Risk min. Monitor, Preferred for pregnancy,

Use; Reduce Thrombi Expansion and formation.
Adverse Reaction; Heparin Induced ; Pregnancy C Thrombocytopenia; Osteoporosis and Hyperkalemia

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12
Q

Low Molecular Weight Heparin (Anticoagulant)

A

Binds to Anti-Thrombin III and inactivates Faction Xa

Reduces Thrombi Expansion prevent Thrombi formation
May be used in conjunction w/ Warfarin and Aspirin

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13
Q

Enoxaparin (LMWH Anticoagulant) Indirect Inhibitor

A

Binds to Anti-Thrombin III and inactivates Faction Xa
Monitor not necessary Longer 1/2 than UFH 3-12 hrs
Pregnant Safe

Use: DVT–> In/out Pt PE; Ischemic Complications, U-Angina, Non Q wave MI. STEMI; Prego preferred
Warning; Spinal/Epidural hematoma–> Paralysis

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14
Q

Dalteparin (LMWH Anticoagulant) Indirect Inhibitor

A

Binds to Anti-Thrombin III and inactivates Faction Xa
No monitor; Long 1/2 L than UHF; No protamine reverse

Use: Prophylaxis of DVT–> PE; Extended Tx Symp VET; reduce reocurrence of VTE in cancer patients

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15
Q

Tinzaparin (LMWH Anticoagulant) Indirect Inhibitor

A

Binds to Anti-Thrombin III and inactivates Faction Xa
Monitor not necessary Longer 1/2 than UFH 3-12 hrs
Pregnant Safe B

Treatment of Acute Symptomatic DVT w/ or w/o PE when administered in conjunction w/ Warfarin

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16
Q

Fondaparinux (Protamine Sulfate Indirect Inhibitor)

A

Binds to AntiThrombin III, selectively inhibits Factor Xa
Less HIT than Heparin (SUB Q) Spinal/Epidural bruise

Use: Prophylaxis of DVT Acute DVT in ortho/Abd Sx Pts Tx of PE in conjunction w Warfarin Na+ initially in Hosp.

17
Q

Warfarin (Indirect Inhibitor)

A

Inhibits Vitamin K cofactors II, VII, IX, X, Protein C and S

Use: Prophylaxis and Tx DVT, PE, Thromboembolic assoc. w/ A-Fib, recurrent MI, stroke, valve replac. C and S deficiency. Not 1/2 life= effect 2-7 days
depends on factor AR: Purple Toe syndrome Preg: X

18
Q

Bivalirudin (Direct Inhibitors)

A

Bind directly to the active site of thrombin Factor IIa prevents fibrinogen to fibrin

PCI Intervention, PTC Angiplasty; Pts w/ HIT or HITTS Dose clearence adjust; Baseline aPTT and maintain aPTT monitoring and Activated Clotting Time ACT

19
Q

Argatroban (Direct Inhibitor)

A

Bind directly to the active site of thrombin Factor IIa prevents fibrinogen to fibrin; Monitor aPTT and hepatic dose

Use; Prophylaxis or Tx for pts of HIT w or w/o thrombo
Pts with or risk for HIT undergoing PCI;

20
Q

Dabigatran (Direct Inhibitor)

A

Direct Thrombin Inhibitor prodrug. Caution- 75 y/o and poor renal fx, underweight; Spinal/Epidural hematoma

Use: Prevention of Stroke, systemic embolism w. nonvalvular A-Fib. Tx/prevent/recurrence of DVT/PE

P-Glycoprotein metabolizes drug; inhibitors of P-Glycoprotein increase rx levels; No prosthetic valve use

21
Q

Idarucizumab (Direct Inhibitor)

A

Humanized monoclonal Ab fragment binds Dabigatran and its metabolites with Inc. affinity than Rx to Thrombi

Use: ER Sx/urgent procedures w/in 8 hrs. Life threatening uncontrolled bleeding D$3,500

22
Q

Rivaroxaban (Direct F Xa Inhibitor)

A

Selectively blocks Xa prevents prothrombin to thrombi
Fewer Rx interactions, no moitoring over warfarin but has no antidote-not for use w/ prosthetic valve; PregoC

Use; Prophylax of DVT in post knee/hip replacement sx
Stroke, systemic embolism w nonvalvular A-Fib CI: Liver disease; avoid P-Glycoprotein/CYP3A4 induce/inh

23
Q

Apixaban (Direct F Xa Inhibitor)

A

Selectively blocks Xa prevents prothrombin to thrombi
Fewer Rx interactions, no moitoring over warfarin but has no antidote-not for use w/ prosthetic valve; PregoB

Reduce Risk of stroke and System embolism In A-Fib
Prophylax in DVT TX;DVT and PE and recurrence; CI:Liver patients

24
Q

Edoxaban (Direct F Xa Inhibitor)

A

Selectively blocks Xa prevents prothrombin to thrombi
Fewer Rx interactions, no moitoring over warfarin but has no antidote-not for use w/ prosthetic valve; Prego C

Thromboembolis in A-Fib; TX DVT and PE following 5-10 day anticoagulant tx–> 3 mths CI:Liver patients; CrCl<15

25
Q

Fibrynolitics/Thrombolytics IV

  • Retaplase; STEMI only
  • Altaplase; Massive PE, STEMI, Stroke (tPA)
  • Tenectaplase; STEMI only (tPA longer 1/2 life)
A

Dissolve clots by activating plasminogen into plasmin that hydrolyzes fibrin lysing thrombus and Factor V VII

Use; Stemi acute STEMI ; Massive PE, acute ischemic stroke w/in 3 hrs

Tisuue Plasminogen Activator (tPA)

26
Q

Pulmonary Embolism Treatment

A

Low Risk= Anticoagulate—- No Fibrynolitics

Submassive PE=Anticoag Evidence of shock, or resp failure/distress Elevated cardiac markers–> Fibrinolytics

Massive PE= Anticoagulate–> Fibrinolytics

27
Q

Tranexamic Acid

A

Forms reversible complex that displaces plasminogen from fibrin–> inh. of fibrinolysis; Inhib. plasmin

Use; Heavy menstrual bleeding, tooth extract, periop
AE: Severe thrombo events, headache, Abd/back pain

28
Q

Oral Iron supplements

  • Ferrous Gluconate
  • Ferrous Sulfate
  • Ferrous fumarate
A

Tx for MC anemia;

Take w/ meals 25% only absorbed; continue 3-6 mths replenish stores

AE; Constipation, increase fiber, melana stool

29
Q

IV Iron supplement

  • Iron Dextran
  • Iron sucrose-
  • Ferumoxytol
  • Ferric carboxymaltose
A

Tx MC Anemia; severe anemic chronic states

Reserved for Pts unable to tolerate oral supplement.
IBD, small bowel resection

CI; Hypersensitivity rx, fatal overdose
Antidote; Deferoxamine

30
Q

Vitamin B12 (Cyanocobalamin)

A

Tx Insufficient intake of Vit B12 (Vegeterians)
Dysfunction of distal Ileum absent absorption IF B12

Use Pernicous Anemia; AE= Ahaphalactic shock and death. Swelling CHF, Thrombosis

31
Q

Folate (Folic Acid)

A

Tx; Pregnancy, Alcohol dependence, hemolytic anemia, renal dialisis, hepatic disease

Folic acid overdose= Antagonist; Trimethropim, pyrimethamine

32
Q

Hematopoetic Growth Factor

  • Epoetin Alfa
  • Darbapoetin Alfa
A

Binds to receptors and prevents apoptosis

Increae risk of death and cardio events; Not initiate if Hgb >10g/dL

Use; RBC production in renal failure; Chemo induced anemia; PTs prepping for Sx

Pharmacology (5 decks)

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