Pharmacology - Anticoagulant, Anti-platelet & Thrombolytic Drugs

Question 1

Anti-platelet

Answer 1

Most effective for ARTERIAL thrombosis

Question 2

Anticoagulant

Answer 2

Most effective for VENOUS thrombosis

Question 3

Anti-platelet Drugs

Answer 3

• Aspirin

- clopidogrel (Plavix)

Question 4

Anticoagulant Drugs

Answer 4

• warfarin (Coumadin)
• heparin (UFH)
• enoxaparin (Lovenox) LMWH

Question 5

Thrombolytics

Answer 5

Agent that remove thrombi that have already formed

Question 6

Thrombolytic Drugs

Answer 6

streptokinase (Streptase)

Question 7

Sequence of Clot Formation

Answer 7

1) platelet aggregation (plug formation)
2) coagulation (fibrin production)
3) physiologic removal of clots
4) thrombosis

Question 8

Coagulation activation pathways

Answer 8

Contact activation pathway (INTRINSIC) & Tissue factor pathway (EXTRINSIC)

Question 9

Physiologic clot removal

Answer 9

Plasminogen –> plasmin

Plasmin = enzyme that degrades mesh network of clot

Question 10

Aspirin - ACTION

Answer 10

.

Question 11

Aspirin - INDICATION

Answer 11

.

Question 12

Aspirin - DOSAGE

Answer 12

Route-

Onset-

Question 13

clopidogrel (PLAVIX)

Answer 13

Action-

Indication-

Onset

Duration

Route

Labs

Antidote

Question 14

warfarin (COUMADIN)

Answer 14

.

Question 15

heparin (UFH)

Answer 15

.

Question 16

enoxaparin (LOVENOX) LMWH

Answer 16

.

Question 17

streptokinase (STREPTASE)

Answer 17

.

Question 18

Warfarin Antidote

Answer 18

.

Question 19

Heparin Antidote

Answer 19

.

Question 20

Enoxaparin Antidote

Answer 20

.

Question 21

Streptokinase Antidote

Answer 21

.

Question 22

Anemia

Answer 22

A decrease in the number, size or hemoglobin content of erythrocytes

Question 23

Causes of Anemia

Answer 23

Blood loss
Hemolysis
Bone marrow dysfunction
Deficiencies: Iron, folic acid, B12

Question 24

Ways iron is eliminated

Answer 24

Excretion (minimal
Menorrhagia
Hemorrhage
Blood donations

Question 25

Sources of Iron

Answer 25

``` Liver Egg yolk Brewers yeast Wheat germ Muscle meat Fish Fowl Whole grain cereals Beans Green leafy veggies ```

Question 26

Types of Anemia

Answer 26

Iron deficiency Vitamin B12 deficiency Folic acid Anemia

Question 27

Iron deficiency anemia

Answer 27

RBCs are MICROCYTIC HYPOCHROMIC | Absence of hemosiderin in bone marrow

Question 28

Ferrous Sulfate

Answer 28

Oral preparation to Tx iron deficiency anemia - Least expensive - AE: GI disturbances, staining of teeth, toxicity **HARMLESS DARK OR GREEN COLOR STOOLS**

Question 29

Iron Dextran

Answer 29

``` PARENTAL For pts who: do not tolerate/respond to PO Fe Unable to absorb bc GI disease Severe blood loss ``` AE: anaphylactic reaction

Question 30

Vitamin B12 Anemia

Answer 30

Megaloblastic Anemia Injury to the nervous system **(pts can develope peripheral neuropathy or anesthesia)** GI disturbances Impaired WBC and platelets

Question 31

Folic Acid & Vit. B12 Link

Answer 31

Folic acid (inactive)--->Vit. B12---> Folic acid (active)---> DNA synthesis ---> normal maturation of RBCs (&other cells)

Question 32

Sources of Vitamin B12

Answer 32

Liver & Dairy Sources

Question 33

Cause of Vit. B12 deficiency

Answer 33

- impaired absorption | - absence of intrinsic factor (pernicious anemia)

Question 34

How to diagnose Vit b12 deficiency

Answer 34

``` Measurement of plasma B12 content Schilling Test (measures B12absorption) ```

Question 35

Cyanobalamin

Answer 35

Vit b12 deficiency drug AE: HYPOKALEMIA D-D: drugs that also cause hypokalemia Used for long term Tx

Question 36

Folic acid

Answer 36

Essential factor for DNA synthesis

Question 37

Sources of Folic acid

Answer 37

``` Green veggies (peas, lentils, broccoli, asparagus, spinach) Oranges Whole wheat Beats Liver ```

Question 38

Causes & diagnosis of Folic acid anemia

Answer 38

Causes: poor diet (alcoholism), malabsorption syndromes (sprue) Diagnosis: Folic acid (folate) levels

Question 39

Consequences of Folic acid anemia

Answer 39

- Megaloblastic anemia | - neural tube defects

Question 40

Folic acid supplements

Answer 40

Types: active & inactive Indications: Tx of Megaloblastic anemia due to Folic acid deficit Prophylaxis during pregnancy initial Tx of severe Megaloblastic anemia from Vit b12 deficit

Question 41

Folic acid supplement WARNING

Answer 41

Adequate doses of folic acid can mask Vit B12 deficiency | Folic acid does NOT protect against damage to the nervous system from lack of B12

Question 42

Who should be treated for obesity?

Answer 42

BMI >30 (obese) BMI 25-29.9 (overweight) that have 2 risk factors Waist circumference >40" (men), >35" (women) plus 2 risk factors

Question 43

Modes of treatment for obesity

Answer 43

``` Diet therapy Exercise Behavior modification Drug therapy Bariatric surgery ```

Question 44

Long term obesity drug

Answer 44

orlistat (XENICAL)

Question 45

orlistat (XENICAL)

Answer 45

- Lipase inhibitor - reduces absorption of fat in GI tract AE: GI effects (oily spotting, flatulence, urgency, oily stools, increase frequency of stools, fecal incontinence) & decreased absorption of fat soluble vitamins Caution: *due to decreased absorption of vitamin K+ the effects of warfarin may be increased*

Question 46

Erectile Dysfunction Medications

Answer 46

Phosphodiesterase type 5 (PEDS5) inhibitors I

Question 47

sildenafil (VIAGRA)

Answer 47

Inhibits PDE5, causes mild vasodilation Use: ED, pulmonary HTN -little or NO effect on men who do not have ED Not approved for use in women AE: hypotension, priapism, nonarteritic ischemic optic neuropathy (NAION), sudden hearing loss D-D: nitrates, alpha blockers, inhibitors cytochrome P450 *ABSOLUTE CONTAINDICATION IF TAKING NITROGLYCERIN*

Question 48

S/S of BPH

Answer 48

``` Urinary hesitancy Urinary urgency Increase frequency of urination Dysuria Nocturnal Straining to void Post void dribbling Decrease force/caliber of stream Sensation of incomplete bladder emptying ```

Question 49

BPH Drug therapies

Answer 49

1) 5-alpha-reductase inhibitor 2) alpha 1-adrenergic antagonists **COMBINED THERAPY is more effective than either drug alone**

Question 50

finasteride (PROSCAR)

Answer 50

5-alpha-reductase inhibitor Reduces level of DHT & PSA levels AE:teratogenic to male fetus (Cat.X)

Question 51

hytrin (TERAZOSIN) & flomax (TAMULOSIN)

Answer 51

Alpha1-adrenergic antagonists Tx BPH Relax smooth muscle in bladder neck, prostate capsule and prostatic urethra

Question 52

Anticoagulant with RAPID onset

Answer 52

Heparin (onset minutes)

Question 53

PT/INR labs should be drawn for which anticoagulant?

Answer 53

Warfarin (Coumadin)

Question 54

Anticoagulant that lasts days

Answer 54

Warfarin (Coumadin)