Pharmacology (Antiplatelets/Anticoagulation) Flashcards
what is the advantage that dabigatran has over rivaroxaban in terms of ADRs
Dabigatran (pradaxa) is not a CYP450 substrate
what is a disadvantage of rivaroxaban that Heparin and Warfarin and Enoxaparin have
no antidote
what are some ADRs for rivaroxaban
GI upset, bleeding, HS, don’t stop abruptly, elevated LFTs
what is rivaroxabans MOA
is a direct Xa irreversible antagonist; indicated to prevent & tx VTE, MI, and ACS
what is Dabigatrans Indications for use and MOA
prevents/tx VTE, MI, ACS by directly inhibiting thrombin
what is the onset of action for both dabigatran and rivaroxaban
2-4 hours
what are some ADRs of ferrous sulfate (feosol)
GI upset, toxicity in children, black stools, HS, *compliance an issue
what are some ADRs of cyanacobalamin B12
diarrhea, PE, CHF, anaphylaxis, polycythemia vera
what are some DI’s of cyanocobalamin B12
folic acid (masks B12 def.) drugs that reduce absorption or stomach acidity
what are some ADRs of folic acid
GI disturbance, CNS symptoms, HS, can mask Vit B12 def.
DI with Folic Acid
anticonvulsants
what is 5-fluorouracil Indications & MOA
tx cancer, skin conditions; acts as a purine/pyrimidine preventing DNA replication
what are some ADRs of 5-fluorouracil
cardiotoxicity, alopecia, pancytopenia, nystagmus, PE photosensitivity
what is methotrexates MOA
inhibits folic acid reductase, antirheumatic MOA unknown
ADRs of methotrexate
mucositis, diarrhea, stomatitis, N&V, myelosuppresion, hepatotoxicity
what is the MOA of both Heparin and Enoxaparin
potentiates antithrombin to inactivate factor Xa, preventing prothrombin-thrombin and fibrinogen-fibrin.
what are the ADRs of Heparin and Enoxaparin
**Bleeding (reversible with protamine), alopecia, osteoporosis, HIT, thrombocytopenia
what is Heparins Onset, time to FE, and time to wear off
45 minutes, FE-few hours, 4 hrs to wear off
Enoxaparin’s onset, time to FE, and to wear off
onset-4-5 hrs, FE-1 day and 24 hrs to wear off
what is the advantages of Enoxaparin over heparin
more selective, predictable, improved bioavailability, more consisten molecular size, longer half-life
what are the DI’s of both heparin and enoxaparin
anticoagulants and antiplatelets
what are some ADRs of warfarin
blue toe syndrome, skin necrosis, rash, bleeding (reversible with Vit. K) *contraindicated with pregnant
what causes skin necrosis from warfarins effect
blocking Protein C which normally has a function to be cytoprotectant by inhibiting apoptosis in healthy endothelium
what are some ADRs with aspirin
bleeding GI ulcers, asthma exacerbation, tinnitus, occult bleeding, thrombocytopenia, AKI, hepatits, Reye syndrome (brain/liver) HS , don’t give children <20
what are some DI’s of aspirin
ADR x2, Live Vaccines,
what is clopidrogel’s MOA
irreversibly inhibits P2Y12 on surface of plts
what are some DI’s of clopidrogel
it is a prodrug that requires liver metabolism hence CYP450 substrate
what are some ADRs of clopidrogel
bleeding, GI ulcers, HS, bone marrow toxicity
what is warfarins Onset, time to FE, and to wear off
Onset-8-12 hours, FE at 5-7 days, and 4 days to wear off
this is a pentasacchide similar to heparin and enoxaparin which increases antithrombin 300 fold, however is not reversible with protamine, and takes longer to wear off (4-5 days)
fondaparinux
describe the mechanism of how B12 is absorbed…
first they bind to R protein in saliva; R protein protects it from stomach acid & then destroyed in duodenum. Next, B12 binds to intrinsic factor made from parietal cells in stomach and can be absorbed in terminal ileum.
this is an autoimmune dz where antibodies against parietal cells reduces intrinsic factor which can cause B12 def.
pernicious anemia
