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Intro To Drugs > test 3 hematologic agents > Flashcards

test 3 hematologic agents Flashcards

1
Q

INR

A

used to determine the clotting tendency of blood

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2
Q

PT

A

used to determine the clotting tendency of blood

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3
Q

PTT

A

blood clotting disorder test

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4
Q

CVA

A

A stroke, or cerebrovascular accident

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5
Q

PCI

A

a set of procedures used to treat coronary heart disease

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6
Q

CABG

A

Coronary artery bypass surgery

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7
Q

ICH

A

Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain tissue itself

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8
Q

Embolus

A

traveling clot

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9
Q

Thrombus

A

stationary clot

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10
Q

Anemia

A

a condition in which the body does not have enough healthy red blood cells

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11
Q

Myelosuppression

A

bone marrow suppression

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12
Q

Neutrophils

A

type of white blood cells

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13
Q

Aspirin MOA

A

Inhibition of thromboxane A2 synthesis, a potent mediator of platelet aggregation and vasoconstriction

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14
Q

Asprin indications

A 
Pain
Fever
Inflammatory conditions 
Cardioprotection 
Prevention of in-stent thrombosis following PCI or CABG
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15
Q

aspirin Adverse effects

A

Bleeding
Dyspepsia- upset stomach or indigestion,
GI bleeding
Tinnitus

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16
Q

aspirin- contraindictions

A

Hypersensitivity to NSAIDS
Pregnancy (3rd trimester)
Viral infection in children

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17
Q

aspirin interactions

A

ACE inhibitors
NSAIDs
Lithium

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18
Q

aspirin patient counseling

A

Take with food to avoid GI upset
Monitor for bleeding
Limit alcohol intake

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19
Q

Clopidogrel- used after stent- MOA

A

Selectively blocks adenosine diphosphate (ADP) to its platelet receptor
Irreversibly inhibits platelet aggregation

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20
Q

Clopidogrel- used after stent- indications

A

Reduces thrombotic events in patients with atherosclerosis

Acute coronary syndromes

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21
Q

Clopidogrel- used after stent- Adverse effects

A

Bleeding

Thrombotic Thrombocytopenic Purpura (TTP)

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22
Q

Clopidogrel- used after stent- BB warning

A

patients may hay abnormality that may Lower active metabolite exposure may result in reduced platelet inhibition and, thus, a higher rate of cardiovascular events following MI or stent thrombosis following PCI.

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23
Q

Clopidogrel- used after stent- contraindications

A

Active bleeding (peptic ulcer disease, ICH)
Proton pump inhibitors
NSAIDs
Anticoagulants

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24
Q

Clopidogrel- used after stent- interactions

A

Proton pump inhibitors
NSAIDs
Anticoagulants

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25
Q

Clopidogrel- used after stent- patient counseling

A

Adherence is crucial!

Monitor for bleeding

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26
Q

Heparin MOA

A

Binds to antithrombin and accelerates antithrombin’s ability to inhibit factors IXa, Xa, XIa, XIIa, and IIa.

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27
Q

Heparin indications

A

Prophylaxis and treatment of thrombosis and embolism
Coagulopathies
Prophylaxis of DVT and PE in high-risk medical and surgical patients
Clotting prevention
Prophylaxis of left ventricular thrombi and cerebrovascular accidents post-MI
“Bridge” to warfarin therapy to prevent CVA in patients with cardiac valve replacements

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28
Q

Heparin adverse effects

A

Bleeding
Heparin induced thrombocytopenia (HIT)
Osteoporosis (with prolonged use)

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29
Q

Heparin Contraindications

A

History of HIT
Uncontrolled active bleeding except when due to disseminated intravascular coagulation
Hypersensitivity to pork products

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30
Q

Heparin key points

A 
Monitored via the PTT
Does not cross the placenta
Can be used in severe renal impairment
Relatively short t1/2
SUBQ injection has variable absorption
Antidote is available
“High Alert” drug
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31
Q

Low molecular weight heparin

A

Black box warning

Spinal or epidural hematomas, including subsequent paralysis, may occur with recent or anticipated neuraxial anesthesia (epidural or spinal anesthesia) or spinal puncture in patients anticoagulated with LMWH or heparinoids.

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32
Q

Warfarin MOA

A

Inhibits the activation of Vitamin K dependent clotting factors

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33
Q

Warfarin indications

A

Inhibits the activation of Vitamin K dependent clotting factors
Prophylaxis and treatment of DVT and/or PE
Prophylaxis and treatment of stroke in atrial fibrillation
Prophylaxis and treatment of thromboembolic complications in cardiac valve replacement
Reduces risk of death, recurrent myocardial infarction, and thromboembolic events

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34
Q

Warfarin adverse effects

A

Bleeding
Purple toe syndrome
Intracranial, Intraocular, retroperitoneal bleeding

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35
Q

Warfarin pregnancy cat.

A

X

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36
Q

Warfarin contraindications

A 
Active peptic ulcer
Active hemorrhage
Noncompliance
Pregnancy
High risk of falls
Alcoholism
Upcoming surgical procedure
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37
Q

Warfarin interactions

A

Aspirin, NSAIDs, anticoagulants

Vitamin K

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38
Q

Warfarin counseling

A

Monitored via the INR
Dosing is incredibly individualized
Many drug-drug, drug-nutrient, drug-disease state interactions
Patients should have a medical alert bracelet or card with them at all times
Patients will bleed and bruise easier

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39
Q

Warfarin key points

A

Antidote is available
High INR = increased risk of bleeding (blood is too thin)
Low INR = increased risk of clotting (blood is too thick)

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40
Q

Dabigtran MOA

A

Direct thrombin inhibitor

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41
Q

Dabigtran indications

A

Prophylaxis of stroke and systemic embolism in atrial fibrillation

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42
Q

Dabigtran adverse effects

A

Bleeding
Dyspepsia
GI bleeding

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43
Q

Dabigtran contraindications

A

Active bleeding

Pregnancy

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44
Q

Dabigtran interactions

A

P-gp substrate

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45
Q

Dabigtran counseling

A

Report signs and symptoms of bleeding
Do not remove from dispensing container
Once bottle opened, capsules are good for x days

46
Q

Dabigtran key points

A

No routine monitoring required
Use with caution in significant renal impairment and in the elderly
No antidote available

47
Q

Rivaroxaban MOA

A

Inhibits platelet activation and fibrin clot formation via direct, selective and reversible inhibition of factor Xa (FXa) in both the intrinsic and extrinsic coagulation pathways

48
Q

Rivaroxaban indications

A

Prophylaxis and treatment of DVT/PE

Prevention of stroke in atrial fibrillation

49
Q

Rivaroxaban adverse effects

A

Bleeding

Bruising

50
Q

Rivaroxaban contraindications

A

Active major bleeding

51
Q

Rivaroxaban interactions

A

CYP3A4/P-gp substrate

Antiplatelets/Anticoagulants

52
Q

Rivaroxaban counseling

A

Report signs and symptoms of bleeding

53
Q

Rivaroxaban key points

A

No routine monitoring required

54
Q

Thrombolytics Alteplase, Activase MOA

A

Stimulates conversion of plasminogen to plasmin

Dissolves fibrin clots

55
Q

Thrombolytics Alteplase, Activase indications

A 
Acute MI
Acute ischemic stroke
Pulmonary embolism
Peripheral arterial thromboembolism
Central venous catheter occlusion
56
Q

Thrombolytics Alteplase, Activase adverse effects

A

Bleeding

Intracranial hemorrhage

57
Q

Thrombolytics Alteplase, Activase contraindications

A 
Active internal bleeding
History of CVA
Recent intracranial or intraspinal surgery or trauma
Intracranial neoplasm
Arteriovenous malformation or aneurysm
Known bleeding diathesis
Severe uncontrolled hypertension
Suspected aortic dissection
58
Q

Thrombolytics Alteplase, Activase interactions

A

Anticoagulants

Antiplatelets

59
Q

Thrombolytics Alteplase, Activase key points

A

Always refer to list of contraindications/relative contraindications prior to administering TPA
Patient is at an increased risk of ICH if TPA administered and they have contraindication criteria
Monitor patient closely for bleeding
Dosing varies depending on indication being used

60
Q

immunosuppressants

A 
Used in patients with various immune disorders and those with organ transplants
Commonly used agents include:
Cyclosporine
Tacrolimus
Mycophenlate
61
Q

Cyclosporine MOA

A

Inhibits T-lymphocyte activation

Suppresses immune response of T-cells

62
Q

Cyclosporine indications

A 
Prevention of organ transplant rejection
Rheumatoid Arthritis (RA)
63
Q

Cyclosporine adverse effects

A

Hypertension
Hirsutism
Gingival Hyperplasia
Edema

64
Q

Cyclosporine BB warning

A

Immunosuppressant agents, including cyclosporine, increase the risk of infection; the risk of developing bacterial, viral (including CMV), fungal, and protozoal infections, including opportunistic infections, is increased.

Immunosuppressant agents, including cyclosporine, may be associated with the development of lymphoma and other malignancies (predominantly skin malignancies).

65
Q

Cyclosporine contraindications

A

Abnormal renal function (RA patients only)
Uncontrolled hypertension
Malignancies

66
Q

Cyclosporine interactions

A

3A4 substrate
Phenytoin, Rifampin
Fluconazole, Amiodarone

67
Q

Cyclosporine key points

A

Cyclosporine products are not interchangable
Drug levels are required
Many drug-drug interactions
Avoid live vaccines

68
Q

Tacrolimus MOA

A

Inhibits T-cell differentiation and proliferation

Preventing allograft rejection

69
Q

Tacrolimus indications

A

Prevention of organ transplant rejection
Prevention of graft-versus-host disease
Moderate–severe atopic dermatitis

70
Q

Tacrolimus adverse effects

A 
Insomnia
N/V/D
Alopecia
New-onset DM
Hypertension
71
Q

Tacrolimus BB warning

A

Immunosuppressant agents, including tacrolimus, increase the risk of infection; the risk of developing bacterial, viral (including CMV), fungal, and protozoal infections, including opportunistic infections, is increased.
Immunosuppressant agents, including tacrolimus, may be associated with the development of lymphoma and other malignancies (predominantly skin malignancies).

72
Q

Tacrolimus contraindications

A

Hypersensitivity

73
Q

Tacrolimus interactions

A

3A4 substrate
3A4 Inducers – Decreases tacrolimus levels
3A4 Inhibitors – Increases tacrolimus levels

74
Q

Tacrolimus counseling

A 
Many drug-drug interactions
Report any signs/symptoms of infection immediately
Drug levels are monitored
Avoid live vaccines
Avoid grapefruit juice
May increase drug levels
75
Q

rheumatoid arthritis (RA)

A

Affects 1% of the population
2-3x more likely to affect women than men
Signs and symptoms:
Generalized fatigue, multiple joint pain, morning stiffness
American College of Rheumatology have clinical practice guidelines to help guide care

76
Q

Drug therapy for RA

A 
NSAIDs/COX2 inhibitors
Glucocorticoids
Disease modifying antirheumatic drugs (DMARDs)
Nonbiologic agents
Hydroxychloroquine, sulfasalazine, methotrexate, gold, auranofin, azathioprine, penicillamine, minocycline, leflunomide
Biologic agents
Etanercept
Infliximab
Adalimumab
Anakinra
77
Q

Crohns Disease

A 
A type of inflammatory bowel disease
Can affect any part of the GI tract from mouth to anus
Symptoms include:
Diarrhea
Stomach cramping
Blood in stool
Ulcers
Weight loss
78
Q

Tumor Necrosis Factor Inhibitors MOA

A

Blocks the action of tumor necrosis factor

Allows healing of the affected joints

79
Q

Tumor Necrosis Factor Inhibitors indications

A

RA

Crohn’s Disease

80
Q

Tumor Necrosis Factor Inhibitors adverse effects

A

Injection site reactions
Rash
Mycobacterial, fungal, and opportunistic infections

81
Q

Tumor Necrosis Factor Inhibitors BB warnings

A

Increased risk of serious infections that may lead to hospitalization or death

82
Q

Tumor Necrosis Factor Inhibitors contraindications

A

Active infection

Sepsis

83
Q

Tumor Necrosis Factor Inhibitors interactions

A

Live immunizations

Other biologic products

84
Q

Tumor Necrosis Factor Inhibitors counseling points

A

Patients should be evaluated for TB before starting therapy

Avoid live immunizations for at least 3 months after therapy

85
Q

Neutropenia

A

Low amount of neutrophils (white blood cells)
Leads to an increased risk of infection (bacterial, viral, and fungal)
Causes include:
Medications
Infection
Radiation
Bone marrow dysfunction

86
Q

Filgrastim – Neupogen/Neulasta – SUBQ/IV injection indications

A

Neutropenia

87
Q

Filgrastim – Neupogen/Neulasta – SUBQ/IV injection Adverse effects

A 
Splenomegaly
Bone/skeletal pain
Fever
Epistaxis
Hypersensitivity
Acute respiratory distress syndrome (ARDS)
Sickle cell crisis
88
Q

Filgrastim – Neupogen/Neulasta – SUBQ/IV injection contraindications

A

Hypersensitivity to Eschericha coli

89
Q

Filgrastim – Neupogen/Neulasta – SUBQ/IV injection counseling points

A

If self administering, do not reuse syringes or needles
Can use analgesics to treat bone pain
Dose can be rounded to nearest syringe size
Do NOT give 2 weeks before or 24 hours following chemotherapy

90
Q

Ferrous Sulfate MOA

A

Replaces iron normally endogenous to the body

91
Q

Ferrous Sulfate indications

A

Iron deficient anemia

92
Q

Ferrous Sulfate adverse effects

A

Constipation and stomach cramping
Dark stools
N/V
GI irritation

93
Q

Ferrous Sulfate interactions

A

Levothyroxine
Antibiotics – fluoroquinolones, tetracyclines
Food

94
Q

Ferrous Sulfate counseling

A

If constipation occurs, increase fluid and fiber content of diet
Take on empty stomach to ensure absorption
Black stool may occur
Keep out of reach of children

95
Q

Ferrous Sulfate key points

A

Product should be dosed on elemental content of iron

Verify mg needed to be dispensed if Rx written only for mLs of liquid

96
Q

Gout

A

Uric acid crystals deposit in joints causing pain and inflammation
Can be caused by overproduction of uric acid or underexcretion of uric acid
Risk factors for gout include obesity, male sex, age >40, alcohol consumption, diet, and certain medications

97
Q

Colchicine – Colcrys dosing

A

tablet

98
Q

Allopurinol – Zyloprim dosing

A

tablet, injection

99
Q

Colchicine MOA

A

Decreases deposition of uric acid and inflammatory reaction

100
Q

Colchicine indications

A

Acute gout attacks
Prophylaxis for acute gout attacks
Treatment of familial Mediterranean fever

101
Q

Colchicine adverse effects

A

N/V/D
Alopecia
Bone marrow suppression
Rhabdomyolysis

102
Q

Colchicine contraindications

A

Concomitant use of p-glycoprotein or strong CYP3A4 inhibitors in the presence of hepatic or renal impairment

103
Q

Colchicine interactions

A

Enzyme inhibitors
Digoxin
Cyclosporine
Ranolazine

104
Q

Colchicine patient counseling

A

Take at the first sign of a gout attack
Do not drink grapefruit juice
Low purine diet and hydration can help reduce gout flares
Diarrhea is the most common side effect

105
Q

Allopurinol MOA

A

Blocks xanthine oxidase

Decreases the production of uric acid

106
Q

Allopurinol indications

A

Prevention of gout attacks
Prevention of tumor lysis syndrome
Prevention of recurrent calcium oxalate calculi

107
Q

Allopurinol Adverse effects

A

Maculopapular rash
Pruritis
Stevens–Johnson syndrome(SJS)/toxic epidermal necrolysis (TENS)
Myelosuppression

108
Q

Allopurinol contraindications

A

Concomitant use of didanosine

109
Q

Allopurinol interactions

A 
Azathioprine
Mercaptopurine
Cyclosporine
Amoxicillin
Warfarin
110
Q

Allopurinol counseling

A

Dose must be titrated up for response
Drug will not help established gout attack
Immediately report any skin rash to physician
Maintain adequate hydration while taking allopurinol
Take allopurinol with food to minimize GI upset
Periodic blood tests may be ordered to monitor for effectiveness and side effects

Intro To Drugs (13 decks)

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