Heme

Question 1

Coagulant used during pregnancies for for immediacy. Follow what lab?

Answer 1

Heparin. PTT

Question 2

Heparin OD. Mech of antidote?

Answer 2

Protamine sulfate. Positively charged molecule that binds heparin

Question 3

LMWH. Names? vs heparin?

Answer 3

Enoxaparin, dalteparin. Act more on factor 10, longer half-life, better bioavailabilty. Not easily reversible

Question 4

HIT?

Answer 4

Heprain-induced thrombocytopenia. development of IgG antibodies against heparin-PF4 complex which activates platelets.

Question 5

Pt with HIT. Alternative? Mech?

Answer 5

Lepirudin, bivalirudin. Inhibits thrombin

Question 6

Used from chronic anticoagulation. MoA?

Answer 6

Warfarin. Interferes with gamma-carboxylation of vit.K clotting factors 2,7,9,10,C,S. Slow developing anticoagulation

Question 7

Anticoagulant metabolized by P-450s. Long half-life. Monitor what pathway?

Answer 7

Warfarin. Monitor PT.

Question 8

Do not use this anticoagulant in pregnancy. Reversal in mild OD? severe OD?

Answer 8

Warfarin. Vit K. Fresh frozen plasma

Question 9

Drug that causes cutaneous necrosis. Mech?

Answer 9

Warfarin. Depletes protein C/S.

Question 10

Heparin: 
structure, 
route, 
site of action, 
onset time, 
duration of action, 
function in vitro? 
OD tx? 
monitor what? 
crosses placenta?

Answer 10

structure - Large negatively charged particle
route -  IV/SC
site of action - blood 
onset time - seconds
duration of action - hours
function in vitro - yes
OD tx - protamin sulfate 
monitor what - PTT
crosses placenta - no

Question 11

Warfarin
Heparin: 
structure, 
route, 
site of action, 
onset time, 
duration of action, 
function in vitro? 
OD tx? 
monitor what? 
crosses placenta?

Answer 11

structure - small lipophillic molecule
route -  oral
site of action - liver 
onset time - slow (limited by half-lives of factors)
duration of action - days
function in vitro - no
OD tx - Vit K or fresh frozen plasma
monitor what - PT
crosses placenta - yes (teratogenic)

Question 12

INR is same thing as?

Answer 12

PT

Question 13

Thrombolytics? Tx OD with?

Answer 13

alteplase, reteplase, tenecteplase. Aminocaproic acid.

Question 14

Drug used in severe MI or early PE. MoA?

Answer 14

Thrombolytics. cleaves thrombin and fibrin

Question 15

Asprin - affect on BT, PT, PTT? Toxicities?

Answer 15

Only increases BP.
Tinnus
Gastic ulceration
Reye’s

Question 16

Drugs that inhibit expression of GP IIb/IIIa?

Answer 16

Clopidrogrel
Ticlodipine
Prasugrel
ticagrelor

Question 17

Pt with coronary stenting - use these drug.

Answer 17

ADP receptor antagonists:
Clopidrogrel
Ticlodipine
Prasugrel
ticagrelor

Question 18

ADP receptor antagonists - toxicities?

Answer 18

Neutropenia

Question 19

Pt with intermittant claudication. Use this as angina prophylaxis/stroke prevention?

Answer 19

cilostazol (Claudication Intermittant), dipyridamole.

Question 20

Pt with TIAs is put on a drug to decrease stoke chance. Comes in with headache, flushing, hypotension. MoA of drug?

Answer 20

cilostazol, dipyridamole.

1) Phosphodiesterase III inhibitor - increases cAMP in platelets, inhibiting aggregation.
2) inhibits adenosine uptake - more adenosine increases cAMP in platelets, inhibiting aggregation

Question 21

Use in pts with acute coronary syndrome?

Answer 21

GP IIb/IIIa inhibitors. Abciximab, eptifibatide, tirofiban

Question 22

Used in treatment of acute bleeding in pt with hemophilia? Mech?

Answer 22

Aminocaproic acid. Inhibits firbinolysis

Question 23

Used in pt with sickle cell? Also used for?

Answer 23

Hydroxyurea (increase HbF). Also used to myeloid neoplasms (inhibits DNA synthesis)