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pharmacology final ( 1st sem) > A: 16-19 > Flashcards

A: 16-19 Flashcards

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1
Q

3 types of anti-PLT therapy

A

COX inhibitiors: Aspirin
Glycoprotein IIb/IIIa receptor inhibitor: Abciximab
ADP-R antagonists: Clopidogrel, Prasugrel, Ticagrelor

ADP זה כמו שהקלידו סתם במקלדת
כמו גרל
Clap your hand and pres on the tica

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2
Q

What is the result of blocking COX in PLT?

A

Decrease TXA2 –> Decrease stimulatory effect of PLT aggregation

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3
Q

Other name for Aspirin

A

Acetylsalicylic acid

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4
Q

Aspirin dosage amount: Anti-PLT vs. Anti-inflammatory

A

Anti-PLT(anti-thrombotic) requires lower dose than anti-inflammatory dose

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5
Q

Aspirin indications

A

Prevention and treatment of arterial thrombosis
Prevents MI, TIA, Ischemic stroke
Prophylaxis in arrhythmias

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6
Q

Aspirin side effects

A

GI toxicity
Nephrotoxicity Apirinnn=neprho

hypersensitivity rxn due to increased Leukotrienea
Hyperventilation metabolic acidosis A=A
Hyperthermia

Coma (overdose)

HSN
Tinnitus

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7
Q

Glycoprotein IIb/IIIa receptor inhibitor=

A

Abciximab

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8
Q

Abciximab

How to give and what is the molecule?

A

Parenteral

IgG Ab

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9
Q

Abciximab indications

A

Acute coronary syndrome (short period) - eg. unstable angina, MI
Used during PCI to prevent re-stenosis

Post angioplasty to prevent stenosis

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10
Q

Abciximab side effects

A

Bleeding

Thrombocytopenia with prolonged use

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11
Q

ADP-R antagonists

A

Clopidogrel
Prasugrel
Ticagrelor

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12
Q

Clopidogrel
Prasugrel

What are they as molecules?
Do they require activation?

A

Prodrugs
Activated by CYP450
Oral

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13
Q

What can block the activation of Clopidogrel, Prasugrel?

A

Omeprazole

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14
Q

Which ADP-R antagonists does not require activation?

A

Ticagrelor

יש לו שם קצת שונה אז בטח הוא תרופה חדשה

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15
Q

Clopidogrel
Prasugrel
Ticagrelor

Indications

A
  • Acute coronary syndrome
  • prevention of restenosis after PCI
  • prevention and treatment of arterial thrombosis

Post angioplasty to prevent stenosis
Prophylaxis in arrhythmias

  • from book table
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16
Q

Clopidogrel
Prasugrel
Ticagrelor

Side effects

A
  • Bleeding
  • GI disturbances
  • Neutropenia (hematologic abnormality) - clopidogrel less hematotoxic!

-TTP: disseminated formation of small thrombi, PLT consumption and
thrombocytopenia (very rare, by toclopidine)

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17
Q

Heparin inactivates

A
  • complexes with anti-thrombin-3
  • irreversibly inactivates : Thrombin and factor Xa

VII
IX
XI
XII

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18
Q

Heparin drugs

A

Unfractionated Heparin
Low Molecular Weight Heparin: Dalteparin, enoxaparin)
Fondaparinux (fond of the parinux) - similar to LMWH

Dalte is like smaller than alpha

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19
Q

Unfractionated Heparin

What is it
How to give it
How to monitor?

A

Acidic polysaccharide polymer
IV, SC. ( we dont use I.M because can cause hematoma!)
aPTT : activated partial thromboplastin time

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20
Q

Low Molecular Weight Heparin

Name of the drug

A

Dalteparin

enoxaparin

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21
Q

Low Molecular Weight Heparin

How is it different than Unfractionated Heparin?

A

Selective for Xa
Higher bioavailability
Longer duration of action
Renal metabolism

  • note: protamine sulfate reversal in only “partially effective “ with LMWH
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22
Q

Synthestic Heparin=

A

Fondaparinux

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23
Q

Fondaparinux target

A

More selective for Xa

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24
Q

Fondaparinux

How to give?

A

SC

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25
Heparin indicactions
Acute and rapid anticoagulation | DIC
26
Which anticoagulation will we give during pregnancy?
LMWH
27
Heparin side effects
Bleeding (monitor with aPTT) HIT "heparin induced thrombocytopenia" Osteoporosis (chronic use) heppaa לחשוב על בהד 10 ועל הבחורה ששברה את הגב שזה מתקשר לאוסטאופורוסיס
28
Warfarin is a type of ______ anticoagulants
Coumarin
29
Warfarin MOA
Inhibit Vitamin K epoxidase reductase (VKOR) | Prevents post-trans. gamma carboxylation of factors II, VII, IX, X
30
Vit. K is important for which factors?
``` II VII IX X Protein C, S ```
31
Complete theraputic effect with Warfarin is achieved after
2-3 days
32
Warfarin drug info
Lipid soluble Oral Highly bound to plasma proteins (albumin; NSAID can displace it )
33
Warfarin metabolism
CYP450 CYP450 inducers * reduce the anticoagulant, increase warfarin clearance - barbiturates - carbamazepine - phenytoin - rifampin, Cytochrome P450 inhibitors (cg, - amiodarone -selective serotonin reuptake inhibitors, - cimetidine reduce warfarin' s clearance and increase the anticoagulant
34
How should we monitor Warfarin use?
PT (INR)
35
INR theraputic range using Warfarin
2-3
36
Warfarin indications
Chronic anticoagulation
37
Warfarin contraindication
Pregnancy
38
Warfarin side effects
- Skin vascular necrosis (thrombosis early in therapy due to defiency of Protein C) - Bleeding (monitor vitk1 & PT) - Teratogenic - Drug interactions note: protein C= endogenous vit-k-dep anticogulant with short T1/2
39
Direct acting Thrombin inhibitors
Bivalirudin Dabigatran ביווה ודבי חברות ממש טובות ושתיהן יחד מעקבות את טרומבין
40
Bivalirudin Dabigatran How are they given?
Bivalirudin: Parenteral Dabigatran: Oral דבי היא זו שמדברת מלא ביווה שקטה יותר
41
Which Direct acting Thrombin inhibitors does not require monitoring by PT/PTT?
Dabigatran כי היא מדברת כל כך הרבה ואף אחד לא רוצה להתקרב
42
Bivalirudin indications
- Anticoag. in patients with HIT | - In combination with Aspirin during PCI
43
Dabigatran indications
- prevention of stoke and systemic emboli in A. Fib (chronic therapy as an alternative therapy for Warfarin ) - prophylaxis of venous thromboemboli (VTE) following hip/knee surgery - reduction of risk of recurrent VTE
44
Which drug class are considered to be Noval Oral Anticoagulants?
Direct acting factor Xa inhibitors
45
Direct acting factor Xa inhibitors:
Rivaroxaban (apixaban, edoxaban) לחשוב על הנהר בציור של סקצי rivaroxxxxaban factor x
46
Rivaroxanban indications
Prevention of : - venous thromboembolism after knee/hip surgery - pulmonary emboli - embolic stroke in A. Fib patients
47
tPA drugs
Alteplase Reteplase אל תתקרב ראה- תה! פלס
48
What is the difference btw. Alteplase and Reteplase?
Alteplase: Rebcombinant tPA Reteplase: Modified Rebcombinant tPA
49
Which has faster and longer duration of action? Alteplase Reteplase
Reteplase rete is more rapid
50
Alteplase Reteplase Indications
Short term management of thrombotic events (MI, PE...) - coronary a. thrombosis - Ischemic stroke - pulmonary embolism
51
Alteplase Reteplase Side effects
Bleeding | Cerebral hemorrhage
52
Alteplase Reteplase What is the drug group?
tPA (thrombolytics) Direct conversion of plasminogen into Plasmin which degrades thrombi
53
Thrombolytic therapy contraindications
``` Active internal bleeding Suspected aortic dissection Recent head trauma Previous hemorrhagic stroke Trauma or surgery in the past 2 weeks Previous ischemic stroke within the last 1 year ```
54
Fibrin foam=
A spongy substance prepared from fibrinogen and thrombin from human blood plasma and used especially after saturation with thrombin as an absorbable clotting agent in surgical wounds
55
Vit. K indications
Vit. K deficiency | Reversal of excessive Warfarin anticlotting activity
56
Who will likely have a Vit. K def.?
Patients with fat malabsorption | New borns
57
Vit. K side effects
severe Infusion reaction when given IV or IM **Can also be given orally
58
Antiplasmin drugs
Aminocaproic acid ( competitively inhibit plasminogen activation) tran-examic acid : analogue of aminocaproic a
59
Aminocaproic acid How to give?
Oral | Parenteral
60
Aminocaproic acid indications
- Management of acute beeding in patients with hemophilia or other bleeding disorders - Reverse the activity of fibrinolytic agents (excessive fibrinolysis)
61
Aminocaproic acid side effects
Thrombosis Hypotension Myopathy Diarrhea
62
Aminocaproic acid Contraindications
DIC | Bleeding of the upper urinary tract
63
Iron drugs I should know for the test
Iron-hydroxide-polymaltose Complex
64
Iron-hydroxide-polymaltose Complex How is it given?
Oral
65
Iron deficiency manifests as which anemia?
Hypochromic microcytic anemia
66
Acute iron overdose
``` Shock Necrotizing gastroenteritis Abdominal pain Bloody diarrhea Lethargy Dysnea ```
67
Chronic iron overdose
Hemochromatosis (Heart, liver, pancreas damage)
68
Antitode for acute iron poisoning
Deferoxamine
69
Vit. B12 preparations (2)
Methyl-cobalamin: Natural | Hydroxo-cobalamin: Synthetic
70
Vit. B12 manifests as which anemia?
Megaloblastic anemia
71
Which drug is used as Cyanide antidote?
Hydroxocobalamin
72
Folic acid is given how?
Oral
73
Folic acid indications
Folic acid deficiency | Prevention of congenital neural tube defects
74
Erythropoiesis stimulating agent=
Epoetin alfa
75
Epoetin alfa indications
Anemia of chronic renal disease, AIDS and cancer | Pre-operative
76
Epoetin alfa side effects
HTN Thrombotic complications RBC aplasia
77
In which case will we give Epoetin alfa?
Very severe anemias
78
How and when to give Epoetin alfa?
IV or SC | 1-3 times/week
79
Myeloid growth factor=
Filgastrin
80
Filgastrin MOA
Stimulates G-CSF receptors expressed on mature neutrphils and their progenitors
81
G-CSF=
Granulocytes Colony Stimulating Factor
82
How is Filgastrim given?
SC daily
83
Filgastrin indications
Neutropenia assosiated with congenital neutropenia Cyclic neutropenia Myelodysplasia Aplastic anemia Mobilization of peripheral blood cells in preparation for stem cell transplantation
84
Filgastrin side effects
Bone pain | Splenic rupture

pharmacology final ( 1st sem) (15 decks)

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