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Pharm 2 > Class 8 Deck 2 > Flashcards

Class 8 Deck 2 Flashcards

1
Q

During bridging therapy, there is an increased risk of what when Novel anticoags are abruptly stopped?

A

-Stroke

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2
Q

Hemodialysis can remove what Novel anticoag?

A

-dabigatran / pradaxa

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3
Q

What drug can reverse rivaroxaban and apixaban?

A

-4 factor prothrombin complex concentrate (Kcentra®)

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4
Q

4 factor prothrombin complex concentrate (Kcentra®) contains what 5 things?

A
  • Factors II, VII, IX, X (inactivated)

- Heparin

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5
Q

Activated 4 factor Prothrombin Complex Concentrate

(FEIBA) contains what? and what does it reverse?

A
  • Factors II, IX, X, activated VII

- Dabigatran

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6
Q

What is the potential problem of Activated 4 factor Prothrombin Complex Concentrate (FEIBA)?

A

-Thrombotic effects of activated factor VII

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7
Q

What does Factor IX Complex (Profilnine SD) do? and what does it contain?

A
  • Reversal for rivaroxaban or apixaban when combined w/ rFactor VIIa
  • Contains II, IX, X (no heparin)
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8
Q

What drug reverse all Novel anticoags?

A

-Recombinant Factor VIIa (NovoSeven®)

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9
Q

What kind of drug is used to keep clots from breaking down?

A

-Hemostatics like Amicar / Tranexamic acid / DDAVP

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10
Q

How does Epsilon Aminocaproic Acid (Amicar®): work?

A
  • Inhibits plasminogen which inhibits fibrinolysis

- Indirect inhibitor of plasmin’s anti platelet effect

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11
Q

When is Epsilon Aminocaproic Acid (Amicar®): used?

A
  • Treatment of excessive bleeding
  • reduces bleeding after CPB
  • Stops oozing in patient w/ cirrhosis
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12
Q

Why should rapid infusion of Epsilon Aminocaproic Acid (Amicar®) be avoided?

A
  • Hypotension
  • Brady
  • Arrhythmias
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13
Q

Tranexamic Acid inhibits what?

A

plasminogen binding sites

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14
Q

when is Tranexamic Acid used?

A
  • Bleeding prophylaxis in Post Bypass, Trauma, Joint replacment
  • Massive transfusion protocol
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15
Q

What is desmopressin (DDAVP) and how does it effect hemostasis?

A
  • Synthetic ADH
  • Causes endothelial cells to release: VIII (VWB), plasminogen activator and prostaglandins
  • Increase platelet adhesions
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16
Q

When is DDAVP used as a hemostatic?

A
  • Uremia
  • Liver disease
  • Hemophilia A
  • Minimize blood loss during cardiac/spine surgery
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17
Q

What are the side effects of DDAVP?

A
  • Hypo/Hypertension
  • Hyponatremia
  • Nausea
18
Q

Name the 5 thrombolytic agents?

A
  • Altepase
  • Reteplase
  • Tenecteplase
  • Streptokinase
  • Urokinase
19
Q

How do the t-PA agents work?

A

Converts plasminogen to plasmin

20
Q

How is streptokinase different from the other thrombolytic agents?

A
  • No intrinsic enzymatic activity
  • Forms a 1:1 complex with plasminogen and cleaves free plasminogen to plasmin
  • Requires loading dose
21
Q

How is urokinase different from the other thrombolytic agents?

A
  • 2 chain serine protease from human kidneys
  • Converts plasminogen to plasmin
  • Very expensive
22
Q

When are thrombolytic agents used?

A
  • Lysing thrombi during MI
  • Treat PE
  • Venous thrombi
  • to open occluded catheters
23
Q

What are the advantages of uro/streptokinase?

A
  • Lack fibrin specificity

- Induce systemic lysis state

24
Q

What are the toxicity concerns for thrombolytic agents?

A
  • Hemorrhage (lysis of fibrin)
  • Intracranial hemorrhage
  • fibrinolytic activity can last 7-24hrs after last dose
25
How does aspirin inhibit platelet aggregration?
Cyclo-oxygenases inhibitor, which decreases Thromboxane -A2 | -Last the life of the platelet
26
How do NSAIDs inhibit platelet aggregration?
-Temporary depression of thrombaxane-A2
27
Name the platelet aggregation inhibitors that are Thienopyridine P2Y12 receptor agonists.
- Clopidogrel (Plavix®) p.o. - Ticlopidyne (Ticlid®) p.o. - Prasugrel (Effient®) p.o. - Ticagrelor (Brilinta®) p.o.
28
How is Ticagrelor (Brilinta®) different from the other Thienopyridine P2Y12 receptor agonists.
- It is reversible | - Stop 5 days prior to surgery
29
Name the platelet aggregation inhibitors that are Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors
Abciximab (ReoPro®) I.V. Eptifibatide (Integrilin ®) I.V. Tirofiban (Aggrastat ®) I.V.
30
When are Thienopyridine P2Y12 receptor agonists used?
- Prevention of thrombosis in cerebral, vascular and coronary disease. - For patients who cannot tolerate aspirin
31
Much like aspirin, platelets exposed to P2Y12 Receptor Antagonists (except ticagrelor) remain affected for how long?
-Lifespan of the platelet
32
Clopidogrel (Plavix) should be stopped how long prior to surgery?
5 days
33
Ticlid should be stopped how long prior to surgery? and what is the reversal?
- 10-14 days | - Methylprednisolone and platelet transfusions
34
Which P2Y12 Receptor Antagonists are pro-drugs?
-Plavix and effient
35
Thienopyridine P2Y12 receptor Antagonists adverse effects?
- Bleeding - Diarrhea and Rash - TTP - Neutropenia
36
How do Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors work?
-Inhibit fibrinogen binding to platelets (Inhibit platelet aggregation)
37
When are Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors used?
- Ischemic complications of PCI | - Unstable angina and MI
38
Adverse effects of Platelet Glycoprotein (GP IIb/IIIa) Receptor Inhibitors.
- Bleeding - Thrombocytopenia - N/V - Hypotension - Anaphlyxis
39
What should be monitored when on low dose coumadin, and when can a catheter be removed?
- PT/INR | - INR<1.5
40
Use of what drugs represents a significant risk for hematoma during neuraxial block?
- Factor Xa inhibitors | - LMWH and Fondaparinux
41
What is Dextran 40? and When is it used?
- Low molecular weight dextran - Expanding intravascular volume - Decreases blood viscosity
42
What are the side-effects Dextran 40?
- Allergic reactions - Increased bleeding time - Rouleaux formation

Pharm 2 (23 decks)

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