Drugs

Question 1

Warfarin (2)

Answer 1

1) Phytonadione 2) Mephyton

Question 2

Indirect Thrombin Inhibitors (4)

Answer 2

1) Warfarin (Coumadin) 2) UF/ HMW heparin 3) LMW Heparin (Lovenix) 4) Fondaparinux (Arixtra)

Question 3

Direct Thrombin Inhibitors (3)

Answer 3

1) Lepirudin (Refludon) 2) Argatroban 3) Bivalirudin (Angiomax)

Question 4

Warfarin -MOA

Answer 4

Inhibits Vitamin-K dependent factors II, VII, IX, X (and Protein C & Protein S) via inhibition of Vitamin-K Epoxide Reductase

Question 5

Warfarin -Monitoring

Answer 5

PT (and INR)

Question 6

Lepirudin -(trade name) -Drug Class -Use

Answer 6

(Refludan); synthetic form of hirudin, -Class = DTI -Use: Alternative anticoagulant/ therapy for HIT patients

Question 7

Lepirudin -Monitoring (2) (why?)

Answer 7

1) aPTT 2) Renal f(x) Why: -VERY antigenic -RENAL clearance (biggest difference between the similar drug, Argatroban=hepatic clearance)

Question 8

Bivalirudin -(trade name) -Drug Class -Use -Monitoring

Answer 8

(Angiomax) -Class = DTI -Use: anticoagulant for HIT patients (expensive) -Monitoring = ECT (but ACT is commonly used)

Question 9

Argatroban -Drug Class -Monitoring -Clearance?

Answer 9

Class = DTI -Monitoring = aPTT

Question 10

UF Heparin (aka) -MOA (2)

Answer 10

aka HMWH (5,000-30,000 Da) - potentiates AT-III (>1000x) interaction with: 1) Thrombin 2) Factor Xa

Question 11

LMWH -MOA -T1/2

Answer 11

-potentiates AT-III interaction with “Factor Xa” only -T1/2: 3-7 hrs (much longer than UF)

Question 12

ASA -MOA (2)

Answer 12

Blocks platelet aggregation via: 1) inactivation of COX-1: -inhibits platelet ADP release -inhibits TXA2 & PGE2 synthesis from Arachadonic Acid 2) modifies COX-2: -production of “lipoxins”

Question 13

Thienopyidines (3)

Answer 13

1) Ticlopidine (Ticlid) 2) Clopidogrel (Plavix) 3) Prasugrel (Effient)

Question 14

Ticlopidine -(trade name) -Black Box Warning (3)

Answer 14

(Ticlid) = Thienopydine Black Box: 1) Aplastic Anemia 2) Neutropenia 3) Thrombotic Thrombocytopenia Purpura

Question 15

Clopidogrel -(trade name) -Drug Class

Answer 15

(Plavix) Thienopydines

Question 16

Prasugrel -(trade name) -Drug Class

Answer 16

(Effient) Thienopydines

Question 17

Thienopydines -MOA (diff. from ASA)

Answer 17

Blocks “ADP-mediated” platelet aggregation which blocks platelet receptors GPIIb/IIIa

Question 18

ASA -Dose for complete platelet inactivation

Answer 18

approx. 160mg = complete platelet inactivation

Question 19

ASA -Side Effects (3)

Answer 19

1) Bleeding 2) GI (gastric ulcers) 3) Kidney damage (interstitial nephritis)

Question 20

GP IIb/IIIa Blockers (3)

Answer 20

1) Abciximab (Repro) 2) Eptifibatide (Integrilin) 3) Tirofiban (Aggrastat)

Question 21

Dipyridamole -(trade name) & Drug Class -MOA

Answer 21

(Persantine) = Platelet Inhibitor blocks cAMP which ultimately inhibits TXA2 synthesis (w/ NO effect on PG)

Question 22

Platelet Inhibitors 1) 2a) 2b) 3)

Answer 22

1) Dipyridamole (Persantine) 2a) Dextran 70 (Macrodex) 2b) Dextran 40 (Rheomacrodex) 3) Hespan

Question 23

Dextrans (2) -MOA -Max Dose

Answer 23

1) Dextran 70 (Macrodex) - Plt. inhibitor 2) Dextran 40 (Rheomacrodex) - Plt. inhibitor -Decreases Factors V, VIII and IX functionality -MAX DOSE = 2g/kg (20 ml/kg)

Question 24

Hespan -MOA -Max Dose

Answer 24

-Platelet Inhibitor (glucose polymer) -significantly reduces Factor VIII; results in elevated aPTT -MAX DOSE = 20 ml/kg

Question 25

Thrombolytics (4)

Answer 25

1) Alteplase/ tPA (Activase) 2) Reteplase (Retavase) 3) Streptokinase (Streptase) 4) Urokinase (Kinlytic)

Question 26

Streptokinase -(trade name) -MOA

Answer 26

(Streptase) = Thrombolytic -attaches to plasminogen and converts it to plasmin; also destroys Fibrinogen, FV, FVII

Question 27

Antithrombin III -2 synthetic forms and sources

Answer 27

1) Thrombate - made from pooled human plasma 2) Atryn - genetically modified goat milk