Hemato Flashcards
1
Q
P2Y12 receptor antagonist
A
Clopidogrel
2
Q
Inhibition of which receptor ↓GP IIb/IIIa expression @Platlets
A
Clopidogrel
Irreversibly
3
Q
Dual antiplatlet therapy
A
Clopidogrel + Aspirin
4
Q
PPI + Clopidogrel
A
↓ conversion to active metabolite
5
Q
Alternative antiagregant to Aspirin @cases of intolerance
A
Clopidogrel
6
Q
Clinical use of monotherapy of Clopidogrel
A
Stroke
7
Q
Contraindications Antiagregant use
A
Allergy
Active/recent bleeding <30days
Severe hypertension
Aortic dissection
Thrombocytopenia
8
Q
Aspirin: onset & duration of therapeutic effect
A
minutes
7-10 days
9
Q
Low dose of Aspirin
A
Antithrombotic (<300mg/day)
10
Q
Intermediate dose of Aspirin
A
Antipyretic + Analgesic
300-2400 mg/day
11
Q
High dose of Aspirin
A
Anti-inflammatory
2400-4000 mg/day
12
Q
Most common adverse effect of Acetylsalicylc Acid
A
GI effect
13
Q
Adverse effects of Aspirin
A
GI effect
Coagulopathy → ↑ bleeding time
Tinnitus
Renal @chronic use
Salicylate poisoning
Allergic runs
14
Q
Antiaggregant contraindicated in febrile illness <19yo
A
Aspirin
15
Q
Is contraindicated @Acute Gout attacks bc it competes with uric acid for renal excretion
A
Aspirin
16
Q
____ is associates with Aspirin use for viral febrile illness @Px <19yo
A
Reye Syndrome
17
Q
T or F: There is NO effect in the concomitant use of Aspirin + Alcohol
A
F
it ↑ bleeding time
18
Q
Which NSAIDs ↓ Aspirins cardio protective function when used together
A
Ibuprofen
Naproxen
19
Q
GpIIa/IIIa inhibitors
A
Abcximab
Tirofiban
20
Q
Prevents platelets from binding to fibrinogen GpIIa/IIIa receptor and blocking them
A
Abcximab
Tirofiban
21
Q
Antiaggregant used to prevent thrombotic complications @HIGH risk Px with unstable angina and/or NSTEMI (non-ST-segment elevation myocardial infraction)
A
Abcximab
Tirofiban
22
Q
Adverse effects of GpIIb/IIIa inhibitors
A
Severe Thrombocytopenia
23
Q
Monoclonal antibody with antiaggregant properties
A
Ancximab
24
Q
Fibynolytics // Thrombolytics
A
Alteplase
Tenecteplasa
Streptokinase
25
Antiaggregants
Clopidogrel
Aspirin
Abcximab
Tirofiban
26
Fibrin specific agents (Fibrinolytics)
Alteplase
Tenecteplasa
27
Non fibrin specific agents
Streptokinase
28
Are recombinant variants of t-PA
Alteplase
Tenecteplasa
29
MOA of Fibrinolytics/Thrombolytics
Directly or Indirectly ↑ concentration of Plasmin → Cleavage of Thrombin and Fibrin
30
Which Fibrinolytic has HIGHER fibrin selectivity + Resistance to Plasminogen Activator inhibitors
Tenecteplasa
31
Greater Thrombolytic effect
Tenecteplasa
32
Thrombolytic that has NO effect in circulating plasminogen
Alteplase
33
First line tx for Pulmonary Embolism
Tenecteplase
34
Enzyme produced by group A Streptococci that catalyzes the conversion of Plasminogen to Plasmin
Streptokinase
35
Themolytic tha binds specifically to Plasminogen the is already bound to Fibrin
Alteplase
36
Fibrinolytic that affects both circulating and bound Plasminogen
Streptokinase
37
Thrombolytic indicated for Early STEMI (<12hrs)
Streptokinase
38
Adverse effect of Fibrinolytics
Bleeding
ex. Intracranial Hemorrhage
39
Intrcranial hemorrhage
Fibrinolytics
40
Thrombolytic who causes Hypersensitivity most commonly
Streptokinase
bc its antigenic
41
Thrombolytic related to endocarditis, and pericarditis as adverse effects
Tenectplasa
42
Tx of Adverse Effects of Fibrinolytics
Antifibrinolytics (Tranexami acid & Aminocaproic acid)
Fresh Frozen Plasma or Crypto-precipitate
Platelet transfusion
43
Prior intracranial hemorrhage is considered an ____ contraidication
Absolute
44
Clinical Use of Thrombolytics
Thrmbolysis @
Acute Ischemic Stroke
Pulmonary Embolism
Myocardial infraction
45
Known malignant intracranial neoplasm, _____ contraindication of Fibrinolytics
Absolute
46
Ischemis Stroke ≤3months ago, is an______ contraindication
Absolute
47
Suspected aortic dissection is an ______ contraindication of Fibrinolytics
Absolute
48
Uncontrolled hypertension is a ______ contraindication of Fibrinolytics
Relative
49
Recent (2-4 weeks) internal bleeding is a ______ contraindication of Fibrinolytics
Relative
50
Active bleeding is a ______ contraindication of Fibrinolytics
Absolute
51
Traumatic or Prolonged CPR or Major Surgery ≤3 months is ______ contraindication of Fibrinolytics
absolute
52
Pregnancy is a ______ contraindication of Fibrinolytics
Relative
53
Active Peptic Ulcer is ______ contraindication of Fibrinolytics
Relative
54
Current use of Warfarin + INR >1.7 is a ______ contraindication of Fibrinolytics
Relative
55
What is a relative contraindication unique to Streptokinase
Prior exposure (≥5 days ago) or Prior allergic reaction to Streptokinase
56
Thrombolytic that is resistant to inhibition by PAI-1 inhibitor of plasminogen activator
Tenectplase
57
Vitamin K Antagonist
Warfarin
Acenocumarol
58
Inhibits hepatic vit.K epoxide reductase
Warfarin
Acenocumarol
59
Px takes warfarin starts presenting small wounds that cease to bleed spontaneously..... what do we do?
STOP warfarin
60
Anticoagulant that can induce Skin Necrosis
Warfarin
After 3-10 days of tx with high doses
61
Purple Toe Syndrome
Warfarin
62
Anticoagulant that can cause abdominal cramps
Warfarin
63
Warfarin induced Skin Necrosis Tx
STOP warfarin
administer IV Vitamin K, Protein C concentrate or FFP
64
Prevention of skin induced necrosis by warfarin
temporary bridging anticoagulation with Heparin
65
T or F: Protein C and S have a shorter life, and are depletes more quickly Annan procoagulants → vascular occlusion, tissue infraction, blood extravasation
T
66
Contraindication for anticoagulants
Hepatic dysfunction ( due to impaired hepatic production of coagulation factors)
67
Vit.K dependent Coagulation factors
2,7,9,10
68
T or F: Warfarin + Other Anticoagulant to have better tx
F
69
Contraindications Warfarin
Coagulopathies
Acute bleeding
Suspected vascular lesions ( hypertension, anuerism, endocarditis, GI bleeding, surgery, tendency to fall)
Severe renal insufficiency
Pregnancy
Concurrent admin of several anticoagulants
70
Warfarin + Rifampicin
↓ Effect
due to CYP460 induction
71
Warfarin + Food rich in Vit.K
↓ Effect
72
Warfarin + PPIs
↓ effect
due to impaired uptake of warfarin
73
Warfarin + Metronidazole
↑ Effect
due to CYP460 inhibition
74
Warfarin + Acetaminophen
↑ Effect
bc interrupts bit.k cycle
75
Warfarin + Sulfonamides
↑ Effect
completely blocks/displaces Warfarin at plasma protein binding sites
76
Vit K. antagonists affect ____ coagulation pathway
Extrinsic
Warfarin Extrinsic Pathway PT = WEPT
77
Mutation and polymorphisms @___ gene alter the effect of Vit.K antagonists
VKORC1
78
Cerebral Embolism Anticogulant
Acenocumarol
79
Prophylaxis of thromboembolism following knee or hip replacement
Warfarin
80
Prophylaxis of thromboembolism following valvular atrial fibrillation
Warfarin
81
Prophylaxis of thromboembolism following heart valve replacement
Warfarin
82
Prophylaxis of thromboembolism following heart valve replacement
Warfarin
83
Low molecular weight heparin
Nadroparin
Enoxaparin
84
T or F: Heparin affects intrinsic pathway
F
85
Admin of therapeutic and prophylaxis Heparin
t = IV
p = SC
86
Preferred anticoagulant for px with renal insufficiency
Heparin
87
Anticoagulant safe to use during pregnancy
Heparin
Nadroparin
Enoxaparin
88
T or F: Low molecular weight heparin is indicated to use in px with renal insufficiency
F
due to its greater bioavailability compared to unfractioned heparin (high molecular heparin)
89
Out of hospital tx for px with DVT or Pulmonary embolism
Low molecular weight hepain
90
HIGH dose Heparin
immediate anticoagulation effect for:
atrial fibrillation
DVT
pulmonary embolism
acute coronary synd
myocardial infraction
unstable angina
mechanical heart valve replacement
91
Anticoagulant of choice for surgery requiring cardiopulmonary bypass
Heparin
92
Anticoagulant for Px with disseminated intravascular coagulation
Heparin
93
Goal of Heparin
Prevent reformation and extension of thrombin and fibrin
94
Antidote for Heparin
Protamine Sulfate
95
Heparin induced Thrombocytopenia
- usually if tx is >7 days
- UFH > LMW
- W > M
96
Side effects of high and low weight heparin
Bleeding
Allergic reaction (IgG)
Heparin induced Thrombocytopenia
Osteoporosis
Hypoaldosenorism → Hyperkalemia
97
Contraindication of Heparin
recent stroke
uncontrolled hypertension
active bleeding
98
How is Heparin tx monitored
by measuring aPTT
99
Nicotine/Tetracyclines + Heparin
Risk of bleeding complications
100
Dextran + Heparin
risk of hemorrhage
101
Heparin binds reversibly to ...
Antithrombin III (ATIII)
causing its potentiation
102
Heparin caused indirect inhibition of:
Factor Xa = ↓activation of prothrombin
Thrombin (Factor IIa) = ↑ thrombin inhibition
= ↓Fibrin
103
Phytomenadione
Vitamin K
104
Cofactor for y-carboxylation of glutamate residues @vit.K dependent proteins involved in coagulation and bone formation
Phytomenadione
105
Postnatal injection of Vit.K
Phytomenadione
to prevent Vit.K deficiency in the New born (VKDB)
106
T or F: IV admin of Phytomenadione carries major risk of anaphylactoid reactions
T
107
Toxicity of Phytomenadione causes...
Oversupplementation of Vit.K
= hemolytic anemia, hyperbilirubinemia, jaundice, kernicterus
108
T or F: IV admin of Phytomenadione must be given at a normal velocity rate
F, SLOWLY
109
Indications of Phytomenadione
Postnatal Vit.K injection (prevent vit.K defieciency in the new born)
Coagulopathy (disorders of the EXTRINSIC pathway)
Reversal of Warfarin
Billiary obstruction
110
Stimulates CFU-E units promoting erythropoiesis @BM
Erythropoyetin
111
Anemia in AIDs px is induced by ______ and tx with
Zivudine
Erythropoyetin
112
MOST common sude effect of Erythoproyetin
Hypertension aggravation
due to rapid rise of hematocrit
113
Adverse Effect of Erytopoyetin
GI effect
Flu-like symptoms
Hypertension aggravation
Thromboembolism
114
Contraindication of Erythropoyetin
uncontrolled Hypertension
115
Growth factors used for Chronic Bone Marrow Failure
Methenolone
116
Admin of Methenolone Acetate
Oral
117
Admin of Methenolen Enathate
IM
118
Antianemic that can cause masculinization
Methenolone
119
Precursor of Vit.B
Hydroxocobalamin
120
Tx for Vit.B12 deficiency
Hydroxocobalamin
121
Megaloblastic anemia caused by folate deficiency
Folic Acids
CANNOT cure B12 deficiency
122
which body store is bigger: Folic Acid or Vit.B12?
Vit.B12 (3-4 years)
123
Most common cause of Macrocytic anemia
Folate deficiency
bc of low body stores (3 weeks-4 months)
124
T or F: For Vit.B12 deficiency the admin of Folic Acid also helps in the tx
T
125
Which deficiency accuses neurological symptoms
Vit.B12
126
Prevention of neural tue defects
Folic acid
begin 1M before pregnancy
127
Dietary defieicny of Vit.B12
strict vegetarian
gastrectomy
128
Oral iron tharpy
Ferrous Sulfate
129
Used when oral iron therapy fails
Iron Dextran
130
Type of Iron the can be given to iron deficiency px and pregnant women, to create iron stores
Parenteral Iron
- Iron Dextran
- Ferric Fumarate
since oral route would take months to achieve it
131
Tx of Choice for Iron deficiency
Ferrous Sulfate
132
Parenteral Iron with less adverse effects
Ferric Saccrate
133
Chronic use of Ferric Saccrate
Renal Tubulointestinal damage
134
Contraindications of Iron Dextran
RA
Hypersensitivity
135
Anticoagulants MOA
Prevent blood clots from forming
Interfere with coagulation factors, affecting secondary hemostasis
136
Warfarin blocks _____ enzyme that inhibits Vit.K recycling
Vitamin K Epoxide Reductase
137
Montoring of Heparin with
INR
Goal (1-3 INR)
138
How is Heparin tx monitored?
aPTT (intrinsic pathway)
50-90 sec @Heparin
aprox 1.5-2.5x
