Neoplasia/Hematology - Pharmacology - Antianemia Agents; Hemostatic Agents Flashcards
(109 cards)
1
Q
Name the most relevant vitamins, minerals, or stimulating factors inducing proper erythropoeisis.
A
Vitamins B12 and B9
Fe2+
Erythropoeitin
2
Q
What medication(s) can be given to stimulate platelet production?
A
Oprelvekin
(IL-11)
3
Q
What medication(s) can be given to stimulate granulocyte production?
A
Filgrastim (G-CSF);
sargramostim (GM-CSF)
4
Q
Vitamins B12 and B9 are necessary for synthesis of what in red blood cells?
A
dTMP
(due to proper activity of dihydrofolate reductase)
5
Q
G-CSF stimulates production of what?
A
Neutrophils
6
Q
GM-CSF stimulates production of what?
A
Granulocytes + other myeloid cells
7
Q
What is the most common type of anemia?
A
Microcytic, hypochromic anemia
(due to iron deficiency)
8
Q
Although most of the iron in the body is bound in hemoglobin, a significant portion is bound to ________, a transport protein, and ________, a storage protein.
A
Although most of the iron in the body is bound in hemoglobin, a significant portion is bound to transferrin, a transport protein, and ferritin, a storage protein.
9
Q
What transporter in the duodenum allows for iron uptake?
A
DMT1
10
Q
In what clinical scenarios should iron be given to a patient with hemolytic anemia?
A
It should not!
(Iron stores are elevated in hemolytic anemia)
11
Q
What dietary forms of iron can be administered to a patient with iron deficiency anemia?
A
Ferrous sulfate;
ferrous gluconate;
ferrous fumarate
12
Q
What parenteral forms of iron can be administered to a patient with iron deficiency anemia?
A
Iron dextran;
sodium ferric gluconate;
iron sucrose
13
Q
Hemochromatosis occurs most often in patients with an __________ disorder of iron __________ and in patients receiving frequent __________ for treatment hemolytic anemia.
A
Hemochromatosis occurs most often in patients with an inherited disorder of iron absorption and in patients receiving frequent transfusions for treatment of hemolytic anemia.
14
Q
How can acquired hemochromatosis be treated?
A
Chelation therapy (deferasirox or deferoxamine)
15
Q
How can inherited hemochromatosis be treated?
A
Phlebotomy
16
Q
True/False.
Folate (B9) is involved in the metabolism of both the following: methylmalonyl-CoA, homocysteine.
A
False.
Cobalamin (B12) is involved in the metabolism of both the following: methylmalonyl-CoA, homocysteine.
17
Q
A deficiency of cobalamin leads to elevated serum levels of what?
A deficiency of folate leads to elevated serum levels of what?
A
Methylmalonic acid, homocysteine;
homocysteine
18
Q
What is the typical scenario in which iron poisoning occurs?
A
A child finding/ingesting supplements
19
Q
What are the signs/symptoms of iron poisoning?
A
Necrotizing gastroenteritis;
shock;
metabolic acidosis
20
Q
The iron stored in intestinal mucosal cells is complexed to / stored in what?
A
Ferritin
(forming apoferritin)
21
Q
What is the most common type of vitamin B12 deficiency anemia?
A
Pernicious anemia
22
Q
Anticoagulants are generally used to prevent what?
A
Venous clots
23
Q
Antiplatelet medications are generally used to prevent what?
A
Arterial clots
24
Q
What medication class is used to prevent venous clots?
A
Anticoagulants
25
What medication class is used to prevent arterial clots?
Antiplatelets agents
26
The hemophilias are disorders of __________ hemostasis.
von Willebrand is a disorder of __________ hemostasis.
The hemophilias are disorders of **_secondary_** hemostasis.
von Willebrand is a disorder of **_primary_** hemostasis.
27
Primary hemostasis mostly involves what?
Platelet adhesion
28
\_\_\_\_\_\_\_\_\_ hemostasis mostly involves inactive circulating proteins primarily made in the \_\_\_\_\_\_\_\_.
**_Secondary_** hemostasis mostly involves inactive circulating proteins primarily made in the **_liver_**.
29
What glycoprotein binds platelets to exposed von Willebrand factor?
gp Ib
30
What glycoprotein binds platelets to each other via fibrinogen?
gp IIb/IIIa
31
Arterial clots are mainly composed of what?
Platelets
32
Venous clots are mainly composed of what?
Fibrin
33
What is the main trigger for arterial clots?
Atherosclerosis
34
What is the main trigger for venous clots?
Stasis
35
Venous clots can bypass the lungs and become arterial if what if present?
A patent foramen ovale
36
**True/False**.
DVTs and PEs typically result due to atherosclerosis and are clots composed _mainly_ of fibrin.
**False**.
DVTs and PEs typically result due to ***stasis*** and are clots composed _mainly_ of fibrin.
37
**True/False**.
MIs and strokes typically result due to atherosclerosis and are clots composed _mainly_ of fibrin.
**False**.
MIs and strokes typically result due to atherosclerosis and are clots composed _mainly_ of ***platelets***.
38
**Bleeding time** is a measure of the time it takes for an incision to stop bleeding.
This is a measure of what process?
Primary hemostasis
39
How long is the average bleeding time?
1 to 9 minutes
40
An abnormal bleeding time indicates defects in either:
\_\_\_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_.
An abnormal bleeding time indicates defects in either:
**_platelets_** or **_vWF_**.
41
**True/False**.
Elevated bleeding times are seen in patients with pure clotting factor deficiencies.
**False**.
***Normal*** bleeding times are seen in patients with pure clotting factor deficiencies.
(Bleeding time measures platelet function in _primary_ hemostasis)
42
In pure clotting factor deficiencies, there is ________ bleeding time.
In pure clotting factor deficiencies, there is **_normal_** bleeding time.
43
What do PFAs measure?
Platelet function
44
What does the prothrombin time measure?
## Footnote
* (Primary or secondary hemostasis?)*
* (Extrinisic or intrinsic pathway?)*
* (Which factors?)*
**Secondary** hemostasis;
**extrinsic** pathway;
factors I, II, V, **VII** and X.
45
What does the partial thromboplastin time measure?
(Primary or secondary hemostasis?)
(Extrinisic or intrinsic pathway?)
(Which factors?)
**Secondary** hemostasis;
**intrinsic** pathway;
factors I, II, V, **VIII**, **IX**, X**, XI**, **XII**
46
Which factors are checked by either a partial thromboplastin or prothrombin time?
I, II, V, X
47
What is a normal prothrombin time?
10 - 15 seconds
48
What test(s) can be used to monitor the effects of unfractionated heparin?
**Partial thromboplastin** time
| (PTT or aPTT)
49
What test(s) can be used to monitor the effects of warfarin?
**Prothrombin** time;
## Footnote
**INR**
50
What test(s) can be used to monitor the effects of antiplatelet drugs?
**Bleeding** time;
## Footnote
**PFA**
51
Name the respective drug or drug class that each of the following tests is used to monitor:
## Footnote
**Prothrombin time (INR)**
**Partial thromboplastin time**
**Bleeding time (or PFA)**
Warfarin
Unfractionated heparin
Antiplatelet medications
52
What is the equation for calculating international normalized ratios (INR)?
**( PTtest / PTnormal )ISI**
*(ISI = the international standard index for that particular manufacturer's test reagent)*
53
What is the typical international normalized ratio (INR) range for healthy individuals?
0.8 - 1.2
54
For those on warfarin therapy, the INR should typically be ____ to \_\_\_\_.
For those on warfarin therapy, the INR should typically be **_2.0_** to **_3.0_**.
55
**True/False**.
A therapeutic aPTT should be _1.5 to 2.5x_ control values.
True.
56
Prothrombin time and INR are used to measure the _________ clotting pathway and monitor the effects of \_\_\_\_\_\_\_\_\_.
Prothrombin time and INR are used to measure the **_extrinsic_** clotting pathway and monitor the effects of **_warfarin_**.
57
Partial thromboplastin times are used to measure the ________ clotting pathway and monitor the effects of \_\_\_\_\_\_\_\_.
Partial thromboplastin times are used to measure the **_intrinsic_** clotting pathway and monitor the effects of **_heparin_**.
58
Bleeding times and PFAs are used to measure the effectiveness of _________ hemostasis and monitor the effects of _________ medications.
Bleeding times and PFAs are used to measure the effectiveness of **_primary_** hemostasis (**platelets**) and monitor the effects of **_antiplatelet_** medications.
59
An elevated bleeding time/PFA would indicate that the patient is receiving medication that may interfere with which of the following?
A. Factor II
B. GPIIb/IIIa.
C. Factor VII
D. Factor XII
E. Vitamin K
B. GPIIb/IIIa.
60
Heparin activates __________ to inhibit factors \_\_\_\_\_\_\_\_\_\_\_\_\_.
Heparin activates **_antithrombin III_** to inhibit factors **_II, IX, X, and XII_**.
61
Unfractionated heparin is highly _______ and also has an especially high affinity for factors ____ and \_\_\_\_.
Unfractionated heparin is highly **_acidic_** and also has an especially high affinity for factors **_II_** (thrombin) and **_X_**.
62
How is unfractionated heparin administered?
**IV** or **subcutaneous**
63
Name the medication that can be used in treating in all the following:
## Footnote
**Venous thrombosis**
**PE**
**Peripheral arterial thrombosis**
Heparin
64
What medication is useful in prevention of post-operative DVT and PE?
Heparin
65
What medication is useful in treatment and prophylaxis of thromboembolic events related to **atrial** **fibrillation**?
Heparin
66
Does enoxaparin have a higher or lower molecular weight than unfractionated heparin?
Lower
(it is a low molecular weight (LMW) heparin)
67
Heparin is dosed based on what?
Enoxaparin is dosed based on what?
aPTT;
body weight
68
Which has a better **bioavailability** and **half-life**, heparin or enoxaparin?
Enoxaparin
69
Which of the following has less activity at factor II (thrombin) and more activity at factor X?
Heparin
Enoxaparin
Enoxaparin
70
Is enoxaparin useful in DVT / PE **prophylaxis** or **treatment**?
**Both**!
71
A patient begins bleeding after heparin sulfate is administered. What do you do to reverse the effects of the heparin?
Administer **protamine sulfate**
(note: often not useful in reversing enoxaparin)
72
What are some of the potential negative side effects of heparin use?
**Hemorrhage**;
heparin-induced **thrombocytopenia**;
**osteoporosis**
73
Why is heparin-induced thrombocytopenia associated with a paradoxical *_thrombosis_*?
Platelet activation
| (in response to the thrombocytopenia)
74
Name a few examples of alternatives to heparin.
**Hirudin**, **lipirudin**, **bivalirudin**,
argatroban, fondaparinux
75
Relative to regular heparin, enoxaparin:
a) can be used without monitoring aPTT
b) has a shorter duration of action
c) is less likely to produce a teratogenic effect
d) is more likely to be given intravenously
e) is more likely to cause thrombosis and thrombocytopenia
a) can be used without monitoring aPTT
76
Warfarin is generally administered as a sodium salt and has \_\_\_\_% bioavailability.
Warfarin is generally administered as a sodium salt and has **_100_**% bioavailability.
77
There is an ___ to ___ \_\_\_\_ delay before warfarin takes effect and a ___ to ___ \_\_\_\_ lag until complete effect due to long half life of **factor II**.
There is an **_8_** to **_12_** **_hour_** delay before warfarin takes effect and a **_2_** to **_3_** **_day_** lag until complete effect due to long half life of **factor II**.
78
\_\_\_% of warfarin is protein bound with a T1/2 of ___ hours (in plasma).
**_99_**% of warfarin is protein bound with a T1/2 of **_36_** hours (in plasma).
79
Warfarin blocks synthesis of which factors?
**II**, **VII**, **IX**, and **X**;
proteins **C** and **S**
80
Warfarin is indicated in prophylaxis and treatment of:
- ______ thrombosis and \_\_\_\_.
- _____________ events related to MI, stroke and atrial fibrillation.
Warfarin is indicated in prophylaxis and treatment of:
- **_Venous_** thrombosis and **_PE_**.
- **_Thromboembolic_** events related to MI, stroke and atrial fibrillation.
81
A patient on warfarin has an INR of 17.0. To prevent hemorrhage, the warfarin should be discontinued and the patient should be treated with (in addition to PCCs):
a) Alteplase
b) Aminocaproic acid
c) Factor VIII
d) Protamine
e) Vitamin K.
e) Vitamin K.
82
A pregnant woman with a history of heparin induced thrombocytopenia is diagnosed with a DVT. The most appropriate therapy is
A. Warfarin
B. Enoxaparin
C. fondaparinux
D. Clopidigrel
E. Aspirin
C. fondaparinux
83
What are some signs of warfarin overdose?
(including INR)
**Hematuria**;
**bleeding** **gums**;
INR **\> 6**
84
How should warfarin overdose be treated?
Fresh frozen plasma
+
vitamin K
85
What are some contraindications to warfarin use?
Pregnancy;
hemorrhagic tendencies;
warfarin-induced skin necrosis
86
What enzyme does warfarin inhibit?
**E****poxide reductase**
87
Patients with what disorder are more at-risk for hemorrhagic skin necrosis upon administration of warfarin?
Protein C deficiency
(remember, warfarin also inhibits protein C!)
88
\_\_\_\_\_\_\_\_\_\_ is an oral medication that can be administered to treat GI bleeding.
**_Thrombin_** is an oral medication that can be administered to treat GI bleeding.
89
Name a few medications that can be used as coagulants.
Fresh frozen plasma (**FFP**);
**cryoprecipitate** (fibrinogen, fVIII, VwF, fXIII);
factor **VIII** concentrate/Factor **IX**;
factor **VIIa**;
prothrombin complex concentrates (**PCCs**)
90
Name the characteristics of the ideal anticoagulant medication in terms of the following:
Route of administration
Timeframe
Monitoring requirement
Reversibility
Drug/diet interactions
**Oral**
**Short-acting**
**No** monitoring required
**Easily** reversible
**No** drug/diet interactions
91
What is the mechanism of dabigatran etexilate?
How can it be reversed?
Thrombin inhibition;
idarucizumab
92
\_\_\_\_\_\_\_\_ is an orally active, selective Factor Xa inhibitor that has a rapid onset and good bioavailability.
**_Apixaban_** is an orally active, selective Factor Xa inhibitor that has a rapid onset and good bioavailability.
93
What is the reversal agent for factor Xa inhibitors?
Andexanet alfa
94
Name a few examples of thrombolytic medications.
Streptokinase (1st gen);
TPAs (2nd gen)
95
Name a few example medications that are in the TPA category.
What is the suffix on these medications?
**Tenecte**plase;
**Rete**plase;
**alte**plase
**'-plase'**
96
The conversion of plasminogen to plasmin can be brought about by:
a) aminocaproic acid
b) heparin
c) aspirin
d) reteplase.
e) warfarin
d) reteplase.
97
Currently, there are four mechanisms by which drugs interfere with platelet function:
**1.** Prostaglandin–\_\_\_\_\_\_\_\_\_\_\_ inhibition
**2.** Inhibition of the ______ binding in platelets
**3.** Cyclic nucleotide **p****hosphodiesterase** inhibition
**4.** Receptor blockade of **gpIIb/IIIa** **receptors**, blocking the final pathway of platelet aggregation
Currently, there are four mechanisms by which drugs interfere with platelet function:
**1.** Prostaglandin–**_Thromboxane A_****_2_** (**TXA2**) inhibition
**2.** Inhibition of the **_ADP_** binding in platelets
**3.** Cyclic nucleotide **phosphodiesterase** inhibition
**4.** Receptor blockade of **gpIIb/IIIa** **receptors**, blocking the final pathway of platelet aggregation
98
Currently, there are four mechanismsby which drugs interfere with platelet function:
**1.** Prostaglandin–**Thromboxane A2** (**TXA2**) inhibition
**2.** Inhibition of the **ADP** binding in platelets
**3.** Cyclic nucleotide ___________ inhibition
**4.** Receptor blockade of \_\_\_\_\_\_\_\_\_\_\_, blocking the final pathway of platelet aggregation
Currently, there are four mechanismsby which drugs interfere with platelet function:
**1.** Prostaglandin–**Thromboxane A2** (**TXA2**) inhibition
**2.** Inhibition of the **ADP** binding in platelets
**3.** Cyclic nucleotide **_phosphodiesterase_** inhibition
**4.** Receptor blockade of _**gpIIb/IIIa** **receptors**_, blocking the final pathway of platelet aggregation
99
Aspirin exerts its antiplatelet effects by inhibiting expression of what?
Thromboxane A2
100
Clopidogrel exerts its anti\_\_\_\_\_\_\_\_ effects by inhibiting \_\_\_\_\_-binding within \_\_\_\_\_\_\_\_.
Clopidogrel exerts its anti**_platelet_** effects by inhibiting **_ADP_**-binding within **_platelets_**.
101
\_\_\_\_\_\_\_\_\_\_\_ exerts its antiplatelet effects by inhibiting ADP-binding within platelets.
**_Clopidogrel_** exerts its antiplatelet effects by inhibiting ADP-binding within platelets.
102
Aspirin inhibits TXA2 production by \_\_\_\_\_\_\_\_\_ly acetylating COX, thereby inhibiting platelet aggregation.
Aspirin inhibits TXA2 production by **_irreversib_**ly acetylating COX, thereby inhibiting platelet aggregation.
103
Name two antiplatelet medications that irreversibly block platelet ADP receptors.
**Clopidogrel**;
ticlopidine
104
As the antiplatelet effects of aspirin and clopidogrel are irreversible, how long will their effects last?
~8 - 10 days
(lifespan of a platelet)
105
Dipyridamole is an antiplatelet medication that inhibits \_\_\_\_\_\_\_\_\_, thus increasing platelet cAMP and decreasing _________ uptake.
Dipyridamole is an antiplatelet medication that inhibits **_phosphodiesterase_**, thus increasing platelet cAMP and decreasing **_adenosine_** uptake.
106
\_\_\_\_\_\_\_\_\_\_ is an antiplatelet medication that inhibits phosphodiesterase, thus increasing platelet cAMP and decreasing adenosine uptake.
**_Dipyridamole_** is an antiplatelet medication that inhibits phosphodiesterase, thus increasing platelet cAMP and decreasing adenosine uptake.
107
What are the indications for clopidogrel usage?
Recent MI, stroke, acute coronary syndrome or peripheral artery disease
108
What medication blocks gpIIb/IIIa?
What is its main indication?
**Abciximab**;
percutaneous coronary intervention (**PCI**)
109
The mechanism of eptifibatide anticlotting action is:
a) activation of antithrombin III
b) blockade of posttranslational modification of clotting factors
c) inhibition of thromboxane production
d) irreversible inhibition of platelet ADP receptors
e) reversible inhibition of glycoprotein IIb/IIIa receptors
e) reversible inhibition of glycoprotein IIb/IIIa receptors
(similar to **abciximab**)
