Pharm: Hem/Onc I Flashcards
(104 cards)
1
Q
Describe antiplatelet drugs
A
decr platelet aggregation (suppress platelets) & inhibit thrombus formation.
effective in arterial circulation
2
Q
Antiplatelet drugs are also known as…
A
- platelet agglutination inhibitor
- platelet aggregation inhibitor
3
Q
Examples of antiplatelet drugs
A
- Aspirin
- Clopidogrel (Plavix)
- Ticagrelor (Brilinta)
- Dipyridamole (Persantine)
4
Q
Describe anticoagulants drugs
A
- prevent the formation of blood clots by suppressing the synthesis or function of various clotting factors in the blood
5
Q
Examples of anticoagulants drugs
A
- Heparin
- Warfarin (Coumadin)
- Enoxaparin (Lovenox)
- Argatroban
- Apixaban
- Rivaroxaban
6
Q
Describe Fibrinolytic
A
stimulate breakdown of the blood clot
7
Q
Fibrinolytic drugs are also known as…
A
- thrombolytic drugs
- “Clot busters”
8
Q
Example of Fibrinolytics
A
- Alteplase (tPA)
- Streptokinase
9
Q
Describe Heparin antagonist
A
- inhibit the anticoag action of heparin
- used for tx of severe heparin OD. reversal agen
10
Q
Examples of Heparin Antagonist
A
Protamine Sulfate
11
Q
Describe Prothrombin complex concentrate (Human)
A
- Prothrombin complex concentrates supply factors II, VII, IX, X and Proteins C & S
- promote coagulation
12
Q
Examples of Prothrombin complex concentrate (Human)
A
Kcentra**
13
Q
Describe Coagulation factor Xa (recombinant)
A
Binds & sequesters factor Xa inhibitor & inhibits tissue factor pathway inhibitor (TFPI), reversing anti-Xa activity & restoring thrombin generation
14
Q
Examples of Coagulation factor Xa (recombinant)
A
Andexxa**
15
Q
Describe blood products
A
- any substance made from human blood
- whole blood, blood components & plasma derivatives.
16
Q
Example of Blood products
A
- Fresh Frozen Plasma [Octaplas]
- Platelets
- Packed Red Blood Cells
17
Q
Describe Colony Stimulating Factors
A
secreted glycoPROs that bind to receptor PROs on the surfaces of hemopoietic stem cells, thereby activating intracellular signaling pathways that can cause cells to proliferate & differentiate into a specific kind of blood cell.
18
Q
Examples of Colony Stimulating Factors
A
- Epoetin Alfa (Epogen)
- Filagrastim (Neupogen)
19
Q
Describe Vitamins
A
an organic molecule that is an essential for organisms in small quantities for the proper functioning of its metabolism.
20
Q
Examples of Vitamins
A
- Vitamin K
- Iron (Ferrous Sulfate)
- Folic Acid (Vit B9)
- Cyanocobalamin (Vit B12)
21
Q
Describe antimetabolites
A
inhibits a metabolite
- these are needed as a part of metabolism of another substance
22
Q
Examples antimetabolites
A
Hydroxyurea
23
Q
Describe Chemotherapy
A
type of cancer tx that can use multiple anti cancer drugs
24
Q
Examples of Chemotherapy meds
A
5-Fluorouricil (Efudex)
6-Mecaptopurine (Purinethol)
Cisplatin
Cyclophosphamide (Cytoxan)
Dactinomycin (Cosmegen)
Doxorubicin (Adriamycin)
Goserelin (Zoladax)
Interferon Alfa 2B (Interferon A)
Rituximab (Rituxan)
Methotrexate
Tamoxifen (Soltamox)
Vincristine (Oncovin)
25
What does ASA reduce?
- risk of MIs & stroke
- risk of cancer
26
What does ASA increase?
- risk of tinnitus
- risk of Reye's Syndrome
27
What other problems can ASA cause?
- pregnancy problems
- permanent inhibiting of platelet aggregation
28
ASA dosage:
81 mg/day
29
ASA: Uses
- acute coronary syndrome
- MI prevention TIA/thromboembolic stroke prevention
- pain/fever
30
ASA: MOA
non-selectively & reversibly inhibits cyclooxygenase, reducing prostaglandin & thromboxane A2 synthesis, producing analgesic, anti-inflammatory, & antipyretic effects & reducing platelet aggregation
31
ASA: Common Rxns
- dyspepsia, N/V, abdom pain
32
ASA: Serious Rxns
- anaphylaxis/anaphylactoid rxn
- angioedema
- bronchospasm
- bleeding
- GI perf/ulcer
33
ASA: Safety
- Pregnancy: May use low dose but avoid full dose in 3rd trimester
- Lactation: Consider alternatives
34
Clopidogrel Dosage
75mg /day
35
How is Clopidogrel used in clinical practice?
used with or instead of ASA
36
Clopidogrel [Plavix]: Uses
- acute coronary syndrome
--> STEMI or NSTEMI
- thrombotic event prevention
37
Clopidogrel [Plavix]: MOA
irreversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation and aggregation
38
Clopidogrel [Plavix]: Serious Rxns
bleeding, severe
hemorrhage
TTP
agranulocytosis
aplastic anemia
39
When should you stop Clopidogrel?
Stop 5 days before elective surg to reduce bleeding risk
40
Clopidogrel: BBW
Diminished Antiplatelet Effect in CYP2C19 Poor Metabolizers (There is a CYP2C19 test available)
41
Ticagrelor [Brilinta]: Uses
- acute coronary syndrome
- CV & cerebrovascular event risk reduction
42
Ticagrelor [Brilinta]: MOA
reversibly binds to P2Y12 adenosine diphosphate receptors, reducing platelet activation & aggregation
43
Ticagrelor: Serious Rxns
bleeding, severe
syncope
TTP
Bradyarrhythmia
AV block
Central sleep apnea
44
Ticagrelor: BBW
- Significant bleeding risk.
- Contraindicated in intracranial hemorrhage. Manage bleeding w/o stopping med if possible.
45
Dipyridamole: Uses
- cardiac stress test
- thromboembolism prevention adjunct, cardiac valve-assoc.
- Stroke prevention when combined with aspirin (Aggrenox)
46
Dipyridamole: MOA
Inhibits platelet adenosine uptake, reducing platelet aggregation; augments cGMP production, dilating coronary arteries
47
Dipyridamole: Serious Rxns
- severe hypotension
48
Dipyridamole is usually used in combo with...
Warfarin or ASA
49
What is the most potent for of Heparin?
Unfractionated Heparin (UFH)
50
Which form of Heparin is used most in surgery?
UFH,
but as the most SEs
51
Describe Type 2 HITT?
most concerning (risk of major clots)
- immune-mediated disorder that occurs 4-10 days after exposure & has life & limb-threatening thrombotic complications.
52
How does HITT manifest?
skin lesions at injection site
systemic rxns: (chills, fever, dyspnea, chest pain)
53
Heparin: Uses
thromboembolism prophylaxis
Percutaneous coronary intervention (prior to initiation)
acute coronary syndrome, adjunct tx
54
Heparin: MOA
acts at multiple sites in coagulation process; binds to antithrombin III, catalyzing inactivation of thrombin & other clotting factors
55
Heparin: Common Rxns
bleeding
thrombocytopenia
prolonged clotting time
local injection site rxn
56
Heparin: Serious Rxns
hemorrhage
thrombocytopenia, severe
Heparin-induced thrombocytopenia (HITT) incl. delayed onset
57
Advantages of LMWH
- Less potent so safer
- More predictable effect
- Less pharmacokinetic Limitations
- No monitoring
- Lower incidence of HIT
- Can be given subcu
- Longer half life
58
Enoxaparin [Lovenox/LMWH]: Uses
- DVT
- angina
- non-Q wave MI
- STEMI
59
Enoxaparin [Lovenox/LMWH]: MOA
binds to antithrombin III and accelerates activity, inhibiting thrombin and factor Xa (low-molecular weight heparin)
60
Enoxaparin [Lovenox/LMWH]: Serious Rxns
hemorrhage, major
prosthetic heart valve thrombosis
anemia
thrombocytopenia
61
Enoxaparin [Lovenox/LMWH]: BBW
Spinal/Epidural Hematomas may occur in anticoagulated pts receiving neuraxial anesthesia or spinal puncture
62
Protamine Sulfate: Uses
- Heparin reversal
- LMWH reversal
63
Protamine Sulfate: MOA
ionically binds heparin, forming a stable complex which neutralizes anticoagulant effects
64
Protamine Sulfate: Serious Rxns
anaphylaxis
anaphylactoid rxn
bronchospasm
angioedema
circulatory collapse
bradycardia, severe
hypotension, severe
65
Protamine Sulfate: BBW
severe hypoTN, CV collapse, noncardiogenic pulm edema, catastrophic pulm vasoconstriction, & pulm HTN
66
Warfarin: Uses
DVT/PE tx
DVT/PE prophylaxis, postpartum
Thromboembolism/ stroke prophylaxis LV thrombus
67
Warfarin: MOA
inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)
68
Warfarin: Serious Rxns
hemorrhage
skin/tissue necrosis
Some foods and herbal teas interfere with Warfarin
69
Warfarin: Safety
- NO PREGNANCY
70
Warfarin: BBW
Bleeding Risk - major or fatal bleeding; more likely during starting period, w/ higher dose; risk factors incl. high intensity anticoagulation (INR >4.0), pts 65 yo
71
Human prothrombin complex concentrate [Kcenctra]: Uses
Vitamin K antagonist reversal
72
Human prothrombin complex concentrate [Kcenctra]: MOA
Supplies factors II, VII, IX, X, and proteins C and S, promoting coagulation
73
Human prothrombin complex concentrate [Kcenctra]: Serious Rxns
anaphylaxis
anaphylactoid rxn
hypoxia
Arterial thromboembolism
Sudden death
PE/DVT
74
Human prothrombin complex concentrate [Kcenctra]: Safety
- Incr risk of thromboembolic events.
- Weigh acute bleeding reversal indication carefully before administering.
75
Apixaban (Eliquis): Uses
- Thromboembolism/stroke prophylaxis
- DVT txt/prophylaxis
75
Argatroban: MOA
selectively inhibits free and clot-bound thrombin (direct thrombin inhibitor)
75
Argatroban: Serious Rxns
hemorrhage, severe
intracranial bleeding
cardiac arrest
ventricular tachycardia
MI
75
Argatroban: Uses
- Anticoag prophylaxis & tx of thrombosis in pts w/ HIT
- PCI adjunct
76
Apixaban (Eliquis): MOA
selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor)
77
Apixaban (Eliquis): Serious Rxns
- bleeding
- thrombocytopenia
78
Apixaban (Eliquis): Safety
- Use alt in pregnancy
- may drug interactions
79
Apixaban (Eliquis): BBW
- Premature Tx Discontinuation – consider an alt when D/C’ing
- Epidural/Spinal Hematoma Risk
80
Rivaroxaban (Xarelto): Uses
Thromboembolism/ stroke prophylaxis
DVT treatment DVT prophylaxis cardiovascular
event risk reduction
81
Rivaroxaban (Xarelto): MOA
selectively blocks active site of factor Xa, inhibiting blood coagulation (factor Xa inhibitor)
82
Rivaroxaban (Xarelto): Serious Rxns
bleeding, severe
thrombocytopenia
agranulocytosis
hypersensitivity rxn
Stevens-Johnson syndrome
83
Rivaroxaban (Xarelto): Safety
- Use alt in pregnancy
- many drug interactions
84
Rivaroxaban (Xarelto): BBW
- Premature Tx Discontinuation – consider an alt when D/C’ing
- Epidural/Spinal Hematoma Risk
85
Recombinant coagulation factor Xa
[Andexxa]: Uses
Apixaban & rivaroxaban reversal
86
Recombinant coagulation factor Xa
[Andexxa]: : MOA
Binds and sequesters factor Xa inhibitor and inhibits tissue factor pathway inhibitor (TFPI), reversing anti-factor Xa activity and restoring thrombin generation
87
Recombinant coagulation factor Xa
[Andexxa]: : Serious Rxns
thrombosis
thromboembolism
Ischemic stroke
MI
*infusion rxn*
88
Recombinant coagulation factor Xa
[Andexxa]: BBW
- Incr risk of life-threatening thromboembolic events.
- Cardiac arrest & sudden death
89
Currently available thrombolytic agents include:
- Alteplase (t-PA or Activase)
- Reteplase (r-PA or Retavase)
- Tenectaplase (TNKase)**
- Urokinase (Abbokinase)
- Streptokinase (not used)
90
What does t-PA mean?
tissue Plasminogen Activator
91
Absolute Contraindications in general for Thrombolytics
Risk of bleeding so don't give if pt is bleeding or a risk of bleeding in places that are dangerous
92
What is the half-life of Alteplase (Activase, t-PA) & why is this important?
- 5 minutes
- critical to start another agent - Heparin in another IV
93
Alteplase [Activase, t-PA): Uses
acute MI (STEMI)
- acute ischemic stroke
- acute massive PE
94
Alteplase [Activase, t-PA): MOA
binds to fibrin and converts tissue plasminogen to plasmin, promoting fibrinolysis
95
Alteplase [Activase, t-PA): Common Rxns
bleeding
96
Alteplase [Activase, t-PA): Serious Rxns
- intracranial hemorrhage
- Bleeding, severe
- Thromboembolism
- Cholesterol embolism
97
Tenectaplase (TNKase): Uses
acute myocardial infarction (STEMI)
acute ischemic stroke
** easier to dose via IV push
98
Tenectaplase (TNKase): MOA
binds to fibrin and converts tissue plasminogen to plasmin, promoting fibrinolysis
99
Tenectaplase (TNKase): Serious Rxns
bleeding, severe
intracranial hemorrhage
Reperfusion arrythmia
Cholesterol embolism
100
Which thrombolytic is no longer used in the US?
Streptokinase
101
Why is Streptokinase no longer used
- produced by streptococci bacteria & causes febrile rxns & allergic rxns
- can't be administered safely a 2nd time w/n 6 months
