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Module 2: Mali: Heme/Onc > pharm chart > Flashcards

pharm chart Flashcards

1
Q

what drug class is iron?

A

hematinics

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2
Q

what is the MOA for iron?

A

supplement

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3
Q

what are the SE of iron supplements?

A

abdominal cramps
BLACK STOOL
anaphylaxis IV formulation

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4
Q

what are the contra for iron supplements? 3

A
  1. anaphylaxis with IV
  2. hemachromatosis (when body absorbs too much iron)
  3. hemolytic anemia
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5
Q

what are the drug interactions for iron supplements? what four drugs bind Fe?

A

anatacids, phenytoin, quinolone, tetracycline

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6
Q

what four things should you monitor for a patient taking iron supplements? 4

A

serum ferritin
transferrin saturation
hgb
reticulocytes

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7
Q

what drug class is defoxamine?

A

iron chelator

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8
Q

what is the MOA for deferoxamine?

A

chetates iron from hemosiderin, ferritin, transferrin (not hemoglobin or cytochromes)

basically binds excess iron in the body to prevent it from causing tissue damage

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9
Q

what is the indication for deferoxamine?

A

excess serum iron levels

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10
Q

what are the SE of deferoxamine? 4

A

leg cramps, hyptension (IV), PULMONARY SYNDROME, neurotoxicity

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11
Q

what drug class is cyanacobalamin B12?

A

vitamin

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12
Q

what is the MOA of cyanacobalamin B12?

A

rate limiting cofactor in the conversion folate to active form and DNA synthesis

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13
Q

what is the SE of cyanacobalamin B12?

A

painful by injection

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14
Q

what is the indications for cyanacobalamin B12?

A

B12 deficiency, depression, megaloblastic anemia

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15
Q

what are 3 drug interactions for cyanacobalamin B12?

A

long term acid suppression therapy
metformin
phenytoin

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16
Q

what is the replenishment regimen for cyanacobalamin B12?

A

IM 1,000 mcg daily for 1-2 weeks

IM 1,000 mcg weekly

IM 1,000 mcg monthly

ORRRRRRR
1,000 mcg daily

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17
Q

what is the storage pool requirement for B12? what is the daily need?

A

3,000-5,000 mcg storage pool

2mcg daily need

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18
Q

what is the controversy around B12 therapy? what is the controversy called?

A

variable oral absorption, dose 1,000 daily but 500 or less absorbed

IM 100-1000 every one to three months

“alternate absorption pathway”

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19
Q

what is the drug class for folic acid?

A

nutritionals

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20
Q

what is the MOA for folic acid?

A

cofactor in DNA synthesis

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21
Q

what is the indication of folic acid? 2

A

megaloblastic anemia

prevention of neural tube defects

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22
Q

what are the SE of folic acid?

A

bronchospasm

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23
Q

what the the drug interactions seen with folic acid?

A 
phenobarbitol
phenytoin
primodone
trimethoprim
methotrexate
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24
Q

what is the dosing for folic acid?

A

variable 1-5 mg daily

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25
Q

what do you monitor when administering folic acid? 2

A

serum folic acid levels

RBC folic acid levels

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26
Q

what is the liver storage amount of folic acid?

A

2-20 mg

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27
Q

how long is the reserve for folic acid in the body?

A

1-6 months

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28
Q

what are two things that can decrease the amount of folic acid in the body that you need to be concious of when treating a patient?

A

dialysis

chronic alcoholism

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29
Q

what do you need to do before treating a patient with folic acid?

A

RULE OUT B12

for the 94094809 time!!

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30
Q

what drug class is epoetin alfa

A

erythrocyte stimulating agent

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31
Q

what is the MOA of epoetin alfa?

A

stimulates erythrocyte proliferation and differentiation

induces release of reticulocytes

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32
Q

what are 4 indications for epoetin alfa?

A

low RBC from HIV, RA, antineoplastic therapy, and end stage renal disease (ESRD)

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33
Q

what are SE of epoetin alfa?

A 
iron deficiency
clotting
hypertension
thrombosis
seizures

think about it, making more cells so these all make sense, if more cells more viscous blood

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34
Q

what is the drug class for filgrastim?

A

myleoid growth factor G-CSF

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35
Q

what is the MOA of filgrastin? 3 things! woah

A
  1. stimulates prolif and diff of myeloid cells
  2. increase phagocyte/neutrophil activity and life span
  3. mobalizes periphreal neutrophils
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36
Q

what is the indication for filgrastin?

A

neutropenia secondary to chemo

think about it!! you’re increasing your immune systems response and wanting to increase defense by increasing WBC!!

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37
Q

what are some SE of filagrastin?

A

BONE PAIN

think about it, increasing cell production!!

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38
Q

what three drugs belong to the indirect thrombin inhibitors?

A

unfractioned heparin
low molecular weight heparin
fondaparinux

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39
Q

what is the drug class for unfractioned heparin?

A

indirect thrombin inhibitors

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40
Q

what is the MOA of unfractioned heparin?

A

accelerates degredation of Xa and thrombin

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41
Q

what are SE of using unfractioned heparin? 4

A

alopecia, osteoporosis, heparin induced thrombocytopenia after 7 days, skin necrosis

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42
Q

what the the contra indications for unfractioned heparin?

A

prior HIT

intracranial bleeding

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43
Q

what are the drg interactions seen with unfractioned heparin?

A

anticoagulants, tNSAIDS, nitroglycerin (NTG) decreases effect

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44
Q

what are four monitorings you want to do with unfractioned heparin?

A

aPTT, platelet count, H&H, occult blood

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45
Q

what are two interesting sources for unfractioned heparin?

A

pork intestinal mucosa

bovine lung tissue

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46
Q

what can’t unfractioned heparin do?

A

fibrinolytic activity

can’t lyse a clot if its already there

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47
Q

what is the drug class for low molecular weight heparin?

A

indirect thrombin inhibitor

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48
Q

what is the MOA of low molecular weight heparin?

A

increased degredation of Xa

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49
Q

what are the 2 indications for low molecular weight heparin?

A

acute coronary syndrome

DVT

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50
Q

what are two SE of low molecular weight heparin?

A

injection site hematoma

increased AST/ALT (liver function tests)

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51
Q

what are 3 contraindications for low molecular weight heparin?

A

active bleeding
pork hypersensitivity
thrombocytopenia

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52
Q

what is low molecular weight heparin a product of?

A

pork

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53
Q

low molecular weight heparin doesn’t need to be renally adjusted above what threshold?

A

> 30 ml/min

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54
Q

what is the drug class for fondaparinux?

A

indirect thrombin inhibitor

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55
Q

what is the MOA for fondaparinux?

A

increases degredation of Xa

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56
Q

what are the indications for fondaparinux?

A

DVT prophylaxis/treament

acute PE

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57
Q

what is a SE of fondaparinux?

A

rash

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58
Q

what is the origin of fondparinux?

A

synthetic!!! NOT OF ANIMAL ORIGIN!!

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59
Q

how is fondaparinux administered?

A

sub q only!!

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60
Q

what is the drug class for protamine sulfate?

A

antagonist of indirect thrombin inhibitors

61
Q

what is the MOA of protamine sulfate?

A

binds to heparin and neutralizes its anticoag effects

if you coag someone, there needs to be a way to reverse it!! think about it*

62
Q

what is the drug class for dabigatran?

A

oral direct thrombin inhibitor

63
Q

what is the MOA of dabigatran?

A

directly inhibits thrombin IIa action that convert fibinogen to fibrin, INHIBITS PLATELET AGREGATION

prevents clotting*

64
Q

what is the indiation for dabigatran?

A

prevents stroke in non-valvular a fib

65
Q

what is are two SE of dibigatran?

A

bleeding 17%

gastritis 3%

66
Q

what CrCl should you not use dibigatran in?

A

CrCl

67
Q

what drug interactions do you worry about for diabigatran? 2

A

P-gp antagonizers

P-gp inhibitors

68
Q

what is NOT avaliable for a patient taking diabigatran? so what might this patient have to do if there is a complication?

A

NO ANTIDOTE, would need to dialyze

69
Q

what is interesting about diabigatrans sensitivity?

A

VERY MOITSURE SENSITIVE

only has a 4 MONTH SHELF LIFE!!

70
Q

what is the drug class for warfarin?

A

coumarin anticoagulants

71
Q

what is the MOA of warfarin?

A

blocks vit k mediated carboxylation of clotting factors 7,9,10,2, C and S

72
Q

what is the indication for warfarin?

A

prevention and treatment of venous thrombosis

73
Q

what are 3 SE of warfarin?

A

easy bruising, skin tissue necrosis, vasculitis

74
Q

what are 2 contraindications for warfarin?

A

active bleeding

skin necrosis

75
Q

what is a drug interaction for warfarin?

A

ginkgo biloba

76
Q

what do you use to monitor a patient taking warfarin?

A

PTINR

H&H

77
Q

what counteracts the effects of warfarin? and how long does this stay in your system after stopping it?

A

Vit K

2-5 days because of half lives

78
Q

what drug class does vitamin K belong to?

A

antagonist of coumarin anticoagulants

79
Q

what is the MOA of vitamin K?

A

promotes liver synthesis of 2, 7, 9, 10

80
Q

what is the indication of vitamin k?

A

counteracts excess warfarin anticoagulation or vit k deficiency

81
Q

what is the difference between the vitamin k onset times when given IV and given PO?

A

oral 6-10H onset, peak 24-48 hours

IV 1-2H onset, 12-14H peak

82
Q

where does vitamin k come from?

A

green leafy vegetables, salads

83
Q

what happens if you give a pt a high dose TX of vitamin K over >10mg? what do you need to do to account for this?

A

may cause warfarin resistance for up to 7 days so use LMWH temporarily

84
Q

what drug class does rivaroxaban belong to?

A

direct factor Xa inhibitor

85
Q

what is the MOA of rivaroxaban?

A

directly and selectively inhibits factor Xa

86
Q

what are the indications for rivaroxaban? 4 things

A
  1. reduce clots associated with knee/hip replacement, non-valvular a fib, DVT/PE
87
Q

what are the contraindications for rivaroxaban? 2 things

A 
active bleeding
mod-severe liver disease child-pugh class B/C
88
Q

what are the drug interactions seen with rivaroxaban?

A

CYP34A drugs P-gp inhibitors/inducers

clarithromycin, fluconazole, carbamazepine, phenytoin, johns wart

89
Q

should you use rivaroxaban in pregnancy/lactation?

A

NO!

90
Q

how should you take rivaroxaban? is there an antidote?

A

with food at dinner, increases the bioavaliability NO ANTIDOTE

91
Q

what is the half life for rivaroxaban? how long does it take to work?

A

7-11 hours halflife

works in 2-4H

92
Q

what should you caution when taking rivaroxaban?

A

grapefruit juice!

93
Q

explain what happens in the elderly when taking rivaroxaban?

A

clear it more slowly so at higher risk for negative symptoms

94
Q

what drug class does streptokinase belong to?

A

fibrinolytic

95
Q

what is the MOA of steprokinase?

A

activates the conversion of plasminogen to plasmin which degrades fibrin

96
Q

what are the SE of using streptokinase?

A

SEVERE DVT, PE, AMI, OCCULDED AV CANNULAS

97
Q

what drug class does animocaproic acid belong to?

A

fibrinolysis inhibitors

98
Q

what is the MOA of aminocaproic acid?

A

binds to plasminogen and plasmin and blocks plasmin lysis of fibrin

99
Q

what is the indication for aminocaproic acid?

A

state of excess fibrinolysis

*to much cloth breaking down

100
Q

what is a rare side effect of aminocaproic acid?

A

muscle necrosis

101
Q

what drug class does alteplase belong to?

A

plasminogen activator tPAs

102
Q

what is the MOA of alteplase?

A

preferentially binds to plasminogen bound to fibrin (theory: confines thrombolysis to formed thrombus only)

103
Q

what is one strange SE associated with alteplase?

A

reprofusion arrythmias

104
Q

what is the drug class for aspirin?

A

anti-platelet drugs

105
Q

what is the MOA for aspirin? does two things!

A

irreversible inactivation (via acetylation) of cyclo-oxygenase

inhibits synthesis of thromboxane A2 which prevents platelet aggregation and vasconstriction by thromboxane A2

106
Q

what is the indication for apsirin?

A

secondary prophylaxis of MI or CVA

107
Q

what are two side effects of taking aspirin?

A

30% gastritis, tinnitus

108
Q

what percent of patient taking aspirin get gastritis?

A

30%

109
Q

what is a strange conta indication for using aspirin in a patient?

A

nasal polyposis (polyps…thats weird!)

110
Q

what are drug interactions for asprin?

A

anticoagulants and NSAIDS

111
Q

what is the pregnancy rating for aspirin?

A

D!!!

112
Q

explain what the aspirin indication is for a patient over 50?

A

320 mg daily

113
Q

what does a higher dose than 320 mg of aspirin do?

A

decrease PGI2 (prostacylcin) that inhibits platelet aggregation in vivo

114
Q

what does class does clopidogrel belong to?

A

platelet ADP inhibitors

115
Q

what is the MOA of clopidogrel?

A

irreversibly blocks ADP receptor on platelets preventing platelet/fibrinogen binding and platelet aggregation

116
Q

what are three indications for clopidogrel

A

secondary prevention of acute myocardial infarction, CVA aka stroke, PAD periphreal artery disease

117
Q

what percent of people experience gastritis when using clopidogrel? what is rare when using this drug?

A

27%

leukopenia is rare

118
Q

what are 3 drug interactions to watch for when taking clopidogrel?

A
  1. antiplatelet/anticoagulant
  2. atorvastatin
  3. MACROLIDE ANTIBOITICS
119
Q

clopidogrel is a________. what is the dosing?

A

PRODRUG!!! doesn’t effect PG metabolism

300 mg loading dose and 75 mg every day!!

120
Q

what is used as a aspirin allergy alternate?

A

clopidogrel!!!!

121
Q

what drug class does abciximab belong to?

A

glyoprotein IIB/IIIA inhibitors

122
Q

what is the MOA for abciximab?

A

blocks platelet GBIIb/IIIa receptors for thromboxane, A2, thrombin, collagen and prevents platelet aggregation

123
Q

what is the indication for abciximab? (two of them and theyre good)

A

coronary artery stent, acute coronary syndrome

124
Q

what is the half life for abciximab when given IV?

A

30 minutes!! woah thats short

125
Q

if there is severe bleeding on abciximab…what might be indicated?

A

platelet infusion

126
Q

what is the drug class for dipyridamole

A

phosphodiesterase inhibitor

127
Q

what is the MOA of dipyridamole?

A

increases platelet concentration of AMP, DECREASING PLATELET AGGREGATION

128
Q

what is the indication for dipyridamole? 3 things!!!

A
  • post op
  • primary prophylaxis for prosthetic heart valves
  • prophylaxis after CVA (stroke)
129
Q

what are four SE of dipyridamole?

A

38% headache
blurred vision
dizziness

130
Q

what is a major side effect of taking dipyridamole and what percent of people experience this?

A

38% headache

131
Q

when is dipyridamole contraindicated for a patient?

A

sever hepatic/renal impairment

132
Q

what drug should you not take when taking dipyridamole?

A

aspirin

…its already in this drug so you would be taking it double!

133
Q

what do you need to monitor when taking dipyridamole?

A

CrCl and H&H

134
Q

what compound do you want to add to dipyridamole to make it more effective?

A

aspirin

dipyridamole alone has questionable efficacy orally, but when taken with aspirin it works better SO DON”T USE IF SOMEONE HAS ASPIRIN SENSITIVITY

135
Q

what drug should someone with a aspirin sensitivity avoid?

A

dipyridamole

136
Q

what is the PG rating for dipyridamole?

A

D, so also avoid lactation!

137
Q

what drug class does cilostazol belong to?

A

phosphodiesterase inhibitor

138
Q

what two drugs are phosphodiesterase inhibitors?

A

dipyridamole and cliostazol

139
Q

what is the MOA of cilostazol?

A

inhibits platelet phosphodiesterase and therefor limits platelet aggregation

140
Q

what is the indication for cilostazol?

A

periphreal arterial disease (intermitten claudication)

141
Q

what are SE (3) that are associated with cilstazol and what are the percents?

A

rhinnititis- 27-34%
headache 12-15%
abnormal stools

142
Q

drugs that interact with cilostazol are

A 
CYP34A inhibitors
macrolides (increase)
NSAIDs
omeprazol
anticoagulants
143
Q

what are two things you should monitor for someone taking cilostazol?

A

walking distance

CrCl

144
Q

what two things do you need to avoid eating when taking cilostazol? 2 things!

A

Grapefruit juice since CYP34A

High fat meals

145
Q

how long does cilostazol take to act and how long does the patient get benefits?

A

2-4 weeks to act

benefits last 12 weeks

146
Q

which patients do you not want to use cilstazole in?

A

CHF patients!!

147
Q

which two drugs are effected by the CYP34A system?

A

rivaroxaban

cilostazol

148
Q

what is interesting about the storage options/shelf life for dabigatran?

A

has a self life of 4 months

HOWEVER, comes in two forms, a 60 day loose caps in a bottle or a blister pack (individually packaged where you punch the pill out), however, the price is the same and literature doesn’t distinguish a discard threshold between the two

you think the blister pack would last longer

Module 2: Mali: Heme/Onc (3 decks)

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