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30 Cards in this Set
- Front
- Back
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Aspirin
MOA: uses: tox: affect on BT/PT/PTT |
MOA: IRREVERSIBLY inh both COX-1 and COX-2; prevents conversion of AA to TXA-2, prostaglandins, and prostacyclins
***most important is inhibition of TXA-2 uses: low dose (<300mg/day): dec pltlt agg intermed dose (300-2400): fever, pain high dose (2400- 4000): anti-inflammatory tox: GI ulcers, bleeds, hyperventilation, acute interstitial neph, Reyes synd, cinchinism, asthma exacerbation BT: inc PT/PTT: no effect |
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NSAIDS
MOA: uses: tox: affect on BT/PT/PTT |
examples: ibuprfen, indomethacin
MOA: REVERSIBLY inh both COX-1 and COX-2; prevents conversion of AA to TXA-2, prostaglandin, prostacyclin most important is prostaglandin uses: fever, pain, inflamm, close PDA (indomethacin), gout (indomethacin) S/E: UGI ulcer, interstitial nephritis, fluid retention, ****aplastic anemia, inc K BT: no effect PT/PTT: no effect |
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Clopidogrel, Ticlopidine
MOA: tox: BT: PT/PTT: |
MOA:
1) IRRIVERSIBLY block ADP rec, thus inh pltlt aggregation 2) prevent glycoprotein 2b/3a expression, thus inh fibrinogen uses: acute coronary syndrome, coronary stenting, dec incidence or recurrence of thrombotic stroke ***only use if pt cant tolerate aspirin tox: bleeding (ticlopidine only--> agranulocytosis, seizures) (clopidogrel only --> TTP) BT: inc PT/PTT: ? (i think no affect) |
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Abciximab
MOA: uses: tox: affect on BT/PT/PTT |
MOA: monoclonal Ab that binds and blocks glycoprotein rec 2b/3a; inh pltlt agg
uses: acute coronary syndrome, PCTangioplasty tox: bleeding, dec pltlts |
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Heparin
MOA: uses: tox: reversal: affect on BT/PT/PTT |
Heparin
MOA: cofactor for anti-thrombin 3; decreases thrombin and thus 10a uses: IMMEDIATE ANTICOAG of: PE, stroke, acute coronary synd, MI, DVT *can be used in preg tox: bleeding, HIT, osteoporosis reversal: protamine sulfate (is positive, heparin is neg) BT: no affect PT: inc PTT: inc, must follow |
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Enoxaprin
class: MOA: uses: tox: reversal: BT: PTT/PT: |
class: low molec wt heparin
MOA: blocks 10a directly (does not have to go through anti-thrombin 3 like heparin) uses: same as heparin CI: HIT??? BT: no change PTT: inc, (DO NOT have to follow) PT: inc tox: |
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HIT
MOA: s/s: labs: Dx: switch to: |
MOA: Heparin acts as a hapten to pltlt: heparin binds to platelet, platelet exposes PF4 epitope, host has Ab's against heparin-platelet (PF4) complex;
destroys some ptlts (leads to low pltlt count) overactivates others (leads to clot extension) s/s: pt may be asxtic, but may present with clot extension (NO BLEED!!) labs: low pltlts, Dx: 1st: ELISA: look for Ab's against heparin-PF4 complexes if ELISA pos: do functional assay (in tube, mix pltlts with heparin, if high serotonin release --> HIT) switch to: argatroban, -rudan |
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Advantages of Enoxaprin over Heparin
Disadvantages of Enoxapron over Heparin |
Advantages: SQ, no HIT, better bioavailability, 2-4 times longer half-life
***DO NOT have to follow INR Disadvantages: Enoxaprin is more expensive |
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LepeviRUDAN, bivaliRUDAN
MOA: uses: CI: |
MOA: directly inhibit thrombin, renal clearance
uses: HIT succeptible pts CI: renal dz "-RRRRudans are RRRRenally cleared" BT: no change PT: inc PTT: inc, must follow |
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Argatroban:
MOA: uses: CI: BT: PT: PTT: |
MOA: directly inhibit thrombin, liver clearance
uses: HIT succeptible pts CI: liver dz BT: no change PT: inc PTT: inc, must follow |
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Warfarin
MOA: uses: tox: CI: BT: PT: PTT: |
MOA: inhibits vit K's gamma carboxylation of 2,7,9, 10, c,s;
p450 dependent uses: chronic anticoag tox: bleed, teratogenic, tissue/skin necrosis, crosses placenta reverse: vit K, (FFP for active bleeding) CI: preggo BT: no change PT: inc (must follow PT/INR) PTT: inc |
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Warfarins PT/INR goal
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2 to 3 times normal
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What does heparin have (that warfarin doesnt) to keep it from crossing placenta?
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methyl group
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Thrombolytics:
ex: MOA: uses: tox: reverse: CI: BT: PT: PTT: |
ex: streptokinase, urokinase, tPA (alteplase), APSAC (antistreplase)
MOA: convert plasminogen to plasmin (plasmin cleaves thrombin and fibrin clots) uses: early MI, early ischemic stroke tox: bleed reverse: aminocaproic acid CI: recent intracranial bleed, surgery, known bleeding problem, severe HTN (>180/110) BT: no change PT: inc PTT: inc |
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Which thromboytic is most specific (will work on new clots)?
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tPA
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Which Heparin of Warfarin inhibits coagulation in vitro?
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Heparin
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How do you administer
-heparin? -warfarin? |
Heparin: IV
(LMWH- Enoxaprin): SQ warfarin: PO |
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COX1 v COX2
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COX1:
highest concentration in GI; maintains prostaglandin synth (maintains gastric mucosa) COX2: highest concentration in inflam cells and vascular endoth. mediates (stimulates) inflamation and pain |
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COX 2
examples uses: S/E: |
ex: celecoxib
uses: RA, OA S/E: inc risk of thrombosis, promotes colon cancer, sulfa allergy ***less toxic to GI mucosa than nonselective COX1/COX2 inh |
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Examples of NSAIDS and their specific uses
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1) Indomethacin: close PDA, gout
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Rx for NSAID induced ulcers
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Misoprostol (PGE analogue)
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Aspirin timeline
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< 20 min: resp alk
(aspirin is fat soluble to goes to brain and causes inc RR) > 20 min: resp alk with met acidosis (absorbing med) ... later: mixed (resp and met) acid (GABA has been stimulated, and is causing breathing to slow down) ... if throw up: metabolic alk |
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ALL thrombolytics have what effects on BT, PT, PTT?
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BT: no change
PT: inc PTT: inc |
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Dipyramadole & Colastozole
MOA: uses: |
MOA: inh the phosphodiesterase (PDE) of pltlts only, thus inc cAMP concentration within the platelet. With high intracellular cAMP concentrations, pltlt cannot take shape necessary or release granules (i.e. pltlt is innactive)
uses: prevent arterial clots, PVDz, ***only use if cant tolerate aspirin |
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Which, Dipyramadole or Colastozole causes aterial dilation?
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Colastozole
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Which drugs act as haptens for platelets and cause autoimmune thrombocytopenia?
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Heparin
Aspirin Quinidine "HAQ" |
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Which drugs act as haptens for RBC's and cause autoimmune hemolytic anemia?
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Cephalosporins
Antimalarials A-methyldopa PTU Penacillin Sulfa drugs "CAAPPS |
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rx for DIC
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NS and FFP
(FFP has all the clotting factors, need to replace the clotting factors that DIC is eating up) |
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rx for polycythemia rubra vera
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phlebotomy, vit E, folate
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essential thrombocythemia
1) pltlt count? 2) rx? |
1) >600 K
2) aspirin |
