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34 Cards in this Set
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Epoetin alfa
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Indication: anemia with chronic kidney disease, surgery, AIDS, cancer chemotherapy, chronic inflammation
MOA: bind to receptors on committed erythroid progenitors in bone marrow, promote survival, proliferation, maturation Paenterally Metabolism: T1/2= 4-8 hrs Adverse effects: thromboembolic effects (migratory thrombophlebitis, microvascular thrombosis, PE), risk with high Hgb, Fe deficiency can develop check once or twice a week until stabilized Recombinant |
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darbapoetin alfa
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Indication: anemia with chronic kidney disease, surgery, AIDS, cancer chemotherapy, chronic inflammation
MOA: bind to receptors on committed erythroid progenitors in bone marrow, promote survival, proliferation, maturation Paenterally Metabolism: T1/2= 4-8 hrs Adverse effects: thromboembolic effects (migratory thrombophlebitis, microvascular thrombosis, PE), risk with high Hgb, Fe deficiency can develop check once or twice a week until stabilized novel |
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sargramostim
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GM-CSF
Indication: autologous bone marrow transplant to shorten neutropenia, intensive chemotherapy,myelodyslpasia, aplastic anemia, AIDS MOA: synergistic with growth factors to increase neutrophil, monocyte production, increase migration, phagocytosis, superoxide production, Ab cell toxicity of neutrophils/macrophages/ esinophils Metabolsim: T1/2 = 2-3 hrs, leukocyte increase over 7-10 days, baseline 2-10 days after stop Side Effects: bone pain, malaise, flu-like symptoms, supraventricular tachycardia 1st dose effect: flushing, hypotension, nausea, vomit, dyspnea--> granulocyte sequestration in pulm circulation |
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filgrastim
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G-CSF
Indication: severe neutropenia after stem cell transplant/ chemo MOA: stimulation of CFU-G to increase neutrophil production, enhance phagocytic, cytotoic fxn of neutrophils Metabolism: t1/2: 3.5 hrs, subq injection Side Effects: bone pain, local skin reaction |
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pegfilgrastim
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G-CSF
Indication: severe neutropenia after stem cell transplant/ chemo MOA: stimulation of CFU-G to increase neutrophil production, enhance phagocytic, cytotoic fxn of neutrophils Metabolism: t1/2: 3.5 hrs, subq injection not cleared by kidney, by neutrophil mediated Side Effects: bone pain, local skin reaction |
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Oprelvekin
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Indication: patients undergoing chemotherapy when severe thrombocyopenia has occured with prior cycles
MOA: recomb form of IL-11 which enhances megakaroyoctye maturation--> increase blood platelet counts Side Effects: fluid retnetion, tachycardia, palpitations, edema, shortness of breath clinical use: drug discontinued when platelets above 100 k |
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Thrombopoietin
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recombo human megakaryocyte growth and development factor/ human thrombopoietin
Indications: chemo therapy and radiation induced myelosuppression with subsequent thrombocytopenia MOA: stem cell differentiation into megakaryocyte progenitors and stimulates megakaryocytopoiesis to increase platelet production Side Effects: anti- recombinant Ab cross reactive with native = thrombocytopenia |
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Ferrous sulfate
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Indication: oral iron in ppl with Fe deficiency and can absorb
MOA: restore Fe stores = marrow can produce normal RBC Side Effects: upper GI discomfort, heartburn, nausea, hemochromatosis/ Fe overload Clinical use: rise in retic count takes 4-7 days so effectiveness cannot determine until 3-4 weeks |
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Ferrous gluconate
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Indication: oral iron in ppl with Fe deficiency and can absorb
MOA: restore Fe stores = marrow can produce normal RBC Side Effects: upper GI discomfort, heartburn, nausea, hemochromatosis/ Fe overload Clinical use: rise in retic count takes 4-7 days so effectiveness cannot determine until 3-4 weeks |
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polysaccharide-Fe complex
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Indication: oral iron in ppl with Fe deficiency and can absorb
MOA: restore Fe stores = marrow can produce normal RBC Side Effects: upper GI discomfort, heartburn, nausea, hemochromatosis/ Fe overload Clinical use: rise in retic count takes 4-7 days so effectiveness cannot determine until 3-4 weeks |
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Sodium Ferric gluconate complex in sucrose
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Indication: Fe deficiency where Iron administration = ineffective, malabsorption states, oral Fe intolerant
Absorption: <500 mg = t 1/2--> 6 hrs, 1 g = 1-2 weeks through reticuloendothelial cells Side effects: malaise, rare anaphylactic reaction, lower than in iron dextran, headache, fever, arthralgias, urticaria |
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Iron Sucrose
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Indication: Fe deficiency where Iron administration = ineffective, malabsorption states, oral Fe intolerant
Absorption: <500 mg = t 1/2--> 6 hrs, 1 g = 1-2 weeks through reticuloendothelial cells Side effects: malaise, rare anaphylactic reaction, headache, fever, arthralgias, urticaria |
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Iron dextran
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Indication: Fe deficiency where Iron administration = ineffective, malabsorption states, oral Fe intolerant
Absorption: <500 mg = t 1/2--> 6 hrs, 1 g = 1-2 weeks through reticuloendothelial cells Side effects: malaise, rare anaphylactic reaction, headache, fever, arthralgias, urticaria |
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Cyanocobalamin
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Indication: treatment of anemia due to B12 deficiency
Absorption: No intrinsic factor or with ileal disease = no absorption, large dose does not equate with greater retention Side effects: anaphylaxis with IV injection, paraenterally = IM Clinical use: only for vitamin defeciency, maintain for life for those who can't absorb |
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Folic acid
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Indication: Megaloblastic anemia due to folate deficiency, pregnancy, disease state with high cell turnover, treat high homocysteine
MOA: essential step in purine synthesis, deficiency --> megaloblastic anemia but no neuro defects, in pregnancy--> neural tube defects Absorption: proximal portion of small intestine and need proteins on mucosal cell membrane, enterohepatic circulation Side Effects: rare reports of reaction to paraenteral injection, large amounts counteract anti-epileptic effect of phenobarbitol, phenytoin, primidone Clinical use: improve megaloblastic anemia of B12 deficiency, but not neuro, need to make sure its folate or B12 deficiency |
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Heparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, antithrombin acts on thrombin, factor Xa (LW), factor IX IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo Unique: Heparin induced Thrombocytopenia, less with LW, caused by IgG Ab vs. heparin + platelet factor 4 = activates platelets and thrombin generated |
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Enoxaparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, acts mostly on factor Xa IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo contraindicated in renal failure |
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dalteparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, acts mostly on factor Xa IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo contraindicated in renal failure |
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ardeparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, acts mostly on factor Xa IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo contraindicated in renal failure |
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nadroparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, acts mostly on factor Xa IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo contraindicated in renal failure |
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raviparin
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: catalyzing antithrombin to inhibit of coagulation, acts mostly on factor Xa IV or subq Metabolism: immediate onset IV, 1-2 hrs subq, 100 u/ kg = t1/2- 1 hr, 800 u/kg = t1/2 5 hrs--> degrade by reticuloendothelial system Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo contraindicated in renal failure |
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Fondaparinux
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Indication: initial treatment of venous thrombosis, PE, acute coronary syndrome, acute MI, coronary surgical procedures, DIC, low dose to prevent venous thromboembolism
MOA: pentasaccharide that is a factor Xa inhibitor subq Metabolism: immediate onset, T1/2 = 17-21 hrs, degrade by reticuloendothelial system contraindicated in renal failure Side Effects: bleeding, hepatic function, osteoporosis, hyperkalemia- inhibit aldo |
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Protamine Sulfate
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Indication: too much heparin
MOA: binds tightly to heparain and neutralizes its anticoagulant effect Side Effects: anaphylactic with diabetes mellitus who have protamine- containing insulin |
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Lepirudin
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Recombo hirudin- leech saliva
Indication: treatment of heperain induced thrombocytopenia Metabolism: IV, excrete by kidney, T1/2 = 1.3 hrs, Side effects: may develop antihirudin Ab MOA: direct thrombin inhibitor |
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Bivalirudin
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Synthetic
Indication: alternative to heperin in angioplasty MOA: directly inhibits thrombin T1/2 = 25 min, cleared by renal, IV |
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Argatroban
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Synthetic based on L-arginine
Indication: alternative to lepirudin for prophylaxis of patients with HIT T1/2 = 40-50 min, excrete in bile MOA: binds reversible to catalytic site of thrombin |
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Danaparoid
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Indication: prophylaxis for deep vein thrombosis, HIT
MOA: inhibits factor Xa by antithrombin Subq T1/2= 1 day, renal clearence |
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Drotrecogin alfa
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recombo form of human activated protein C
MOA: inhibits coagulation by inactivation of factors Va and VIIIa help with severe sepsis |
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Warfarin
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indications: oral anticoagulant to prevent/ recurrance of DVT, PE, systemic embolization from prosthetic valve, atrial fib
MOA: antagonist of vitakmin K, decrease 30-50% vit K dependent coagulation factor made by liver, factors made less active Absorption: complete absorbed, 99% plasma bound, does achieve effect on circulationg coagulation factors have been cleared, 3-5 days later/ duration 2-5 days after cessation Side Effects: bleeding, birth defects, skin necrosis, purple toe syndrome, alopecia, urticaria, dermatitis, fever, venous limb gangrene, mulitcentric skin lesions drug interactions: alter uptake/ metabolism of oral anticaogulant, vitamin K 2) alteration of synthesis , function, clearence of hemostatic factors |
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Streptokinase
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from B hemolytic streptococci
Indication: acute treatment of MI, non-hemorrhagic stroke, dissolve pathogenic thrombi - occlude arteries, PE, prosthetic heart valves MOA: actives plasminogen to plasmin by binding to plasminogen and form complex which activates plasminogen to plasmin- no intrinsic enzymatic activity, plasmin then lyses fibrin Side effects: bleeding 1) lysis of fibrin at site of injury 2) systemic lytic state breaking down clotting factors Contraindications: recent major surgery, serious recent bleeding, uncontrolled HTN, CVA, Intracranial disease, aortic dissection, acute pericarditis |
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Alteplase
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Indication: acute treatment of MI, non-hemorrhagic stroke, dissolve pathogenic thrombi - occlude arteries, PE, prosthetic heart valves
MOA: directly activates plasminogen, more specific to activating plasminogen attached to fibrin = more clot specific T1/2 = 5-10 min, IV Side effects: bleeding 1) lysis of fibrin at site of injury 2) systemic lytic state breaking down clotting factors Contraindications: recent major surgery, serious recent bleeding, uncontrolled HTN, CVA, Intracranial disease, aortic dissection, acute pericarditis |
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Reteplase
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Indication: acute treatment of MI, non-hemorrhagic stroke, dissolve pathogenic thrombi - occlude arteries, PE, prosthetic heart valves
MOA: directly activates plasminogen, more specific to activating plasminogen attached to fibrin = more clot specific T1/2 = 5-10 min, IV Side effects: bleeding 1) lysis of fibrin at site of injury 2) systemic lytic state breaking down clotting factors Contraindications: recent major surgery, serious recent bleeding, uncontrolled HTN, CVA, Intracranial disease, aortic dissection, acute pericarditis Side effects: bleeding 1) lysis of fibrin at site of injury 2) systemic lytic state breaking down clotting factors Contraindications: recent major surgery, serious recent bleeding, uncontrolled HTN, CVA, Intracranial disease, aortic dissection, acute pericarditis |
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tenecteplase
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Indication: acute treatment of MI, non-hemorrhagic stroke, dissolve pathogenic thrombi - occlude arteries, PE, prosthetic heart valves
MOA: directly activates plasminogen, more specific to activating plasminogen attached to fibrin = more clot specific T1/2 = 5-10 min, IV Side effects: bleeding 1) lysis of fibrin at site of injury 2) systemic lytic state breaking down clotting factors Contraindications: recent major surgery, serious recent bleeding, uncontrolled HTN, CVA, Intracranial disease, aortic dissection, acute pericarditis |
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Aminocaproic acid
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Indication: reduce bleeding after surgery (prostate, tooth extraction)
MOA: competes for lysine binding sites on plasminogen and plasmin, blocks the interaction of plasmin with fibrin, reverse excessive fibrinolysis oral/ IV absorbed rapidly, excrete unchanged Side Effects: excessive thrombosis, myopathy, muscle necrosis |
