Pharm Winter Exam 2

Front 1

Inhaled Agents

Back 1

General Anesthetics
Inhaled Agents

Mech: nebulous, likely ↑GABAA activity
SE: respiratory depression, ↓BP, hypothermia, nausea, ↑ICP; Emergence: ↑BP, tachy

Front 2

Halothane

Back 2

General Anesthetics
Inhaled Agents

MAC 0.75; Blood/Gas 2.54; slow induction/awakening; SE: ↑catecholamine sensitivity, myocardial depression, hepatic necrosis, malignant hyperthermia

Front 3

Isoflurane

Back 3

General Anesthetics
Inhaled Agents

MAC 1.17; B/G 1.46; common, $$, faster, useful in neurosurgery (↓ cerebral O2 consumption), low toxicity, pungent odor (no induction); SE: ↑HR

Front 4

Sevoflurane

Back 4

General Anesthetics
Inhaled Agents

MAC 1.80; B/G 0.69; rapid induction/awakening, least irritating, safest for CV disease (least ↓BP)

Front 5

Desflurane

Back 5

General Anesthetics
Inhaled Agents

MAC 6.60; B/G 0.42; most rapid, low toxicity, irritating (no induction); SE: ↑HR

Front 6

Nitrous Oxide

Back 6

General Anesthetics
Inhaled Agents

MAC 105, B/G 0.46; rapid, adjuvant to increase rate of induction w/ other agents, analgesia, diffusion hypoxia, attenuates hypotension; SE: nausea; Toxicity: megaloblastic anemia, peripheral neuropathy, abuse

Front 7

IV Agents

Back 7

General Anesthetics
IV Agents

Mech: ↑GABAA activity

Front 8

Thiopental

Back 8

General Anesthetics
IV Agents

barbiturate, not really used anymore, CI: porphyria

Front 9

Midazolam (Versed)

Back 9

General Anesthetics
IV Agents

ultrashort acting, sedation, ↓anxiety, amnesia, IV; reversed w/ Flumazenil

Front 10

Propofol

Back 10

General Anesthetics
IV Agents

DOC anesthetic, rapid on/off, ↓cerebral blood flow→ ↓ICP SE: respiratory depression, ↓BP w/ no ↑HR, anaphylactic rxn (eggs, albumin)

Front 11

Etomidate

Back 11

General Anesthetics
IV Agents

no BP effect; SE: nausea

Front 12

Ketamine

Back 12

General Anesthetics
IV Agents

NMDA antagonist, dissociative effect, analgesia, little resp. dep. or nausea, date rape drug; SE: emergence delirium in adults

Front 13

Fentany

Back 13

General Anesthetics
Opioid Analgesics

IV opioid for analgesia, rapid, lollipops, reversed w/ Naloxone (Narcan)

Front 14

Local Anesthetics

Back 14

Local Anesthetics

Mech: block Na channels, higher affinity activated channels, base form crosses membrane; Inflammation→ ↓body pH →↑ionized drug→ ↓effect
[BH+] / [B] = 10(pKa – pH)
Carbonation - ↓ intracellular pH→ ↑ intracellular drug[ ]; Vasoconstrictors (Epi) ↓drug diffusion away from site
Toxicity: CNS – tongue numb/metallic taste, aud/vis disturbance, twitching, convulsions;
CV – arrhythmias; PABA (esters) allergy

Front 15

Esters

Back 15

Local Anesthetics


Esters – one “i”, metabolized in blood by pseudocholinesterase

Front 16

Procaine (Novocain)

Back 16

Local Anesthetics
Esters

short axn, PABA inhibits sulfonamides

Front 17

Tetracaine (Pontocaine)

Back 17

Local Anesthetics
Esters

slower, longer, spinal anesthesia, w/ 10% dextrose to ↑specific gravity in CSF

Front 18

Benzocaine

Back 18

Local Anesthetics
Esters

topical for sunburn (tooth – Anbesol), OTC

Front 19

Cocaine

Back 19

Local Anesthetics
Esters

short axn, topical, blocks NE reuptake, vaso-c, tachy

Front 20

Amides

Back 20

Local Anesthetics
Amides

two “i’s”, metabolized in liver

Front 21

Lidocaine (Xylocaine)

Back 21

Local Anesthetics
Amides

rapid onset, intermediate duration, infiltration & epidural,

Front 22

Bupivacaine (Marcaine)

Back 22

Local Anesthetics
Amides

long duration, infiltration & epidural; SE: cardiotoxicity

Front 23

Ropivacaine (Naropin)

Back 23

Local Anesthetics
Amides

long duration, S-isomer (Bup is racemic); ↓lipid soluble, ↓cardiotoxic

Front 24

Mepivacaine (Carbocaine)

Back 24

Local Anesthetics
Amides

int duration

Front 25

Prilocaine (Citanest)

Back 25

Local Anesthetics
Amides

SE: methemoglobinemia; CI: CV or respiratory disease

Front 26

Anticonvulsants

Back 26

Anticonvulsants

Seizures – Partial: Simple – jerking, ~20 sec, preservation of consciousness
Complex – impaired consciousness <2 min
Generalized: Tonic-Clonic (Grand Mal) – loss of consciousness, muscle contractions
Absence (Petit Mal) – staring, ~30 sec
Myoclonic – brief muscle contraction
Possible due to ↓GABA or ↑Glutamate (NMDA) activity
CI: pregnancy

Front 27

Phenytoin (Dilantin)

Back 27

Anticonvulsants

prolongs Na channel inactivation; Tx: partial & tonic-clonic seizures; Induces P450, ↑ [warfarin], ↑oral contraceptive metabolism, dose dependent elimination; SE: gingival hyperplasia, hirsutism

Front 28

Carbamazepine

Back 28

Anticonvulsants

blocks Na channels; Tx: partial(DOC) & tonic-clonic seizures, trigeminal neuralgia, bipolar disorder; Drug intraxns, induces P450, SE: blood dyscrasias, GI upset;

Front 29

Phenobarbital

Back 29

Anticonvulsants

– prolongs Cl- opening at GABA; Barbiturate; Tx: partial & tonic-clonic

Front 30

Gabapentin (Neurontin)

Back 30

Anticonvulsants

GABA analog but nebulous mech; Tx: adjunct for partial & tonic- clonic seizures, neuropathic pain, bipolar disorder; kidney excretion

Front 31

Pregabalin (Lyrica)

Back 31

Anticonvulsants

tx: neuropathic pain, fibromyalgia

Front 32

Topiramate

Back 32

Anticonvulsants

blocks Na, ↑GABA, ↓glutamate

Front 33

Ethosuximide

Back 33

Anticonvulsants

↓Ca current in thalamus; Tx: absence seizures(DOC); SE: GI pain

Front 34

Valproic Acid

Back 34

Anticonvulsants

↓repetitive firing; Tx: absence + tonic-clonic(DOC), myoclonic, bipolar, migraine; SE: hepatotoxicity; Many drug intraxns

Front 35

Clonazepam (Klonopin)

Back 35

Anticonvulsants

Tx: absence seizures

Front 36

Diazepam (Valium)

Back 36

Anticonvulsants

Tx: status epilepticus(DOC

Front 37

Stevens-Johnson Syndrome

Back 37

Hypersensitivity autoimmune (immune complex) reaction; can happen w/ anticonvulsants; Epidermis separates from dermis; Tx: discontinue drug
Erythema multiforme, arthritis, nephritis, CNS abnormalities, myocarditis

Front 38

Opioid Analgesics (Narcotics)

Back 38

Also inhibit GABA →↓inhibition of inhibitory pain fibers (3 inhibitions) →↓pain
Opioid Effects – analgesia (sensory & affective), sedation, euphoria/dysphoria, antitussive, respiratory depression, ↑ICP, miosis, constipation, antidiuresis
Tolerance – High: analgesia, euphoria, sedation; Minimal: miosis, constipation
Intraxns – MAOI’s: hyperpyrexic coma; Tx: pain, cough, diarrhea, anesthesia, pulmonary edema
CI: head injuries (↑ICP); pregnancy; pts w/ impaired pulmonary, renal, or hepatic function
OD: CNS depression, ↓ respiration, miosis →mydriasis (hypoxic, near death)
Withdrawal: dysphoria, diarrhea, rhinorrhea, insomnia, anxiety, vomiting, hostility, more prone to certain infections

Front 39

Opiate receptors

Back 39

– Gi, close presynaptic Ca channels→ ↓transmitter release (sub P, Ach, NE, 5HT, glutamate); open postsynaptic K channels (μ)→ hyperpolarize
Mu (μ) – euphoria, analgesia, sedation, miosis, ↓GI motility
Kappa (κ) – dysphoria, analgesia, miosis
Delta (δ) – dysphoria, hallucinations, mydriasis

Front 40

Morphine

Back 40

Opioid Analgesics (Narcotics)
Strong Agonists

binds μ,κ,δ; ext 1st pass (oral); t1/2= 2hrs; Liver metabolism 1o; Conjugated to 3- glucuronide →antagonizes morphine & 6- which is more potent analgesic; Schedule II; Causes histamine release→ peripheral vaso-D, ↓BP

Front 41

Hydromorphone (Dilaudid)

Back 41

Opioid Analgesics (Narcotics)
Strong Agonists

morphine derivative; stronger, faster

Front 42

Hydrocodone

Back 42

Opioid Analgesics (Narcotics)
Strong Agonists

oral; Metabolism: Cyp2D6; inhibitors will ↓analgesia (quinidine, SSRI’s)

Front 43

Vicodin, Lortab, Lorcet

Back 43

Opioid Analgesics (Narcotics)
Strong Agonists

hydrocodone/acetaminophen

Front 44

Oxycodone (OxyContin)

Back 44

Opioid Analgesics (Narcotics)
Strong Agonists

oral; Tx: pain, restless leg, Tourette’s; Liver met – Cyp2D6

Front 45

Percocet

Back 45

Opioid Analgesics (Narcotics)
Strong Agonists

oxycodone/acetaminophen

Front 46

Meperidine (Demerol)

Back 46

Opioid Analgesics (Narcotics)
Strong Agonists

oral/parenteral; short acting; Dilates pupils; No antitussive; antimuscarinic; blocks 5HT reuptake, addictive; metabolite: normeperidine →anxiety, seizures, kidney exc, not reversed by naloxone; MPTP →parkinson’s

Front 47

Methadone

Back 47

Opioid Analgesics (Narcotics)
Strong Agonists

oral/rectal; longer axn; milder withdrawal; Tx: pain, heroin addicts, w/drawal

Front 48

Fentanyl

Back 48

Opioid Analgesics (Narcotics)
Strong Agonists

100x morphine, shorter axn; Met: Cyp3A4 (ind/inh will cause intraxns);
Tx: chronic pain, induction, anesthesia (maintains cardiac stability in surgery, attenuates hemodynamic response→ less ↓BP)

Front 49

Alfentanil

Back 49

Opioid Analgesics (Narcotics)
Strong Agonists

10x morphine; shorter axn than fentanyl; $$; Met: Cyp3A4

Front 50

Sufentanil

Back 50

Opioid Analgesics (Narcotics)
Strong Agonists

1000x morphine

Front 51

Heroin

Back 51

Opioid Analgesics (Narcotics)
Strong Agonists

passes BBB; 10x morphine; metabolized to morphine

Front 52

Codeine

Back 52

Opioid Analgesics (Narcotics)
Moderate Agonists

must be metabolized by Cyp2D6 →morphine (inh by quinidine, SSRI’s); Tx: mild pain, antitussive; low addiction potential

Front 53

Tylenol 3

Back 53

Opioid Analgesics (Narcotics)
Moderate Agonists

codeine/acetaminophen

Front 54

Propoxyphene

Back 54

Opioid Analgesics (Narcotics)
Moderate Agonists

like codeine, more toxic; high dose →seizure, psychosis

Front 55

Darvocet

Back 55

Opioid Analgesics (Narcotics)
Moderate Agonists

propoxyphene/acetaminophen

Front 56

Pentazocine

Back 56

Opioid Analgesics (Narcotics)
Mixed Agonists/Antagonists

agonist on κ, partial agonist on μ; less effective than morphine, more hallucinations

Front 57

Buprenorphine

Back 57

Opioid Analgesics (Narcotics)
Mixed Agonists/Antagonists

partial agonist on μ&κ; Tx: heroin addiction; IV, sublingual, intranasal; sublingual combined w/ naloxone (not absorbed sub-L) to prevent IV abuse

Front 58

Tramadol

Back 58

Opioid Analgesics (Narcotics)
Mixed Agonists/Antagonists

weak μ agonist; Inh reuptake of 5HT & NE; mild SE’s; Tx: moderate pain

Front 59

Dextromethorphan (Robitussin)

Back 59

Opioid Analgesics (Narcotics)
Antitussives

no analgesic or addictive properties; CI: MAOI’s

Front 60

Codeine

Back 60

Opioid Analgesics (Narcotics)
Antitussives

Front 61

Naloxone (Narcan)

Back 61

Opioid Analgesics (Narcotics)
Antagonists

IV; short axn; can precipitate withdrawal symptoms

Front 62

Naltrexone (ReVia)

Back 62

Opioid Analgesics (Narcotics)
Antagonists

Oral; long axn; used to prevent the opiate high

Front 63

Nalmefene (Revex)

Back 63

Opioid Analgesics (Narcotics)
Antagonists

like naloxone but longer axn

Front 64

Autocoids

Back 64

Autocoids

Phospholipase A2 – takes membrane phospholipids → Arachidonic Acid

Front 65

COX-1

Back 65

Autocoids

PG’s, TX’s; constituitive; protects gastric mucosa, +platelet aggregation, vaso-C

Front 66

COX-2

Back 66

Autocoids

PG’s, TX’s; inducible; +inflammation, inh platelet agg; vaso-D

Front 67

Lipoxygenase

Back 67

Autocoids

Leukotrienes

Front 68

PGI

Back 68

Autocoids

vaso-D, broncho-D, ↑GFR; Tx: pulm HTN

Front 69

PGE

Back 69

Autocoids

vaso-D, broncho-D, ↑GFR, uterine contraction; Tx: abortion, induce labor, penile injection for ED, maintain patent DA, GI protection (Misoprostol)

Front 70

PGF

Back 70

Autocoids

broncho-C, uterine contraction, Tx: glaucoma [Latanoprost – (Xalatan)]

Front 71

TXA

Back 71

Autocoids

vaso-C, broncho-C

Front 72

NSAID’s

Back 72

-Acetylsalicylic Acid (Aspirin) – irreversibly inh COX-1 & 2; anti-inflammatory, analgesic, antipyretic, inh platelets; kidney exc; initial ↑respiration, then ↓; low dose →↓uric acid excretion, high dose →↑uric acid exc; induces asthma; ↑GI acid, ↓PG’s →ulcers; Long term→ kidney damage; Reye’s Syndrome – cerebral edema in kids w/ viral inf

Front 73

Diflunisal, Salsalate

Back 73

NSAID’s
Salicylates

Tx: RA, OA, pain

Front 74

Celecoxib (Celebrex)

Back 74

NSAID’s
COX-2 Inhibitors

COX-2 inh (cox-2:1 inh 7:1); fewer GI SE’s

Front 75

Rofecoxib (Vioxx)

Back 75

NSAID’s
COX-2 Inhibitors

COX-2 inh (cox-2:1 inh 70:1); Blood clotting CV events, w/drawn

Front 76

Indomethacin

Back 76

NSAID’s
Nonspecific COX Inhibitors

– inh Phospholipase A2, inh PMN migration; potent; most SE’s; Tx: close PDA

Front 77

Diclofenac

Back 77

NSAID’s
Nonspecific COX Inhibitors

inh COX

Front 78

Arthrotec

Back 78

NSAID’s
Nonspecific COX Inhibitors

diclofenac/misoprostol

Front 79

Ketorolac

Back 79

NSAID’s
Nonspecific COX Inhibitors

inh COX; potent; oral/IV/IM Tx: post-op pain, use max 5 days (SE’s)

Front 80

Ibuprofen

Back 80

NSAID’s
Nonspecific COX Inhibitors

inh COX; analgesia, antipyretic, anti-inf; low SE’s; ↓ASA effect; Tx: OA, RA

Front 81

Naproxen (Naprosyn, Aleve)

Back 81

NSAID’s
Nonspecific COX Inhibitors

like ibuprofen; long t1/2; CI: pregnancy

Front 82

Piroxicam

Back 82

NSAID’s
Nonspecific COX Inhibitors

↓ROS, inh PMN migration; long t1/2, many SE’s

Front 83

Nabumetone

Back 83

NSAID’s
Nonspecific COX Inhibitors

long t1/2, few SE’s

Front 84

Etodolac

Back 84

NSAID’s
Nonspecific COX Inhibitors

Front 85

Excedrin

Back 85

NSAID’s
Nonspecific COX Inhibitors

acetaminophen/aspirin/caffeine

Front 86

Acetaminophen/Paracetamol (Tylenol)

Back 86

NSAID’s
Other

nebulous mech; antipyretic, analgesic, no anti-inf; safe at therapeutic doses; Toxicity: hepatotoxicity (10-15g), hepatic necrosis (25g), toxic metabolite exceeds GSH levels; Toxicity Tx: n-acetylcysteine (Mucomyst)

Front 87

DMARD’s

Back 87

DMARD’s take weeks to months for full effect

Front 88

Methotrexate

Back 88

DMARD’s

inh dihydrofolate reductase (DHFR)→ ↓DNA synthesis & maybe ↓T-cell activation; CI: pregnancy, liver disease

Front 89

Aurothioglucose

Back 89

DMARD’s

oral/parenteral; gold salts; inh phagocytosis, ↓PG’s, ↓proteolytic enzymes

Front 90

Penicillamine

Back 90

DMARD’s

oral; chelating agent, ↓T-cell activity, ↓IgM Rheumatoid Factor, inh collagen synthesis; adverse rxns

Front 91

Hydroxychloroquine (Plaquenil)

Back 91

DMARD’s

oral; antihistamine, anti-Ach, antiprotease, ↓PG’s, ↓chemotaxis; SE: hemolysis in G6PD def

Front 92

Sulfasalazine

Back 92

DMARD’s

oral; maybe inh COX & LO; well tolerated; Tx: RA, IBD; SE: GI upset

Front 93

Infliximab (Remicade)

Back 93

DMARD’s

IV; chimeric IgG against TNF-α; Tx RA w/ methotrexate

Front 94

Rituximab

Back 94

DMARD’s

IV; chimeric IgG against CD20 (B-cell); Tx: RA, non-Hodgkin Lymphoma

Front 95

Adalimumab (Humira)

Back 95

DMARD’s

SC; human IgG against TNF-α; Monotherapy for RA; SE: rash, flu- like symptoms

Front 96

Etanercept (Enbrel)

Back 96

DMARD’s

IV/SC; TNF-α receptor fusion protein, binds and inactivates TNF

Front 97

Abatacept

Back 97

DMARD’s

IV; human recombinant fusion protein, blocks T-cell activation

Front 98

Leflunomide

Back 98

DMARD’s

oral; inh DHODH→ ↓pyrimidine synthesis; inh COX-2

Front 99

Mycophenolate Mofetil (MMF)

Back 99

DMARD’s

oral/IV; prodrug, inh IMPDH→ ↓lymph purine synthesis

Front 100

Anakinra

Back 100

DMARD’s

– SC; IL-1 Receptor antagonist (IL-1Ra); monotherapy or w/ other DMARD

Front 101

Drugs for The Gout

Back 101

Drugs for The Gout

Drugs CI in The Gout: Thiazide & Loop diuretics, Triamterene, Aspirin, Etoh, more

Front 102

Colchicine

Back 102

Drugs for The Gout
Drugs for Acute Attacks

oral; binds tubulin→ inh microtubules→ inh PMN activity, ↓inf; no analgesia; SE: diarrhea; used prophylactically w/ uricosuric agents

Front 103

Indomethacin, Naproxen, Celecoxib

Back 103

Drugs for The Gout
Drugs for Acute Attacks
NSAID's

CI: aspirin b/c ↓ uric acid excretion

Front 104

Drugs for Hyperuricemia
Uricosuric Agents

Back 104

Drugs for The Gout
Drugs for Hyperuricemia

Block active reabsorption of uric acid in proximal tubule
SE: kidney stones (drink lots of water), ↓excretion of other acidic compounds
May trigger gouty attack (prophylax w/ colchicine); Not used in acute attacks

Front 105

Probenecid

Back 105

Drugs for The Gout
Uricosuric Agents

Front 106

Sulfinpyrazone

Back 106

Drugs for The Gout
Uricosuric Agents

inh platelet agg, inh warfarin metabolism

Front 107

Allopurinol

Back 107

Drugs for The Gout
Xanthine Oxidase Inhibitors

inh XO: blocks purines→hypoxanthine→xanthine→uric acid; may trigger gouty attack; inh metabolism of warfarin & probenecid

Front 108

Rasburicase

Back 108

Drugs for The Gout
Other

recombinant urate oxidase (not endogenous in humans) from Aspergillus; uric acid→ allantoin (readily excreted); Anaphylaxis on 2nd admin possible

Front 109

Migraine Drugs

Back 109

Migraine Drugs

Migraine – throbbing, 2-72 hrs, visual auras, photosensitivity, nausea
First phase – intracranial vaso-C, ischemic changes, prodromic visual aura
Second phase – extracranial vaso-D, vasoactive material release→ pain, inf
Cluster – excruciating pain, around eyes, during sleep 15-90 min
Tension – stress onset, dull, persistent, tightening, 30 min – 7 days

Front 110

Sumatriptan (Imitrex)

Back 110

Migraine Drugs
Symptomatic Treatment
5HT Agonists

5HT1D&1B agonist →vaso-C intracranial; oral/SC; SE: vasospasm, stroke, intracranial bleeding, peripheral ischemia; CI: PAD, CAD, cerebrovascular disease; Tx: acute migraine

Front 111

Naratriptan, Rizatriptan, Eletriptan, etc.

Back 111

Migraine Drugs
Symptomatic Treatment
5HT Agonists

Front 112

Aspirin, Acetaminophen, Codeine, etc.

Back 112

Migraine Drugs
Symptomatic Treatment
Analgesics

Front 113

Naproxen, Ibuprofen, etc

Back 113

Migraine Drugs
Symptomatic Treatment
NSAID’s

Front 114

Ergot Alkaloid

Back 114

Migraine Drugs
Prophylaxis

ergot is a fungus, grows on rye ; wet season→ Ergotism (St. Anthony’s Fire): vaso-C (burning), gangrene, hallucinations

Front 115

Ergotamine

Back 115

Migraine Drugs
Prophylaxis

partial agonist 5HT & α receptors; Tx: migraine during prodrome SE: ergotism

Front 116

Methysergide (Sansert)

Back 116

Migraine Drugs
Prophylaxis

partial agonist on 5HT, weak vaso-C; Tx: migraine prophylaxis; SE: retroperitoneal fibrosis

Front 117

ß-Blockers

Back 117

Migraine Drugs
Prophylaxis

Propanolol

Front 118

Calcium Channel Blockers

Back 118

Migraine Drugs
Prophylaxis

Verapamil

Front 119

Antidepressants

Back 119

Migraine Drugs
Prophylaxis

Amitriptyline, Lithium Carbonate, Valproic Acid, Topiramate

Front 120

Female Hormones

Back 120

Migraine Drugs
Prophylaxis

Estradiol

Front 121

Drugs of Abuse

Back 121

-Cocaine
-Methamphetamine
-Nicotine
-Caffeine
-Alcohol
-Benzodiazepines
-Opioids
-Marijuana
-LSD
-Mescaline
-MDMA (Ecstasy)
-Phencyclidine (PCP, Angel Dust)
-Ketamine (Special K)
-Inhaled

Front 122

Drugs Affecting Coagulation

Back 122

Intrinsic – XII, XI, IX, VIII; PTT time
Extrinsic – TF, VII; PT time, INR
Common – X, V, II, I
Collagen – vWF – GP1b
GPIIb/IIIa - Fibrinogen
Platelet activation - ADP, TXA2, 5HT
Anticoagulation – TFPI, Thrombomodulin, ATIII
Fibrinolysis – Plasminogen→ Plasmin, Protein C, t-PA, urokinase, streptokinase

Front 123

Heparin sodium

Back 123

Drugs Affecting Coagulation
Anticoagulants

IV; accelerates ATIII axn; ↑PTT time; axn prolonged in renal/hepatic dys

Front 124

Enoxaparin (Lovenox)

Back 124

Drugs Affecting Coagulation
Anticoagulants

– LMWH; SC; SE: HIT; CI: intracranial hemorrhage, renal/hepatic disease; Useful in pregnancy, doesn’t cross placenta

Front 125

Lepirudin

Back 125

Drugs Affecting Coagulation
Anticoagulants

direct inh thrombin; leeches; Renal exc; difficult to reverse; Tx: HIT

Front 126

Argatroban

Back 126

Drugs Affecting Coagulation
Anticoagulants

direct inh thrombin; Liver met; difficult to reverse; Tx: HIT

Front 127

Warfarin (Coumadin)

Back 127

Drugs Affecting Coagulation
Anticoagulants

Vit K analog, ↓II, VII, IX, X; sweet clover, rat poison; monitor w/ PT/INR; Initial ↑clotting (rapid ↓protein C); Effect takes 12-16 hrs to develop; 98% plasma protein bound; oral contraceptives ↓effect; Cimetidine ↑effect
Reversal – Vit K, FFP, Factor IX
Anticoagulant Reversal Agents

Front 128

Protamine sulfate

Back 128

Drugs Affecting Coagulation
Anticoagulant Reversal Agents

heparin antagonist; In absence of heparin, anticoagulant effect

Front 129

Vitamin K1

Back 129

Drugs Affecting Coagulation
Anticoagulant Reversal Agents

warfarin reversal

Front 130

Tissue plasminogen activator (t-PA)

Back 130

Drugs Affecting Coagulation
Fibrinolytic Agents

activates plasminogen→ plasmin; $$

Front 131

Streptokinase

Back 131

Drugs Affecting Coagulation
Fibrinolytic Agents

fibrinolytic; may cause AB formation→ allergic response, ↓efficacy

Front 132

Urokinase

Back 132

Drugs Affecting Coagulation
Fibrinolytic Agents

activates plasminogen→ plasmin

Front 133

Anistreplase

Back 133

Drugs Affecting Coagulation
Fibrinolytic Agents

plasminogen/streptokinase

Front 134

Aminocaproic acid

Back 134

Drugs Affecting Coagulation
Antifibrinolytic Agents

inh plasminogen activation; Tx: bleeding disorders, reverse fibrinolytic agents

Front 135

Aspirin

Back 135

Drugs Affecting Coagulation
Antiplatelet Agents (Antithrombotics)

↓platelet agg, irreversible for life of platelet (7-10 days)

Front 136

Clopidogrel (Plavix)

Back 136

Drugs Affecting Coagulation
Antiplatelet Agents (Antithrombotics)

oral; inh ADP in platelet; less GI SE’s than aspirin

Front 137

Abciximab (ReoPro)

Back 137

Drugs Affecting Coagulation
Antiplatelet Agents (Antithrombotics)

IV; inh GPIIb/IIIa; $$

Front 138

Eptifibatide (Integrilin)

Back 138

Drugs Affecting Coagulation
Antiplatelet Agents (Antithrombotics)

IV; inh GPIIb/IIIa; rattle snake venom derived

Front 139

Tirofiban (Aggrastat)

Back 139

Drugs Affecting Coagulation
Antiplatelet Agents (Antithrombotics)

IV; inh GPIIb/IIIa