Pharmacology Ii - Exam Ii

Front 1

Normal dopamine transmission removes the inhibition on the what via what?

Back 1

Thalams, via secreation of GABA, thus inhibited by GABA.

Front 2

After the Thalamus what happens with the transmission?

Back 2

Glutamatergic neuron transmission.

Front 3

What is the goal and strategies in the pharmacological Tx of Parkinsons?

Back 3

Goal = To restore normal functioning of the striatum. Strategies: 1. Restore DA levels to normal 2. Correct imbalance between ACh and DA in striatum and #. Directly stimulate striatal DA receptors with agonist drug.

Front 4

Parkinson's Drugs not in a specific class.

Back 4

Levadopa
Carbidopa
Amantadine

Front 5

Levadopa and Carbidopa

Back 5

Levadopa is given with carbidopa and entacapone to increase dopamine levels. Carbidopa is a dopa decarboxylase inhibitor, it inhibits the conversion of L-Dopa to Dopamine.

Front 6

Parkinson's COMT Inhibitors

Back 6

Entacapone and Tolcapone

Front 7

Entacapone and Tolcapone MOA

Back 7

Keep COMT inhibited so that it can't metabolized L-Dopa into Dopamine

Front 8

Parkinson's Dopamine Agonist

Back 8

Bromocriptine
Pramipexole
Ropinirole
Apomorphine
Rotigotine
Cabergoline

Front 9

Bromocriptine

Back 9

Is an ergot derivative that acts as anb agonist at the D2 like family of DA receptors, some selectivity for D3

Front 10

Parmipexole

Back 10

Non-Ergot dopamine agonist that acts at the D2 and D3 receptors

Front 11

Ropinirole and Rotigotine

Back 11

Non-Ergot dopamine agonist at D2, D3 receptor. Rotigotine also at D1

Front 12

Apomorphine

Back 12

D1 and D2 dopamine agonist

Front 13

Cabergoline

Back 13

Long acting D2 receptor agonist

Front 14

MAOI Inhibitors

Back 14

Selegeline and Rasageline

Front 15

Selegeline and Rasageline

Back 15

Selective and IRREVERSIBLE MAO-B Inhibitors

Front 16

Parkinson's Anticholinergic Drugs

Back 16

Procyclidine, Trihexyphenidyl, Benztropine, Biperiden

Front 17

Procyclidine, Trihexyphenidyl, Benztropine, Biperiden MOA

Back 17

Block the effects of ACh in striatum restoring balance between DA and ACh

Front 18

Amantadine is what kind of drug and what is its MOA?

Back 18

It is an anti-viral drug, and its MOA is unknown

Front 19

Neuroleptic Drugs: Phenothiazines

Back 19

Prochlorperazine
Chlorpromazine
Thioridazine
Penphenazine
Fluphenazine

Front 20

Neuroleptic Drugs: Butyrophenones

Back 20

Haloperidol
Droperidol

Front 21

Neuroleptic Drugs: Thioxanthines

Back 21

Thiothixine
Chlorprothixene

Front 22

Neuroleptic Drugs: Atypical Anti-Psychotics

Back 22

Quietidine
Risperidone
Clozapine
Paliperidone
Aripiprazole
Pimozide
Loxapine
Olanzapine
Olanzapine and Fluoxitine
Melindone
Ziprasidone

Front 23

Neuroleptic Drugs: Bi-Polar

Back 23

Lithum
Valproic Acid
Cabemazepine

Front 24

Antipsychotic Drugs MOA

Back 24

Block D2 receptors but extent varies, alpha 1 and 5HT2 blockade is common, atypical antipsycholtics have affinity for 5HT2A receptors, less for D2 receptors

Front 25

Clozapine MOA

Back 25

D4 and 5HT2 Blocker

Front 26

Lithium MOA

Back 26

Decreases IP3 and DAG levelvs thus decreases PKC activity. Lithium inhibits enzymes of inositol recycling, uncouples G proteins at least explains some side effects. Polyuria is due to uncoupling of G protein from vasopression receptor. Hypothyroidism is due to uncoupling of TSH receptor.

Front 27

Opiods: Opiod Agonist

Back 27

Sufentanyl, Fentanyl, Alfentenil, Remifentanyl, Oxymorphone, Hydromorphone, Oxycodone, Diacetylmorphine(HEROIN), Methadone, Morphine, Normophine, Codeine, Propoxyphene, Tramadol

Front 28

Opiod Agonist MOA

Back 28

1. Direct Inhibition 2. Indirect Inhibition

Front 29

Opiod Agonist MOA
1. Direct Inhibition?

Back 29

Presynaptic and Postsynaptic
Presynaptic - Inhibit opening of voltage gated Ca channels which inhibits Ca entry and decreases NT release.
Postsynaptic - Gi/Go activation causes opening of K channels leading to hyperpolarization. Gi/Go activation inhibits adenylate cyclase which decreases cAMP and PKA which decresaes phosphorylation of many cellular proteins including Na channels decreasing neuronal excitability

Front 30

Opiod Agonist MOA
2. Indirect Inhibition

Back 30

Indirect inhibition of synaptic transmission release of engogenous opiopeptides thus causing even more inhibition.

Front 31

Opiod: Mixed Agonist/Antagonist and Partial Antagonist

Back 31

Pentazocine
Nalbuphine
Butorphanol
Buprenorphine

Front 32

Opiod: Opiod Antagonist

Back 32

Naloxone
Naltrexone
Nalmefene

Front 33

Hematopoeisis: Iron Drugs

Back 33

Iron Dextram
Iron Sucrose
Iron Gluconate

Front 34

Hematopoeisis: Iron Chelators

Back 34

Deferoxamine
Deferasirox

Front 35

MOA for Deferasirox

Back 35

Selective for Fe3+, binds 2:1 ratio and excretion is fecal.

Front 36

B-12 Deficiency Tx

Back 36

Cyanocobalamin
Hydroxocobalamin

Front 37

Sickle Cell Anemia Tx

Back 37

Hydroxyurea

Front 38

MOA for Hydroxyurea?

Back 38

Unknown

Front 39

Hematopoeitic Growth Factors:

Back 39

Epoetin Alfa (Epogen, Procrit)
Darbepoetin Alfa (Aranesp)
G-CSF (Filgastrin, Neupogen)
Pegfilgastrin (Neulasta)
GM-CSF (Sargramastin, Leukine)
IL-II (Opreleukin, Neumega)
Thrombopoeitin (Romiplastim, Nplate)

Front 40

Erythropoeitin MOA

Back 40

Stimulate RBC production, binds to erythropoeitin receptors on red cell progenitor cells.

Front 41

Myeloid Growth Factors MOA

Back 41

Glycoproteins that stimulate the proliferation and differentiation of myeloid cell lines. Bind and activate cytokine receptors of the JAK/STAT superfamily.

Front 42

Granulocyte-Colony Stimulating Factor (Filgastrim, Neupogen) MOA

Back 42

Stimulates the proliferation and differentiation of cells committed to the neutrophil lineage, activates mature neutrophils, mobilzes hematopoeitic stem cells from bone marrow to peripheral blood.

Front 43

Granulocyte-Macrophage-Colony Stimulating Factor (Sargromastim, Leukine) MOA

Back 43

Stimulates the proliferation and stimulation of early and late granulocytic progenitor cells, erythroid, and megakayrocyte progenitors.

Front 44

Interleukin II (Oprelvekin, Neumega) MOA

Back 44

Stimulates the growth of megakaryocytic progenitors which increases platelets

Front 45

Antiplatelet Drugs:

Back 45

Aspirin and NSAIDS

ADP Inhibitors: Clopidigril and Toclipine

Glycoprotein IIb/IIIa Inhibitors: Abciximab, Tirofiban, Eptifabitide

Dipyridamole

Front 46

Antiplatelet Drugs MOA: ADP Inhibitors - Ticlopidine and Clopidogrel

Back 46

Irreversible inhibitors of ADP binding to its receptor. Decrease ADP-mediated platelet aggregation.

Front 47

Antiplatelet Drugs MOA: Glycoprotein IIb/IIIa Inhibitors - abciximab, trofiban, and eptifibatide

Back 47

A cell surface receptor on platelets involved in platelet cross linking with fibrinogen for aggregation. GPIIb/IIIa inhibitors bind to this receptor and block fibrinogen from binding.

Front 48

Antiplatelet Drugs MOA: Dipyridamole

Back 48

Inhibits the uptake of adenosine into platelets, inhibits phosphodiesterase which then leads to increase cAMP, inhibits Thromboxane A2 synthesis.

Front 49

Anticoagulants: Oral and Parenteral

Back 49

Oral - Warfarin
Parenteral - 1. Unfractionated Heparin
2. LMW Heparin - Tinzaparin, Enoxaparin, Dalteparin and Danaparoid
3. Lepirudin or hirudin, desirudin, bivalrudin
4. Argatroban
5. Human recombinant antithrombin III: Endogenous Human Anticoagulant

Front 50

Anticoagulants: Oral-Warfarin MOA

Back 50

Interferes with the vitamin K dependent y-carboxylation of glutamate residues on several clotting factors which renders them inactive.

Front 51

Anticoagulants: Unfractionated Heparin MOA

Back 51

Thrombin inhibitor, heparin binds to AT III and speeds up its activity.

Front 52

Anticoagulants: LMWH - Tinzaparin, Enoxaparin, Dalteparin, and Danaparoid MOA

Back 52

Preferentially inhibit factor Xa

Front 53

Anticoagulants: Direct Thrombin Inhibitors - Lepirudin MOA

Back 53

Lepirudin - binds and inactivates both fibrin bound thrombin and circulating thrombin

Front 54

Anticoagulants: Direct Thrombin Inhibitors - Desirudin MOA

Back 54

Desirudin - Similar to Lepirudin

Front 55

Anticoagulants: Direct Thrombin Inhibitors - Bivalirudin

Back 55

Bivalirudin - Similar to Lepirudin but synthetic - inhibits thrombin, reversible binding to thrombin.

Front 56

Anticoagulants: Argatroban MOA

Back 56

Argatroban MOA - Binds only to the active site of thrombin, not the exosite

Front 57

Thrombolytic Drugs:

Back 57

Tissue Plasminogen Activator t-PA
Streptokinase
Anistreplase

Front 58

Thrombolytic Drugs: Tissue Plasminogen Activator t-PA MOA

Back 58

Converts fibrin bound plasminogen to plasmin within clots

Front 59

Thrombolytic Drugs: Streptokinase MOA

Back 59

Forms a stable complex with plasminogen (1:1) exposing its proteolytic active site such that other plasminogen molecules get converted to plasmin

Front 60

Thrombolytic Drugs: Anistreplase MOA

Back 60

Is a prodrug converted to plasminogen, then plasmin

Front 61

Drugs for Bleeding Disorders:

Back 61

Vitamin K - Phytonadione or Menadione
Clotting Factors - Fresh frozen human plasma, factors VIII or IX
Antiplasmin Agents - Aminocaproic Acid, Tranexamic Acid
Protamine

Front 62

Drugs for Bleeding Disorders - Antiplasmin Agents MOA

Back 62

Aminocaproic Acid, Tranexamic Acid - Inhibit conversion of Plasminogen to Plasmin

Front 63

Hypothalamic/Pituitary Hormones

Back 63

Oxytocin/Vasopressin

Front 64

Hypothalamic Hormones

Back 64

GHRH, Somatostatin, Thyrotropin Releasing Hormone, Corticotrophin Releasing Hormone, GnRH, LHRH Prolactin RH, Prolactin IH

Front 65

Somorelin does what?

Back 65

It is an analog for GHRH

Front 66

Octreotide is an analog for what?

Back 66

Somatostatin which inhibits release of GH, TSH, gastrin, glucagon, insulin, vasoactive intestinal peptide, GI motility, and sphlancnic blood blow.

Front 67

Proteirelin is an analog for what?

Back 67

TRH, this increases Thyroid Stimulating Release

Front 68

Gonadoralin and the synthetic Leuprolide

Back 68

Are analogs for Gonadotropin releasing hormone, they increase LH and FSH

Front 69

What are the GnRH analogs

Back 69

Nafarelin, goserelin and histrolin.

Front 70

What is a GnRH antagonist

Back 70

Ganirelix - prevents premature surges of LH

Front 71

Prolactin Inhibiting Hormone is?

Back 71

Dopamine - Inhibits Prolactin

Front 72

Growth hormone-Somatatropin analog

Back 72

Somatrem, Increases GH levels

Front 73

Anterior Pituitary Hormones are?

Back 73

GH, TSH, ACTH, FSH, LH

Front 74

TSH analog is

Back 74

Thyrotropin a - prompts iodine uptake in normal thyroid cells

Front 75

ACTH analog is?

Back 75

Cosyntropin - increases cortisol

Front 76

FSH analogs

Back 76

Follitropin B, Urofollitropin, Increases follicle development in females, and increases spermatogenesis in males.

Front 77

LH analog

Back 77

hCG human chorionic gonadotropin - is the major stimulate of gonadal steroid production.

Front 78

Oxytocin analog

Back 78

Syntocinon, increases uterine contraction and triggers milk ejection, increases post partum milk production

Front 79

ADH/Vasopression analog

Back 79

DDAVP - Desmopressin V2 recepotors in kidney, V1 receptors in vacular smooth muscle. Modified form of vasopression that has minimal activity at V1.

Front 80

Vasopression analog

Back 80

Aqueous vasopression

Front 81

Levadopa DDI

Back 81

Pyridoxiine, antipsychotic drugs, MAOIs - D/C at least two weeks prior to Tx with MAOIs

Front 82

Pramipexole DDI

Back 82

Cimetidine due to decreased renal tubular secretion, antipsychotic drugs

Front 83

Ropinirole DDI

Back 83

Ciprofloxacin, cimetidine, opioids, smoking increases clearance, food delays absorption, hepatic metabolism via CYP1A2

Front 84

Selegiline and Rasagiline DDI

Back 84

TCA, SSRIs, Meperidine, MAOIs - can lead to Seratonin Syndrome, hyperpyrexia, delirium, coma and death

Front 85

Rasagiline DDI

Back 85

Ciprofloxacin CYP1A2 inhibitor, inhibits metabolism and increases level of rasagiline two fold

Front 86

Anticholinergic DDI

Back 86

Other drugs with antimuscarinic activities

Front 87

Lithium DDI

Back 87

Plasma levels change with hydration status, dehydration, or patients taking diuretics increases lithium levels to toxicity. Thiazide diuretics, NSAIDS, decrease clearance toxicity. Theophyline increases Lithium's clearance rate. Antipsychotics increase risk of EPS, antimeitic effects of antipsychs can mask LI nausea. Li nausea is the first sign of Li intoxication. Increase dose during pregnancy, don't breast feed, decrease dose after birth.

Front 88

Meperedine DDI

Back 88

w/MAOIs death caused by hypertensive crisis and or serotonin syndrome. DDI with SSRI/TCA that can lead to serotonin syndrome

Front 89

Opioid DDI

Back 89

Other CNS depressants, ETOH, sedative hypnotics, anesthetics, antipsychotics, TCAs, antihistamines can have additive CNS depression

Front 90

Warfarin DDI

Back 90

Metabolized by CYP2C9, C19, 1A2, 3A4, and CYP450 inducers increase clearance, cause therapuetic failure (barbituates, CBZ, PHT), CYP450 inhibitors cause decreased clearance and bleeding. Warfarin is hihgly plasma protein bound, maintain consistent intake of dietary vitamin K and avoid NSAIDS and ASA, increased risk of GI bleed, avoid ETOH

Front 91

What is neuroleptic malignant syndrome?

Back 91

o Occurs with antipsychotics or an L-dopa drug holiday
o Fever, encephalopathy, unstable vitals, elevated enzymes, metabolic acidosis, rigidity of muscles

Front 92

How do you treat it?

Back 92

o d/c neuroleptic, cool patient, give benzos, hydrate, alkalinize urine

Front 93

What 2 drugs are also used to treat hyperprolactinemia?

Back 93

o Bromocriptine and cabergoline

Front 94

What 2 drugs are also used to treat restless leg syndrome?

Back 94

o Pramipexole and Ropinirole

Front 95

Which drug must be given with an antiemetic?

Back 95

o Apomorpine

Front 96

Which 2 drugs cause heart valve problems?

Back 96

o Pergolide and cabergoline

Front 97

What 2 drugs are metabolized by CYP1A2?

Back 97

o Ropinirole and rasagiline

Front 98

What drug would increase their levels by inhibiting CYP1A2?

Back 98

o Ciprofloxacin

Front 99

Which drugs can be used alone to treat parkinsons initially?

Back 99

o Pramipexole, Ropinirole, selegiline, rasagiline

Front 100

Food delays the absorption of what 2 drugs?

Back 100

o L-dopa and ropinirole

Front 101

Which 2 drugs can cause arrhythmias?

Back 101

o L-dopa and amantadine

Front 102

• What 2 drugs are used for anti-emetics?

Back 102

o Prochlorperazine and droperidol

Front 103

• What drugs cause arrhythmias?

Back 103

o Thioridazine, Sertindole, Ziprasidone

Front 104

• What drugs are used for tourettes?

Back 104

o Pimozide (DOC), Haloperidol, Risperidone

Front 105

• What drugs block H1 receptors?

Back 105

o All atypicals (clozapine highly), and chlorpromazine

Front 106

• What are side effects common to older typical drugs?

Back 106

o Sedation, neuroleptic syndrome, extrapyramidal side effects, increased PRL secretion

Front 107

• What drugs are used to treat parkinsonian syndrome?

Back 107

o Benzotropine, trihexyphenidyl, amantidine

Front 108

• What drug is used to treat acute dystonic rxns (muscle spasms)?

Back 108

o Diphenyhydramine (benadryl)

Front 109

• What drug is used to treat neuroleptic malignant syndrome?

Back 109

o Bromocriptine
o DO NOT give dantrolene

Front 110

• Which drugs is associated with impotence?

Back 110

o Thioridazine

Front 111

• What drug causes bone marrow suppression, agranulocytosis, and aplastic anemia?

Back 111

o Clozapine (take weekly WBC counts for 6 mo.)

Front 112

• What 2 drugs may improve negative schizophrenic symptoms?

Back 112

o Olanzapine, sertindole

Front 113

• What drug is used for refractory major depressive disorder?

Back 113

o Aripiprazole

Front 114

• Which drugs are given for agitation?

Back 114

o Haloperidol, olanzapine, ziprasidone

Front 115

• What drug is used for management of autism?

Back 115

o Risperidone

Front 116

• Which drug causes retinal deposits or “brown vision” at toxic levels?

Back 116

o Thioridazine

Front 117

• What are the therapeutic levels of lithium?

Back 117

o 0.8-1.2 mEq/L (>1.6 is intoxication)

Front 118

• What are the 4 endogenous opioid peptides?

Back 118

o Enkephalins, nociceptins, endorphins, endomorphins

Front 119

• What groups of peptides bind to Mu receptors?

Back 119

o Enkephalins and endomorphins, morphines and fentanyls

Front 120

• What binds to kappa receptors?

Back 120

o Dynorphins, morphine, nalmorphine

Front 121

• What drugs bind to the sigma site?

Back 121

o Pentazocine and nalorphine

Front 122

• What drug is the most euphoric?

Back 122

o Heroin

Front 123

• What is darvocet and what is a problem with it?

Back 123

o Propoxyphene + APAP, overdose is common

Front 124

• What is the main reason for deaths from opioid overdose?

Back 124

o Respiratory arrest, caution in patients with copd/asthma

Front 125

• Which opioids do not cause miosis?

Back 125

o Meperidene, amphetamine, cocaine

Front 126

• What symptoms of opioids do not develop tolerance?

Back 126

o Miosis, constipation

Front 127

• Which drugs cause the most histamine release?

Back 127

o Morpine, meperidine

Front 128

• What drug is used to reverse trunk muscle rigidity from fentanyl and others?

Back 128

o Naloxone

Front 129

• What drug is preferred during labor and why?

Back 129

o Meperidine because of less effect on uterine tone

Front 130

• Which drug is metabolized to a convulsant metabolite?

Back 130

o Meperidine converted to normeperidine

Front 131

• What is the DOC for opioid overdoses?

Back 131

o Naloxone

Front 132

• What drug is given PO for alcohol/opioid dependence?

Back 132

o Naltrexone

Front 133

• What are 3 antitussive drugs?

Back 133

o Codeine, hydrocodone, detromethorphan

Front 134

• What are 3 anti-diarrhea drugs?

Back 134

o Diphenoxylate, loperamide, deodorized tincture of opium

Front 135

• What drug is used for withdrawal management?

Back 135

o Methadone

Front 136

• What has to be prescribed with iron supplements?

Back 136

o Stool softeners

Front 137

• Which drug requires a small test dose due to anaphylaxis?

Back 137

o Iron dextran

Front 138

• What are cobalamins and what are they used for?

Back 138

o Isomers of B12, used for B12 deficiency

Front 139

• What are 4 reasons the folic acid cycle is important?

Back 139

o Synthesis of purines, DNA, methionine, and decreases levels of homocysteine (causes heart probs)

Front 140

• What 3 drugs cause folate deficiencies?

Back 140

o Methotrexate, trimethoprim, pyrimethamine

Front 141

• What are A.R.s of erythropoietin?

Back 141

o HTN, DVT, PE

Front 142

• What are myeloid growth factors (GCSF/GMCSF) used for?

Back 142

o Chemo induced neutropenia, any neutropenia, aplastic anemia

Front 143

• What are some A.R.s of GCSF?

Back 143

o Bone pain, hypersensitivity rxns, spenomegaly (long term use), rare nectrotizing vasculitis

Front 144

• Besides these what are A.R.s of GMCSF?

Back 144

o Flu symptoms, peripheral adema, pericardial/pleural effusion

Front 145

• What other growth factor increases fluid retention?

Back 145

o Interleukin 11/ oprelvekin (caution in CHF)

Front 146

• What kind of drugs are used to treat arterial thrombosis?

Back 146

o Antiplatelet agents

Front 147

• What drugs are used to treat venous thrombosis?

Back 147

o Anticoagulants

Front 148

• What are the types of antiplatelet drugs?

Back 148

o COX inhibitors, ADP inhibitors, glycoprotein IIb/IIIa inhibitors

Front 149

• What drugs are used only acutely after angioplasties?

Back 149

o Abciximab, eptifibatide, tirofiban

Front 150

• What drug is used for cardiac perfusion tests?

Back 150

o Dipyridamole (it’s a vasodilator)

Front 151

• How does warfarin work?










• How is this treated?
o Immediately stop heparin/LMWH and provide anticoagulation if necessary
o Do not give heparin or warfarin
• What anticoagulants can be used in these patients?
o Fondaparinux, Argatroban, lepirudin, bivalirudin, danaparoid (outside U.S.)

• What conditions are contraindicated for LMWH and Fondaparinux?
o Patients with epidurals and intrathecal catheters
• What drug is used for disseminated intravascular coagulation (DIC)?
o Antithrombin III
• How do thrombolytic drugs work?
o Convert plasminogen to plasmin to split clots
• What is a A.R. of streptokinase?
o Systemic fibrinolysis, antigenic responses
• What can be given to patients with hemophilia?
o Clotting factors VIII, IX, fresh frozen plasma, aminocaproic acid, and tranexamic acid
• T/F do LMWH require lab monitoring?
o False
• What drugs increase INR when given with warfarin?
o Amiodarone, azithromycin, bactrim, ciprofloxacin, dexamethasone, antiarrhythmics, cephalosporins, nsaids, pain relievers, statins
• What drugs decrease INR when given with warfarin?
o Anti-thyroids, barbiturates, OCPs

Back 151

o Blocks vit. K action on clotting factors = inactivates them
o Interferes with clotting factors 2,7,9,10
o Interferes with protein C and protein S

Front 152

• What does it mean for warfarin to be a category X drug?

Back 152

o Causes severe birth defects such as bleeding and bone defects

Front 153

• How is warfarin toxicity reversed (also if INR >9)?

Back 153

o Vitamin K, fresh frozen plasma, factor IX

Front 154

• What enzymes metabolize warfarin?

Back 154

o CYP2C9, 2C19, 1A2, 3A4
o CYP450 inducers increase clearance = decrease INR
o CYP450 inhibitors cause decreased clearance = increase INR
• Other DDIs with warfarin are?
o PPB drugs, NDAIDs, ASA, EtOH

Front 155

• What drug is given for heparin overdoses?

Back 155

o Protamine

Front 156

• How does heparin work?

Back 156

o Binds to ATIII leading to thrombin inactivation

Front 157

• How do you monitor Warfarin levels?

Back 157

o PT/INR tests

Front 158

• How do you monitor heparin levels?

Back 158

o PT tests

Front 159

• How do LMWH work?

Back 159

o Inhibit factor Xa

Front 160

ARTICLE:
• What is heparin induced thrombocytopenia?

Back 160

o Unfractionated Heparin binds to platelet factor 4 (PF4) on some cells causing antibodies to be made, leading to thrombin generation and thrombosis

Front 161

• How is this treated?

Back 161

o Immediately stop heparin/LMWH and provide anticoagulation if necessary
o Do not give heparin or warfarin

Front 162

• What anticoagulants can be used in these patients?

Back 162

o Fondaparinux, Argatroban, lepirudin, bivalirudin, danaparoid (outside U.S.)

Front 163

• What conditions are contraindicated for LMWH and Fondaparinux?

Back 163

o Patients with epidurals and intrathecal catheters

Front 164

• What drug is used for disseminated intravascular coagulation (DIC)?

Back 164

o Antithrombin III

Front 165

• How do thrombolytic drugs work?

Back 165

o Convert plasminogen to plasmin to split clots

Front 166

• What is a A.R. of streptokinase?

Back 166

o Systemic fibrinolysis, antigenic responses

Front 167

• What can be given to patients with hemophilia?

Back 167

o Clotting factors VIII, IX, fresh frozen plasma, aminocaproic acid, and tranexamic acid

Front 168

• T/F do LMWH require lab monitoring?

Back 168

o False

Front 169

• What drugs increase INR when given with warfarin?

Back 169

o Amiodarone, azithromycin, bactrim, ciprofloxacin, dexamethasone, antiarrhythmics, cephalosporins, nsaids, pain relievers, statins

Front 170

• What drugs decrease INR when given with warfarin?

Back 170

o Anti-thyroids, barbiturates, OCPs