Pharmacology.block 2 Anticoags And Dmards

Front 1

You decide to administer an IL1 antagonist to a patient with aggressive rheumatoid arthritis, what is the drug you would use?

Back 1

Anakinra

This is the ONLY Interluekin antagonist

Front 2

First line DMARD for rheumatoid arthritis

Back 2

Methotrexate

Front 3

MOA of heparin?

Back 3

Prevent fibrin formation by binding to and activating antithrombin III. Antithrombin III then forms inactive complexes with IIa, IXa and Xa.

Remember, LMW heparain only interacts with Factor Xa

Front 4

main alternative to the use of aspirin in pts with a recent MI or stroke

Back 4

Clopidogrel

Front 5

Can be given orally and used for prolonged anticoagulant therapy

Back 5

Warfarin

(Rivaroxaban is also an oral agent, this is used to prevent DVT following surgery)

Front 6

MOA of Zafirlukast?

Back 6

leukotriene receptor antagonist

Front 7

Soluble fibrinogen is converted by _ to insoluble fibrin forming mesh network that along with the aggregated platelets forms a thrombus

Back 7

thrombin

Front 8

Antithrombin is a _that inactivates thrombin (factor IIa), IXa, and Xa

Back 8

serine protease inhibitor

Front 9

Antithrombin is a serine protease inhibitor that inactivates _, _, and _

Back 9

thrombin (factor IIa), IXa, and Xa

Front 10

What effect would a lack of vitamin K have on coagulation?

Back 10

Decrease coagulation*

Front 11

(T/F) LMW Heparin does not inhibit thrombin *

Back 11

True

Front 12

The dose of UF heparin should be adjusted for

Back 12

Hepatic insufficiency
Renal disease

Front 13

Gq-coupled receptors cause

Back 13

Release of Ca2+ from the ER*
Activation of PKC *

Front 14

does not inhibit thrombin, only interacts with factor Xa

Back 14

Enoxaparin (LMWH)

Front 15

mixture of heparAN

Back 15

Danaparoid

Front 16

Thrombin inhibitor that is CI in renal insufficiency

Back 16

Lepirudin

Front 17

Thrombin inhibitor that is CI in hepatic insufficiency

Back 17

Argatroban

Front 18

Direct Thrombin Inhibitor that is specific to factor IIa and can be taken orally

Back 18

Dabigatran

- All other direct thrombin inhibitors are given by injection.
- Because this is oral, side effects include GI effects such as dyspepsia, GERD, and ulcer

Front 19

Block the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X by blocking vitamin K reductuase

Back 19

Warfarin

Front 20

Specific factor Xa inhibitor

Back 20

Rivaroxaban

Front 21

binds to and activates plasminogen to cause conversion of plasminogen to plasmin.

Back 21

Streptokinase

(plasminogen activator - fibrinolytic agents)

Front 22

inhibits plasminogen, therefore decreasing bleeding

Back 22

Tranexamic acid

Front 23

Serine protease inhibitor that inhibits plasmin, which decreases bleeding.

Back 23

Aprotinin

(no longer used)

Front 24

Bind to and inhibit the p2Y12 receptor (G coupled), which is the receptor for ADP release, blocking platelet aggregation

Back 24

ADP antagonists

such as Clopidogrel and Prasugrel

Front 25

Humanized monoclonal antibody

Back 25

Abciximab

Front 26

Inhibits BOTH purines and Pyrimidines.

Back 26

Methotrexate

Front 27

RA drug that can cause pulmonary fibrosis

Back 27

Methotrexate

Front 28

Used in very mild cases of RA. (also an antimalarial)

Back 28

Hydroxycloroquine

Front 29

Used if methotrexate does not give a sufficient result. Used as an adjunct in combo with methotrexate

Back 29

Sulfasalzine

(RA)

Front 30

Can add on on to methotrexate if Meth+Sulfa is not enough

Back 30

Leflunomide

(RA)

Front 31

IGG monoclonal antibody, binds to soluble and bound TNF alpha

Back 31

Infliximab

(Biological agents - RA)

Front 32

The only Interluekin antagonist

Back 32

Anakinra

(Biologic agents, RA)

Front 33

RA drug that can cause angioedema, ankle edema, or significant vomiting and hypotension. Allergic type rxns. Cautious in COPD and asthma.

Back 33

Rituximab

Anti CD20 Monoclonal Antibody (Biologic Response modifier)

Front 34

known to cause lots of anaphylactic rxns

Back 34

Abatacept

BRM - for RA

Front 35

Converted in intestine to two separate active metabolites: sulfapyradine (antibact) and mesalamine (antiinflam)

Back 35

Sulfasalzine

(limited use because of it's GI side effects)

Front 36

_ reduces formation of pyrimidines, while _ reduces formation both purines and pyrimidines

Back 36

Leflunomide

Methotrexate

Front 37

How do you treat heparin overdose?

Back 37

Antidote - Protamine!

Heparin is removed relatively quickly so unless it's life threatening, it may be best to wait.

Front 38

irrevsibly binds ONLY the catalytic site on thrombin

Back 38

Monovalent anticoagulant agents --- argatroban (LMW), Dabigatran

Front 39

_ reduce dabigatran effects and should be avoided with use.

Back 39

P-glycoprotein inducers (rifampin)

Front 40

Warfarin inhibits what enzyme

Back 40

vitamin K reductase. therefore it prevents activation of coagulation factors

Front 41

Pregnant women can only receive (heparin/warfarin), not the other

Back 41

heparin

Front 42

prevention of deep vein thrombosis following hip or knee replacement, Specific factor Xa inhibitor

Back 42

Rivaroxaban

Front 43

Streptokinase is a _

Back 43

fibrinolytic

it binds to and activates plasminogen to cause conversion of plasminogen to plasmin which will degrade a clot

Front 44

Big picture Plasminogen will (form/break) clots

Back 44

break


Therefore, tissue plasminogen activators such as Alteplase, Streptokinase are FIBRINOLYTICS

Front 45

Big picture: Serine Protease Inhibitors will (form/break) clots

Back 45

form

they inhibit plasmin thus decreasing bleeding

Front 46

PGI2 is released by _, binds to a _ receptor , and causes _ (with regards to coagulation)

Back 46

intact endothelial cells

Gs-coupled prostacyclin receptor (on platelets)

increase cAMP and decreased release of Ca from the ER

This INHIBITS (in normal circumstances) the formation of clots in healthy, intact blood vessels.

Front 47

Your pt with rheumatoid arthritis is put on a drug that inhibits both purines and pyrimidines. What is the most serious side effect that can occur in this patient? What supplement do they need to be on?

Back 47

Pulmonary Fibrosis; folic acid

this drug is methotrexate, it works by inhibiting dihydrofolate reductase ultimately resulting in inhibiting both purines and pyrimidines

Front 48

Your pt with rheumatoid arthritis is put on a drug that inhibits both purines and pyrimidines. 6 months later, he still suffers from morning stiffness and joint pain? Should you increase the dose or add another drug?

Back 48

this patient was on methotrexate. When this fails, you should add SULFASALZINE.

Front 49

Sulfasalazine requires _ to be converted to it's active form

Back 49

Colonic bacteria

So if you wipe out the colonic bacteria (by taking chronic antibacterials), you will have a problem activating this drug

Front 50

If Methotrexate+sulfasalazine doesn't work, whats the next drug you can try in combo with Methotrexate?

Back 50

Leflunomide

Front 51

Antihypertensive therapy should be withheld for 12 hours prior to the administration of what BRM?

Back 51

Rituximab,

It causes temporary vasodilation. could lead to a hypotensive issue