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51 Cards in this Set
- Front
- Back
You decide to administer an IL1 antagonist to a patient with aggressive rheumatoid arthritis, what is the drug you would use?
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Anakinra
This is the ONLY Interluekin antagonist |
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First line DMARD for rheumatoid arthritis
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Methotrexate
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MOA of heparin?
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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 |
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main alternative to the use of aspirin in pts with a recent MI or stroke
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Clopidogrel
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Can be given orally and used for prolonged anticoagulant therapy
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Warfarin
(Rivaroxaban is also an oral agent, this is used to prevent DVT following surgery) |
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MOA of Zafirlukast?
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leukotriene receptor antagonist
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Soluble fibrinogen is converted by _ to insoluble fibrin forming mesh network that along with the aggregated platelets forms a thrombus
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thrombin
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Antithrombin is a _that inactivates thrombin (factor IIa), IXa, and Xa
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serine protease inhibitor
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Antithrombin is a serine protease inhibitor that inactivates _, _, and _
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thrombin (factor IIa), IXa, and Xa
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What effect would a lack of vitamin K have on coagulation?
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Decrease coagulation*
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(T/F) LMW Heparin does not inhibit thrombin *
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True
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The dose of UF heparin should be adjusted for
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Hepatic insufficiency
Renal disease |
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Gq-coupled receptors cause
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Release of Ca2+ from the ER*
Activation of PKC * |
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does not inhibit thrombin, only interacts with factor Xa
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Enoxaparin (LMWH)
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mixture of heparAN
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Danaparoid
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Thrombin inhibitor that is CI in renal insufficiency
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Lepirudin
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Thrombin inhibitor that is CI in hepatic insufficiency
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Argatroban
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Direct Thrombin Inhibitor that is specific to factor IIa and can be taken orally
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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 |
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Block the gamma-carboxylation of glutamate residues in prothrombin, factors VII, IX, and X by blocking vitamin K reductuase
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Warfarin
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Specific factor Xa inhibitor
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Rivaroxaban
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binds to and activates plasminogen to cause conversion of plasminogen to plasmin.
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Streptokinase
(plasminogen activator - fibrinolytic agents) |
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inhibits plasminogen, therefore decreasing bleeding
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Tranexamic acid
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Serine protease inhibitor that inhibits plasmin, which decreases bleeding.
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Aprotinin
(no longer used) |
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Bind to and inhibit the p2Y12 receptor (G coupled), which is the receptor for ADP release, blocking platelet aggregation
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ADP antagonists
such as Clopidogrel and Prasugrel |
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Humanized monoclonal antibody
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Abciximab
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Inhibits BOTH purines and Pyrimidines.
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Methotrexate
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RA drug that can cause pulmonary fibrosis
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Methotrexate
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Used in very mild cases of RA. (also an antimalarial)
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Hydroxycloroquine
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Used if methotrexate does not give a sufficient result. Used as an adjunct in combo with methotrexate
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Sulfasalzine
(RA) |
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Can add on on to methotrexate if Meth+Sulfa is not enough
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Leflunomide
(RA) |
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IGG monoclonal antibody, binds to soluble and bound TNF alpha
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Infliximab
(Biological agents - RA) |
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The only Interluekin antagonist
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Anakinra
(Biologic agents, RA) |
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RA drug that can cause angioedema, ankle edema, or significant vomiting and hypotension. Allergic type rxns. Cautious in COPD and asthma.
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Rituximab
Anti CD20 Monoclonal Antibody (Biologic Response modifier) |
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known to cause lots of anaphylactic rxns
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Abatacept
BRM - for RA |
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Converted in intestine to two separate active metabolites: sulfapyradine (antibact) and mesalamine (antiinflam)
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Sulfasalzine
(limited use because of it's GI side effects) |
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_ reduces formation of pyrimidines, while _ reduces formation both purines and pyrimidines
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Leflunomide
Methotrexate |
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How do you treat heparin overdose?
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Antidote - Protamine!
Heparin is removed relatively quickly so unless it's life threatening, it may be best to wait. |
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irrevsibly binds ONLY the catalytic site on thrombin
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Monovalent anticoagulant agents --- argatroban (LMW), Dabigatran
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_ reduce dabigatran effects and should be avoided with use.
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P-glycoprotein inducers (rifampin)
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Warfarin inhibits what enzyme
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vitamin K reductase. therefore it prevents activation of coagulation factors
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Pregnant women can only receive (heparin/warfarin), not the other
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heparin
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prevention of deep vein thrombosis following hip or knee replacement, Specific factor Xa inhibitor
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Rivaroxaban
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Streptokinase is a _
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fibrinolytic
it binds to and activates plasminogen to cause conversion of plasminogen to plasmin which will degrade a clot |
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Big picture Plasminogen will (form/break) clots
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break
Therefore, tissue plasminogen activators such as Alteplase, Streptokinase are FIBRINOLYTICS |
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Big picture: Serine Protease Inhibitors will (form/break) clots
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form
they inhibit plasmin thus decreasing bleeding |
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PGI2 is released by _, binds to a _ receptor , and causes _ (with regards to coagulation)
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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. |
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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?
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Pulmonary Fibrosis; folic acid
this drug is methotrexate, it works by inhibiting dihydrofolate reductase ultimately resulting in inhibiting both purines and pyrimidines |
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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?
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this patient was on methotrexate. When this fails, you should add SULFASALZINE.
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Sulfasalazine requires _ to be converted to it's active form
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Colonic bacteria
So if you wipe out the colonic bacteria (by taking chronic antibacterials), you will have a problem activating this drug |
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If Methotrexate+sulfasalazine doesn't work, whats the next drug you can try in combo with Methotrexate?
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Leflunomide
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Antihypertensive therapy should be withheld for 12 hours prior to the administration of what BRM?
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Rituximab,
It causes temporary vasodilation. could lead to a hypotensive issue |