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pharm II: heme, chemo tx, & anticoags (exam 3)

Terms in this set (69)

ferrous sulfate
preferred iron supplement to treat iron deficiency anemia
which iron sup does not have a metallic taste
polysaccharide-iron complex (prescription, not OTC)
Which two parenteral iron treatments have a BBW of death assoc. to anaphylaxis
dextran and ferumoxytol
What is secondary hemochromatosis and hemosiderosis associated with
parenteral iron toxicity
acute iron toxicity treatment
deferoxamine
polyglutamate
ingested form of folate from diet/leafy greens
What enzyme converts polyglutamate to monoglutamate? What can block this reaction?
conjugase; phenytoin blocks
absorption of _________ can be inhibited by alcohol and birth control in the jejunum
monoglutamate
indications for folic acid
megaloblastic anemias due to folate def
prevent neural tube defects in pregnancy
What can be given with fluorouracil in the tx of colon cancer
leucovorin (folate preparation)
What can be given as an antidote for folate antagonists as well as rescue therapy for MTX?
leucovorin
cyanocobalamin indicates
pernicious anemia
increased utilization of B12 (neoplastic tx)
increased B12 req (due to pregnancy, thyrotoxicosis, hemorrhage, malignancy, or liver/kidney dz)
cyanide poisoning tx
hydroxocobalamin (cyanokit)
What can cause red urine and urine oxalate crystals
hydroxocobalamin (used for cyanide poisoning)
What binds to erythropoietin receptor on erythroid progenitor cells to stimulate differentiation into mature RBCs and inhibits apoptosis?
epoetin alfa (Epogen, Procrit)
Darbepoetin alfa (Aranesp)
What drug is indicated for the below pathologies?
CKD, HIV, chemo, or surgery associated anemia
epoetin alfa
Pt with CKD induced anemia is receiving epoetin alfa. What do you need to be extremely cautious about?
BBW warning for increased mortality and serious CV event
BBW for epoetin alfa in cancer pts
increased mortality and/or tumor progression
BBW for epoetin alfa in surgery pts
increased thromboembolic events → consider DVT prophylaxis
Difference in indications for Darbepoetin vs Epoetin alfa
Darbepoetin only for CKD and chemo assoc. anemia.

Epoetin can ALSO cover surgery and HIV assoc. anemia.
Methoxy polyethylene glycol-epoetin beta (Mircera) indication
CKD assoc. anemia
Which anticoagulant acts in a catalytic fashion?
heparin, LMWH, and fondaparinux
Heparin primarily inhibits...
Xa and thrombin
LMWH primarily inhibits...
mostly Xa with some minor thrombin
Fondaparinux inhibits
Xa only
unfractionated IV heparin indications
prophylaxis and tx of thromboembolism
PCI
adjunct in ACS
chemical antagonist of heparin
protamine sulfate (used for heparin OD)
What is the most commonly used LMWH?
lovenox
LMWH BBW
Spinal or epidural hematoma formation
What is the most commonly used anticoagulant in pregnancy
LMWH
Which has less AEs - LMWH or fondaparinux
fondaparinux
Derivatives of Huridin
direct thrombin (factor IIa) inhibitors
Argatroban, Bivalirudin, and Desirudin
PARENTERAL direct thrombin (factor IIa) inhibitors
indications for Argatroban, Bivalirudin, and Desirudin
heparin induced thrombocytopenia
Desirudin BBW
Epidural or spinal hematoma with possible paralysis
Dabigatran indications
thromboembolism/stroke prophylaxis
recurrent or post hip arthroplasty DVT/PE prophylaxis
DVT/PE
cardioversion
How do you switch pt from warfarin to Dabigatran?
Start dabigatran when INR <2
dabigatran BBW
epidural/spinal hematoma
Tx discontinuation
idarucizumab
used to treat dabigatran toxicity → speeds up excretion
Bleeding is 50% lower in ______________ vs that with Warfarin
factor Xa inhibitors
Factor Xa inhibitors
Rivaroxaban
Apixaban
Edoxaban
-xaban
direct factor Xa inhibitor
Why are factor Xa inhibitors now preferred over warfarin
- immediate onset of action and effects diminish immediately after stopping
- no monitoring of INR
Which factor Xa inhibitor should be taken with food?
rivaroxaban
T/F apixaban and edoxaban should not be taken with food
true
What two factor Xa inhibitors are primarily metabolized through the CYP3A4 pathway
rivaroxaban and apixaban
inhibitors of rivaroxaban and apixaban
carbamazepine
phenytoin
rifampin
St. john's wort (OTC)
inducers of rivaroxaban and apixaban
dronedarone
ketoconazole, itraconazole
ritonavir
clarithromycin, erythromycin
cyclosporine
Antidote for Rivaroxaban and Apixaban
andexanet
Factor Xa inhibitor BBW
spinal/epidural hematoma
premature discontinuation (risk for VTE)
Warfarin prevents the carboxylation of....
factors 2, 7, 9, and 10
Warfarin BBW
pregnancy
bleeding risk
phytonadione
Vitamin K → used to treat warfarin toxicity
thrombolytics MOA
recombinant forms of human tissue plasminogen activator (tPA)
-plase
thrombolytic agent
alteplase indications
acute MI, ischemic stroke, massive PE
reteplase and tenecteplase indications
STEMI
defibrotide indications
hepatic veno-occlusive dz
When should thrombolytics be initiated when treating a stroke
within 4.5 hrs of stroke onset
thrombolytic contraindications
prior risk of bleeding
Defibrotide is a ....
thrombolytic (exact MOA unknown)
Aminocaproic acid and tranexamic acid
inhibit fibrinolysis and plasminogen activation
Cisplatin, carboplatin toxicity
acoustic nerve damage and nephrotoxicity
Which chemo agent can cause peripheral neuropathy
Vincristine
Which chemo agents can cause pulmonary fibrosis
bleomycin and busulfan
Doxorubicin can cause....
Cardiotoxicity
Cyclophosphamide toxicity
hemorrhagic cystitis
5-FU, 6-MP, and MTX toxicity
myelosuppression
mesna indications
hemorrhagic cystitis prophylaxis
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