Term
| Bleeding disorders are caused by: |
|
Definition
| plasma protein defect; platelet abnormality; defect in platelet-endothelial cell interactions |
|
|
Term
| 4 examples of coagulation protein defects leading to bleeding |
|
Definition
| True protein deficiency; inhibition of active region of protein; production of abnormal protein molecule; enhanced protein clearance |
|
|
Term
| Causes of decrease in platelet count: |
|
Definition
| thrombocytopenia; metastatic cancer; B12 deficiency; folate deficiency |
|
|
Term
|
Definition
| disorders of adhesion; acquired platelet disorders |
|
|
Term
| example of disorder of adhesion |
|
Definition
|
|
Term
| examples of acquired platelet disorder: |
|
Definition
| liver disease; cardiopulmonary bypass; carious drugs |
|
|
Term
| to diagnose prolonged bleeding with normal platelet count look at: |
|
Definition
| vWF, platelet function, and for rare connective tissue disorders |
|
|
Term
| Examples of rare connective tissue disorders: |
|
Definition
| scurvy; ehlers-danlos syndrome |
|
|
Term
|
Definition
| severe ascorbic acid deficiency |
|
|
Term
|
Definition
|
|
Term
| examples of screening tests for bleeding disorders: |
|
Definition
| aPTT (6-9 mins); PT (15-30 secs), platelet count; bleeding time; TCT |
|
|
Term
| screening test to determine bleeding disorders associated with intrinsic pathway |
|
Definition
|
|
Term
| Prolonged PT and aPTT cause: |
|
Definition
| disseminated IV coagulation; liver disease; VitK deficiency; abnormal fibrinogen molecules |
|
|
Term
| Prolonged PT and aPTT must be treated by: |
|
Definition
|
|
Term
| 2 types of anticoagulation systems |
|
Definition
|
|
Term
| inherited disorders can form thrombi through: |
|
Definition
| antithrombin; protein c; protein s; FV leiden mutation; hyperhomocysteinemia; prothrombin 20210 |
|
|
Term
| acquired disorders that increase risk of clotting in the heart are: |
|
Definition
| arrhythmias; AF (primary cause); placement of mechanical heart valve; prolonged bed rest; cancer |
|
|
Term
| types of drugs used in coagulation disorders: |
|
Definition
| anticoagulant inhibitors; antiplatelet inhibitors; thrombin inhibitors; fibrinolytic inhibitors |
|
|
Term
| medications reducing clotting and dissolving clots: |
|
Definition
| Heparin; LMWH; Hirudin; warfarin, aspirin, GP IIb/IIIa inhibitors; recombinant coag factor |
|
|
Term
| risk factors for development of venous thrombosis |
|
Definition
| primarily AF; placement of mechanicla heart valve; prolonged bed rest; protein C deficiency |
|
|
Term
|
Definition
| parenteral anticoagulant; glycosaminoglycan made of D-glucosamine and iduronic acid; accelterates activity of ATIII to inactivate thrombin, Xa, and IXa |
|
|
Term
|
Definition
| DVT, PE, arterial and cerebral thromboembolism |
|
|
Term
| heparin contraindicated with: |
|
Definition
| bovine protein hypersensitivity; patients with HIT |
|
|
Term
|
Definition
| bleeding, bleeds from gums |
|
|
Term
|
Definition
| enoxaparin, dalteparin, tinzaparin |
|
|
Term
|
Definition
| doesn't require as rigorous medical monitoring of aPTT |
|
|
Term
|
Definition
| DVT; lower chance of miscarriage; improve preganncy outcomes in women with APS |
|
|
Term
| 2 classes of direct thrombin inhibitors |
|
Definition
| bivalent DTI and monovalent DTI |
|
|
Term
|
Definition
| a specific irreversible thrombin inhibitor; a 65 AA compound made in trace amounts by European medicinal leech |
|
|
Term
|
Definition
| anticoagulant; not inhibited by platelet factor IV; thrombin times exceed 200 seconds |
|
|
Term
|
Definition
| anticoagulation in patients with HIT |
|
|
Term
|
Definition
| yeast-derived recombinant form of natural anticoagulant hirudin; identical to hirudin except leucine is substituted for isoleucine at N-terminal and sulfate group on tyrosine portion 63 is deleted |
|
|
Term
| action of Lepirudin (refludan) |
|
Definition
| direct inhibitor of free thrombin or thrombin entrapped w/in clots; trhombin times exceed 200 seconds, not inhibited by platlet factor IV |
|
|
Term
| Lepirudin (refludan) used for |
|
Definition
| anticoagulation in pts w/ HIT |
|
|
Term
| Lepirudin contraindicated: |
|
Definition
| in pts with hirudin hypersensitivity |
|
|
Term
| AE of lepiruding (refludan) |
|
Definition
| bleeding major risk! monitor aPTT |
|
|
Term
|
Definition
| specific reversible direct thrombin inhibitor; blocks circulating thrombin and clot-bound thrombin |
|
|
Term
| bivalirudin (angiomax) used for: |
|
Definition
| tx of pts with unstable angina undergoing percutaneous transluminal coronary angioplasty (PTCA) |
|
|
Term
| Bivalirudin (angiomax) is contraindicated in: |
|
Definition
| not be initiated in patients with baseline aPTT ratio of 2.5 more |
|
|
Term
| AEs of bivalirudin (angiomax) |
|
Definition
| bleeding major risk; discontinue breast-feeding |
|
|
Term
| examples of drugs that block thrombin-induced platelet activation: |
|
Definition
| Lepirudin and Eptifibatide |
|
|
Term
|
Definition
| a N2-substituted derivative of arginine |
|
|
Term
|
Definition
| selective direct thrombin inhibitor, reversibly inhibits catalytic site of circulating thrombin adn clot-bound thrombin |
|
|
Term
| examples of selective thrombin inhibitors: |
|
Definition
| argatroban, bivalirudin, desirudin, lepirudin |
|
|
Term
|
Definition
| HIT, end-stage renal disease, coronary artery thrombosis prophylaxis; percutaneous coronary intervention (PCI)in patients with or risk of HIT |
|
|
Term
| contraindication of argatroban |
|
Definition
| aPTT shouldn't exceed 100 seconds; hepatic impairment; breast feeding |
|
|
Term
| Melagatran and Ximelegatran (Exanta) is: |
|
Definition
| new anticoagulant molecules that directly inhibit thrombin |
|
|
Term
| Melagatran and Ximelegatran (Exanta) used for: |
|
Definition
| prevention of DVT and PE in patients going for surgery; prevention of stroke in pts with AF; secondary prevention of venous thromboembolism |
|
|
Term
| Melagatran and Ximelegatran (Exanta) AE: |
|
Definition
|
|
Term
|
Definition
| oral coumarin anticoagulant; VitK is co-factor for carboxylation of glutamate residues to gamma-carboxyglutamates on N-terminal regions of VitK-dependent proteins; anticoagulant effects are steroselective; S-isomer of warfarin is 3-5x more potent than R-isomer |
|
|
Term
|
Definition
| prevent or treat thromboembolic disease |
|
|
Term
| contraindication for warfarin: |
|
Definition
| crosses placenta, so not in pregnancy! |
|
|
Term
|
Definition
| fatal bleeding, necrosis of skin |
|
|
Term
| Mech of Action for Coumadin |
|
Definition
| inhibits syntesis of vitK-dependent coagulation factors II, VIII, IX, and C and antigoagulant proteins C and S; inhibits C1 subunit of vitK epoxide reductase which reduces regeneration of VitK epoxide; carboxylation allows coagulation proteins to have conformational change needed for activation |
|
|
Term
|
Definition
| International normalized ration; PT ratio of test/control |
|
|
Term
| dosing of warfarin contingent upon: |
|
Definition
| INR; liver and kidney dysfunction; frequent blood tests to measure PT are taken to avoid risk of excessive thinning and bleeding |
|
|
Term
| drugs enhancing action of coumadin: |
|
Definition
| aspirin, tylenol, alcohol, ibuprofen, oxendrolone, vitamins, antibiotics |
|
|
Term
| drugs inhibiting coumadin: |
|
Definition
| metronidazole; fluconazole, tmp-smx; amiodarone, disulfiram; cimetidine |
|
|
Term
| types/locations of anti-platelet agents: |
|
Definition
| platelet membrane receptors; generated w/in platelet to interact with membrane receptor; generated w/in platelet to act w/in platelet |
|
|
Term
| this drug blocks the ADP receptor on teh platelet membrane: |
|
Definition
|
|
Term
| Gp IIb/IIIa inhibitors at clinical trials: |
|
Definition
| tirofiban, eptifibatide, lambifiban, abciximab |
|
|
Term
|
Definition
| GP IIb/IIIa inhibitor that blocks ligand binding |
|
|
Term
|
Definition
| GP IIb/IIIa inhibitor that blocks ligand binding |
|
|
Term
|
Definition
| a peptidomimetic, platelt GP IIB/IIIA inhibitor, IV form |
|
|
Term
| MA of tirofiban (aggrastat) |
|
Definition
| competitive inhibitor of GP IIb/IIIa; blocks cross-linking of activated platelets; inhibits ex vivo platelet aggregation induced by ADP |
|
|
Term
| Use of Tirofiban (aggrastat) |
|
Definition
| tirofiban plus heparin more effective than heparin alone for acute coronary syndromes; reduces ischemic complications associated with PCI |
|
|
Term
| CIs of tirofiban (aggrastat) |
|
Definition
| prolonged bleed time; inhibition of platelet aggregation |
|
|
Term
| AE of tirofiban (aggrastat) |
|
Definition
| bleeding secondary to drug-induced platelet dysfunction |
|
|
Term
| Epitifibatide (integrilin) |
|
Definition
| cyclic peptide; platelet GP IIb/IIIa inhibitor; given IV |
|
|
Term
| Epitifibatide (integrilin) action |
|
Definition
| blocks binding to VWF, fibrinogen, and other adhesion molecules to activated platelets; prevents platelet aggregation regardless of agonist involved |
|
|
Term
| Epitifibatide (integrilin) use |
|
Definition
| pts undergoing PCI; tx of unstable angina; non-Q-wave MI |
|
|
Term
| Epitifibatide (integrilin) contraindications and AEs |
|
Definition
| bleed time prolongation; ex vivo aggregation induced by ADP and other agonists; bleeding secondary to induced platelet dysfunction |
|
|
Term
|
Definition
| blocks platelt GP RECEPTOR of Ib/IIIA; used for unstale angina, prolongs bleeding, investigational |
|
|
Term
|
Definition
| 1st FDA approved platelet GP IIb/IIIa inhibitor, IV injection |
|
|
Term
| abciximab (reopro) action: |
|
Definition
| blocks binding of VWF, fibrinogen, and other adhesion molecules to activated platelets |
|
|
Term
|
Definition
| PCI (like angioplasty, atherectomy, stent placement); use with aspirin and heparin lowers acute MI |
|
|
Term
| abciximab (reopro) AE and CI: |
|
Definition
| bolus dose is rapidly bound to platelet receptors and increases mediab bleeding time for 5-30 minutes; 2 hours after bolus dose over 80% of GP IIb/IIIA receptors are blocked and platelelt aggregation is nonexistent; increased risk of bleeding secondary to drug-nduced platelet dysfunction |
|
|
Term
| abciximab (reopro) AE and CI: |
|
Definition
| bolus dose is rapidly bound to platelet receptors and increases mediab bleeding time for 5-30 minutes; 2 hours after bolus dose over 80% of GP IIb/IIIA receptors are blocked and platelelt aggregation is nonexistent; increased risk of bleeding secondary to drug-nduced platelet dysfunction |
|
|
Term
| phosphodiesterase inhibitors: |
|
Definition
| dipyridamole (persantine) and cilostazol (pletal) |
|
|
Term
| dipyridamole (persantine) |
|
Definition
| vasodilator and blocks adenosine uptake and cGMP phosphodiesterase activity |
|
|
Term
|
Definition
| promotes vasodilation adn blocks platelet aggregation |
|
|
Term
| dipyridamole (persantine) |
|
Definition
| non-titrate coronary vasodilator that also inhibits platelet aggregation |
|
|
Term
| dipyridamole (persantine) action |
|
Definition
| increases coronary blood flow by selectively dilating small resistance vessles that supply the heart; does not dilate coronary blood vessels in ischemic area |
|
|
Term
| dipyridamole (persantine) use: |
|
Definition
| ineffective as antithrombotic for patients with acute MI, DVT, or TIAs; combo with warfarin prevents thrombosis in patients with valve disorders; combo with aspirin is approved for stroke prophylaxis |
|
|
Term
| dipyridamole (persantine)CI: |
|
Definition
| not use in pts with hypotension; induces orthostatic hypotension, may exacerbate angina due to vasodilatory effects, elevated hepatic enzymes |
|
|
Term
|
Definition
| platelet aggregation inhinitor with vasodilating activity; has antithrombotic, antiplatelelt, and vasodilatory actions |
|
|
Term
|
Definition
| peripheral arterial disease in pts with diabetic neruopathy; redces leg pain due to poor circulation (intermittent claudication) |
|
|
Term
|
Definition
| hemostatic disorders; active pathologic disorders - GI bleeding, retinal bleeding, retroperitoneal bleeding, intracranial bleeding |
|
|
Term
| 1-fibrinolytic activators |
|
Definition
| thrombolytic agents that lyse thrombi; examples are the "plase"es and tPA and streptokinase and urokinase |
|
|
Term
|
Definition
| parenteral thrombolytic agent, complex consisting of streptokinase and human lysplasminogen |
|
|
Term
|
Definition
| acylation of this complex inhibits its lyses coronary arterial thrombi; degradation by endogenous fibrinolysis inhibitors BUT its fibrin-binding activity is unaffected |
|
|
Term
|
Definition
| reduces infarct size; improves ventricular funtion post-AMI; reduces mortality associated with AMI |
|
|
Term
|
Definition
| bleeding; hazardous in patients with AFib, Atrial flutter, cardiac disease (increases cerebral embolism) |
|
|
Term
|
Definition
| parenteral thrombolytic agent that exerts action on endogenous fibrinolytic system to convert plasminogen to plasmin |
|
|
Term
| Alteplase (Activase) use: |
|
Definition
| lysis of PTE; lysis of acute coronary arterial thromboembolism; for tx of AMI with ST-elevation |
|
|
Term
| Alteplase (Activase) CI and AE |
|
Definition
| hazardous in patients with AFib, atrial flutter, cardiac disease; minor bleeding or major internal bleeding |
|
|
Term
|
Definition
| recombinant plasminogen activator (r-PA) that is a fibrin-selective thrombolytic agent |
|
|
Term
| Reteplase (retavase) use: |
|
Definition
| tx of AMI; improvement of ventricular fonction post-AMI; reduction of incidence of CHF; reduction of mortality associated with AMI |
|
|
Term
|
Definition
| bleed; AFib; atrial flutter; cardiac disease; |
|
|
Term
|
Definition
|
|
Term
|
Definition
| modified form of tPA that binds to fibrin and converts plasminogen to plasmin; has increased resistance to PTA-1 |
|
|
Term
| Tenecteplase (TNKase) use: |
|
Definition
| tx of AMI; thrombolytic agent |
|
|
Term
| Tenecteplase (TNKase) CI and AE: |
|
Definition
| Afib, Aflutter, cardiac disease, hypersensitivity to alteplase variants; causes bleeding |
|
|
Term
| Tenecteplase (TNKase) CI and AE |
|
Definition
| Afib, Aflutter, cardiac disease, hypersensitivity to alteplase variants; causes bleeding |
|
|
Term
| 2-fibrinolytic inhibitors: |
|
Definition
| aminocaproic acid (EACA) and Tranexamic acid |
|
|
Term
|
Definition
| similar to amino acid lysine; synthetic inhibitor of fibrinolysis; competitively inhibits plasminogen activation; don't use with patients iwth DIC |
|
|
Term
|
Definition
| analog of aminocaproic acid; not present in USA, shoudln't be used with patients with DIC |
|
|
Term
| Aminocaproic acid (Amicar) |
|
Definition
| inhibits fibrinolysis by binding to lysine-binding sites w/in plasminogen/plasmin molecule blocking the plasmin's activity; decreases tuberculin reaction in pts sensitivie to tuberculin |
|
|
Term
| Aminocaproic acid (Amicar) use: |
|
Definition
| tx of hemorrhage caused by hyperfirinolysis; tx of systemic and urinary hyperfibrinolysis |
|
|
Term
| Aminocaproic acid (Amicar) CI and AE |
|
Definition
| not for pts with DIC or active intravascular clotting; hypotension and sinus bradycardia |
|
|
Term
| Tranexamic acid (cyklokapron) |
|
Definition
| 10x more potent than aminocaproic acid; cometitive inhibitor of plasminogen activation |
|
|
Term
| Tranexamic acid (cyklokapron) use: |
|
Definition
| tx of primary menorrhagia; reduce or prevent hemorrhage in pts with hemophelia A or B; bleeding prophylaxis; dysfunctional uterine bleeding |
|
|
Term
| Tranexamic acid (cyklokapron) CI and AE: |
|
Definition
| renal insufficiency, subarachnoid hemorrhage, acquired defective color vision; increased risk of clot formation when adminitered with clotting factors (rFVIIa) |
|
|
Term
|
Definition
| serin protease inhibitor discontinued in US; affects finrinolysis in 2 steps by inhiiting kallikrein-kinin system and inhibiting plasmin-induced lysis of fibrin by reducing conversion of plasminogen to plasmin |
|
|
Term
|
Definition
| reduces surgical bleeding; for pts non-responsive to thrombolytic therapy; during repeat CABGs |
|
|
Term
| Aprotinin (Trasylol) CI and AE |
|
Definition
| increased risk for renal toxicity and dialysis perioperatively; may increase mortality |
|
|
Term
| Therapeutic strategies & mechanisms of actions of NSAIDs: |
|
Definition
| anti-inflammatory, analgesic, antipyretic, antiplatelet |
|
|
Term
|
Definition
| tx moderate pain; inhiits COX, inhibits platelet aggregation prevents arterial and venous thormbosis |
|
|
Term
|
Definition
| GI disturbance, platelet dysfunction |
|
|
Term
|
Definition
| para-aminophenol analgesic, active metabolite of phenacetin, weak COX1 and COX2 inhibitor in peripheral tissues and COX3 in CNS, interacts with NOS2 gene |
|
|
Term
| Acetaminophen (Acephen) use: |
|
Definition
| weak anti-inflammatory properties, relieves pain, reduces fever, does not relieve redness, stiffnes, or swelling form RA, does tx mild arthritis |
|
|
Term
| Acetaminophen (Acephen) AE: |
|
Definition
| metabolite, N-acetyl-para-benzoquinoneimine (NAPQI) is hepatotoxic |
|
|
Term
|
Definition
| renal and resp. failure, vasomotor collapse; hypoprothrombinemia; fever, dehydration, metabolic acidosis, tinnitus, central hyperventilation; gastic intolerance, bleeding, hypersensitivity; impaired homeostasis |
|
|
Term
|
Definition
| biosynthesis of prostaglandins |
|
|
Term
| nonselective NSAID inhibitors of prostaglandin synthesis: |
|
Definition
|
|
Term
| selective inhinitors of prostaglandin biosynthesis: |
|
Definition
| piroxicam, sulindac, NSAIDS like aspirin andindomethacin, -coxibs |
|
|
Term
|
Definition
| sulfinylindene is prodrug form converted by liver to sulfide and irreversible oxidation of sulfone metabolite |
|
|
Term
|
Definition
| regress colorectal polyps in FAP, analgesic and antipyretic properties |
|
|
Term
|
Definition
| GI, platelet dysfunction; vaginal bleeding |
|
|
Term
|
Definition
| selective COX2 inhibitor for rheumatoid arthritis, juvenile rheumatoid arthritis, acute moderate pain, or dysmenorrhea, interacts with gene PTGS2 |
|
|
Term
|
Definition
| serious CV thrombotic events, MI, stroke, GI dysfunction, bleed |
|
|
Term
|
Definition
| discontinued in US, lacks sulfonamide chain and behaves like ibuprofen, for osteoarthritis or acute pain, anti-inflammatory analgesic and antipyretic, doesn't block platelet aggregation, interacts with PTGS2, gauses adverse GI reactions and elevations of ALT or AST |
|
|
Term
| a patient on HCTZ and rofecoxib develops gradual increase in BP due to |
|
Definition
| inhibition of COX2 by rofecoxib which leads to decreased renal blood flow |
|
|
Term
|
Definition
| not approved. potent and selective, orally active COX-2 inhibitor for dental pain, dysmenorrhia, RA but causes CV risks |
|
|
Term
|
Definition
| an oxicam derivative structurally related to piroxicam used for RA but causes GI bleedin gand ulceration and serious CV problems like MI, stroke, and thrombotic events that may increase with duration of use |
|
|
Term
|
Definition
| selective COX2 discontinued due to SJS, but FDA made interim recommendations for using it, but not for those ewith GI bleeds. anti-inflammatory, analgesic, antipyretic bu causes back pain, dizziness, flu-like symptoms, and overuse perpetuates episodic migraine. |
|
|
Term
| Etanercept produces antirheumatic effects by: |
|
Definition
| reducing circulating TNF-a levels |
|
|
Term
|
Definition
| NSAID of acetic acid derivative; analgesic/antipyretic; tablet topical or opthalmic forms; severe GI AEs like bleeding and ulceration) and cardiovascular thormbotic events like MI and stroke |
|
|
Term
|
Definition
| difluorophenyl dreivative of salicylic acid so not metabolized by salicylic acid, has analgesic porperties for osteoarthritis and RA; given orally with water, milk, or fod; AEs are HA, blurred vision, and rash |
|
|
Term
|
Definition
| NSAID of indole and indene acetic acid derivative for osteoarthritis, RA, acute pain (even post-op), supresses expression of adhesion molecules and induces apoptosis; causes rash, blurred vision, dysuria |
|
|
Term
|
Definition
| NSAID of propionic acid derivative used as antipyretid and analgesic for osteoarthritis and RA administered orally with water, milk, food, AEs are mild GI, dyspepsia, consitpation, and NV |
|
|
Term
|
Definition
| NSAID of the propionic acid derivative used as anti-inflammatory, analgesic and antipyretic for osteoarthritis and RA; reduces bone resporption in peridontal disleas by inhibiting carbonic anhydrase; oral or topical application to eyes; AEs are mild GI, pyspepsia, constipation and NV |
|
|
Term
|
Definition
| NSAID of porpionic acid derivative with analgesic proerties for rheumatism and arthritis; interacts with genes PTGS2 and Cyp19A1; AEs are serios GI effects and cardiovascular thrombotic events like MI and stroke |
|
|
Term
|
Definition
| NSAID of indole and indene acetic acid derivative; inhiits COX to generate ptostaglandins, inhibits motility of polymorphonuclear leukocytes; analgesi and antipyretic of osteoarthritis and RA; multi-drug resistance is limiting factor in application of drug, modulated ABCCA and PTGS1; AEs are NV, dyspepsia, pyrosis, and epigastric pain |
|
|
Term
|
Definition
| NSAID propionic acid derivative; inhibits COX 1 and 2; analgesic and antipyretic used to tx RA and osteoarthritis; interacts with gene SLC22A11; AEs dyspepsia, retinal hemorrhage, bleeding, ulceration of stomach and intestines |
|
|
Term
| Methotrexate (Methotrexate LPF, Rheumatrex) |
|
Definition
| DMARD, analog of aminopterin which is derived from folic acid. used for malignant and non-malignant conditions; tx TA and prevents graft-vs-host disease; oral and parenteral forms |
|
|
Term
| Methotrexate (Methotrexate LPF, Rheumatrex) action: |
|
Definition
| folate antimetabolite. Methotrexate competitively inhibits dihydrofolate reductase, which is the enzyme responsible for converting folic acid to reduced folate cofactors |
|
|
Term
|
Definition
| supresses hematopoiesis and causes anemia, aplastic anemia, andleukopenia |
|
|
Term
|
Definition
| cell cycle-phase nonspecific antineoplastic agent; N mustard adn member of alkylating-agent class; for tx of CLL |
|
|
Term
| Chlorambucil (Leukeran) action and AE |
|
Definition
| it substitutes alkyl groups for hydrogen ions in both DNA & protein. DNA-DNA interstrand crosslink and DNA-protein crosslink occur, leading to interference in DNA replication, transcription of RNA, and nucleic acid function; causes bone marrow suppression! |
|
|
Term
| Cyclophosphamide (Cytoxan) |
|
Definition
| is an alkylating agent & is a prodrug that requires hepatic activation to become cytotoxic. given orally or intermittent IV cyclophosphamide |
|
|
Term
| Cyclophosphamide (Cytoxan) use: |
|
Definition
| tx RA; tx standard for proliferative lupus nephritis; tx of lymphoma and leukemia; activity against neoplastic disease |
|
|
Term
| Cyclophosphamide (Cytoxan) AE: |
|
Definition
| sterility, birth defects, mutations, cancer |
|
|
Term
|
Definition
| oral and parenteral immunosuppressive agent interacts with gene ABCB1 and CYP3A4, inhibit first phase of T-cell activation but can cause nephrotoxicity |
|
|
Term
| Cyclosporine (Gengraf) use: |
|
Definition
| tx during transplantation to improve survival, tx various autoimmune conditions, IBS, RA, iveitis, psoriasis, RA |
|
|
Term
|
Definition
| immunosuppressive agent analog of endogenous purines adenine, ganine, adn hypoxanthine metabolized to 6-mercaptopurine; given orally adn IV |
|
|
Term
| Azathioprine (Azasan) use: |
|
Definition
| tx transplant patients, RA, lupus nephritis, and psoriatic arthritis. when combined with hydroxychloroquine can be used for RA; decreases metabolism of purines; causes bone marrow depression |
|
|
Term
| Mycophenolate Mofetil (CellCept) |
|
Definition
| prodrug for mycophenolic acid (MPA); immunosuppressive drug; myfortic is delayed-release tablet of it; used in conjunction with cyclosporine and corticosteroids in renal allograft and for RA and pts resistant to methotrexate |
|
|
Term
| Mycophenolate Mofetil (CellCept) action: |
|
Definition
blocks T-cell proliferation & blocks leukocyte adhesion to E-selectin, p-selectin, & ICAM.
inhibits lymphocyte purine synthesis by reversibly.
It noncompetitively inhibits inosine monophosphate dehydrogenase (IMPDH). IMPDH is an important enzyme in the de novo synthesis of purines |
|
|
Term
| Mycophenolate Mofetil (CellCept) AE |
|
Definition
gastrointestinal (GI) tract
constipation,
diarrhea, dyspepsia
nausea/vomiting |
|
|
Term
|
Definition
| synthetic antimalarial agent to tx RA,systemic lupus erythematosus, systemic therapy of amebic liver abscesses, interacts with gene TP53, may interfere with lysosomal degradation of hemoglobin. Oral and IM, causes visual impairment. |
|
|
Term
|
Definition
| synthetic antimalarial agent to tx RA,systemic lupus erythematosus, systemic therapy of amebic liver abscesses, interacts with gene TP53, may interfere with lysosomal degradation of hemoglobin. Oral and IM, causes visual impairment. |
|
|
Term
| Gold; Aurothiomalate (aurolate) and aurothioglucose |
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Definition
| DMARDs; uset for RA, juvenile RA, given with salicylates or othe rNSAIDs in initial stage, interacts iwth albumin, administered IM, causes facial flushing, diaphoresis, dizziness, N/V, hypotension, metallic taste. |
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Term
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Definition
| oral chelating agent used to tx Wilson's disease, cystinuria, resistant RA by chelating heavy metals like Cu, Fe, Pb, and Hg adn forming stable complexes that are excreted by kidneys; may cause adverse hematologic toxicity, bone marrow depression, leukopenia, thrombocytopenia, mortality |
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Term
| Sulfasalazine (Azulfidine) |
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Definition
| PRODRUG! used to treat ulcerative colitis and RA; a combination of sulfapyridine and 5-aminosalicylic acid (mesalamine). metabolized to its active components, sulfapyridine and mesalamine, by bacteria in the colon |
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Term
| Sulfasalazine (Azulfidine) action and AE: |
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Definition
| beneficial effects primarily from antiinflammatory properties; mesalamine inhibits leukotriene synthesis and arachidonic acid metabolism by inhibitng COX and reducing colonic inflammation. AE anorexia, diarrhea, GI distress |
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Term
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Definition
| adalimumab; infliximab; etanercept |
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Term
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Definition
| recombinant human IgG1 monoclonal antibody; specific for TNF-a; tx RA - reduces disease progression; SC injection; AEs are HA and rash at injection site |
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Term
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Definition
| first monoclonal antibody; chimeric IgG1k monoclonal antibody targeted against TNF-a; tx Chron's disease, RA, ankylosing spondylitis, psoriatic arthritis; combo of infliximab and methotrexate; IV admin; causes elevated hepatic enzymes |
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Term
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Definition
| dimeric fusion protein produced by recombinant DNA technology in Chinese hamster ovary cell systems; extracellular ligand-binding portion of the human 75 kD (p75) TNF-a receptor; tx RA; prevents TNF binding to receptor; SC admin; AE pain at injection and bleeding bruising at injection |
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Term
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Definition
| antiinflammatory properties; tx articular pain, treatment of acute gouty arthritis, & amyloidosis and biliary and hepatic cirrhosis; interferes with the inflammatory response to urate crystal deposition by binding to proteins in microtubules of neutrophils and inhibits migration of neutrophils inot area of inflammation; prevents release of inflammatory glycoprotein from phagocytes; causes N/V and diarrhea |
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Term
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Definition
| oral uricosuric; tx hyperuricemia assoc with gout; not effective for acute attacks of gout and can aggravate inflammation during initial stages; interferes with tubular handling of organic acids within the nephron; causes HA and N/V |
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Term
| Sulfinpyrazone (Anturane) |
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Definition
| uricosuric agent; tx chronic or intermittent gouty arthritis but LACKS analgesic or antiinflammatory effects; inhibits COX; dose should be slowly titrated to prevent kidney stones; oral and IV; may dispose urate stores and cause N/V/dairrhea |
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Term
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Definition
| structural analog of the natural purine base, hypoxanthine; prevention of gout, renal calculi due to either uric acid or calcium oxalate and in prophylaxis and tx of uric acid nephropathy; tx S/S of primary or secondary gout |
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Term
| Allopurinol (Aloprim) action and AE |
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Definition
| inhibits the enzyme xanthine oxidase, which blocks the metabolism of hypoxanthine and xanthine (oxypurines) to uric acid; interferes with catabolism of purines; oral and IV; AE hypersensitivity and should be discontinued at first sign of rash |
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Term
| types of nutritional anemia |
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Definition
| iron deficiency anemia; cobalamin deficiency; folic acid deficiency; megaloblastic anemia |
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Term
| clinical manifestations of anemia |
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Definition
| oxygen-carrying capacity of blood; whole volume of blood; rate at which reduction in oxygen-carrying capacity adn change in blood volume developed; manifestations of underlying illness causing anemia |
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Term
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Definition
| complete blood count or automated blood count; covers seven values relating to RBCs including Hb, Hct, RBC count, MCV (100 fL), MCH (29 picog/RBC), and MCHC (32-36dL) |
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Term
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Definition
| a type of macrocytic anemia caused by vitamin B12 deficiency or folate deficiency |
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Term
| Etiology of iron deficiency anemia (need more iron): |
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Definition
| physiologic stress (growth, pregnancy), pathologic causes (blood loss), inadequate iron supply (low iron consumption, impaired absorption, abnormal transferrin) |
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Term
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Definition
| inadequate erythropoiesis or hemoglobin synthesis; inadequate B12; lack of intrinsic factor; iron-deficiency; kidney failure and insufficient erythropoietin hormone; loss of blood; RBC destruction |
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Term
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Definition
| lack of intrinsic factor from glands of stomach |
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Term
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Definition
| complete cessation of RBC production from unknown causes |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| hypoxia, necrosis, low blood osmolarity (tissue edema) and low blood viscosity (heart races and pressure drops) |
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Term
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Definition
| blood cell production; stimulated by erythropoietin, thrombopoietin, and CSFs |
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Term
| formation of an erythrocyte |
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Definition
| proertythoblast to erythroblast to normoblast to reticulocyte to erythrocyte |
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Term
| nutrients needed for RBC production |
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Definition
| iron, B12, 2, 6, folic acid, niacin, VitC, A, E, Copper, Cobalt, AAs, calories, proteins |
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Term
| how to treat iron deficiency anemia |
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Definition
| oral iron replacement (ferrous sulfate) or parenteral (iron dextran, Iron gluconate) |
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Term
| complications of parenteral tx for iron deficient anemia |
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Definition
| allergic reactions and anaphylaxis limit tx to specific health conditions like inability to absorb iron from GI tract or inability to tolerate oral iron |
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Term
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Definition
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Term
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Definition
| active forms of folic acid are derived from this. acts as methyl donor for purine and pyrimidine synthesis; converts deoxyuridine monophosphate to deoxythymidine monophosphate for DNA synth. |
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Term
| causes of cobalamin deficiency |
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Definition
| nutritional; abnormal intragastric events; deficient or defective IF; abnormal events in small bowel; disordered mucosa |
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Term
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Definition
| goal is to replenish total body stores by administering cyanocobalamin IM or oral use of pancreatic extract |
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Term
| monitoring tx of anemia is done by: |
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Definition
| reversion of megaloblastic hematopoiesis to normal hematopoiesis; reticulocyte counts; methylmalonic acid and homocysteine levels return to normal; RBC count, hemoglobin and hematocrit |
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Term
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Definition
|
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Term
| from the small intestine, folic acid goes: |
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Definition
| to the serum where it is free or loosely and nonspecifically bound to serum proteins |
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Term
| in tissues other than the liver, folic acid: |
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Definition
| enters and remains within cell through its lifespan |
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Term
| stored folic acid in liver: |
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Definition
| can be released into biliary circulation |
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Term
| biliary drainage does what to serum folate levels? |
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Definition
| dramatically decreases serum folate levels |
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Term
| causes of folic acid deficiency: |
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Definition
| inadequate intake; increased requirements due to pregnancy, lactation, psoriasis, hemolysis; intestinal malabsorption; drug interactions; defective cellular uptake |
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Term
| causes of intestinal malabsorption of folic acid: |
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Definition
| spure, drugs like methotrexate or phenytoin, chron's disease, HIV-related enteropathy |
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Term
| Drugs causing folic acid deficiency |
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Definition
| methotrexate, phenytoin, ethanol, sulfa drugs, barbiturates |
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Term
| folic acid deficiency is determined by: |
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Definition
| low serum folic acid level; measurement of RBC folic acid; serum homocysteine and methylmalonic acid levels. TOtal serum homocysteine level is elevated in deficient patients, but methylmalonic acid levels are normal in patients with folic acid deficiencies |
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Term
| tx of folic acid deficiency is done by: |
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Definition
| oral folic acid 1-5 mg/day even when intestinal malabsorption of food folate exists |
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Term
| prophylactic folic acid should be given to: |
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Definition
| women contemplating pregnancy, pregnant or lactating women, patients with chronic hemolysis and increased erythropoiesis |
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Term
| folic acid supplements decrease: |
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Definition
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Term
| hematopoietic growth factors |
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Definition
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Term
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Definition
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Term
| recombinant myeloid growth factors |
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Definition
| Filgrastim (neupogen), sargramostim (leukine), pegfilgrastim (neulasta) |
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Term
| megakaryocyte growth factors |
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Definition
| thrombopoietin and interleukin-11; recombinant IL-11 is Oprelvekin (Neumega) |
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Term
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Definition
| post-chemo, post-radiotherapy, alastic anemia, thromboctopenia purpura, prenatal thormbocytopenia, and more! |
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