Term
| Define which events occur during primary vs secondary hemostasis? |
|
Definition
Primary: Platelet adhesion with hemostatic plug
Secondary: Coagulation cascade; activation of thrombin and formation of permanent plug |
|
|
Term
| What clotting factors are synthesized by the liver and require vitamin K for synthesis? |
|
Definition
|
|
Term
| This drug blocks production of active Vitamin K and interferes with the synthesis of four clotting factors to produce an anticoagulant effect? |
|
Definition
|
|
Term
| Clots or ____ maybe break off, forming ___ that lodge in smaller vessels of major organs? |
|
Definition
|
|
Term
| What is the primary risk of overdosing an anticoagulant? Under-dosing? |
|
Definition
Hemmorrhage - OD
Embolism - UD |
|
|
Term
| These three drugs affect platelets? |
|
Definition
Aspirin
Plavix (clopidogrel)
Effient (prasugrel) |
|
|
Term
| T/F. Coumadin, Heparin, and Lovenox affect platelets? |
|
Definition
False.
Coumadin
Heparin
Lovenox (enoxaparin)
Pradaxa (dabigatran)
Xarelto (rivaroxaban)
Eliquis (apixaban)
Lixiana (edoxaban)
all affect clotting cascade |
|
|
Term
| The suffix -aban is associated with which drugs? |
|
Definition
| Anti-Coagulants (Clotting cascade) |
|
|
Term
| Two activators (targets) of platelet activation? |
|
Definition
|
|
Term
| Aspirin inhibits the formation of what platelet activator through the inhibition of COX 1? |
|
Definition
|
|
Term
| Acetylsalicylic acid MOA? |
|
Definition
| Non-competitive (irreversible) and non-selective inhibitor of Cox 1 and Cox 2 enzymes |
|
|
Term
| How long does it take to recover following discontinuation of aspirin (range)? |
|
Definition
|
|
Term
| ___ is used for pain, fever, inflammation and anti-platelet, typically combined with Plavix? |
|
Definition
|
|
Term
| Aspirin adverse effects primarily effect which body system? |
|
Definition
| Gastrointestinal (Bleeding and Ulcers) |
|
|
Term
| This drug is contraindicated in patients with Asthma, GERD, Kidney disease, Gout, Pregnancy or Reyes? |
|
Definition
|
|
Term
| 81 mg daily dose of Aspirin is most likely for _____, while 325 mg a day is indicated for ____? |
|
Definition
81 mg help prevent stroke, TIA, MI, and angina reoccurrence.
325 mg daily is suggested for anticoagulation therapy. |
|
|
Term
| T/F. The American Heart Association recommends that all seniors over 62 take aspirin to help prevent a stroke or MI? |
|
Definition
| False, only whens theres evidence of heart disease. |
|
|
Term
| T/F. Aspirin and Plavix are non-competitive and irreversible? |
|
Definition
True.
Aspirin inhibits COX 1,2
Plavix is a P2Y12 antagonist |
|
|
Term
| Plavix prevents the binding of _____ to platelets? |
|
Definition
|
|
Term
| T/F. Plavix is a prodrug that not everyone can metabolize? |
|
Definition
| True. 2-14% can't metabolize. |
|
|
Term
| T/F. Inhibition of platelet aggregation last the lifetime of the platelet in a patient taking plavix? |
|
Definition
| True. Its irreversible platelet inhibitor |
|
|
Term
|
Definition
|
|
Term
| T/F. Aspirin will have a lifelong affect on the platelets? |
|
Definition
| False. Aspirin effects only last 4-10 days? |
|
|
Term
| Adverse effects of Plavix? |
|
Definition
|
|
Term
| Key drug interactions of Plavix (clopidogrel) include (3)? |
|
Definition
Azole antifungals
Proton pump inhibitors (Prolosec and Nexium)
NSAIDs |
|
|
Term
| Why MIGHT NSAIDs be contraindicated for patients taking Plavix? |
|
Definition
| They inhibit COX and production of TXA2 leading to potential synergistic anticoagulant effect. |
|
|
Term
| T/F? Effient (prasugrel) and Plavix have the same MOA? |
|
Definition
|
|
Term
| Effient (prasugrel) is ____ potent than Plavix, and has _____ interactions with proton pumps than Plavix? |
|
Definition
|
|
Term
| T/F. If possible elective dental procedures should be deferred until the patient has completed Plavix therapy? |
|
Definition
True
12 months after Drug Eluting Stents
1 month for bare-metal stent implantation |
|
|
Term
| The ADA recommends that patients undergoing necessary dental procedures continue their anti-platelet and/or anti-coagulant therapy due to the risk of dangerous coagulopathies? |
|
Definition
|
|
Term
| Persantine (dipyridamole) is ______ inhibitor and ___ receptor antagonist? |
|
Definition
|
|
Term
| Patients with prosthetic heart valve replacement maybe be on a combination of Coumadin (warfarin) and _____ for anticoagulation therapy? |
|
Definition
| Persantine (dipyridamole) |
|
|
Term
| Aggrenox is a combination of _____ with _______? |
|
Definition
Aspirin
Persantine (diphyridamole) |
|
|
Term
| 3 key drug interactions of Persantine (dipyridamole)? |
|
Definition
ADP antagonists
NSAIDs
Antacids/Proton pump inhibitors (reduce absorption of dipyridamole) |
|
|
Term
| Contraindications for Persantine (dipyridamole) a PDE inhibitor and ADP receptor antagonist? |
|
Definition
|
|
Term
| Coumadin (warfarin) blocks activation of Vitamin ____? |
|
Definition
|
|
Term
| This drugs inhibits vitamin-K epoxide reductase and should not be taken with green leafy vegetable shakes made of Kale, collards, spinach, turnip greens, mustard greens, brussel sprouts, or broccoli. |
|
Definition
|
|
Term
What is the half life of coumadin?
What is the duration of action? |
|
Definition
|
|
Term
| What are the 21 Warfarin Drug Interactions? |
|
Definition
jk. How could you possibly learn these.
Fibrates*
Fluvastatin
Ibuprofen
Indomethacin
Ketoprofen
Metronidazole
Miconazole
Neomycin
Salicylates
Sulfonamides**
Acetaminophen
Aspirin***
Azithromycin**
Cefixime**
Chloral Hydrate
Bactrim**
Dolobid (diflunisal) (NSAID)
Erythromycin**
Fluoroquinolones**
Tetracyclines**
Statins* |
|
|
Term
| T/F. In patients taking Coumadin, risk of life threatening bleeding is less than risk of a thrombotic event? |
|
Definition
|
|
Term
| What is the MOA of Heparin? |
|
Definition
| Covalently binds to anti-thrombin III and prevents its from activating other clotting factors. |
|
|
Term
| Heparin is a natural substance found in _____ cells ? |
|
Definition
|
|
Term
| Antihistamines may _____ effects of Heparin? |
|
Definition
|
|
Term
| Heparin prevents/blocks which factors of the coagulation cascade? |
|
Definition
| Thrombin and Activated factor X |
|
|
Term
| Heparin can induce what platelet disorder? |
|
Definition
|
|
Term
| Lovenox (enoxaparin) is used to bridge into _____ medication? |
|
Definition
|
|
Term
| What is Lovenox (enoxaparin)? |
|
Definition
Low molecular weight heparin.
Has longer half life and is given 1-2 times a day to bridge into coumadin therapy. |
|
|
Term
| Prothrombin is cleaved to thrombin by what two factors? |
|
Definition
|
|
Term
| Thrombin activates what 5 factors? |
|
Definition
V, VII, VIII, XI, and XIII.
13 polymerizes fibrin after being cleaved by fibrinogen |
|
|
Term
| What is the MOA of pradaxa (dabigatran)? |
|
Definition
|
|
Term
| What is the half life of Pradaxa (dabigatran) vs Wafarin? |
|
Definition
|
|
Term
| Three drugs increase metabolism of Pradaxa (dabigatran) by increasing the metabolism of the drug. |
|
Definition
| Rifampicin, Tegretol, Dilantin (phenytoin) and St. Johns wort. |
|
|
Term
| These drugs inhibit metabolism and increase blood levels of Pradaxa? |
|
Definition
| Ketoconazole, itraconazole, prograf, and cyclosporin A |
|
|
Term
| T/F. INR monitoring is not needed for Pradaxa users? |
|
Definition
|
|
Term
| What is the MOA of Xarelto (rivaroxaban) and Eliquis (apixaban)? |
|
Definition
| Direct Factor Xa Inhibitor |
|
|
Term
| Xarelto and Eliquis have what drug interactions that inhibit the metabolism of the drug increasing blood levels? |
|
Definition
| Ketoconazole, itraconazole, clarithromycin, and Norvir |
|
|
Term
| T/F. Xarelto and Eliquis need INR monitoring? |
|
Definition
|
|
Term
| What medications don't have an antidote available? |
|
Definition
Xarelto (Factor Xa inactivator)
Eliquis (Factor Xa inactivator)
Pradaxa (Thrombin inhibitor) |
|
|
Term
| Statins generally inhibit what enzyme? |
|
Definition
|
|
Term
|
Definition
| Competitive HMG-CoA reductase inhibitor |
|
|
Term
| Pharmcological effect of Zocor (simvastatin)? |
|
Definition
| Stimulated increased expression of hepatic LDL receptors to lower blood cholesterol |
|
|
Term
| GI complaints, myositis (muscle inflammation), myalgia (muscle pain) Rhabdomyolysis (Muscle breakdown are adverse effects of ____? |
|
Definition
|
|
Term
| Key drug interactions of Zocor (simvastatin)? |
|
Definition
Grapefruit juice
Clarithromycin
Ketoconzaole
HIV protease inhibitors
All decrease metabolism |
|
|
Term
| T/F. Zocor (simvastatin) is contraindicated in pregnant women? |
|
Definition
|
|
Term
| The suffix -_______ are all HMG-CoA reductase inhibitors? |
|
Definition
|
|
Term
|
Definition
| Blocks intestinal cholesterol transpoter NPC1l1. |
|
|
Term
| T/F Zetia (ezetimibe) an intestinal cholesterol transporter reduces plasma LDL? |
|
Definition
| True. Less cholesterol available, more LDL receptors made, reducing LDL in blood, heads to liver (this MOA is a guess) |
|
|
Term
| Zetia (ezetimibe) is typically a first line therapy to lower cholesterol? |
|
Definition
| False. 2nd line for statin-unresponsive individuals |
|
|
Term
| Adverse effects of Zetia (ezetimibe)? |
|
Definition
Headache
Fatigue
Diarrhea
Myalgia
Rhabdomyolysis |
|
|
Term
| Fibrates interact with which two hypercholeterolemia medications? |
|
Definition
Cholesterol Absorption inhibitors
HMG-CoA reductase |
|
|
Term
| There is currently no clear advantage for _____ a combination statin/exetimibe? |
|
Definition
|
|
Term
| Lopid (gemfibrozil) and TriCor (fenofibrate) are PPARa ______ that increase the muscle expression of lipoprotein pipe to help breakdown TG? |
|
Definition
|
|
Term
| Lopid (gemfibrozil) and TriCor (fenofibrate) increase which lipoprotein? |
|
Definition
|
|
Term
| Lopid (gemfibrozil) and TriCor (fenofibrate) lower cholesterol or triglycerides? |
|
Definition
|
|
Term
| Taste perversion and Hyperglycemia are two adverse effects of ? |
|
Definition
| Lopid (gemfibrozil) and TriCor (fenofibrate) (Fribric Acid Derivatives) |
|
|
Term
| Contraindication of Lopid (gemfibrozil) and TriCor (fenofibrate) include? |
|
Definition
Pregnancy
Active liver disease |
|
|
Term
| All cholesterol medicines have what potential adverse effect? |
|
Definition
|
|
Term
| Niacin lowers release of ____ and ___ but reducing lipase activity in adipocytes? |
|
Definition
Free fatty acids
Triglycerides |
|
|
Term
| Adverse effects of of Niacin? |
|
Definition
Flushing, itching
Hyperuricemia
Cholestasis
Possible acute hypotension |
|
|
Term
| Three contraindications for Niacin (Vitamin B3)? |
|
Definition
Peptic ulcers
Gout
Active liver disease |
|
|
Term
| Bile acid binding resin _______ sequester bile acids and are subsequently eliminated in feces? |
|
Definition
|
|
Term
| Cholestyramine is used to treat _____ ? |
|
Definition
|
|
Term
| Potential tooth discoloration and enamel erosion are seen in patients taking ____? |
|
Definition
| Cholestyramine (bile acid binding resins) |
|
|
Term
| This drug interferes with the adoration of fat-soluble vitamins and many different drugs in general because of its MOA? |
|
Definition
|
|
Term
| Lovaza and Epanova are ____, that have potential mechanism of ____? |
|
Definition
Omega 3 Acids Ethyl Esters
Inhibit acyl-CoaA:1,2-diacylglycerol acyltransferase |
|
|
Term
| Pharmocological effect of Lovaza and Epanova? |
|
Definition
Increased Peroxisomal oxidation in the liver.
Decrease lipogenesis in the liver
Increase plasma lipoprotein lipase activity |
|
|
Term
| Lovaza or Epanova has an increased bioavailability? |
|
Definition
|
|
Term
| Production of ___ and vasoactive ____ are characteristics of acute inflammation? |
|
Definition
Eicosanoids
Vasoactive amines |
|
|
Term
| ___ can be due to dysfunctional regulation or persistent infection and can cause seizure, shock, and tissue damage? |
|
Definition
|
|
Term
| Mediators of inflammation Histamine and Nitric Oxide function to ___? |
|
Definition
| Dilate Vessels increasing vascular permeability |
|
|
Term
| Prostaglandin in inflammation function to _____? |
|
Definition
increase pain sensitivity
Vasodilate to increase permeability |
|
|
Term
| This is the key inflammatory response trigger? |
|
Definition
|
|
Term
| ____ are involved in bronchoconstriction, vascular permeability, and mucosal edema mediators of inflammation? |
|
Definition
|
|
Term
| A prostaglandin _____ is involved with inflammation in mediating pain, vasodilation, pain, and bronchoconstriction? |
|
Definition
|
|
Term
| Hypothalamus secretes ____ in response to stress? |
|
Definition
| Corticotropin releasing hormone |
|
|
Term
| In response to CRH the pituitary gland synthesizes ____ which signals the adrenal gland to make cortisol? |
|
Definition
|
|
Term
| T/F. Cortisone is an inactive metabolite? |
|
Definition
|
|
Term
| What enzyme converts cortisone to hydrocortisone? |
|
Definition
| 11-beta hydroxysteroid dehydrogenase |
|
|
Term
| Cortisol endures cells passively and regulate gene expression via intracellular receptors by affecting histones. Fact. |
|
Definition
|
|
Term
| ____ regulates which genes are available for transcription? |
|
Definition
|
|
Term
| ____ rewinds DNA making it inaccessible to RNA polymerase? |
|
Definition
|
|
Term
| Cortisol receptors _____ pro inflammatory gene histones, and ____ anti-inflammatory gene histones? |
|
Definition
|
|
Term
| Glucocorticoids affect histones, but unrelated also inhibit what enzyme? |
|
Definition
Phospholipase A2.
Responsbile for production of prostaglnadins and leukotrienes. |
|
|
Term
| Fact. Glucocorticoids are the most potent and effective anti inflammatory medications currently available. |
|
Definition
|
|
Term
| What the major adverse effect of long term steroid use? |
|
Definition
| Shut down immune response. |
|
|
Term
| ____ is the drug primarily used for chronic inflammatory and autoimmune disease? |
|
Definition
|
|
Term
| T/F. Glucocorticoid steroids do not have any curative properties? |
|
Definition
| True. They only decrease signs and symptoms of disease, like inflammation and pain |
|
|
Term
| T/F. Fluticasone is used for asthma and allergic rhinitis? |
|
Definition
|
|
Term
| What is the oral dosage form of corticosteroid? |
|
Definition
|
|
Term
| Diprolene (betamethasone) is a corticosteroid in what form? |
|
Definition
|
|
Term
| There are multiple groups of topical steroids depending on their potency. Group ____ is the most potent and group ____ is the weakest? |
|
Definition
|
|
Term
| T/F. Prednisone is a pro-drug? |
|
Definition
| True, it is metabolized to methylprednisolone |
|
|
Term
| Prednisone is given orally or by injection as what derivative? |
|
Definition
|
|
Term
| Medrol dose pak is a tapered dose of ____ over time, to slowly wean off steroids? |
|
Definition
|
|
Term
Joint pain
Muscle pain
Fatigue
Fever
Nausea and vomiting
Decreased appetite
Weight loss
Withdrawl effects of ___? |
|
Definition
|
|
Term
| The most important adverse effect of corticosteriods? |
|
Definition
| Compromised immunity to opportunistic infections |
|
|
Term
| Pharmacologic immunoosuppression may increase susceptibility to infection and/or ____? |
|
Definition
|
|
Term
| Leucovorin (methotrexate) MOA? |
|
Definition
| Inhibits dihydrofolate reductase |
|
|
Term
| Pharmocological effect of Leucovorin (methotrexate)? |
|
Definition
| Inhibits DNA, RNA, and protein synthesis, by inhibiting tetrahydrofolate production |
|
|
Term
| _____ leads to apoptosis of CD4 and CD8 T cells? |
|
Definition
| Leucovorin (methotrexate) |
|
|
Term
| Leucovorin (methotrexate) is primarily used to treat _____ disease? |
|
Definition
| autoimmune (Rheumatoid arthritis, psoriasis, graft vs host, severe asthma) |
|
|
Term
| What type of vaccines might be contraindicated for Leucovorin (methotrexate)? |
|
Definition
| Live vaccines - it decreases immunity! |
|
|
Term
| Leucovorin (methotrexate) decreases white blood cell response therefore an adverse effect may be ? |
|
Definition
| leukopenia and infection risk |
|
|
Term
| What effect does NSAIDS and probenacid have on Leucovorin (methotrexate)? |
|
Definition
| inhibits renal elimination |
|
|
Term
| What is the effect of penicillin on Leucovorin (methotrexate)? |
|
Definition
|
|
Term
| What effect do tetracyclines have on Leucovorin (methotrexate)? |
|
Definition
| Inhibits binding to plasma protein, increasing blood levels, elevating pharmacological effects. |
|
|
Term
| CellCept (mycophenolate mofetil) inhibits what enzyme? |
|
Definition
| Inosine monophosphate dehydrogenase |
|
|
Term
| Prograf (tacrolimus) is a ____ that key target is to inhibit the synthesis of _____ by activated T cells? |
|
Definition
|
|
Term
| Prograf (tacrolimus) prevents dephosphorylation of _____ by deactivating _____ ? |
|
Definition
Nuclear Factor of Activated T-Cells (NFAT)
Calcineurin |
|
|
Term
| Xeljanz (tofacitinib) is a _____ inhibitor used for _____? |
|
Definition
JAK-STAT
Rheumatoid Arthritis |
|
|
Term
| Which Histamine receptors are responsible for inflammation? |
|
Definition
|
|
Term
| Anti-histamines for H1 receptors are ____, while H2 receptors medications antagonize _______? |
|
Definition
Inverse agonist
Competitive |
|
|
Term
| Medications like Benadryl, phenergan, and Claritin have anti---______ effects like dry mouth, constipation, blurred vision? |
|
Definition
|
|
Term
| Allegra (fexofenadine) is a ___ generation H1 anti-histamine, while Benedryl (diphenhydramine) is a ____ generation? |
|
Definition
|
|
Term
| Colycrys (colchincine) inhibits activation of _____, and can therefore lead to ____? |
|
Definition
|
|
Term
| Zyloprim (allopurinol) is a non-competitive inhibitor of ______ oxidase and decreases biosynthesis of ____? |
|
Definition
|
|
Term
| Zyloprim (allopurinol) is contraindicated in patients also taking ___? |
|
Definition
|
|
Term
| Probenecid targets what part of the rebel tubule to block reabsorption of urate? |
|
Definition
|
|
Term
| Probenecid inhibits the elimination of what three medications? |
|
Definition
| Methotrexate, acetaminophen and naproxen |
|
|
Term
| Enbrel (Etanercept) is a _____ against _____, to alleviate this diease? |
|
Definition
Monoclonal antibody
TNF
Rheumatoid Arthritis |
|
|
Term
| Infliximab (Remicade) is a monoclonal antibody to the TNF alpha receptor as is Adalimumab (humira)? T/F? |
|
Definition
|
|
Term
| Rheumatoid arthritis medicines shute down the bodes ability to fight off? |
|
Definition
|
|
Term
| CNS demyelination, sepsis and increased risk of TB are associated with which medications? |
|
Definition
Rheumatoid Arthritis
Enbrel
Remicade
Humira |
|
|
Term
| Rheumatoid Arthritis maybe linked to what disease process? |
|
Definition
Periodontitis
PAD is required to make citrullinated proteins.
Antibodies are found in RA patients to these proteins.
P gingivalis is the only bacteria to have PAD. |
|
|
Term
| What two GI inflammatory disease might Enbrel or Humira treat? |
|
Definition
Crohns
Ulcerative Colitis |
|
|
Term
| Ambien and lunesta agonize what receptors? |
|
Definition
|
|
Term
| Never take Ambien or Lunesta with? |
|
Definition
|
|
