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1. Drugs for Treating Anemia a. Describe/Diagram the sites of action of the hematopoietic growth
factors in the differentiation and maturation of marrow cell lines. b. Describe the approved therapeutic indications and
pharmacokinetics for recombinant erythropoietin and darbepoetin. c. Describe the possible etiologies, which should be considered if a
delayed or diminished response to doses of recombinant erythropoietin
within the recommended dose range occurs. d. Analyze the
pharmacokinetics and therapeutic effects of darbepoetin alpha (novel
erythropoiesis stimulating protein, NESP) and epoetin alpha
(erythropoietin) in anemic dialysis patients. e. Relate factors that can lead to abnormal iron balance including genetic hemochromatosis to the iron absorption and transport pathways and the f. State the criteria used for the diagnosis of iron deficiency anemia and criteria for oral therapy versus parenteral iron therapy. What are the associated side effects and the predicted rates of response to the two therapies? g. Summarize the risks of acute iron poisoning in children and its
treatment. h. Describe the pharmacologic management of chronic iron overload
disease (e.g. secondary to chronic blood transfusion, iron absorption
disturbances, etc.). i. Describe the sources, transport, metabolism, storage, and
excretion of vitamin B-12 and folic acid. State the factors, which
influence the bioavailability of vitamin B-12 and folic acid. j. Describe the biochemical systems, which are impaired in B-12 and
folic acid deficiency, and the role of cyanocobalamin and folic acid in
correcting the metabolic defect in DNA thymine and methionine synthesis. k. Explain the appropriate management of the patient with a
megaloblastic anemia in regards to both acute and chronic management,
vitamin dosage and expected response. l. Compare the possible metabolic reasons why folic acid will
correct the erythropoietic lesion but not the neurologic lesion in
Addisonian pernicious anemia. m. What is the rationale for the use of folic acid in elevated serum
levels of homocysteine and in spina bifida? n.
Know the advantages and disadvantages
of pegfilgrastim vs. G-CSF (filgrastim) in the management of
neutropenia. 2. Anticoagulant, Antithrombotic and Thrombolytic
Drugs a. Identify the sites of action of anticoagulant,
antithrombotic and thrombolytic drugs in the coagulation process. b. Contrast
the effects and time course of acetylsalicylic acid, standard nonsteroidal anti-inflammatory
agents (NSAIDs) and cyclooxygenase 2 (COX2) inhibitors on platelet
function. c. Compare
differences and similarities in mechanism of action, pharmacokinetics,
adverse effects and appropriate clinical indications for antiplatelet
agents: e.g. acetylsalicylic
acid, dipyridamole, ticlopidine, clopidogrel, abciximab. d. Explain the role of the platelet glycoprotein IIb/ IIIa inhibitors in
the management of coronary disease. e. Describe the mechanism of action and
pharmacokinetics of the following antithrombin agents: heparin, low
molecular weight heparin, lepirudin, danaparoid. f.
Describe the
complications associated with heparin therapy, e.g. excessive bleeding and
heparin induced thrombocytopenia with associated thrombosis, and the
management of heparin toxicity including protamine to reverse the effects
of heparin and hirudin. g. Contrast the management of heparin therapy using
standard versus low molecular weight heparin preparations. h. Among the antithrombin agents, know how
argatroban and fondaparinux, are used clinically for anticoagulation in
patients with heparin-induced thrombocytopenia. i.
Describe the effect
of Vitamin K on the coagulation factors (II, VII, IX and X) and Proteins C
and S. j.
Discuss the onset
of action and duration of action of warfarin effect in relationship to
half-life of clotting factors and their production in the human. k. Discuss the consequences of warfarin inhibition
of Vitamin K dependent clotting factors and the procoagulant effects in the
presence of protein C or Protein S deficiencies. l.
Relate how the
monitoring of warfarin therapy using PT, INR and the indications for
measuring warfarin levels is affected by the pharmacokinetics of warfarin
(absorption, distribution, metabolism and excretion). m. Discuss adverse effects, contraindications and
toxicities of warfarin, including embryo and fetal toxicities. n. Discuss drug-drug, drug-food, and drug-disease
interactions with warfarin. o. Discuss clinical uses and goals of warfarin
therapy including its use in venous thromboembolic diseases, atrial
fibrillation, myocardial infarction, and strokes. p. Discuss
the approach to the management of the patient on short term and long term
oral anticoagulation. q. Relate the major adverse effect of thrombolytic
drugs to their mechanism of action. r.
Describe the pharmacokinetics of the
thrombolytic agents and their use in thrombolytic therapy. s. Consider the problems associated with
thrombolytic therapy e.g. streptokinase in primary post MI. t.
Identify the major
indications for and contraindications to thrombolytic drug therapy. u. Discuss epsilon-aminocaproic acid (EACA), a
fibrinolytic inhibitor, which is used routinely along with desmopressin and
factor replacement in dental procedures in patients with hemophilia and von
Willebrand’s disease and for non-dental bleeding episodes in both diseases. |
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