6. Anti-Hemostatic Agents Flashcards
Venous thrombosis is commonly triggered by blood stasis or inappropriate activation of the ______.
coagulation cascade
Arterial thrombosis usuallu consists of a ______ clot.
platelet-rich
What are the anti-hemostatic agent drug classes?
- Anticoagulents
2. Platelet inhibitors
The coagulation process culminates in the generation of _______ which stimulates conversion of ______ to the glycoprotein fibrin
thrombin, fibrinogen
T/F The cascade of anticoagulent therapy consists of three interrelated pathways
False, two
In anticoagulent therapy, drugs that are acting within the ________ pathway (which is most important in vivo) affect the synthesis of ________.
extrinsic, vitamin k-dependent coagulation factors
in anticoagulent therapy, drugs that are acting within the ______ pathway inhibit the activity of _______.
intrinsic, coagulation factors
What are the anticoagulent drug classes?
Vitamin K “Antagonists”
Coagulation Factor Antagonists
An example of Vitamin K Antagonist?
Coumadin [Warfarin]
What is the mechanism of Coumadin?
Inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)
What are the drug interactions of Azole antifungals, Macrolides, Fluoroquinolones and Tetracyclines in the presence of Coumadin?
Impaired metabolism
What are the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids in the presence of Coumadin?
Additive
T/F Coumadin is contraindicated in recent ocular surgery, HTN and DM.
True
What is Coagulation Factor Antagonists?
It’s under the class of anticoagulent drugs of anti-hemostatic therapies.
What are the Coagulation Factor Antagonists?
- Enoxaparin [Lovenox®, Xaparin®, Clexane®] “MOST COMMON”
2. Rivaroxaban [Xarelto®]
What is the indication for Enoxaparin (Coagulation Factor Antagonists)?
Post-op DVT prophylaxis, Unstable Angina.
What is the mechanism of action of Enoxaparin?
Binds to Antithrombin-III and accelerates its activity, inhibiting thrombin and Factor-Xa
What are the common adverse effects of Enoxaparin?
hemorrhage and fever
What is the more serious adverse effects of Enoxaparin?
Anemia
What is the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids with Enoxaparin?
Additive
What should you be cautious about when taking Enoxaparin?
- Recent ocular surgery
- Diabetic retinopathy
- Hypertension
- Diabetes
What are the platelet inhibitor drug classes?
- Adenosine Receptor Blockers
2. Glycoprotein 2b/3a Receptor antagonists
What are the Adenosine Receptor Blockers?
- Clopidogrel [Plavix®] “MOST COMMON”
- Ticlopidine [Ticlid®]
- Prasugrel [Effient®]
- Dipyridamole [Persantine®]
What is the indication for Clopidogrel (Adenosine Receptor Blockers)?
Acute Coronary Syndrome and Thrombotic Event Prophylaxis
What is the mechanism of action of Clopidogrel?
- Prodrug: metabolized to active metabolite by the CYP450 enzyme CYP2C19*
- Irreversible inhibition of platelet ADP receptors which normally trigger platelet activation and aggregation via downstream activation of the GPIIb/IIIa complex
What are the common adverse effects of Clopidogrel?
Hemorrhage, pruritus cough, bronchitis, dizziness and headache
What are the serious adverse effects of Clopidogrel?
- Hypersensitivty: Angioedema, steven johnson syndrome and Toxic epidermal necrolysis (TEN)
- Hematology: thrombotic thrombocytopenic purpura (TTP)
What is the drug interactions of Evening Primrose Oil (omega 6), Flaxseed (omega 3), Omega-3 FA, NSAIDs with Clopidogrel?
Additive
What is the drug interactions of Ketoconazole in the presence of Clopidogrel?
Reduced metabolism/activation
What should you be cautious about when taking Clopidogrel?
Ocular disease
What are the different Glycoprotein IIb/IIIa Receptor Antagonists drugs?
- Abciximab [Reopro] “MOST COMMON”
2. Eptifibatide [Integrilin]
What is the indication for Abciximab?
- An adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications
- Unstable angina
What is the dosing for Abciximab?
IV bolus
What is the mechanism of action of Abciximab?
Fab fragment: a chimeric human-murine mAB
Binds to the GP IIb/IIIa receptor of human platelets and inhibits platelet aggregation
Binds to the vitronectin (αvβ3) receptor on platelets and vessel wall endothelial and smooth muscle cells
What are the common adverse effects of Abciximab?
hemorrhage, hypotention, dizziness and headache
What are the drug interactions of Omega-3 & Omega-6 fatty acids, NSAIDs and opthalmic NSAIDs with Abciximab?
Additive
What are the contraindications of Abciximab?
Recent surgery or trauma and uncontrolled hypertension
