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Systemic Pharmacology_Dr. McNaughton > 6. Anti-Hemostatic Agents > Flashcards

6. Anti-Hemostatic Agents Flashcards

1
Q

Venous thrombosis is commonly triggered by blood stasis or inappropriate activation of the ______.

A

coagulation cascade

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2
Q

Arterial thrombosis usuallu consists of a ______ clot.

A

platelet-rich

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3
Q

What are the anti-hemostatic agent drug classes?

A
  1. Anticoagulents

2. Platelet inhibitors

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4
Q

The coagulation process culminates in the generation of _______ which stimulates conversion of ______ to the glycoprotein fibrin

A

thrombin, fibrinogen

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5
Q

T/F The cascade of anticoagulent therapy consists of three interrelated pathways

A

False, two

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6
Q

In anticoagulent therapy, drugs that are acting within the ________ pathway (which is most important in vivo) affect the synthesis of ________.

A

extrinsic, vitamin k-dependent coagulation factors

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7
Q

in anticoagulent therapy, drugs that are acting within the ______ pathway inhibit the activity of _______.

A

intrinsic, coagulation factors

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8
Q

What are the anticoagulent drug classes?

A

Vitamin K “Antagonists”

Coagulation Factor Antagonists

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9
Q

An example of Vitamin K Antagonist?

A

Coumadin [Warfarin]

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10
Q

What is the mechanism of Coumadin?

A

Inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, proteins C and S)

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11
Q

What are the drug interactions of Azole antifungals, Macrolides, Fluoroquinolones and Tetracyclines in the presence of Coumadin?

A

Impaired metabolism

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12
Q

What are the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids in the presence of Coumadin?

A

Additive

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13
Q

T/F Coumadin is contraindicated in recent ocular surgery, HTN and DM.

A

True

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14
Q

What is Coagulation Factor Antagonists?

A

It’s under the class of anticoagulent drugs of anti-hemostatic therapies.

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15
Q

What are the Coagulation Factor Antagonists?

A
  1. Enoxaparin [Lovenox®, Xaparin®, Clexane®] “MOST COMMON”

2. Rivaroxaban [Xarelto®]

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16
Q

What is the indication for Enoxaparin (Coagulation Factor Antagonists)?

A

Post-op DVT prophylaxis, Unstable Angina.

17
Q

What is the mechanism of action of Enoxaparin?

A

Binds to Antithrombin-III and accelerates its activity, inhibiting thrombin and Factor-Xa

18
Q

What are the common adverse effects of Enoxaparin?

A

hemorrhage and fever

19
Q

What is the more serious adverse effects of Enoxaparin?

A

Anemia

20
Q

What is the drug interactions of NSAIDs, Omega-3 & Omega-6 fatty acids with Enoxaparin?

A

Additive

21
Q

What should you be cautious about when taking Enoxaparin?

A
  1. Recent ocular surgery
  2. Diabetic retinopathy
  3. Hypertension
  4. Diabetes
22
Q

What are the platelet inhibitor drug classes?

A
  1. Adenosine Receptor Blockers

2. Glycoprotein 2b/3a Receptor antagonists

23
Q

What are the Adenosine Receptor Blockers?

A
  1. Clopidogrel [Plavix®] “MOST COMMON”
  2. Ticlopidine [Ticlid®]
  3. Prasugrel [Effient®]
  4. Dipyridamole [Persantine®]
24
Q

What is the indication for Clopidogrel (Adenosine Receptor Blockers)?

A

Acute Coronary Syndrome and Thrombotic Event Prophylaxis

25
Q

What is the mechanism of action of Clopidogrel?

A
  • 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
26
Q

What are the common adverse effects of Clopidogrel?

A

Hemorrhage, pruritus cough, bronchitis, dizziness and headache

27
Q

What are the serious adverse effects of Clopidogrel?

A
  1. Hypersensitivty: Angioedema, steven johnson syndrome and Toxic epidermal necrolysis (TEN)
  2. Hematology: thrombotic thrombocytopenic purpura (TTP)
28
Q

What is the drug interactions of Evening Primrose Oil (omega 6), Flaxseed (omega 3), Omega-3 FA, NSAIDs with Clopidogrel?

A

Additive

29
Q

What is the drug interactions of Ketoconazole in the presence of Clopidogrel?

A

Reduced metabolism/activation

30
Q

What should you be cautious about when taking Clopidogrel?

A

Ocular disease

31
Q

What are the different Glycoprotein IIb/IIIa Receptor Antagonists drugs?

A
  1. Abciximab [Reopro] “MOST COMMON”

2. Eptifibatide [Integrilin]

32
Q

What is the indication for Abciximab?

A
  • An adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications
  • Unstable angina
33
Q

What is the dosing for Abciximab?

A

IV bolus

34
Q

What is the mechanism of action of Abciximab?

A

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

35
Q

What are the common adverse effects of Abciximab?

A

hemorrhage, hypotention, dizziness and headache

36
Q

What are the drug interactions of Omega-3 & Omega-6 fatty acids, NSAIDs and opthalmic NSAIDs with Abciximab?

A

Additive

37
Q

What are the contraindications of Abciximab?

A

Recent surgery or trauma and uncontrolled hypertension

Systemic Pharmacology_Dr. McNaughton (12 decks)

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