Adverse Effects From Antiplatlet/anticoagulants And Thrombolytics

Question 1

Asa side effects

Answer 1

1. Peptic ulcer disease
2. Reyes syndrome
3. Asthma exacerbation of respiratory disease

Question 2

Reyes syndrome occurs in

Answer 2

<19 yrs +viral infection when taking aspirin

Question 3

Reyes syndrome effects

Answer 3

Damage to liver- ammonium build upcausing cerebral edema, seizures, altered mental status
Also lactic acid build up- metabolic acidosis

Question 4

Aspirin toxicity symptoms (mild)

Answer 4

Nausea
Vomiting
Tinnitus

Question 5

Aspirin toxicity severe symptoms

Answer 5

Increase lactic acid + ketone bodies leads to anion gap acidosis
Stimulates increase in respiratory rate and depth causing respiratory alkaloids
Damage to lung parenchema leading to pulmonary edema and noncardiogenic cardioedema

Question 6

Treatment aspirin toxicity

Answer 6

IV fluids
Hemodialysjs
Na bicarbonate to alkaline blood

Question 7

P2Y12 receptor blockers Adverse Effects

Answer 7

1.Thrombotic thrombocytopenia Purpura
2. Suppress the Bone Marrow (neutropenia, anemia)
3. Bleeding risk

Question 8

What is TTP

Answer 8

Thrombotic Thrombocytopenia Purpura

Question 9

Features of Thrombotic Thrombocytopenia Purpura

Answer 9

FATRN
Fever
Anemia
Thrombocytopenia (low platlet level)
Renal failure
Neurosymptoms

Question 10

what is ADAMTS12

Answer 10

Extracellular enzyme that breaks down Von wilibrands factor therefore decreasing platlet activation

Question 11

How does P2Y12 Receptor inhibitors cause TTP

Answer 11

P2Y12 can activate immune system to creat autoantibodies. These antibodies decrease Adamss12. Therefore, increasing VWF with lots of sights for platelets to stick

Question 12

Which P2Y12 Receptor Blockers create a higher bleeding risk

Answer 12

Prasugrel
Ticagular

Question 13

Which P2Y12 receptor blocker is metabolized by Cyp2c19

Answer 13

Clopidogrel is converted to active form via Cyp2C19. Some patients have increased activity of this enzyme (Cyp2C19) causing increased responsiveness. The opposite is also true. (We can test P2y12 levels - if good responders have decreased levels.

Question 14

Phosphodiesterase Inhibitors adverse effects

Answer 14

1. Vasodilation - especially cerebral (HA)
2. Increased mortality in patients with CHF …..AVOID!