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Pharmacology 2 > AGENTS AFFECTING BLOOD CLOTTING > Flashcards

AGENTS AFFECTING BLOOD CLOTTING Flashcards

1
Q

(3) Blood clot categories related medications?

A
  • Prevent clot formation
  • Remove an existing clot - Lyse
  • Promote clot formation
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2
Q

What (2) classes of drugs prevent clot formation?

A
  • Anticoagulants
  • Anti-platelet drugs
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3
Q

What class of drug removes an existing clot?

A

Thrombolytics

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4
Q

What class of drug promotes clot formation?

A

anti-fibrinolytics

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5
Q

What are reversal agents of clotting meds?

A
  • Heparin antagonist
  • Warfarin Na antagonist
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6
Q

The goal of anticoagulants is prevention of the __________ of clot by inhibiting
certain clotting factors

A

formation

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7
Q

Anticoagulants are given __________________ because they have no direct effect on blood clot already formed.

A

prophylactically (preventatively)

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8
Q

Anticoagulants are given for treatment of some existing clots by promoting the _______________ of the clot

A

reabsorption

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9
Q

Anticoagulants promote imbalance of ______________________ towards lysing of a clot

A

feedback mechanism

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10
Q

What specific anticoagulant drug directly blocks existing clotting factors?

A

Heparin

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11
Q

Heparin binds with __________________?

A

Antithrombin III

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12
Q

Binds with Antithrombin III = Blocks
conversion of ___________to ______________

A

Prothrombin to Thrombin

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13
Q

What specific anticoagulant drug block a precursor & prevent factors from being
made?

A

Coumadin (warfarin) - Vitamin K

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14
Q

(2) types of exogenous Heparin (PARENTAL)?

A
  1. Standard Heparin
  2. Low molecular weight heparin
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15
Q

______________ heparin is a mucopolysaccharide found in various body tissues, most abundant in the liver and lung.

A

Endogenous

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16
Q

Exogenous heparin obtained from ________________?

A

animal tissue

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17
Q

Why should exogenous heparin not be administered orally?

A

It is lipophobic, so does not cross cell membranes easily

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18
Q

What are the (2) types of Heparin available?

A
  • Standard heparin
  • Low molecular weight heparin
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19
Q

Which type of heparin is typically given in hospital for prophylactic and active
treatment of clots?

A

Standard heparin (usually given IV, rarely given SubQ)

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20
Q

What type of heparin is used extensively for locking central access lines?

A

Standard heparin

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21
Q

What type of heparin is more extensively used for therapy – home therapy?

A

Low Molecular Weight Heparin

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22
Q

What route is Low Molecular Weight Heparin given?

A

Only SubQ

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23
Q

Standard heparin is highly __________________, metabolized by the liver and excreted by the kidney

A

protein bound

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24
Q

Standard heparin is only given parenterally because it is not absorbed from the GIT. True or false?

A

True

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25
Q

_______________ is a procedure that filters a patient’s blood to remove waste and excess fluid when their kidneys are no longer functioning properly

A

Hemodialysis

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26
Q

Heparin therapy inhibits the bodies attempts to create a _______ and tips the net outcome towards ______ of clots

A
  1. clot
  2. lysis
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27
Q

The existence of a clot induces another opposite reaction that is?

A

Negative feedback mechanism

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28
Q

_____________ is the enzyme that lyses a clot

A

Plasmin

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29
Q

standard _____________ is superior to warfarin to prevent pulmonary complications in cases of thrombophlebitis

A

Heparin

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30
Q

what does TPA stand for?

A

Tissue plasminogen activator

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31
Q

Adverse effects/events of standard heparin are (2)?

A
  • Heparin induced thrombocytopenia
  • Bleeding (random + generalized)
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32
Q

What are we monitoring with regular blood testing in standard heparin?

A

Platelet count for signs of thrombocytopenia

33
Q

Does standard heparin cross the placenta barrier or enter breast milk?

A

No

34
Q

Heparin is measured in what unit?

A

Units

35
Q

What are (2) Antidote/Reversal agents for standard heparin?

A
  • Whole blood and/or plasma
  • Protamine sulphate (IV slow)
36
Q

Protamine sulphate dissociates the _________________ complex?

A

heparin- antithrombin

37
Q

Is low molecular weight heparin more or less potent than standard heparin?

A

More

38
Q

Does low molecular weight heparin have a longer or shorter half-life than standard heparin?

A

Longer

39
Q

Which type of heparin is safer and effective for management of
thromboembolism?

A

low molecular weight heparin

40
Q

Why is heparin not given IM?

A

IM IS not done since muscle tissues are very vascular and bleeds easily

41
Q

Heparin is given based on ___________________________?

A

PTT (partial thromboplastin time)

42
Q

If PTT (partial thromboplastin time) outside therapeutic range, what are your next steps (2)?

A

Hold next dose & contact prescriber

43
Q

(3) LMW heparin agent names?

A
  • Ardeparin( Normiflo®)
  • Dalteparin (Fragmin®)
  • Enoxaparin(Lovenox®)
44
Q

What type of heparin inactivates factor Xa in the cascade?

A

LMW heparin

45
Q

Heparin adverse reaction in large doses can lead to (2)?

A
  • renal suppression
  • osteoporosis
46
Q

____________ is an oral anticoagulant that acts on the liver to prevent the synthesis of Vit. K-dependent clotting factors

A

Warfarin

47
Q

Effect does not occur until _______ days after warfarin is started

A

3-5 days

48
Q

Warfarin and other anticoagulants are highly __________________?

A

protein bound

49
Q

What drugs will displace warfarin off their protein receptors?

A
  • salicylates (ASA)
  • Ibuprofen (Motrin,® Advil®)
  • Naproxen
50
Q

What are (2) drug Interactions with warfarin?

A
  • Penicillin type drugs
  • Diet rich in vitamin K or supplements
51
Q

INR stands for?

A

international normalized ratio

  • a blood test that measures how long it takes for blood to clot
52
Q

Do not give a dose of warfarin if INR is greater than _______?

A

3.5

Notify the healthcare prescriber.

53
Q

What are (2) adverse events for warfarin?

A
  • Leucopenia
  • Fetal abnormality when given in early pregnancy
54
Q

Reversal agent for warfarin is?

A

Vitamin K

55
Q

_______________ are routinely administer to newborns to prevent hemorrhage.

A

Vitamin K shots

56
Q

Newer oral anticoagulants that are more selective inhibitors (direct acting) of clotting factors are (3)?

A
  1. Apixaban (Eliquis®)
  2. Dabigatran (Pradaxa®)
  3. Rivaroxaban (Xarelto®)

expensive though!

57
Q

Arterial thrombi are primarily due to _______________?

A

platelet aggregate

58
Q

venous thrombi are usually
composed of (2)?

A

fibrin and red blood cells

59
Q

What class of drugs are used to reduce the risk of venous thrombi?

A

Anticoagulants

60
Q

What class of drugs are used to reduce the risk of arterial thrombi?

A

anti-platelets

61
Q

Is ASA (Aspirin) an anti-platelet drug or anticoagulant drug?

A

anti-platelets

62
Q

For an MI, aspirin can be used in an emergency. Do they chew or swallow whole?

A

chew the aspirin (150 mg roughly)

63
Q

What anti-platelet drug is used to prevent thrombus in patients with indwelling devices, TIAs, acute MI, etc?

A

Aspirin

64
Q

When stimulated, does A1 vasodilate or vasoconstrict?

A

Vasodilates

65
Q

When stimulated, does A2 vasodilate or vasoconstrict?

A

Vasoconstricts

66
Q

(4) anti-platelet agents

A
  • Ibuprofen and Other ASA-related drugs
  • Clopidogrel (Plavix®)
  • Prasugrel (Effient®)
  • Ticagrelor (Brilinta®)
67
Q

What class of drugs work directly or indirectly to convert plasminogen to
plasmin and used to dissolve thrombi?

A

Fibrinolytics (thrombolytic agents)

68
Q

Fibrinolytics stimulate the conversion of plasminogen to __________?

A

Plasmin

69
Q

What is the role of plasmin?

A

It breaks down fibrin, the structure that makes up thrombus

70
Q

the conversion of plasminogen to plasmin is AKA ______________?

A

fibrinolysis

71
Q

The goal of fibrinolytics therapy to re-establish ____________ as quickly as
possible and limit _________________?

A
  1. blood flow
  2. tissue damage
72
Q

fibrinolytics have a high risk for _________________?

A

Hemorrhage

73
Q

Only use fibrinolytics when a ______ is the confirmed cause of a ischemic event

A

clot

74
Q

What route are fibrinolytics usually given?

A

IV

75
Q

_________________ prevents the formation of thrombin.

A

Anti-thrombin ll

76
Q

________________ which converts to plasmin

A

Plasminogen

77
Q

conversion to plasmin is facilitated by (4):

A
  • Anti diuretic hormone (ADH)
  • Norepinephrine (NE)
  • urokinase
  • streptokinse
78
Q

Blood plasma contains (2) main factors that inhibit blood clotting:

A
  • Anti-thrombin ll
  • Plasminogen

Pharmacology 2 (6 decks)

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