Anti-clotting

Question 1

Aspirin MOA?

Answer 1

Block COX, stopping conversion of Arachidonic acid to PGG2.
No TXA2, PGI2 and PGE2

Question 2

Aspirin uses?

Answer 2

Prophylactic treatment of transient cerebral ischemia

Lower incidence of recurrent AMI

lower mortality in post-AMI patients.

Question 3

ADR of aspirin

Answer 3

Bleeding
Gastric upset, ulcers
GI bleeding

Question 4

Antiplatelet Class - Glycoprotein 2B/3A Receptor Blockers?

Answer 4

Abciximab
Eptifibatide
Tirofiban

Question 5

MOA of Abciximab?

Answer 5

2B/3A is a platelet membrane surface protein. It functions as receptor for coagulants e.g. fibrinogen

1. Humanized monoclonal Ab against 2B/3A complex.
2. Reversibly inhibits binding of ligands to GP2B/3A

Question 6

MOA of Eptifibatide?

Answer 6

Analog of sequence at delta chain of fibrinogen
Pretend to be fibrinogen, preventing binding to receptor

Question 7

MOA of Tirofiban?

Answer 7

Small molecule blocker of GPIIB/IIIA receptor

Question 8

USe of Glycoprotein Receptor blockers?

Answer 8

Prevent restenosis after coronary angioplasty and are used in acute coronary syndromes

Question 9

Anticoagulant names?

Answer 9

Heparin
Warfarin

Question 10

Heparin MOA?

Answer 10

Bind to ATIII and cause conformational change, which exposes its active site for more rapid interaction with proteases.

For thrombin inhibition, heparin needs to bind to thrombin + ATIII.

To inhibit Factor 10 it only needs to bind ATIII.
LMWHs increase action of ATIII on F10a but not its action of thrombin.

Question 11

Heparin Uses?

Answer 11

Treat DVT, Pulmonary embolism, AMI

Combine with thrombolytics for revascularization

Combine with GPIIb/IIIa inhibitors during angioplasty and placement of coronary stents.

When anticoagulant is needed in pregnancy

Question 12

Heparin ADR?

Answer 12

Haemorrhage: stop heparin therapy and protamin sulfate

Thrombosis and Thombocytopenia

IM administration can cause haematoma

Question 13

Coagulant name?

Answer 13

Vitamin K

Question 14

MOA of Vitamin K

Answer 14

Essential to make Clotting factors 2, 7, 9, 10

Reduced Vit K is a cofactor in carboxylation of glutamate residues

Question 15

Use of Vitamin K?

Answer 15

Treat bleeding from oral anticoagulants like warfarin

Prevent haemorrhagic disease of infants

Question 16

Warfarin MOA?

Answer 16

Blocks Vit K reductase, blocking Vit K recycling

Question 17

USes of warfarin?

Answer 17

Treat DVT, Pulmonary embolism, AMI

Combine with thrombolytics for revascularization

Combine with GPIIb/IIIa inhibitors during angioplasty and placement of coronary stents.

When anticoagulant is needed in surgery

Question 18

ADR of warfarin?

Answer 18

Bleeding

Banned for pregnancy - cause haemorrhagic disorder in fetus and fetal proteins with gamma-carboxyglutamate residues found in bone and blood can be affected by warfarin

Question 19

Thrombolytic agents names?

Answer 19

Streptokinase
Alteplase
Urokinase
Anistreplase

Question 20

MOA of thrombolytic agents?

Answer 20

Enhance conversion of Plasminogen -> Plasmin, more Fibrinogen degradation product

Question 21

Uses of Thrombolytic agents?

Answer 21

1. Emergency treatment of Coronary Artery Thrombosis
2. Peripheral arterial thrombosis and emboli
3. Ischaemic stroke (<4.5hr window)
   ALL EMERGENCY USE

Question 22

ADR of thrombolytic agents?

Answer 22

Bleeding
Banned for pregnancy
Banned for healing wound