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IHO Week 6 > Anti Coag Drugs > Flashcards

Anti Coag Drugs Flashcards

1
Q

First phase of hemostasis

A

Vascular constriction limits the flow of blood to the area of injury

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2
Q

Second phase of hemostasis

A

Platelets become activated and aggregate at the site of injury, forming a temporary, loose platelet plug (primary)

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3
Q

Third phase of hemostasis

A

Fibrin mesh (clot) forms and entraps the plug (secondary)

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4
Q

Fourth phase of hemostasis

A

The clot is dissolved in order for normal blood flow to resume following tissue repair

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5
Q

What is primarily responsible for stimulating platelet clump?

A

Fibrinogen

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6
Q

Platelets clump by binding to collagen that becomes exposed following…

A

rupture of the endothelial lining of vessels

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7
Q

Upon activation, platelets release

A

ADP and TXA2 (activate additional platelets), 5HT, phospholipids, lipoproteins etc.

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8
Q

White thrombus

A

plug contains only platelets

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9
Q

Red thrombus

A

plug contains red cells as well

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10
Q

The dissolution of a clot occurs through the action of this protein

A

plasmin

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11
Q

3 classes of drugs to reduce clotting -

A
  1. Antiplatelet drugs
  2. Anticoagulant drugs
  3. Fibrinolytic drugs
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12
Q

4 types of antiplatelet drugs

A

COX inhibitors
ADP Receptor Antagonists
GPIIb/IIIa Receptor inhibitors
Adenosine reuptake inhibitors

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13
Q

COX inhibitor used in anti-clotting therapy

A

Aspirin (irreversible)

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14
Q

ADP Receptor Antagonists

A

Clopidogrel
Ticlopidine
Prasugrel

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15
Q

GPIIb/IIIa Receptor Inhibitors

A

Abciximab
Eptifibatide
Tirofiban

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16
Q

Adenosine Reuptake Inhibitor

A

Dipyridamole

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17
Q

Antiplatelets act at

A

phase 2 - platelet plug formation

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18
Q

Anticoagulants act at

A

Phase 3 - secondary hemostasis

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19
Q

Fibrinolytic drugs

A

Phase 4

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20
Q

4 types of anticoagulants

A
  1. indirect thrombin inhibitors
  2. direct thrombin inhibitors
  3. Vitamin K analog
  4. Factor Xa Inhibitor
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21
Q

Indirect thrombin inhibitors

A

Heparin
LMW heparin
Fondaparinux

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22
Q

Reverse Heparin

A

Protamine

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23
Q

Direct thrombin inhibitors

A

Bivalirudin
Argatroban
Dabigatran etexilate (oral)

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24
Q

Vitamin K analog

A

Warfarin

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25
Q

Reverse Warfarin

A

Vitamin K (phytonadione)

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26
Q

Factor Xa Inhibitor

A

Rivaroxaban

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27
Q

Fibrinolytic drugs - Tissue plasminogen activators

A

Alteplase
Reteplase
Tenecteplase

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28
Q

List some therapeutic uses for anti-coags

A

Venous thromboembolism, Unstable angina, Acute MI, Stroke, Prevent thrombosis during angioplasty and cariopulmonary bypass, A. fib

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29
Q

Aspirin - things to know

A

Acetylsalicylate
COX1 in platelets
AE: Bleeding, GI dist., tinnitus

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30
Q

Low dose vs high dose aspirin

A

Low dose - effect platelet

High dose - anti inflammation

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31
Q

ADP receptor Antagonists

A

Irreversible, last as long as platelet
Oral, days duration
Stenting and patients who don’t tolerate aspirin

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32
Q

AE of ADP receptor antagonists

A

Bleeding, nausea, diarrhea, rash, leukopenia

TTP - rarely with ticlopidine

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33
Q

Clopidogrel and Prasugrel have _____ than Ticlopidine

A

Fewer side effects

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34
Q

Clopidogrel may require activation via

A

CYP2C19

Omeprazole - use with caution

35
Q

Are ADP receptor antagonists reversible?

A

No, last lifetime of platelets

36
Q

GPIIb/IIa Receptor Inhibitors MOA

A

Prevent binding of adhesive glycoproteins such as fibrinogen and vWF to activated platelets

37
Q

AE of GPIIb/IIa Receptor Inhibitors

A

Bleeding

Thrombocytopenia (chronic use)

38
Q

Dipyridamole MOA

A
  • Increases cAMP and inhibits platelet activation
  • phosphodiesterase 3 inhibitor (increases cAMP by preventing breakdown to 5 AMP by phosphodiesterase)
  • Inhibits platelet uptake of adenosine and thus increases the adenosine interaction with A2 receptor - increase cAMP
39
Q

Dipyridamole is also a

A

Vasodilator

40
Q

AE of dipyridamole

A

Headache (vasodilation)

41
Q

Is dipyridamole effective alone?

A

No, must be used in combination with aspirin or warfarin

42
Q

Thrombin inhibitors

A

Parenteral anticoagulant heparin and derivatives

43
Q

Indirect thrombin inhibitors

A

Unfractionated heparin
LMW heparin
Fondaparinux

44
Q

Direct thrombin inhibitors

A

Bivalirudin
Argatroban
Dabigatran Etexylate (oral, new)

45
Q

Indirect thrombin inhibitors MOA

A

Bind to antithrombin

46
Q

Antithromin normally

A

inactivates thrombin and factor Xa

47
Q

When indirect thrombin inhibitors bind to antithrombin

A

antithrombin does a better job

48
Q

Basically.. heparin makes antithrombin…

A

Work REALLY WELL

49
Q

Heparin is highly variable anticoag because

A

binds all over (plasma proteins, platelets, macrophages, endothelial cells)

50
Q

HMW heparin

A

works on both thrombin and Xa so they don’t work

51
Q

LMW

A

works on thrombin and Xa

52
Q

Fonduparidonox

A

Xa only

53
Q

Protamine

A

highly basic pos. charged peptide that combines negatively charged heparin to form a stable complex that lacks anti-coag activity.

54
Q

Protamine only binds

A

long heparin

55
Q

Does HMW heparin have a short or long half life?

A

Short

56
Q

Protamine and LMWH

A

incomplete reversal

57
Q

Protamine and Fondaparinux

A

Won’t do anything

58
Q

Heparin monitored with

A

PTT

59
Q

AE of Heparin, LMWH, Fondaparinux

A

Bleeding, heparin induced thrombocytopenia

60
Q

Heparin induced thrombocytopenia

A

Thrombotic complications may precede
2x more likely in women
IgG ab against heparin/factor 4

61
Q

Direct thrombin inhibitors

A

bind directly to thrombin to inhibit enzyme

62
Q

Warfarin

A

Blocks synthesis of Vitamin K dependent clotting factors

Tricky drug that requires monitoring (PT) and has tons of drug interactions

63
Q

Direct Factor Xa

A

Rivaroxaban
no antidote or monitoring
rapid onset and short half life

64
Q

Warfarin MOA

A
  • inhibits Vitamin K dependent exposite reductase VKORC1

- Inhibits vitamin K dependent gamma carboxylation of factors II, VII, IX, X and protein C

65
Q

Warfarin inhibits

A

Vitamin K dependent gamma carboxylation of factors II, VII, IX and X. Protein C

66
Q

Warfarin onset

A

Need to bridge, won’t work initially but protein C will stop - could result in initial clotting.

67
Q

AE Warfarin

A 
Bleeding
Drug Interactions (like, everything)
Flatulence and diarrhea
cutaneous necrosis
chondrodysplasia punctata
68
Q

Warfarin enantiomers

A

S more active

R and S metabolized differently (liver, cytochromes)

69
Q

Polymorphism in CYP2C9

A

30% are slower metabolizers

70
Q

Polymorphism in C1 subunit of VKORC1

A

influences warfarin interaction - dosage may need to be adjusted

71
Q

Pharmacokinetics

A

ADME

72
Q

For oral anticoagulants, pharmacokinetic drug interactions are due to

A

enzyme induction
enzyme inhibition
Decreased PBP

73
Q

Pharmacokinetics

A

Biochemical and physiological effect of drug and MOA

74
Q

for oral anticoags, pharmacodynamic drug ineractions due to

A

reduced clotting factor synthesis
competitive antagonism with vitamin K
hereditary resistance

75
Q

Too much warfarin - what do you do?

A
  • Stop the drug

- Add vitamin K ( or phytonadione, prothrombin complex concentrates, recombinant factor VIIa)

76
Q

Streptokinase

A

rarely used clinically, complexes with plasminogen so facilitates formation of plasmin

77
Q

Urokinase

A
  • Kidney enzyme that directly converts plasminogen to plasmin
  • promotes extravascular fibrinolysis
78
Q

Fibrinolytic Drugs

A

tPAs - tissue plasminogen activators
-preferentially activate plasminogen that is bound to fibrin which confines it to the thrombus rather than systemic activation

79
Q

Fibrinolytic Drugs - name 3

A

Alteplase
Reteplase
Tenecteplase

80
Q

Common features of Fibrinolytic Drugs

A

Dissolves existing life-threatening thrombi
Activate plasminogen
Given IV
Narrow spectrum

81
Q

AE fibrinolytic drugs

A

Bleeding and cost

82
Q

MOA of fibrinolytic drugs

A

Selective activation of fibrin bound plasminogen

only thrombolytics approved for use in stroke

83
Q

Aminocaproic acid

A 
Potent inhibitor of fibrinolysis
Blocks interaction of plasmin with fibrin
Minor use (prostatic sugery, tooth surgery in hemophiliacs)

IHO Week 6 (7 decks)

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