Anti-Coag drugs Flashcards
How is aspirin an anti-coag drug?
Cox1 inhibitor…therefore, inhibits Thromboxane production and Prostaglandin production.
How long does the effect of Aspirin on plateletts last?
5-7 days
Adverse effects of Aspirin
GI bleeds, hemorrhagic stroke, asthma
Contraindications of aspirin?
Coumadin, peptic ulcer disease, aspirin sensitivity
Do NSAIDS have antiplatelett effect?
Yes but its temporary and reversible…may actually interefere with aspirin and increase risk for CVD for those taking aspirin to prevent it.
Acetaminophen?
Pain and fever reducer but very little anti-inflammatory or anti-platelett effect. Weak COX 1 and 2. Great pain releiver for people on heparin and warfarin
Does Aspirin also target COX2
Yes.
Do NSAIDs target both COXs?
Yes
What does Celecoxib do?
Selectively targets COX2 so no antiplatelett effect, actually pro-thrombotic effect. More risk for CVD.
So aspirin and clopidegrel are only used for what?
Anti-platelett
How does dipyridamole work?
inhibits platelett aggregation by inhibiting platelett phosphodiesterase.
How do platelet phosphodiesterases work?
Phosphodiesterase is an enzyme that degrades cyclic AMP in cells. By inhibiting it, you keep cyclic AMP around longer and plateletss are turned off.
Is Dipyridamole a powerful anticoagulant when used alone?
No. Good in combo with aspirin though. Also good with warfarin in pts with heart valves. Good vasodilator
Adverse effects of dipyridamole?
GI bleed, headache, dizziness
WHat receptor mediates plataelett activation
P2Y12
How does Clopidogrel work?
ADP antagonist
What is special about clopidogrel?
It is a prodrug that must be activated by CYP2C19
What is an ADP inhibitor you can give to someone with a CYP2C19 plymorphism
Prasugrel….it is also an ADP inhibitor that is a prodrug but it is metabolized by Cyp2B6 and 3A4
Clopidogrel (Plavix) plus Aspirin?
Can be beneficial for patients that have peripheral artery disease
How does Eptifibidate work
Prevents binding of fibrinogen, VWF to IIb and IIIa
Abciximab?
blocks GpIIb/IIIa receptor
How does streptokinase work?
Activates ciculating fibrin bound plasminogen into plasmin and produces a lytic state.
What is the problem with streptokinase
Many abs exist for it. Can develop an immune rxn to it. ONE TIME USE ONLY
Urokinase
also a fibrinolytic
t-PA
Tissue type plasminogen activator
Reteplase
Third generation fibrinolytic
COX inhibitors we need to know
Aspirin
Phosphodiesterase inhibitors
dipyrimidole
P2Y12 or ADP inhibitors
Clapidugrel, Prasugrel
Gp IIb/IIIa
Eptifibidate, Abciximab
Thrombolytics
Streptokinase, Urokinase, Reteplase, t-PA
What is the ADP receptor
P2Y12
What does ADP do?
Activates GpIIb/IIIa
At Dawn
Cordarelle Patterson Eats At RUby TueSday
WHat is the purpose of GpIIB IIIa
Its a fibrionogen receptor that accepts fibrinogen so it can become fibrin and link plateletts together.. So if you block it the clot is not strongt
When do you give GpIIbIIIa inhibitors
prior to catheterization and angioplasty to prevent thrombosis
When should fibrinolytic agents be used
After Mi, Stroke, Pulmonary embolism, DVT
Major toxicity of Fibrinolytics.
Intracranial hemorhage
What is urokinase made from
fetal kidney cells
Does Urokinase cause allergic rxns?
No
