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Pharmacology > Anti-coagulants > Flashcards

Anti-coagulants Flashcards

1
Q

What are absolute contraindications for thrombolysis?

A 
Haemorrhagic/ischaemic stroke <6months 
CNS neoplasia 
Recent trauma/surgery 
GI bleed <1month 
Bleeding disorder
Aortic dissection
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2
Q

What are relative contraindications for thrombolysis?

A

Warfarin
Pregnancy
Advanced liver disease
Infective endocarditis

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3
Q

What are the main types of anti-coagulants?

A

Anti-platelets
Anti-coagulants
Fibrinolytics

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4
Q

What are examples of anti-platelets?

A 
Aspirin
Dipyridamole
Clopidogrel
Ticagrelor 
Abciximab
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5
Q

What is the route of administration of aspirin?

A

Oral

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6
Q

What are the indications of aspirin?

A

Management of ACS
Suspected TIA
Acute ischaemic stroke

Secondary prevention

  • CVS disease
  • stroke/TIA if other agents contraindicated
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7
Q

What is the mechanism of aspirin as an anti-platelet?

A

Reduction of TXA2 synthesis by COX-1 inhibition

Inhibits platelet aggregation

Reduces platelets forming clots

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8
Q

What are the side effects of aspirin?

A

Prolonged bleeding time

Dyspepsia

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9
Q

What are the indications of Clopidogrel?

A

Prevention in patients intolerant to aspirin

Reduces morbitity/mortality post thromboembolic stroke

Reduces secondary events post MI

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10
Q

What are the routes of administration of Clopidogrel?

A

Oral

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11
Q

What is the mechanism of Clopidogrel?

A

Inhibits binding of ADP to P2Y12 receptor

Inhibits activation GPIIb/IIIa receptors

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12
Q

What are the side effects of Clopidogrel?

A

Diarrhoea
GI discomfort
Haemorrhage
Skin reactions

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13
Q

What are the indications for ticagrelor?

A

Prevention of atherothrombotic events in patients with history of MI/ACS

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14
Q

What are the routes of administration of ticagrelor?

A

Oral

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15
Q

What is the mechanism of ticagrelor?

A

Inhibits binding of ADP to P2Y12 receptor

Inhibits activation GPIIb/IIIa receptors

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16
Q

What are the side effects of ticagrelor?

A 
Constipation 
Diarrhoea
Dyspepsia
Gout
Haemorrhage
Hypotension
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17
Q

What is the mechanism of abciximab?

A

Monoclonal antibody irreversibly blocks GPIIb/IIa receptors

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18
Q

What is the effect of blocking GPIIb/IIIa receptors?

A

Prevents binding of fibrinogen and VWF

Prevents platelet aggregation

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19
Q

What is a side effect of abciximab?

A

thrombocytopenia

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20
Q

What are the indications of dipyramidole?

A

Secondary prevention

  • ischaemic strokes
  • TIAs
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21
Q

What is the route of administration of dipyramidole?

A

Oral

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22
Q

What is the mechanism of dipyramidole?

A

Inhibits cellular uptake of adenosine
Increased plasma adenosine
Inhibits platelet aggregation

Phosphodiesterase inhibitor
Prevents cAMP + cGMP degradation
Inhibits expression of GPIIb/IIIa

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23
Q

What are the side effects of dipyramidole?

A 
Angina 
Flushing
Headache 
Hypersensitivity 
V+D
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24
Q

What are examples of fibrinolytics?

A

Alteplase
Reteplase
Streptokinase

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25
Q

What is the function of fibrinolytics?

A

Breakdown clots

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26
Q

What are the indications for Alteplase/reteplase?

A

Acute MI
PE
Acute ischaemic stroke

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27
Q

What are the routes of administration of Alteplase/reteplase?

A

IV

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28
Q

What is the mechanism of Alteplase/reteplase?

A

Bind to + activate plasminogen

Plasminogen converted to plasmin which degrades the clot

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29
Q

What are the side effects of Alteplase?

A 
Cardiac arrest 
Bleeding 
Heart failure
Hypotension 
Nausea
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30
Q

What are the indications for streptokinase?

A 
Acute MI 
DVT 
Central retinal/arterial thrombosis 
PE
Occlusive peripheral arterial disease
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31
Q

What are the routes of administration of streptokinase?

A

IV

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32
Q

What is the mechanism of streptokinase?

A

Activates plasminogen

Plasminogen converted to plasmin which degrades the clot

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33
Q

What are the side effects of streptokinase?

A 
Anaphylactic reaction 
Cardiac arrest
Haemorrhafe
Hypotension 
N+V
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34
Q

What is the mechanism of anticoagulant agents?

A

Prevent thrombus formation and thrombus growing

35
Q

What are the types of anticoagulants?

A 
Vitamin K antagonists
Unfractioned heparin 
Low molecular weight heparin 
DOACs
Fondaparinux
36
Q

What is the vitamin K antagonist?

A

Warfarin

37
Q

What are the indications of warfarin?

A

DVT prophylaxis/treatment
PE prophylaxis + treatment
AF
Protein C + S deficiency

38
Q

What is the route of administration of warfarin?

A

Oral

39
Q

What is the mechanism of warfarin?

A

Inhibits production of vitamin K dependent clotting factors

  • Prothrombin
  • VII
  • IX
  • X
40
Q

What is the half life of warfarin?

A

40 hours

41
Q

What are the side effects of warfarin?

A

Haemorrhage

N+V

42
Q

What drugs does warfarin interact with?

A

Inhibition of hepatic metabolism

  • Amiodarone
  • Clopidogrel
  • Quinolones
  • Metronidazole

Inhibit platelet function
- Aspirin

Reduce vitamin K by eliminating gut flora
- Cephalosporins

Displacement of warfarin from albumin
- NSAIDs

Acceleration of warfarin metabolism

  • Barbiturates
  • Phenytoin
  • rifampicin
  • St John’s wort
43
Q

What blood test is used to monitor warfarin?

A

INR

44
Q

What INR is required for those on warfarin due to DVT?

A

2.5

45
Q

What INR is required for those on warfarin due to PE?

A

2.5

46
Q

What INR is required for those on warfarin due to AF?

A

2.5

47
Q

What INR is required for those on warfarin due to recurrent DVT/PE?

A

3.5

48
Q

What INR is required for those on warfarin due to mechanical valve?

A

3.5

49
Q

What are the indications for Unfractioned heparin?

A 
PE
Unstable angine 
Acute peripheral arterial occlusion 
DVT 
Thromboprophylaxis
50
Q

What are the routes of administration of UFH?

A

IV

SC

51
Q

What is the mechanism of UFH?

A

Binds to antithrombin

Inactivates

  • Thrombin IIa
  • Xa
  • IXa
  • XIa
  • XIIa
52
Q

What are the side effects of UFH?

A

Haemorrhage
Heparin-induced thrombocytopenia
Skin reactions

53
Q

What are examples of LMWHs?

A

Dalteparin

Enoxaparin

54
Q

What are the indications for Dalteparin?

A

Unstable coronary artery disease
Thromboprophylaxis
DVT/PE treatment

55
Q

What are the routes of administration of Dalteparin?

A

SC

56
Q

What is the mechanism of Dalteparin?

A

Inhibits factor Xa

57
Q

What are the side effects of Dalteparin?

A

Haemorrhage
Heparin-induced thrombocytopenia
Skin reactions

58
Q

What are the indications for enoxaparin?

A

Treat VTE in pregnancy
Thromboprophylaxis
ACS

59
Q

What are the routes of administration of enoxaparin?

A

SC

60
Q

What is the mechanism of enoxaparin?

A

Inhibits factor Xa

61
Q

What are the side effects of enoxaparin?

A

Haemorrhage
Heparin-induced thrombocytopenia
Skin reactions

62
Q

What is used to reverse heparin?

A

Protamine sulphate

63
Q

What is the route of administration of heparin?

A

IV

64
Q

What is the mechanism of protamine sulphate?

A

Dissociates heparin from antithrombin III

65
Q

What are the side effects of protamine sulphate?

A

Hypertension

Hypercoagulability

66
Q

What are examples of DOACs?

A

Apixaban
Rivaroxaban
Dabigatran

67
Q

What are the indications for apixaban?

A

VTE prophylaxis

Treatment of DVT/PE

68
Q

What is the route of administration of apixaban?

A

Oral

69
Q

What is the mechanism of apixaban?

A

Inhibits factor Xa

70
Q

What are the side effects of apixaban?

A

Anaemia
Haemorrhage
Nausea
Skin reactions

71
Q

What are the indications of rivaroxaban?

A

VTE prophylaxis
Treatment of DVT/PE
Prophylaxis of atherothrombotic events

72
Q

What is the mechanism of rivaroxaban?

A

Inhibits factor Xa

73
Q

What are the routes of administration of rivaroxaban?

A

Oral

74
Q

What are the side effects of rivaroxaban?

A

Anaemia
D+V
Haemorrhage
Menorrhagia

75
Q

What are the indications of dabigatran?

A

VTE prophylaxis

DVT/PE treatment

76
Q

What is the route of administration of dabigatran?

A

Oral

77
Q

What is the mechanism of dabigatran?

A

Direct competitive thrombin inhibitor

78
Q

What are the side effects of dabigatran?

A

Abnormal hepatic function

Haemorrhage

79
Q

What is fondaparinux?

A

Synthetic pentasaccharide

80
Q

What are the indications for fondaparinux?

A

VTE prophylaxis
ACS treatment
DVT/PE treatment

81
Q

What is the route of administration of fondaparinux?

A

SC

82
Q

What is the mechanism of fondaparinux?

A

Selectively inhibits factor Xa by binding to antithrombin III

83
Q

What are the side effects of fondaparinux?

A

Anaemia

Haemorrhage

Pharmacology (27 decks)

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