anti-coagulants and anti-thrombotics Flashcards
what anti-coagulants do?
prevent thrombus formation or expansion
main uses of anti-coagulants
- unstable angina
- PE
- DVT
- at fibrillation
what heparin do?
as anti-thrombin III inhibits thrombin IIa and Xa fomation
characteristics of heparin
- fast onset and short action
- variable effect
- non-teratogenic
- 1-4% risk heparin-induced thrombocytopenia in prolong use
what LMWH do?
inhibits Xa formation
examples of LMWH
- dalteparin
- enoxaparine
- beniparin
characterisics of LMWH
- consistent effect
- longer acting
- less risk of HIT
what is protamine?
- an antidote for heparin overdose
- prevent haemorhage
- reversal of anti-coagulants effect
examples of hirudin
- lepirudin - renal
- bivalirudin- renal
- argatroban- liver
what hirudin do?
- direct thrombin inhibitors
- used in HIT
what warfarin do?
- reduced clotting factor synthesis
- competitive antagonism with vit K
- low therapeutic index
warfarin metabolised by
CYP 2C9
what combinations of drugs and warfarin will affect?
- reduced clotting factor and increase anticoagulant
- increase warfarin effect
- changes in warfarin metabolism
characteristics of dabigatran
- direct thrombin inhibitor
- unaffected by CYP 450
- rapid onset and offset
what is fondaparinux and what it does?
- synthetic pentasaccharide
- increase anti-thrombin inactivation of factor Xa
what rivaroxaban do?
direct inhibitor of factor Xa
what anti-platelets do?
inhibit platelets aggregation , more effective against arterial thrombosis
examples of anti-platelets
- aspirin
- dipyridamole
- clopidogrel
- abciximab
- tirofiban
- epoprostenol
what fibrinolytics do?
activate plasminogen to plasmin which degrades fibrin
examples of fibrinolytics
- streptokinase
- urokinase
- alteplase
- reteplase
- anistreplase
side effects of fibrinolytics
- nausea
- vomiting
- bleeding
what antifibrinolytics do?
prevent bleeding or treat excessive fibrinolysis
examples of antifibrinolytics
tranexamic acid (aprotinin)
function of clopidogrel and ticlopidine
inhibits expression of glycoprotein IIa/b
function of abciximab, tirofiban and eptifibatide
glycoprotein IIa/b receptor antagonist
