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Gen Med (Haem) > Anti-Platelet and Anti-Coagulant Drugs > Flashcards

Anti-Platelet and Anti-Coagulant Drugs Flashcards

1
Q

What is the mechanism of action of aspirin?

A

Works by inhibiting the cyclo-oxygenase enzyme which inhibits thromboxane A2 and reduces platelet aggregation

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2
Q

What are some common side effects of aspirin?

A

Bleeding, bronchospasm and peptic ulceration

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3
Q

Aspirin should not be used in individuals of less than what age and for what reason?

A

Those aged < 16 due to risk of Reye’s syndrome (the exception to this is Kawasaki’s disease)

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4
Q

The use of aspirin can potentiate the effects of which other drugs?

A

Oral hypoglycaemics, warfarin and steroids

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5
Q

What is the mechanism of clopidogrel, prasugrel and ticagrelor?

A

ADP receptor antagonists causing inhibition of platelet activation

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6
Q

When using a PPI alongside clopidogrel, which specific PPI is it best to use?

A

Lansoprazole

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7
Q

What is the mechanism of action of dipyridamole?

A

Phosphodiesterase inhibitor

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8
Q

Give an example of a GP IIa/IIIb inhibitor, a type of anti-platelet drug?

A

Abciximab

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9
Q

How long before an elective operation should anti-platelet drugs be stopped?

A

7 days

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10
Q

How can the action of anti-platelet drugs be ‘reversed’ if someone who is taking them suffers serious bleeding?

A

Platelet transfusion

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11
Q

What is the first-line anti-platelet drug regime to be offered following an ACS?

A

Aspirin (lifelong) and ticagrelor (12 months)

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12
Q

What is the second-line anti-platelet drug regime to be offered following an ACS?

A

Clopidogrel (lifelong)

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13
Q

What is the first-line anti-platelet drug regime to be offered following an ischaemic stroke or TIA?

A

Clopidogrel (lifelong)

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14
Q

What is the second-line anti-platelet drug regime to be offered following an ischaemic stroke or TIA?

A

Aspirin and dipyridamole (lifelong)

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15
Q

What is the first-line anti-platelet drug regime to be offered for peripheral arterial disease?

A

Clopidogrel (lifelong)

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16
Q

What is the second-line anti-platelet drug regime to be offered for peripheral arterial disease?

A

Aspirin (lifelong)

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17
Q

What are the two most common indications for long-term use of anti-coagulant drugs?

A

Venous thrombosis and atrial fibrillation

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18
Q

The appropriate dose of heparin is based on what?

A

Weight

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19
Q

How are unfractionated and LMW heparin administered?

A

Unfractionated is given IV, LMW is given SC

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20
Q

What is the mechanism of action of heparin?

A

Potentiates anti-thrombin III

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21
Q

LMWH potentiates the effect of anti-thrombin III on which clotting factor?

A

Factor Xa

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22
Q

What investigation is used for monitoring the use of unfractionated heparin?

A

APTT

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23
Q

Though not used routinely, what investigation is used for the monitoring of the use of LMWH?

A

Anti-factor Xa assay

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24
Q

What electrolyte abnormality is most likely to arise as a result of heparin use?

A

Hyperkalaemia

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25
Q

What are the three main adverse effects of the use of heparin?

A

Bleeding, heparin induced thrombocytopenia and osteoporosis

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26
Q

How soon after treatment does heparin induced thrombocytopenia typically present?

A

5-10 days after starting treatment

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27
Q

What are the three main features of heparin induced thrombocytopenia?

A

Greater than 50% reduction in platelets, thrombosis and skin allergy

28
Q

What medication can occasionally be used to reverse the anti-thrombin effect of heparin, and allow complete reversal of unfractionated heparin and partial reversal of LMWH?

A

Protamine sulphate

29
Q

Which has a longer duration of action- unfractionated or LMW hepatin?

A

LMWH

30
Q

Which has a lower risk of side effects- unfractionated or LMW heparin?

A

LMWH

31
Q

What is the target INR for VTE?

A

2.5

32
Q

What is the target INR for recurrent VTE?

A

3.5

33
Q

What is the target INR for AF?

A

2.5

34
Q

Use of which antiplatelet/anticoagulant would cause an isolated rise in PT, with no change in APTT, bleeding time or platelet count?

A

Warfarin

35
Q

Use of which antiplatelet/anticoagulant would cause an isolated rise in APPT, with no change in PT, bleeding time or platelet count?

A

Heparin

36
Q

Use of which antiplatelet/anticoagulant would cause an isolated rise in bleeding time, with no change in APTT, PT or platelet count?

A

Aspirin

37
Q

What is the mechanism of action of warfarin?

A

Antagonist of vitamin K

38
Q

Warfarin use causes a deficiency of which clotting factors?

A

II, VII, IX and X

39
Q

What investigation is used to monitor the use of warfarin?

A

INR

40
Q

After starting warfarin, how long may it take to achieve a stable INR?

A

Several days

41
Q

What is the major adverse effect of warfarin use?

A

Bleeding

42
Q

Can warfarin be used in pregnancy/breastfeeding?

A

It can’t be used in pregnancy but can in breastfeeding

43
Q

What can be used to reverse the action of warfarin in around 6 hours time?

A

Vitamin K

44
Q

What can be used to reverse the action of warfarin immediately, but only works for a short period of time?

A

Prothrombin complex concentrate

45
Q

What are some factors that can potentiate the effect of warfarin?

A

Liver disease, cranberry/grapefruit juice, NSAID use

46
Q

If a person’s INR is too low, this means they are at risk of what?

A

Thrombus formation

47
Q

If a person’s INR is too high, this means they are at risk of what?

A

Bleeding

48
Q

What effect do cytochrome P450 inducers have on warfarin?

A

Reduced INR

49
Q

What effect do cytochrome P450 inhibitors have on warfarin?

A

Increased INR

50
Q

When patients are started on warfarin, they should also be given what other drug for a short period of time?

A

Heparin

51
Q

What is the mechanism of action of dabigatran?

A

Oral direct thrombin inhibitor

52
Q

What is the mechanism of rivaroxaban, apixaban, edoxaban?

A

Oral factor Xa inhibitor

53
Q

Which NOAC is excreted renally?

A

Dabigatran

54
Q

Is any monitoring required for patients on NOACs?

A

No

55
Q

If a patient is taking an antiplatelet for stable CV disease, but for some reason also need an anticoagulant, what should be done?

A

Anticoagulant monotherapy

56
Q

How long are anticoagulants given for after ACS?

A

12 months

57
Q

If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, what scoring system is used to determine if they should continue their antiplatelet or not?

A

HASBLED

58
Q

If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, and they are deemed low-risk of bleeding, what should be done?

A

Continue anti-platelet and start anti-coagulant

59
Q

If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, and they are deemed moderate to high-risk of bleeding, what should be done?

A

Consider stopping anti-platelet and start anti-coagulant

60
Q

If a patient on warfarin has an INR of 5-8 but no active bleeding, what should be done?

A

Withhold 1 or 2 doses, and reduce the maintenance dose of warfarin

61
Q

If a patient on warfarin has an INR of 5-8 but is bleeding, what should be done?

A

Stop warfarin and give IV vitamin K

62
Q

If a patient on warfarin has an INR of > 8 but no active bleeding, what should be done?

A

Stop warfarin and give oral vitamin K

63
Q

If a patient on warfarin has an INR of > 8 but is bleeding, what should be done?

A

Stop warfarin and give IV vitamin K

64
Q

Following management of a raised INR, warfarin should be restarted when the INR falls below what value?

A

5

65
Q

If a patient on warfarin has major bleeding, what should be done?

A

Stop warfarin, give IV vitamin K and prothrombin complex concentrate

Gen Med (Haem) (12 decks)

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