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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?

30
Q

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

31
Q

What is the target INR for VTE?

32
Q

What is the target INR for recurrent VTE?

33
Q

What is the target INR for AF?

34
Q

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

35
Q

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

36
Q

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

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?

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?

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?

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?

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?

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?

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?

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?

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?

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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