Anti-Platelets/Anti-Coagulants Flashcards
dabigatran category of drug
oral direct acting thrombin inhibitor
drug interactions with warfarin
- NSAIDS- Amiodarone- Cimetidine
UFH/LMWH MOA
- inhibits factors Xa and thrombin by acting on anti-thrombin
when do we give fibrinolytic drugs?
- immediately to treat STEMIS
enoxaparin is given how?
- subQ
half life of factor 10a
- 40 hours
warfarin/coumadin category of drugs
oral indirect acting vitamin K inhibitors
P2y12 inhibitors MOA
- irreversibly block ADP receptor binding for platelets
- non competitive antagonists
MOA of warfarin
- vitamin K reductase inhibitor
what is an alternative to heparin in patients with HIT?
- argatroban
how do we manage until warfarin kicks in?
- heparin bridging
argatroban category of druggiven how
- direct acting thrombin inhibitor
- IV
COX1/2 inhibitors used to treat
- unstable angina- MI- stroke
P2y12 inhibitors used to treat
- MI - stroke
how must GPIIb/IIIa inhibitors be given?
- IV
before warfarin effects begin, what must happen?
- affected coagulation factors must degrade
diet and warfarin
- variability in diet makes warfarin dosing problematic
- dependent on vitamin K intake
half life of factor 7a
- 6 hours
what proteins is vitamin K responsible for
- 2- 7- 9- 10- proteins C and S
GPIIb/IIIa inhibitors MOA
- prevent activated platelets from sticking together
Abciximab class of drug
- GPIIb/IIIa inhibitor
what part of heparin binds to the anti-thrombin
- the pentasaccharide
toxicities of COX 1/2 inhibitors
- gastric damage
when do we give Streptokinase or alteplase
- immediately to treat pulmonary emboli
fondaparinux MOA
- inhibits factor Xa by acting on anti-thrombin
half life of factor 2a (thrombin)
- 60 hours
UFH toxicities
- heparin-induced thrombocytopenia
unfractionated heparin and enoxaparin category of drug
- indirect acting thrombin and factor Xa inhibitors
half life of factor 9a
- 24 hours
role of Alteplase and Streptokinasehow must they be administered
- proteins that convert inactive plasminogen into active plasmin
- IV because they are large molecules
fondaparinux category of druggiven how
- indirect acting factor Xa inhibitor
- SubQ
fibrinolytics should definitely not be used for
- strokes caused by cerebral hemorrhage
- those patients who for blood clotting is good
unfractionated heparin is given how?
- IV- SubQ- too large a molecular size
COX1/2 inhibitors MOA
- inhibit COX synthesis of TXA2
Pharmacokinetics issues with wafarin
- slow onset of action
- may take up to a week to reach therapeutic levels
- polymorphism issues
- variability in diet
When can we also give alteplase
- immediately to treat stroke
aspirin class of drug
- COX1/2 inhibitor
how Amiodarone and Cimetidine interact with warfarin
- decrease warfarin metabolism
- increase INR
Tirofiban class of drug
- GPIIb/IIIa inhibitor
how does heparin-induced thrombocytopenia occur
- platelet coated with immune complex and heparin
- platelet removed by splenic macrophages
Eptifibitide class of drug
- GPIIb/IIIa inhibitor
how NSAIDS impact warfarin
- kick warfarin off albumin- increase free warfarin- increase bleeding risk
clopidogrel class of drug
- P2y12 inhibitors
platelet activation is what phase of hemostasis?
- primary hemostasis
- apixaban, rivaroxaban, edoxaban category of drug
oral direct acting factor Xa inhibitor
GPIIb/IIIa inhibitors used to treat
- angioplasty- stent placement
what is fondaparinux really?
- only the pentasaccharide portion of heparin
Warfarin toxicities
- birth defects- fetal warfarin syndrome- category X toxin
thrombin activation is what phase of hemostasis?
- secondary hemostasis
Pharmacokinetics issues with P2y12 inhibitors
- given in the prodrug form first
- must be activated by CYP2C19-
slow metabolizers (activators) will have reduced therapeutic effects
role of TXA2
- platelet activation and aggregation
which polymorphisms affect warfarin dosing?
- VKORC1- CYP2C9