Anti-thrombotic drugs

Question 1

what are the 3 types of anti-coagulant drugs?

Answer 1

1. prevent coagulation = anti-coagulants
2. block platelets = anti-platelet
3. if the clot still forms, you want to lyse the clot = fibrinolytics

Question 2

what are examples of anti-coagulants?

Answer 2

heparin and warfarin

Question 3

what is the MOA and indication for heparin?

Answer 3

MOA:

• activates anti-thrombin 3 = increases the protein’s inactivation of clotting factors
• stimulates tissue factor pathway inhibitor

(has a fast onset!)

Used for:

• thromboembolism
• pregnant women at risk of thrombosis (does not cross placenta)

Question 4

what is the side effect/contraindication for heparin?

Answer 4

heparin-induced thrombocytopenia

osteoporosis in long-term usage

Question 5

what is the MOA and indication for warfarin?

Answer 5

MOA:
- inhibits vitamin k epoxide reductase = cannot form clotting factors 2, 7, 9 and 10

(has slow onset!)

Used for:
- maintenance and prophylaxis (not so much treatment)

Question 6

what is the side effect/contraindication for warfarin?

Answer 6

has a narrow therapeutic window = increased risk of bleeding

can cross placenta so cannot be used in pregnant women = or else have metal warfarin syndrome

has many DDI’s too

Question 7

after anti-coagulants, what are the examples of anti-platelets?

Answer 7

aspirin
clopidogrel
GPIIa/b antagonists

general aim of anti-platelets is to just prevent platelet aggregation

Question 8

what is the MOA and use of aspirin?

Answer 8

blocks COX enzymes in platelets = cannot produce thromboxane A2 for clotting

Used for: preventing arterial thrombosis

Question 9

what are the side effects of aspirin?

Answer 9

GI bleeding
hypersensitivity
renal dysfunction

Question 10

what is the MOA and use of clopidogrel?

Answer 10

inhibitor of ADP-induced platelet aggregation

used for: alternative to aspirin in preventing arterial thrombosis

Question 11

what are the side effects of clopidogrel?

Answer 11

GI disturbance

rashes

Question 12

what is the MOA and use of GPIIa/b antagonist?

Answer 12

monoclonal antibodies that target fibrinogen receptor

used for: preventing ischemic complications

Question 13

after anti-coagulants and anti-platelets, your last resort is to lyse the clot. what are the examples of fibrinolytics?

Answer 13

streptokinase and urokinase

Question 14

what is the MOA and use of streptokinase/urokinase?

Answer 14

activates plasminogen to plasmin = plasmin enzyme can degrade and break down fibrin clots

used in AMI, acute ischemic stroke