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CVS Pharm > Anti thrombotic, platelet and coagulants > Flashcards

Anti thrombotic, platelet and coagulants Flashcards

1
Q

What are the 3 classes of anti clotting drugs?

A
  1. Antiplatelets
  2. Anticoagulants
  3. Thrombolytics
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2
Q

Name the classes of anti platelet drug and example of each

A
  1. NSAID: aspirin
  2. Platelet receptor blockers: abciximab
  3. ADP receptor blockers: clopidogrel
  4. Phosphodiesterase inhibitors: Dipyridamole
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3
Q

What is the MOA of aspirin?

A

Blood thinner

Inhibitor COX, hence stop production of thromboxane which promotes platelet aggregation.

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4
Q

What is the MOA of platelet receptor blockers?

A

Activation of this receptor complex is the final common pathway for platelet aggregation.

By inhibiting this, effectively inhibit platelet aggregation

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5
Q

What is the clinical use of platelet receptor blockers?

A

Prevent restenosis after coronary angioplasty and are used in ACS

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6
Q

Name an ADP receptor antagonist and its MOA

A

Clopidogrel.

By binding irreversibly to the ADP receptor, clopidogrel inhibits the amplification of platelet activation signals, preventing the activation of the glycoprotein IIb/IIIa receptor on the platelet surface.

Reduced ability for platelets to aggregate - less chance of forming a clot

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7
Q

Name a phosphodiesterase inhibitor

A

Dipyridamole

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8
Q

Name 3 anticoagulants

A
  1. Warfarin
  2. Heparin
  3. Rivaroxaban
  4. Dabigatran
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9
Q

What is the MOA of warfarin?

A

Vitamin K antagonist. Since it is a critical component of synthesis of prothrombin, factor 7,9,10, it inhibits production of those factors and hence stop coagulation

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10
Q

What is the MOA of heparin?

A

Inhibits thrombin.

Heparin binds to anti thrombin 3, causing a conformational change to its active site
- this allows it to bind to thrombin (forming a 3 molecule complex) to inactivate thrombin

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11
Q

What is the action of thrombin?

A
  1. Cleaves fibrinogen to fibrin
  2. Activates factor 13
  3. Cause platelet aggregation and stimulate cell proliferation
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12
Q

** Compare low molecular weight heparins to regular unfractionated heparins.

A

Pro: LMWH have better bioavailability and longer half life.

Con: Increase the action of antithrombin 3 on factor 10a but NOT ON THROMBIN.

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13
Q

Which coagulation factor does LMWH act on?

A

Factor 10a

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14
Q

Can LMWH increase action of anti thrombin 3 on THROMBIN?

A

NO

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15
Q

What is the clinical use of heparin?

A
  1. Treatment of deep vein thrombosis, pulmonary embolism and acute MI
  2. Can be used when an anticoagulant is need in pregnancy
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16
Q

What is the adverse effect of giving IM heparin?

A

Hematomas!!!

17
Q

What are the adverse effects of heparin?

A

Haemorrhage
Thrombocytopenia

18
Q

Can warfarin be given to pregnant women?

A

NO

19
Q

How is warfarin metabolised?

A

In the liver by CYPO450 enzymes

20
Q

What are the adverse effects of warfarin?

A

Bleeding/haemorrhage
Cannot give during pregnancy (warfarin can cross placenta and cause haemorrhagic disorder)

21
Q

Name 3 thrombolytic agents

A
  1. Alteplase
  2. Urokinase
  3. Streptokinase
  4. Anistreplase
22
Q

What is the MOA of thrombolytic agents?

A

Dissolve an existing blood clot

Actively converts plasminogen to plasmin, the enzyme that catalyses the breakdown of fibrin to fibrin degradation products.

23
Q

What are the ROAs of heparin?

A

IM or IV

24
Q

What are the ROAs of thrombolytic agents?

A

IV or intracoronary

25
Q

What are the clinical uses of thrombolytic agents?

A

Emergency treatment of coronary artery thrombosis
Peripheral arterial thrombosis and emboli

Need to give quickly in order to dissolve the clot ASAP and restore blood flow to occlusion site

26
Q

Which is the ONLY anti clotting drug that can be given to pregnant women?

A

Heparin

26
Q

What are the adverse effects and contraindication of thrombolytic agents?

A

Bleeding
CANNOT GIVE during pregnancy and healing wound

CVS Pharm (6 decks)

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