Anti- Thrombotics

Question 1

What are they useful for

Answer 1

in thromboembolic diseases - prophylaxis and treatment of acute or chronic arterial or venous thrombosis

Question 2

Virchow triad

Answer 2

endothelial lesion (arterial, white thrombus); blood stasis (venous, red thrombus), hypercoagubility (hematological disease)

Question 3

Antithrombotic medicine

Answer 3

anticoagulants, fibrinolytics, antiplatelet agents

Question 4

What do anticoagulants do

Answer 4

inhibit blood coagulation, act upon clotting factors

Question 5

Thrombin inhibitors - UFH

Answer 5

Unfractionated heparin

Question 6

Thr. inhibitors - Low molecular weight heparins

Answer 6

certoparin, dalteparin, enoxaparinm, nadroparin, reviparin, tinzaparin

Question 7

Thr, inhibitors - Heparinoids with saccharide structure

Answer 7

fondaparin, dulodexid

Question 8

Thr. inhibitors -Heparinoids, direct inhibitors of thrombin

Answer 8

hirudin, lepirudin, bivalirudin, dabigatran

Question 9

Direct inhibitors of Xa factor “-xabans”

Answer 9

apixaban, rivaroxaban

Question 10

Antivitamin K drugs (oral anticoagulants)

Answer 10

acenucumarol, warfarin

Question 11

UFH

Answer 11

parenterally (Not absorbed by GI mucosa&destroyed by oral enzymes); weak cutaneous abs., latency 20-60 minutes after subcutaneous and immediate after IV,does not cross placenta or breast milk due to high molecular weight, renally eliminated, good for pregnant women.

Question 12

Indications of UFH - High dose

Answer 12

DVT, PE, acute coronary, prevention of coronary occlusion after thrombolysis, prophylazis of thrombosis in hemofiltration, hemodialysis, extracorpeal circulation.

Question 13

UFH indications - low dose

Answer 13

Prophylaxis of post-operatory thrombosis or consumption coagulopathy.

Question 14

UFH side effects

Answer 14

bleeding (increased risk with dose and prolongation of clotting times), thrombocytopenia and thus platelet counts must be checked, allergic reactions, osteoporosis, increased transaminases, alopecia, tissue necrosis, hyperaldosteronism

Question 15

UFH contraindications

Answer 15

bleeding, renal or liver failure, thrombocytopenia, diastolic BP over 110 mmHG, endocarditis, diabetic retinopathy and intraocular bleeding, after brain bone or eye surgery, stroke, surgery severe trauma, birth, puncture, biopsy, gastrointestinal and urogenital bleeding, allergy

Question 16

UFH interactions

Answer 16

with antiplatelet agents (aspirin), oral anticoagulants, colloid (Dextran) increases bleeding risk; nitroglycerin IV decreases its effect =

Question 17

LMWH Pharmacokinetics

Answer 17

SC bioavailability >90%, longer and constant T1/2 than UFH (3-4 hours), renally eliminated

Question 18

LMWH Indications

Answer 18

Prophylaxis of peri/postoperatpory thromboembolic accidents (general/orthopedic); DVT, PE, acute coronary, AMI (after fibrinolysis), thrombophlebitis (OA contra), SC once or twice daily, one cannot be replaced with the other , protamine sulphate not as efficient in case of overdose

Question 19

LMWH Side effects

Answer 19

Bleeding, thrombocytopenia

Question 20

Hep w/ Sacch

Answer 20

long half life, bind to antithrombin III with selective and intense antiXA

Question 21

Hep w/ Saccharide indications

Answer 21

prophylaxis of DVT (after ortho on lower limb), phlebothrombosis, PE, acute coronary syndrome, once daily SC injection, no antidote for overdose

Question 22

Hep w/ Saccharide side effects

Answer 22

bleeding, thrombocytopenia, digestive intolerance, hypersensitivity

Question 23

Hep w/ Saccharide contraindications

Answer 23

bleeding, renal failure, acute bacterial endocarditis

Question 24

Hep Direct inhibitors of thrombin adverse effects

Answer 24

bleeding, thrombocytopenia, hypersensitivity/ anaphylactic shock (Lepirudin

Question 25

Hep Direct inhibitors of thrombin contraindications

Answer 25

bleeding, clotting disorders, pregnancy and lactation period, renal failure with Clcreat less than 30 ml / min, severe hepatic impairment