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Pharmacology > Anti-Thrombotics (Anti-Coagulants & Anti-Platelets) > Flashcards

Anti-Thrombotics (Anti-Coagulants & Anti-Platelets) Flashcards

1
Q

Anti-Coagulants

A

= Blood thinners that delay blood clotting

DOACS = Warfarin, Rivaroxaban/Apixaban, Dabigatran

PARENTERAL = Heparin, LMWH (Dalteparin, Enoxaparin), Fondaparinux

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2
Q

* DOACS*

A
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3
Q

Direct Factor Xa (Protease) Inhibitors

A

Drugs = Rivaroxaban, Apixaban
Mechanism = inhibit liver-made Factor Xa (protease)
Factor Xa = cleaves prothrombin –> thrombin (CF)

Uses = VTE, PE, DVT, AF/Stroke

+ No blood test required for PT
- INC. risk of GI bleed = dark brown/black/red stools

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4
Q

Vitamin K Antagonist

A

Drug = Warfarin
Mechanism:
= Inhibits enzyme Vitamin K epoxide reductase
= Carboxylation of glutamic acid residues
= Inhibits PT (Factor II), CF’s (VI, IX, X) activation

Uses = DVT, PE, AF, Heart Valve replacement

+ Vitamin K antagonist

  • INC. risk in bleeding (provide VK antidote)
  • Low VK = high PT = INC. bleeding risk
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5
Q

PARENTERAL

A
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6
Q

Unfractioned Heparin (UFH)

A

= Mucopolysaccharides (short duration, rapid onset)
Mechanism:
= Bind to activate Factor Xa + thrombin
= Activate anti-thrombin III by INC. affinity for serine proteases

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7
Q

LMWH

A

Drugs = Enoxaparin, Dalteparin, Fondaparinux (SC injection)

Mechanism = bind to Factor Xa but not thrombin

Uses = VTE, DVT, hospital prophylaxis, PE, ACS

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8
Q

Difference between UFH & LMWH?

A

= UFH binds to Factor Xa and thrombin

= LMWH binds to Factor Xa only

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9
Q

Ant-Platelets

A

= Keep clots from forming by keeping blood clots from sticking together

Uses = MI, stent, CABG, TIA, Stroke

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10
Q

Aspirin

A

Mechanism:
= Irreversible COX-inhibitor (acetylates COX enzymes)
= Selectively inhibit thromboxane production
= Reduces platelet aggregation ability

Dose = 75mg/day

Uses = ACS, MI (75mg daily + 300mg LD), stroke

      • GI tract irritation (give with PPI for long term)
      • Increased bleeding risk
      • Hypersentivity reactions
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11
Q

Clopidogrel

A

Mechanism:
= Irreversible purine antagonist
= Prodrug activated by CYP2C19 in liver
= Binds to P2Y2 receptor to block calcium induced release of ADP

Uses = ACS, stents, CVS, AF

      • Bleeding, dyspepsia, diarrhoea
      • (Prodrug) CYP2C19 interactions = DEC. efficacy (thus ovoid Omeprazole)
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12
Q

Ticagrelor

A

Mechanism:
= Reversible purine antagonist
= Binds to P2Y2 receptor at allosteric site
= Not a prodrug, so doesn’t need hepatic activation

+ Faster onset than Clopidogrel
+ First choice
+ Easier to stop pre-surgery

      • Dyspnea, bleeding
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13
Q

Thrombolytics

A

Drugs = Alteplase, Streptokinase

Mechanism = convert plasminogen to plasmin (degrades fibrin strands)

Alteplase = selective for fibrin bound plasminogen

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14
Q

Statins

A 
Drugs = Simvastan, Atorvastatin
Mechanism:
 = Inhibit HMG-CoA Reductase
 = Prevents HMG-CoA --> Mevalonic acid conversion
 = Reduce cholsterol levels

+ Effective in evening time (once in evening)

      • Muscle pain/cramps
      • DON’T TAKE CLARYTHROMYCIN!
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15
Q

Which of the following drugs could be used to treat deep vein thrombosis?

A

Dalteparin

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16
Q

An 80 year old man is bought to the emergency department by his daughter whio is his carer. She explains to you that noticed a small amount of blood in his urine (haematuria) earlier today which is confirmed on the urine dipstick. His blood pressure is normal and he feels well. He is currently taking warfarin for thromboprophylaxis as he has a diagnosis of atrial fibrillation. His target INR is 2-3 and a month ago was 2.7. You request an emergency INR which is reported as 8.2.

Which option would provide the most appropriate immediate course of action?

A

Give vitamin K by slow intravenous infusion

17
Q

A 75 year old gentleman is admitted with left sided upper limb weakness for 2 hours that then completely resolves. He is seen by the stroke team who diagnose a transient ischaemic attack and suggest simvastatin 40mg amongst other medication for secondary prevention.

Which of the following options would be most appropriate to communicate to the patient?

A

When taking clarithromycin, the statin should be stopped

18
Q

Which of the following enzymes are inhibited by statins to reduce plasma cholesterol?

A

HMG-Co-reductase

19
Q

ou are called about a 67 year old woman with an INR of 6.1 (target 2-3). She has a past medical history of myocardial infarction and atrial fibrillation. She appears well and examination reveals no bleeding. She has completed a course of erythromycin for a chest infection one week ago. Her current prescription is bisoprolol (2.5 mg oral daily) and warfarin 3mg daily.

Select the most appropriate option with regard to her anticoagulation.

A

Omit warfarin for 2 days and recheck her INR

20
Q

Which dose regimen is the most appropriate for the administration of oral statins?

A

Once daily in the evening

21
Q

What effect will an inhibitor of the liver enzyme CYP2C9 have on the INR of a patient stabilised on warfarin?

A

Increase the INR (+ INC. plasma concentration)

22
Q

What is the mechanism of action for the anticoagulant effects of warfarin?

A

Vitamin K epoxide reductase inhibitor

23
Q

Which of the following drugs is a thrombolytic agent selective for fibrin bound plasminogen?

A

Alteplase

24
Q

Which of the following drugs is an irreversible purine receptor antagonist?

A

Clopidogrel

25
Q

A 73 year old man is admitted with pneumonia. He had deep vein thrombosis 2 years ago (finished a course of warfarin 18 months ago) and diabetes. He is treated with IV anrtibiotics and requires 60% oxygen. You are unable to palpate the dorsalis pedia nor the posterior tibialis pulses bilaterally, but the foot is warm and he denies pain. There is no evidence of acute limb ischaemia.

Prescribe one method of thromboprophylaxis.

A

Dalteparin 5,000 units SC daily

26
Q

Which adverse effect is most likely to develop in patients taking statins?

A

Muscle pain

27
Q

What is the appropriate daily dose of aspirin in the secondary prevention of cardiovascular disease?

A

75mg

28
Q

A 26 year old woman attends the emergency department following a sudden onset of breathlessness. She has complained of a tender and swollen left calf for the last 3 days. On examination BP 118/72, RR 22/min SaO2 91% on air, HR 108 bpm. She is afebrile, her left leg is swollen and she weighs 80kg.

Prescribe one drug for the immediate treatment of the presumed embolus.

A

Dalteparin 15,000 units s/c once daily

Pharmacology (7 decks)

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