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Cardio > Anticoagulant, Antiplatelet and Thrombolytic Drugs > Flashcards

Anticoagulant, Antiplatelet and Thrombolytic Drugs Flashcards

1
Q

Describe the process of Haemostasis

A

vascular wall damage exposes collagen and tissue factor
primary haemostasis causes local vasoconstriction platelet adhesion activation and aggregation via fibrinogen
activation of blood clotting( coagulation) to form a stable clot by fibrin enmeshing platelets

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2
Q

d: haemostasis

A

arrest of blood loss from a damaged vessel

physiological

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3
Q

What is thrombosis?

A

pathological haemostasis

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4
Q

d: thrombosis

A

haematological plug in the absence of bleeding

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5
Q

Name the 3 predisposing factors that lead to thrombosis and what they are called collectively?

A

injury to vessel wall
abnormal BF
coagulability
Virchow’s Triad

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6
Q

What colour is an arterial thrombus?

A

white

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7
Q

what is an arterial thrombus treated with?

A

anti-platelets primarily

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8
Q

What is a venous thrombus treated with?

A

anticoagulants

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9
Q

What colour is a venous thrombus?

A

red

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10
Q

What are anticoagulants mainly used for?

A

prevention and treatment of venous thrombosis and embolism

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11
Q

Name the main Anticoagulant drugs

A

Warfarin
Heparin
Orally active Inhibitors

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12
Q

What receptors does ADP bind to in Primary Haemostasis?

A

GPCR PURINE receptors

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13
Q

How does warfarin work as an anticoagulant?

A

competes with vit K

this renders clotting factors II,VII,IX and X inactive

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14
Q

where do arterial thrombus normally lodge?

A

left heart, carotid artery, brain

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15
Q

where does venous thrombus normally lodge as an embolism/

A

lungs

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16
Q

How is warfarin taken and it has a fast/slow onset of action?

A

orally

slow

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17
Q

What is a risk of all anticoagulants?

A

haemorrhage

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18
Q

do anticoagulants have a low/high therapeutic index? what does this mean?

A

low

therefore not that safe

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19
Q

what is INR?

A

internalized normal ratio

used to check how fast blood is clotting under warfarin

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20
Q

How is a warfarin overdose treated?

A

vitamin K

concentrate of plasma clotting factors

21
Q

How does Heparin work?

A

binds to anti-thrombin iii (inhibitor of coagulation) they inhibit factor Xa by binding to ATIII and Xa at the same time.

22
Q

How is Heparin administered?

A

either IV -immediate

or SC-delayed an hour

23
Q

What are some adverse effects of heparin?

A

haemorrhage
osteoporosis
hyperaldosteronism
hypersensitivity reaction

24
Q

What type of Heparins are preferred, why?

A

Low molecular weight Heparins

25
Q

What type of Heparins are preferred, why? How are they given?

A

Low molecular weight Heparins
inhibit factor Xa, but not thrombin (IIa)
SC

26
Q

When are LMWH not preferred?

A

renal failure

27
Q

Name 2 orally active inhibitors

A

Dabigatran

Rivaroxaban

28
Q

What does Dabigatran do?

A

direct inhibitor of thrombin

29
Q

What does Rivaroxaban do?

A

direct inhibitor of factor of Xa

30
Q

Name the 2 key antiplatelet drugs

A

Aspirin

Clopidogrel

31
Q

How does aspirin work?

A

irreversibly blocks COX in platelets, preventing TXA2 synthesis
TXA 2 is responsible for activation of platelets

32
Q

How is aspirin given?

A

orally as thromboprophylaxis

33
Q

side effects of aspirin?

A

GI bleeding and ulceration

34
Q

How does Clopidogrel work?

A

inhibits P2Y12 receptor

Blocks binding of ATP to P2Y12 receptor which causes activation of platelets resulting in o fibril linking

35
Q

How is Clopidogrel given?

A

orally synergistic with aspirin

36
Q

What do the drugs that are fibrinolytics do?

A

used to reopen occluded arteries in acute MI or stroke but prefer PCI

37
Q

What is PCI?

A

percutaneous Coronary Intervention

38
Q

Name some fibrinolytics

A

streptokinase

alteplase and duteplase

39
Q

How does streptokinase work? And what is it?

A

protein extracted from cultures of streptococci

40
Q

What drug do you use for rapid anticoagulation?

A

warfarin and heparin together

41
Q

What drug do you use for less serious anticoagulation?

A

warfarin

42
Q

After 4 days of streptokinase why cant further doses not be given?

A

action blocked after 4 days by the generation of antibodies

43
Q

What does streptokinase do?

A

reduces mortality in MI but cation blocked after 4 days

44
Q

How does streptokinase work?

A

activates plasminogen

plasmin which breaks down the fibrin down to fragments lysing the clot

45
Q

side effects of Streptokinase?

A

may cause allergic reactions

and cant be used after 4 days

46
Q

How do alteplase and duteplase work?

A

Are recombinant tissue plasminogen activator (rt-PA)

47
Q

Why are alteplase and duteplase more effective on fibrin bound plasminogen than plasma plasminogen?

A

show selectivity for clots

no allergic reactions

48
Q

How Alteplase and duteplase given? Why?

A

IV

short half life

49
Q

Name the major adverse affects of fibrinolytics?

A

haemorrhage which may be controlled by oral tranexamic acid which inhibits plasminogen activation

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