Anticoagulant Pharm Flashcards
An____ prevents coagulation, ____ dissolves blood clots and ____ decrease platelet aggregation and inhibit thrombus formation
Anticoagulant
Thrombolytic
Antiplatelet agent
What are the 3 clotting pathway portions?
1-Extrinsic pathway (factor VII)
2-Intrinsic (factors XII, XI, IX, VIII)
3-Common pathway (where the int and ext converge, factors I, II, V, and X)
What are 5 things thrombin does?
1-Cleave fibrinogen that then forms fibrin clot
2-Activate upstream clotting factors
3-Activate factor XIII (crosslinks fibrin polymer)
4-Plateley activation
5-activate protein C exerting anticoagulant effects
What enzyme is fibrinolytic?
Plasmin
*plasminogen is the inactive precursor
What enzyme is released when injury occurs in the plasmin pathway?
t-PA (tissue plasminogen activator)
*encourages plasminogen- Plasmin conversion
Unfractionated heparin binds what?
Endogenous antithrombin III (ATIII)
What complex irreversibly inactivates thrombin and several other factors, particularly factor Xa?
Heparin-ATIII complex
What large sulfated polysaccharide from animal sources, is acidic but can be neutralized by protamine?
Heparin
What low molecular weight fraction of heparin has greater bioavailability and longer duration of action?
enoxaparin (Lovenox)
What fast onset, large polysaccharide is administered parenterally, acts in the blood by activating antithrombin III does not cross placental barrier and can be reversed with protamine?
Heparin
*ATIII inactivates coag factors like thrombin and factor Xa
What slow onset, small lipid-soluble drug is taken orally, acts in the liver by imparting post-translational modification of factor II, VII, IX, X, is reversed by Vit, K, used for chronic anticoag and has a narrow therapeutic window?
Warfarin (Coumadin)
*diet restrictions. elimination depends on Cyp P450
How do anticoagulant drugs affect blood pressure?
They do nothing to lower it
What drug was discontinued in 2012 but is recombinant form of the leech protein hirudin?
Lepirudin
*direct thrombin inhibitor
Which direct thrombin inhibitor is used in angioplasty?
Bivalirudin (Angiomax)
Which drug has a rapid onset of action with a shorter half-life than warfarin and bones to both free and bound factor Xa in the clotting complex?
Rivaroxaban (Xarelto)
*used to treat venous thromboembolism after hip/knee surgery
What two groups of drugs act to promote the Plasminogen- plasmin pathway leading to degradation of clots by splitting fibrin?
T-PA analogs (Alteplase)
Streptokinase (can be used for coronary artery thrombosis is ideal conditions)
What drug blocks COX and thus thromboxane A2?
Aspirin
*Thromboxane A2 stimulates lately aggregation
What three drugs are glycoprotein IIb/IIa receptor inhibitors resulting in inhibition of fibrin binding to platelets glycoprotein receptors?
1-abciximab (ReoPro)
2-tirofiban (Aggrastat)
3-eptifibatide (integrelin)
*rapid onset, Iv administration, used to prevent acute cardiac ischemia complications
Which 3 drugs are ADP receptor antagonists and inhibit ADP mediated platelet aggregation?
1-clopidogrel (Plavix)
2-Prasugrel (Effient)
3-ticlopidine (Ticlid)
What drug is a phosphodiesterase 3 inhibitor, has a dual mechanism involving cAMP and is a vasodilator?
cilostazol (Pletal)
What two things are necessary for DNA synthesis and result in anemia when deficient?
1-B12
2-Folic acid
*Iron essential for heme
What drug acts on receptors of erythroid progenitors in the bone to produce red cells and promote their release from marrow?
Erythropoietin
What are 4 things Warfarin, Aspirin and clopidogrel are used for?
1-Coronary artery disease
2-Angina pectoris (unstable)
3-Myocardial infarction (prevent future infarcts)
4-Stroke
What are 5 hemostatic agents in dentistry?
1-Hemostatic collagen (Collaplug) 2-Cellulose (actcel;surgicel) 3-Gelfoam 4-Bone wax (ethicon) 5-Local epinephrine
