Anticoagulant Pharm

Question 1

An____ prevents coagulation, ____ dissolves blood clots and ____ decrease platelet aggregation and inhibit thrombus formation

Answer 1

Anticoagulant

Thrombolytic

Antiplatelet agent

Question 2

What are the 3 clotting pathway portions?

Answer 2

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)

Question 3

What are 5 things thrombin does?

Answer 3

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

Question 4

What enzyme is fibrinolytic?

Answer 4

Plasmin

*plasminogen is the inactive precursor

Question 5

What enzyme is released when injury occurs in the plasmin pathway?

Answer 5

t-PA (tissue plasminogen activator)

*encourages plasminogen- Plasmin conversion

Question 6

Unfractionated heparin binds what?

Answer 6

Endogenous antithrombin III (ATIII)

Question 7

What complex irreversibly inactivates thrombin and several other factors, particularly factor Xa?

Answer 7

Heparin-ATIII complex

Question 8

What large sulfated polysaccharide from animal sources, is acidic but can be neutralized by protamine?

Answer 8

Heparin

Question 9

What low molecular weight fraction of heparin has greater bioavailability and longer duration of action?

Answer 9

enoxaparin (Lovenox)

Question 10

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?

Answer 10

Heparin

*ATIII inactivates coag factors like thrombin and factor Xa

Question 11

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?

Answer 11

Warfarin (Coumadin)

*diet restrictions. elimination depends on Cyp P450

Question 12

How do anticoagulant drugs affect blood pressure?

Answer 12

They do nothing to lower it

Question 13

What drug was discontinued in 2012 but is recombinant form of the leech protein hirudin?

Answer 13

Lepirudin

*direct thrombin inhibitor

Question 14

Which direct thrombin inhibitor is used in angioplasty?

Answer 14

Bivalirudin (Angiomax)

Question 15

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?

Answer 15

Rivaroxaban (Xarelto)

*used to treat venous thromboembolism after hip/knee surgery

Question 16

What two groups of drugs act to promote the Plasminogen- plasmin pathway leading to degradation of clots by splitting fibrin?

Answer 16

T-PA analogs (Alteplase)

Streptokinase (can be used for coronary artery thrombosis is ideal conditions)

Question 17

What drug blocks COX and thus thromboxane A2?

Answer 17

Aspirin

*Thromboxane A2 stimulates lately aggregation

Question 18

What three drugs are glycoprotein IIb/IIa receptor inhibitors resulting in inhibition of fibrin binding to platelets glycoprotein receptors?

Answer 18

1-abciximab (ReoPro)
2-tirofiban (Aggrastat)
3-eptifibatide (integrelin)

*rapid onset, Iv administration, used to prevent acute cardiac ischemia complications

Question 19

Which 3 drugs are ADP receptor antagonists and inhibit ADP mediated platelet aggregation?

Answer 19

1-clopidogrel (Plavix)
2-Prasugrel (Effient)
3-ticlopidine (Ticlid)

Question 20

What drug is a phosphodiesterase 3 inhibitor, has a dual mechanism involving cAMP and is a vasodilator?

Answer 20

cilostazol (Pletal)

Question 21

What two things are necessary for DNA synthesis and result in anemia when deficient?

Answer 21

1-B12
2-Folic acid

*Iron essential for heme

Question 22

What drug acts on receptors of erythroid progenitors in the bone to produce red cells and promote their release from marrow?

Answer 22

Erythropoietin

Question 23

What are 4 things Warfarin, Aspirin and clopidogrel are used for?

Answer 23

1-Coronary artery disease
2-Angina pectoris (unstable)
3-Myocardial infarction (prevent future infarcts)
4-Stroke

Question 24

What are 5 hemostatic agents in dentistry?

Answer 24

1-Hemostatic collagen (Collaplug)
2-Cellulose (actcel;surgicel)
3-Gelfoam
4-Bone wax (ethicon)
5-Local epinephrine