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Pharmacology Blood > Anticoagulants > Flashcards

Anticoagulants Flashcards

1
Q

Classify anticoagulants

A
  1. used in vitro used
  2. in vivo -
    a)parental anticoagulants -
    i) Indirect thrombin inhibitor’s
    ii) direct thrombin inhibitor’s
    b)oral anticoagulants -
    i)coumarin derivatives 
    ii) indandione derivatives
    iii)direct thrombin inhibitor
    iv)factor Xa inhibitor
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2
Q

Name in vitro Anticoagulant drugs

A
  1. Heparin
  2. sodium citrate
  3. sodium oxalate
  4. sodium edetate
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3
Q

Name in the Vivo parental indirect thrombin inhibitor‘s

A
  1. Unfractionated heparin
  2. low molecular weight heparin‘s
  3. synthetic
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4
Q

Name low molecular weight heparin

A
  1. Enoxaparin
  2. Dalteparin 
  3. Tinzaparin
  4. Ardeparin
  5. Reviparin
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5
Q

Name a synthetic parenteral anticoagulant in vivo thrombin inhibitor

A

Fondaparinux

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6
Q

Name parental anticoagulants in vivo that are direct thrombin inhibitor’s

A
  1. Lepirudin
  2. bivalirudin
  3. Argatroban
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7
Q

Name anticoagulant used orally in vivo Coumarin derivatives

A
  1. Warfarin 
  2. Dicumarol
  3. Acenocoumarol
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8
Q

Name indandione derivatives

A

Phenindione 

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9
Q

Name oral anticoagulants that can be used in vivo that are direct thrombin inhibitor’s

A

Dibigatran

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10
Q

Name factor Xa inhibitor

A

Rivaroxaban

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11
Q

What is the mechanism of action of heparin

A
  1. Forms of complex with plasma antithrombin III
  2. Inhibits factors Xa, IIa , IXa, XIa, XIIa, XIIIa.
  3. Binds to thrombin and antithrombin
  4. low concentration, inhibits conversion of prothrombin to thrombin
  5. high doses, antiplatelet action
  6. releases lipoprotein lipase which hydrolyzes triglycerides
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12
Q

Why is heparin not used intramuscularly

A

It can cause a haematoma

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13
Q

If life-threatening haemorrhage occurs, which heparin antagonist/drug should be used to neutralize the effect

A

Protamine sulphate [strong base]

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14
Q

How much milligrams of protamine sulphate is needed to neutralize 100 units of heparin

A

1 mg

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15
Q

How does heparin induced thrombocytopenia in in which molecule is incidence higher

A

Formation of antibodies against platelet factor four – heparin complex
Incidence is higher in unfractioned heparin

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16
Q

What are the adverse effects of heparin

A
  1. Bleeding
  2. heparin induced thrombocytopenia
  3. hypersensitivity reactions
  4. osteoporosis
  5. reversible alopecia
  6. abnormalities in liver function
17
Q

What are some contraindications of heparin 

A
  1. Hemophiliacs
  2. patients with heparin induced thrombocytopenia
  3. severe hypertension
  4. intracranial haemorrhage
  5. bacterial endocarditis
  6. active TB 
  7. Peptic ulcer
  8. threatened abortion
  9. cirrhosis
  10. renal failure
18
Q

How do low molecular weight heparin’s prevent coagulation

A

By inhibiting factor Xa through antithrombin

19
Q

What are the advantages of molecular weight heparin

A
  1. Higher subcutaneous bioavailability then UFH
  2. Longer half life
  3. They do not require aPTT monitoring
  4. lower incidence of thrombocytopenia and osteoporosis as compared to UFH
20
Q

What are the uses of fondaparinux

A

They’re used for
1. pulmonary embolism
2. deep vein thrombosis

21
Q

Which Drugs can be used as an anticoagulant in patients with heparin induced thrombocytopenia

A

Parental direct thrombin inhibitors
1. Lepirudin
2. Agratroban

22
Q

What is the mechanism of action of warfarin

A

Warfarin competitively inhibits the synthesis of vitamin K dependent factors - II, VII, IX, and X - by inhibiting epoxide reductase enzyme

23
Q

What is the duration of anticoagulant effect of warfarin

A

It depends on the half-lives of clotting factors. Over a period of 1 to 3 days

24
Q

What is the treatment of overdosage on warfarin

A

Fresh frozen plasma and vitamin K1

25
Q

What are the adverse effects of warfarin/oral Anti-coagulants

A
  1. Bleeding
  2. teratogenic effect
  3. skin necrosis
  4. others: diarrhea, alopecia, urticaria, dermatitis, abdominal cramps and anorexia.
26
Q

What are the drugs or Warfarin/anticoagulants Cannot be taken with

A
  1. Cholestyramine
  2. barbiturates/carbamazepine/rifampicin
  3. oral contraceptives
  4. phenytoin/sulfonamines 
  5. erythromycin/metronidazole
  6. tetracyclines
  7. aspirin another NSAIDs
  8. Cefoperfazone/ceftriaxone
27
Q

What is the interaction between warfarin and cholestyramine

A

Reduced absorption of warfarin

28
Q

What is the interaction between oral coagulants and barbiturates/carbamazepine/rifampicin

A

they are enzyme inducers, increase metabolic clearance of oral coagulants and decrease anticoagulant effect

29
Q

What is the effect of taking warfarin and oral contraceptives together

A

Level of Clotting factors increase Leading to Decreased anticoagulant affect

30
Q

What is the interaction between warfarin and phenytoin/suulfonamides

A

The displace war friend from plasma protein binding site and increase free plasma concentration of warfarin, can lead to bleeding

31
Q

What is the interaction between warfarin and erythromycin/metronidazole

A

Decrease were Warfarin Clearance and increase anticoagulant affect

32
Q

What is the interaction between warfarin and tetracyclines

A

They suppress bacterial flora and decrease vitamin K production, leading to increase warfarin affect

33
Q

What is the interaction between warfarin and ceftriaxone/Cefoperazone

A

Severe bleeding can occur due to hypoprothrombinaemia

34
Q

What is the interaction between warfarin and aspirin and other NSAIDs 

A

NSAID have an anti-platelet effect, displace warfarin plasma protein and potentiate warfarin affect

Pharmacology Blood (5 decks)

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