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Drugs for Final Pharm > anticoagulants > Flashcards

anticoagulants Flashcards

1
Q

thrombotic disorder

A

tx with anticoagulants, fibrinolytic

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2
Q

bleeding/hemorrhage

A

hemophilia tx with coagulation factor and transfusion

vit k def tx with vit k

thrombocytopenia

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3
Q

response to injury

A

VC
platelet plug
clot formation (secondary hemostasis)
fibrinolysis

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4
Q

keeps platelets in inactive state

A

NO
prostacylin
ADPase

all inc cAMP in platelets which act. Ca efflux pump to lower Ca

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5
Q

primary hemostasis

A

collagen and von willebrand leads to platelet adhesion

dec cAMP and inc Ca activates platelets

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6
Q

platelet act.

A

platelet release thromboxane A2
adenosine diphosphate
serotonin
thrombin

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7
Q

platelet aggregation

A

inc in GPIIb/IIIa rec on surface of platelet
bind to cirullating fibrinogen
creates platelet plug

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8
Q

anti-platelet drugs targers

A

inhibition of TxA2 synthesis
inhibition of ADP receptors
blockage of GPIIb/IIIa rec
phosphodiesterase inhibitors/vasodilators

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9
Q

inhibition of TxA2 synthesis

A

oral aspirin
irreversible inhibition of COX-1
platelet life is 7-10 days

NSAIDS-reversible

dont give at same time

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10
Q

inhibition of ADP receptors

A

oral clopidogrel

irreversible inhibition of P2Y12 receptor

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11
Q

blockage of GPIIb/IIIa rec

A

IV abciximab monoclonal Ab

irreversible inhibition of fibrin receptor

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12
Q

phosphodiesterase inhibitors/vasodilators

A

oral dipryridamole
vasodilator
reversible PDE inhibition inc. cAMP and dec Ca

given in combo w/aspirin to prevent cerebrovascular ischemia

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13
Q

secondary hemostasis

A

several minute
fibrin stabilizes
PL produce negatively charged polyphosphates that trigger intrinsic pathway

tissue factor triggers extrinsic pathway

Xa act factor II (prothrombin) into factor IIa (thrombin)

cleaves next factor that is Zymogen

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14
Q

factor XIIIa

A

transglutaminase

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15
Q

antithrombin

A

AT is a serine protease inhibitor and inactivates the serine proteases of the intrinsic pathway

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16
Q

4 classes of anticoagulant

A

vit k antagonist
indirect thrombin inh
direct thrombin inh
dircect inh of factor Xa

17
Q

vit k antagonist

A

oral warfarin

dicoumarol in clover silage, hemorrhagic disease in cattle

Wisconsin Alumni Research Foundation coumARIN

attacks vit k reductase

SNP can lead to high risk of bleeding so need to monitor

18
Q

phytonadione (mephyton)

A

oral vitamin K1

19
Q

warfarin R isomer

A 
cyp1a2/3A4 inhibitors
ciprofloxacin
most statins
fenofibrate
macrolide AB
CYP inducers
phenytoin
20
Q

warfarin S isomer

A 
CYP2C9
Metronidazole
Amiodarone
Azole antifungals
Sulfamethoxazole/trimethoprim
21
Q

indirect thrombin inh

A

IV unfractionated heparin

SC, IV LMW heparins: Enoxaparin

22
Q

IV unfractionated heparin

A

Pentasaccharide sequence binds to AT and exposes it leading to Xa inactivation

short half, continued infusion

23
Q

SC, IV LMW heparins: Enoxaparin

A

2,000 to 9,000 daltons

longer half life, infected ONCE daily, NO monitoring needed

24
Q

protamine sulfate

A

antidote to heparin
basic, positively charged
Inj
monitored

25
Q

direct thrombin inh

A 
oral dabigatran
DOAC
large prodrug
reversible inh thrombin serine protease
half life of 12-24 hr, once daily

better than warfarin, heparin, and inj thrombin inhibitors b/c there is NO NEED TO MONITOR

26
Q

dircect inh of factor Xa

A

oral Rivaroxaban
most recent DOAC

all better choices than warfarin because NO MONITORINg

27
Q

positive regulators of fibrinolysis

A

damaged endothelium releasing tissue Plasminogen Activator
tPA binds to plasminogen bound to fibrin rather than circulating plasminogen
tPA cleaves plasminogen into plasmin

28
Q

fibrinolytic or thrombolytic drugs

A

IV tPA alteplase

tPAs prefer plasminogen bound to fibrin, fibrinolysis will only occur in the formed thrombus and avoids act in the systemic flow

29
Q

alteplase

A

recombinant full length glycosylated human tPA
very fibrin selective
efficient in dissolving older clots

30
Q

management of DOACS

A

anti factor Xa assay before sx

no reversal agents so consider cessation of DOAC medication before sx

31
Q

collagen plug/sponge

A

acc aggregation of platelets and forms physical barrier

microfibrillar collagen (avitene)
collagen sheets
32
Q

topical thrombin

A

added to matrix, gelfoam

CAUTION if allergic rx from bovine thrombin

33
Q

fibrin sealant (fibrin glue)

A

mix of thrombin and CaCl2 in one syringe, conc of thrombin determines rate of clot

fibrinogen, factor XIII, fibrinogen determines strength of clot

34
Q

astringents or styptics

A 
VC, induce platelet
aluminum chloride (plugs incapillaries)
tannic acid (CAUTION incompatible with metal salts)
35
Q

vasoconstrictor agents

A

epinephrine

short term bleeding
long term use is ischemia nd tissue necrosis

36
Q

fibrinolytic inhibitors

A

maintain clot stability, comp inh plasminogen act

aminocaproic acid
tranexamic acid

cover risk of hemorrhage in ptwith hemophilia (replace with coag factor)

Drugs for Final Pharm (8 decks)

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