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Human Diseases > Anticoagulants, antifibrinolytic and antiplatelet drugs > Flashcards

Anticoagulants, antifibrinolytic and antiplatelet drugs Flashcards

1
Q

What are the stages of haemostasis?

A

Constriction of damaged vessels
Mechanical blockage of hole by platelet plug
Coagulation cascade
Thrombolysis

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2
Q

What causes platelet activation and aggregation?

A

Thromboxane A2 (TXA2)
ADP
Thromboxane

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3
Q

what is the purpose of fibrinogen?

A

Links adjacent platelets

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4
Q

Other than TXA2, what activates platelets?

A

Thrombin

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5
Q

When does thrombolysis occur?

A

Fibrin mesh is prevented from increasing so is slowly dissolved by plasmin

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6
Q

What 3 stages can drugs target?

A

Platelets - anti-platelet
Coagulation - anti-coagulant
Thrombolysis - thrombolytic therpay

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7
Q

What is the most common anti-platelet drug?

A

Aspirin

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8
Q

Indications for antiplatelet therapy?

A 
Previous MI
Previous stroke
stable angina
Claudication
Atrial fibrillation
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9
Q

what kind of anti-platelet drug is aspirin?

A

Cyclooxygenase inhibitor

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10
Q

Function of cyclooxygenase?

A

Formation of thromboxane

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11
Q

Mechanism of action of cyclooxygenase inhibitors like aspirin?

A

Inhibit the formation of thromboxane - stop platelet activation and aggregation

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12
Q

What dose is aspirin given prophylactically?

A

75mg/day

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13
Q

What dose is aspirin given in emergency?

A

300mg/day

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14
Q

Contraindications of aspirin?

A 
Allergies
Age less than 12
GI bleeding
Bleeding disorder
Severe liver disease
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15
Q

How do ADP receptor antagonists work?

A

Inhibit binding of ADP so platelet aggregation cannot occur

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16
Q

When are ADP receptor antagonists (clopidogrel) chosen over aspirin?

A

Safer in GI bleeding

Less toxicity

17
Q

What drugs can clopidogrel (ADP receptor antagonist)?

A

Proton pump inhibitors

18
Q

When are adenosine re-uptake inhibitors used? (dipyridamole)

A

Prosthetic heart valves, alternative or in addition to aspirin

19
Q

When is dipyridamole (adenosine re-uptake inhibitor) contraindicated?

A

Uncontrolled angina - may exacerbate

20
Q

Mechanism of action of anticoagualnt like heparin?

A

Vitamin K antagonist
Enhance antithrombin III
Inactive prothrombin
Impair platelet function

21
Q

Why can heparin not be given through GI tract?

A

Poorly absorbed

22
Q

How is heparin adminsitered?

A

Low dose = subcutaneous

High dose = Iv

23
Q

Why are low molecular weight heparin sometimes used?

A

Once daily dosing
No need to monitor
Smaller bleeding risk
Reduced risk of thrombocytopeaenia

24
Q

What are the disadvantages of low molecular weight heparins?

A

Less reversible than heparin

25
Q

Unwanted effects of heparin?

A

Haemorrhage
Thrombocytopenia
Allergy

26
Q

What kind of drug is warfarin?

A

Anti-coagulant - vit K antagonist

27
Q

Why is warfarin slow acting?

A

Highly protein bound

28
Q

How can warfarin be reversed?

A

Vit K

29
Q

Disadvantages of warafarin?

A

Drug interactions with everything

30
Q

Warfarin uses?

A

Prevent DVT (deep vein thrombosis)
Treatment of PE (pulmonary embolism)
Atrial fibrillation - prevent risk of embolisation
Prosthetic heart valves to prevent emboli developing on valves

31
Q

Problems with warfarin?

A

Increased risk of bleeding (unless INR is less than 4)

32
Q

How do thrombolytics work?

A

Plasminogen activators (degrades clots)

33
Q

What is an indication for thrombolysis

A

Arterial thrombosis

34
Q

When is INR value required?

A 
For procedures where there is a risk of bleeding
extractions
Surgery that involves making a flap
extensive RSI
IDB
35
Q

What is the threshold INR value for no risk of bleeding?

A

4

36
Q

How does dabigatran work?

A

Direct thrombin inhibtor

37
Q

Disadvantage of direct oral anticoagulants?

A

No INR value - dont know how bleeding will go

Human Diseases (37 decks)

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