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Cardiovascular II > Anticoagulants, antiplatelets, and fibrinolytics > Flashcards

Anticoagulants, antiplatelets, and fibrinolytics Flashcards

1
Q

ADP and P2Y12 inhibitors

A

Clopidogrel
Prasugrel
Ticagrelor
Ticlopidine - not in US (aplastic anemia)

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2
Q

Mechanism of ADP and P2Y12 inhibitors

A

Block ADP receptors which lead to inactivation of P2Y12 receptors, leading to an increase in cAMP to inhibit platelet aggregation

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3
Q

Clinical uses of ADP and P2Y12 inhibitors

A

Treatment of ACS
Stroke prevention
Dual antiplatelet therapy

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4
Q

Adverse effect of ADP and P2Y12 inhibitors

A

Bleeding

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5
Q

GP IIb/IIIa inhibitors

A

Abciximab
Tirofiban
Eptifibatide

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6
Q

Mechanism of GP IIb/IIIa inhibitors

A

Inhibit binding of fibrinogen to IIb/IIIa receptors to prevent platelet aggregation

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7
Q

Clinical uses of GP IIb/IIIa inhibitors

A

ACS
PCI

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8
Q

Adverse effect of GP IIb/IIIa inhibitors

A

Bleeding

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9
Q

Platelet adenosine uptake inhibitor that works by inhibiting phosphodiesterase

A

Dipyridamole

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10
Q

Clinical uses of dipyridamole

A

Thromboembolism prophylaxis
Pharmacologic cardiac stress test

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11
Q

PDE3 inhibitor that inhibits phosphodiesterase for an antiplatelet action

A

Cliostazol

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12
Q

Use of cliostazol

A

Intermittent claudication (PVD)

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13
Q

Protease-activated receptor 1 (PAR-1) inhibitor that inhibits platelet aggregation induced by thrombin and thrombin receptor agonist peptide (TRAP)

A

Vorapaxar

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14
Q

Clinical use of vorapaxar

A

Thrombotic event prevention

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15
Q

Adverse effects of vorapaxar

A

Bleeding
Depression
Rash

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16
Q

Thromboxane A2 (TXA2) inhibitor that irreversible acetylates COX1 receptors in platelets

A

Aspirin

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17
Q

Prophylactic use of aspirin

A

MI and CVA

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18
Q

Adverse effects of aspirin

A

GI upset
Bleeding

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19
Q

Vit K antagonist that inhibits the hepatic synthesis of vit K clotting factors (II, VII, IX, and X) by blocking the gamma-carboxylation of clotting factors

A

Warfarin

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20
Q

Bleeding values affected by warfarin use

A

INR and PT –> extrinsic pathway

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21
Q

Indication for warfarin use

A

Ambulatory anticoagulation

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22
Q

Contraindication of warfarin

A

Pregnancy –> crosses placenta –> teratogenic –> bone defects

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23
Q

Adverse effects of warfarin

A

Bleeding
Skin necrosis
Purple toe syndrome (3-8 wks)

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24
Q

Increased risk for developing skin necrosis with warfarin use

A

Pts with decreased protein C

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25
Q

Antidote to warfarin

A

Vit K1 (phytonadione)

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26
Q

Activates the plasma antithrombin III by enhancing serine protease activity to cause inactivation of clotting factors IIa, IXa, Xa, XIa, and XIIa

A

Heparin

27
Q

Bleeding values affected by heparin

A

PTT –> intrinsic pathway

28
Q

Adverse effects of heparin

A

Heparin induced thrombocytopenia (HIT)
Osteoporosis

29
Q

Antidote to heparin

A

Protamine sulfate

30
Q

Low molecular weight heparins with a higher half-life than heparin and less risk of thrombocytopenia. Higher activity against factor X and no impact on PT or PTT.

A

Enoxaparin
Dalteparin

31
Q

Contraindication of enoxaparin

A

Prosthetic valve

32
Q

Synthetic heparinoid with selective antithrombin III mediated Xa inhibition. Safer to use in heparin induced thrombocytopenia.

A

Fondaparinux

33
Q

Recombinant hirudin obtained from yeast cells with direct thrombin inhibitory action

A

Lepirudin

34
Q

Synthetic derivative of hirudin with direct thrombin inhibitory action

A

Bivalirudin

35
Q

Indications for use of hirudin family drugs

A

Prevent thrombosis in pts with unstable angina and acute MI

36
Q

Adverse effect of the hirudin family of drugs

A

Bleeding

37
Q

Synthetic direct thrombin inhibitor indicated for use in treatment of thrombosis in pts with HIT

A

Argatroban (IV)

38
Q

First oral direct thrombin inhibitor used to reduce risk of stroke in A fib and prevent thrombotic complications after joint replacement surgeries.

A

Dabigatran/Pradexa

39
Q

Adverse effects of dabigatran/Pradexa

A

Bleeding
Gastritis-like symptoms

40
Q

Interactions of dabigatran/Pradexa

A

Substrate for P-glycoprotein –> contraindicated in Pgp inducers (rifampin)
Caution with Pgp inhibitors (verapamil, amiodarone, clarithromycin)

41
Q

Active factor Xa inhibitors

A

Apixaban/Eliquis
Rivaroxaban/Xarelto

42
Q

Uses of apixaban

A

In A fib to reduce stroke risk
Prevention and treatment of venous thromboembolism

43
Q

Uses of rivaroxaban

A

DVT
Blood clots
PE
After knee replacement

44
Q

Adverse effect of active factor Xa inhibitors

A

Bleeding

45
Q

Indications for anticoagulant therapy

A

Thromboembolic disorders –> DVT, PE, A fib
Unstable angina undergoing PCI

46
Q

Only anticoagulant approved for use with synthetic valves

A

Warfarin

47
Q

General contraindications for anticoagulant therapy

A

Hypersensitivity
Underlying coagulation disorder
Ulcer disease
Severe thrombocytopenia
Active bleeding

48
Q

General adverse reactions to anticoagulant therapy

A

Hyperlipidemia
Thrombocytopenia
Pain at site of injection
Spinal and/or epidural hematoma

49
Q

Heparin goal –> bleeding values

A

PTT > 1.5-2.5x normal
Normal PTT of 21-35 sec

50
Q

Warfarin goal –> bleeding values

A

INR > 2.5x normal
Normal INR is 1

51
Q

Clinical uses of fibrinolytics/thrombolytics

A

Acute MI
Acute PE
DVT
Thomboembolic stroke

52
Q

Drug class that works by activating conversion of plasminogen to plasmin, causing lysis of fibrin clot to degradation products

A

Fibrinolytics/thrombolytics

53
Q

Serine protease inhibited by alpha-2 antiplasmin

A

Plasmin

54
Q

Tissue plasminogen activators –> recombinant DNA and clot specific

A

Altepase
Reteplase
Tenecteplase

55
Q

Protein obtained by beta-hemolytic strep that can be used as a non-specific fibrinolytic

A

Streptokinase

56
Q

Adverse effects of streptokinase fribinolytic

A

Allergic reaction
Hypotension
Decreased antibody activity after recent use

57
Q

Prodrug of isolated streptokinase that acts as a slow release

A

Anistreplase

58
Q

Fibrinolytic enzyme obtained from human neonatal kidney only approved for use in PE

A

Urokinase

59
Q

Adverse effects of fibrinolytic therapy

A

Bleeding and hemorrhage –> additive

60
Q

Contraindications of fibrinolytic therapy

A

Serious GI bleed
Active bleeding or hemorrhagic disorder
Surgery within 10 days
Aortic dissection

61
Q

Antidote for fibrinolytic therapy

A

Aminocaproic acid

62
Q

Adverse effects of aminocaproic acid

A

Thrombosis
Hypotension
Arrhythmias

63
Q

Anti-fibrinolytic drug used to treat heavy menstrual bleeding

A

Tranexamic acid

64
Q

Increased risk factors for thrombotic adverse effect with tranexamic acid

A

Obese
Cigarette smoking
OCP

Cardiovascular II (29 decks)

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