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CVS II Pharmacology > Anticoagulants, Antiplatelets, and Fibrinolytic Drugs > Flashcards

Anticoagulants, Antiplatelets, and Fibrinolytic Drugs Flashcards

1
Q

what is the MOA of clopidogrel

A

ADP/P2Y12 inhibitors (antiplatelets)

inactivation of p2y12 receptors increases cAMP

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2
Q

what is the MOA of prasugrel

A

ADP/P2Y12 inhibitors (antiplatelet)

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3
Q

what is the MOA of ticagrelor

A

ADP/P2Y12 inhibitor

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4
Q

what is the MOA of abciximab

A

GP IIb/IIIa inhibitor (antiplatelet)

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5
Q

what is the MOA of eptifibatide

A

GP IIb/IIIa inhibitor (antiplatelet)

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6
Q

what is the MOA of tirofiban

A

GP IIb/IIIa inhibitor (antiplatelet)

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7
Q

what is the MOA of dipyridamole

A

phosphodiesterase inhibitor (PDE3)

when PDE3 is inhibited, the breakdown of cAMP is reduced

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8
Q

what is the MOA of Cilostazol

A

PDE3 inhibitor

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9
Q

what is the MOA of vorapaxar

A

protease-activated receptor-1 inhibitor (antiplatelet)

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10
Q

what is the MOA of Aspirin

A

Thromboxane A2 inhibitor via irreversible acetylation of COX1 receptors in platelets (antiplatelet)

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11
Q

what are the clinical uses of aspirin

A

prophylaxis in MI and stroke

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12
Q

what are the adverse effects of aspirin

A

GI upset and bleeding

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13
Q

which P2Y12 inhibitor is not used in the states due to life-threatening aplastic anemia

A

ticlopidine

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14
Q

does the inactivation of P2Y12 increase or decrease cAMP levels

A

increase, causing inhibition of platelet aggregation

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15
Q

what are the clinical uses of ADP/P2Y12 inhibitors

A

Treatment of ACS, prevention of stroke, DAPT (dual antiplatelet therapy) for drug eluted stent (usually combined with aspirin)

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16
Q

how does glycoprotein IIb/IIIa inhibition contribute to antiplatelet formation

A

it inhibits fibrinogen from binding to IIb/IIIa receptors

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17
Q

what is the MOA of Dipyridamole

A

inhibition of phosphodiesterase

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18
Q

what is the MOA of cilostazol

A

inhibition of PDE3 (phosphodiesterase 3)

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19
Q

what are the clinical uses of dipyridamole

A

thromboembolism prophylaxis, cardiac stress test for patients who can’t use the treadmill

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20
Q

what is the clinical use of cilostazol

A

treatment of intermittent claudication (PVD)

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21
Q

what is the clinical use of vorapaxar

A

thrombotic event prevention

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22
Q

what are some adverse effects of vorapaxar besides bleeding

A

depression and rash

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23
Q

what is the MOA of warfarin

A

Vit K antagonist (inhibits hepatic synthesis of vit k factors II, VII, IX, and X)

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24
Q

what are the adverse effects of warfarin besides bleeding

A

skin necrosis, purple toe syndrome, teratogenic (bone defects)

25
Q

what is the anticoagulant that is teratogenic

A

warfarin

26
Q

why is warfarin an ambulatory anticoagulant

A

bc it takes 2-3 days to work)

27
Q

what is the MOA of skin necrosis with warfarin therapy

A

since protein c depends on gamma carboxylation and that’s the MOA of warfarin, it can cause a protein C deficiency ultimately leading to hypercoagulability

28
Q

what is the MOA of unfractionated heparin

A

potentiator of antithrombin: activates the plasma antithrombin III by enhancing the serine protease activity. In turn, the antithrombin III will inactivate factors IIa, IXa, Xa, XIa, and XIIa

29
Q

what is an adverse effect of heparin

A

heparin induced thrombocytopenia, osteoporosis

30
Q

why is heparin safe during pregnancy

A

it doesn’t cross the placenta, unlike warfarin

31
Q

What is the MOA of LMWHs: enoxaparin and dalteparin

A

potentiator of antithrombin via activity against factor X

32
Q

what is the MOA of synthetic heparinoid, fondaparinux

A

selective antithrombin III Xa inhibition

33
Q

why is enoxaparin contraindicated in prosthetic valves

A

high risk of thromboembolism

34
Q

of the LMWH, which one is safer in heparin induced thrombocytopenia

A

fonaparinux

35
Q

what is the MOA of the hirudin family of drugs

A

direct thrombin inhibitor

36
Q

what are the clinical uses of lepirudin and bivlirudin (direct thrombin inhibitors)

A

prevention of thrombosis in pts with unstable angina and acute MI

37
Q

what is the MOA of argatroban

A

synthetic direct thrombin inhibitor

38
Q

what is the clinical use of argatroban

A

treatment of thrombosis in pts with HIT

39
Q

what is the MOA of dabigatran (pradaxa)

A

(oral) direct thrombin inhibitor

40
Q

what are the clinical uses of dabigatran

A

reduce the risk of stroke in prs with afib; prevent thrombotic complications of hip and knee replacement surgery

41
Q

what is a unique side effect of dabigatran

A

gastritis like symptoms

42
Q

why is dabigatran contraindicated with Pgp inducers (rifampin) and pgp inhibitors (verapamil, amiodarone and clarithromycin)

A

because its a substrate for P-glycoprotein (Pgp)

43
Q

what is the MOA of apixaban (eliquis)

A

oral direct factor Xa inhibitor

44
Q

what are the clinical uses of apixaban

A

Afib to reduce risk of stroke, prevention and treatment of venous thromboembolism

45
Q

what is the MOA of rivaroxaban (xarelto)

A

oral direct factor Xa inhibitor

46
Q

what are the clinical uses of rivaroxaban (xarelto)

A

DVT, blood clots and pulmonary embolism after knee replacement

47
Q

what are the overarching clinical uses of anticoagulants

A
  1. thromboembolic disorders: DVT, PE, and Afib
  2. Unstable angina undergoing PCI
48
Q

what is the antidote for heparin

A

protamine sulfate

49
Q

what is the antidote for warfarin

A

Vit K1 (phytonadione)

50
Q

Heparin affects PT/PTT while warfarin affects PT/PTT?

A

heparin: PTT (intrinsic pathway)
warfarin: PT (extrinsic pathway)

51
Q

what test do you need to run every 2 weeks for patients on warfarin

A

INR (normal is 1.0 and warfarin patients should be around 2.0)

52
Q

what is the normal PTT that you would expect to see in pts on heparin

A

normal is 21-35 sec, heparin pts expect 50-55

53
Q

what are the overarching clinical uses of fibrinolytics (thrombolytics)

A

Acute MI, Acute PE, DVT, Thromboembolic stroke

54
Q

what is the MOA of fibrinolytics

A

activate the conversion of plasminogen to plasmin –> causes lysis fibrin clot

55
Q

what is the antidote or alteplase/fibrinolytics

A

aminocaproic acid

56
Q

what are the most common 3 tPA drugs

A

alteplase, reteplase and tenecteplase

57
Q

what antifibrinolytic drug is used to treat heavy menstrual bleeding

A

tranexamic acid

58
Q

what are the adverse effects of tranexamic acid

A

thrombotic events (increased in pregnant women and obese pts)

CVS II Pharmacology (9 decks)

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