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CV 2 > Anticoagulants, antithrombotics, and thrombolytics > Flashcards

Anticoagulants, antithrombotics, and thrombolytics Flashcards

1
Q

What is the purpose of anticoagulant drugs?

A

Slow clotting time and stop coagualtion cascade

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2
Q

Which anticoagulants are used for rapid termination of clot propagation? How are these administered?

A

Heparin, LMWH, and fondaparinux

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3
Q

Which anticoagulants would be used for a slow and prolonged effect?

A

Warfarin (Coumadin)

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4
Q

What would antiplatelet drugs be used for?

A

Inhibition of platelet activation and aggregation

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5
Q

What does aspririn do?

A

Inhibits produciton of thromboxane inhibiting platelet activation

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6
Q

What are clopidogrel, ticlodipine, prasugrel?

A

Inhibits the ADP receptor

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7
Q

What is cilostazol?

A

Inhibits platelet aggregation and stimulates vasodilation

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8
Q

What are abciximan, eptifibatide, and tirofiban?

A

Blockers of the GpIIb-IIIa complex

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9
Q

Whare are fibrinolytic drugs? What are two examples?

A

these are given to cause thrombolysis

t-PA and urokinase

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10
Q

Where is heparin isolated from?

A

Procine intestinal mucosa or bovine lung

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11
Q

What are the effects of heparin?

A

Heparin serves as a template for the binding of ATIII to thrombin

Also inhibits IXa, Xa, XIa, XIIa, and kalikrein

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12
Q

What are the effects of heparin on clotting times?

A

Prolongs aPTT and TT

Only high concentrations will prolong PT

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13
Q

How can heparin be administered and why?

A

Heparin is a large molecule which will be digested in the GI tract. It must be administered parenterally

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14
Q

How does the onset of action of heparin determine administration?

A

Heparin’s onset is directly related to the rate at which it appears in the blood. When rapid onset is required, an IV bolus with continuous IV perfusion is administered. When slower onset is sufficient, a subcutaneous injection is administered.

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15
Q

What is the process of a continuous heparin infusion?

A

Continuous infusion is initiated and then the bolus is given. Rate of infusion is adjusted base on aPTT. Although this allows rapid onset, hypervolemia may occur.

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16
Q

Why is intermittent intravenous heparin not recommended??

A

Can result in fluctuations of blood concentrations

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17
Q

What is normal aPTT time for heparin thearapy?

A

1.5-2.5

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18
Q

What are the two major manifestations of heparin toxicity?

A

Hemorrhage or HIT-1 and HIT-2

HIT-1 is a transient thrombocytopenia which normally resolves

HIT-2 is the formation of autoantibodies to the platelet factor-4 heparin complex. this causes thrombocytopenia, but immune complex damage of the endothelium will cause a prothrombotic state.

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19
Q

What are five indications for heparin use?

A

AMI, unstable angina, PE, DVT, or DIC

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20
Q

How do you treat heparin toxicity?

A

Immediate withdrawal of heparin and IV administration of protamine sulfate

Note: cannot reverse the effects of warfarin

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21
Q

What is protamine sulfate?

A

Protamine sulfate is a strongly negative protein which complexes and inactivates the strongly positive heparin protein

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22
Q

What are potential side effects (3) of protamine sulfate?

A

transient hypotension, thrombotic state, or anaphylaxis

23
Q

What is the prototype of LMWH and its suffic

A

Enoxoparin

suffix = parin

24
Q

What is the effect of LMWH?

A

LMWH has a greater affinity for Xa specifically over all others

25
Q

What are the benefits of LMWH affinity?

A

It allows less frequent dosing reducing the risk of side effects

26
Q

What are the indications (5) for LMWH?

A

Used to prevent DVT and thromboembolic events in abdominal surgery, hip replacement, knee replacement, and severe immobility

27
Q

How does LMWH home therapy work?

A

pre-filled syringes are provided to the patient

28
Q

What is Fondaparinux?

A

This is a synthetic analog of heparin, which inhibits Xa and not thrombin or platelet activity

29
Q

What is the route of administration and benefits (3) of fondaparinux?

A

Administered subcutaneously

No HIT
does not prolong aPTT, PT, or bleeding time
Doesn’t affect platelet function

30
Q

What are the indications for fondaparinux?

A

DVT, knee replacement, hip replacement, abdominal surgery, and immobility

31
Q

What is hirudin and lepirudin? What are the uses? How is lepirudin administered?

A

Hirudin and lipirudin are irreversible thrombin inhibitors

Hirudin is produced by medicinal leeches and lipirudin is the recombinant form.

used to treat thrombosis in HIT

Administered by IV

32
Q

What is argatrobin?

A

It is a reversible thrombin inhibitor used for HIT patients

33
Q

What is warfarin?

A

It is an oral anticoagulant which interferes with the vitamin K-dependent coagulation factors. Inhibits II, VII, IX, X, PrS, PrC, and PrZ

34
Q

What is the onset, absorption, bioavailability, duration of action, and termination of warfarin?

A

Onset is 36 to 72 hours. Completely absorbed through the GI mucosa and 99% bound to albumin. The duration of action is long because the termination half-life is 40 hours.

35
Q

What are the toxic manifestations (4) and contraindication of warfarin?

A

Toxicity - hemorrhage, anorexia, nausea, vomiting, and diarrhea

Contraindication - pregnancy

36
Q

What is warfarin used for?

A

Prophylaxis in any condition increasing thromboemboli

37
Q

How is warfarin therapy monitored?

A

Monitored by INR with PT time. Normal INR is 2-3

38
Q

How do you treat warfarin toxicity?

A

Withdrawal of warfarin, administration of vitamin K, and possibly frozen plasma rich in II, VII, X

39
Q

What is dabigatran etexilate?

A

This is an orally administered thrombin innhibitor which also reduces the thrombin activation of platelet aggregation. It is rapidly absorbed as a prodrug and converted in the blood by esterases.

Note: has a less variably effect compared to warfarin and doesn’t require INR monitoring.

40
Q

What is rivaroxaban?

A

An orally administered factor Xa inhibitor which seems more effective than LMWH

41
Q

How does aspirin act as an antiplatelet agent?

A

aspirin is an irreversible COX-1 inhibitor which blocks the production of thromboxane-2.

42
Q

What are the indications for aspirin in CVD?

A

primary prevention of MI and secodary prevention of MI

43
Q

What is clopidogrel?

A

This is an orally administered drug which irreversibly inhibits the ADP receptor on platelets and subsequently the ADP-dependent activation of the gpIIb-gpIIIa complex. Administered as a prodrug.

44
Q

What are the indications (4) of clopidogrel?

A

prophylaxis of stroke, MI, PAD, and ACS

45
Q

What is the mechanism of action, indication, and adverse effects (2) of ticlodipine?

A

Irreversible blocks the binding of ADP and fibrinogen to platelets. Used to prevent stroke and TIA. Can cause TTP and aplastic anemia.

46
Q

What is cilostazol? what is the mechanism of action? What is the indication? what is the contraindication?

A

Cilostazol is an inhibitor of cAMP PDE-III. Increases the concentration of cAMP in blood vessels causing vasodilation and inhibition of platelet aggregation.

Used for intermittent claudication. contraindicated in CHF

47
Q

What is dipyridamole? What are its three indications?

A

It is a PDE inhibitor which raises cAMP levels.

Used for secondary prevention of AMI in prosthetic valve patients. Prevention of stroke in TIA. Maintenance of valve patency in coronary bypass graft.

48
Q

What is abciximab? Its mechanism of action? Indications (2)?

A

Abciximab is a monoclonal antibody which inhibits gpIIb-IIIa inhibiting platelet aggregation. Used for high risk angioplasty and ACS.

49
Q

What is pentoxyifylline?

A

This drug increases the flexibility of erythrocytes and decreased blood viscosity. Used for intermittent claudication.

50
Q

Name three thrombolytics?

A

t-PA (alteplase, reteplase, and tenecteplase), streptokinase, urokinase

51
Q

What are the 4 indications for thrombolytics?

A

AMI, PE, DVT, and stroke

52
Q

What is significant about the blood interactions of streptokinase?

A

Many patients have developed antibodies, so a loading dose must be given to saturate these sites.

53
Q

What are the uses of aPTT (4)?

A

monitor intrinsic pathway, hemophilias A and B (factor VIII and IX deficiency), and unfractionated heparin therapy.

CV 2 (7 decks)

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