Anticoagulants, Antithrombotics, & Thrombolytic Drugs

Question 1

Which factors are involved in the intrinsic pathway?

Answer 1

Factors XII, XI, IX, and VIII

Question 2

Which factors are involved in the extrinsic pathway?

Answer 2

Factors VII and III (aka Tissue Factor)

Question 3

What lab tests the intrinsic pathway?

Answer 3

PTT/Partial Thromboplastin Time

Question 4

What lab test the extrinsic pathway?

Answer 4

PT/Prothrombin Time

Question 5

Aspirin

1) Mechanism of Action
2) Use

Answer 5

1) Antiplatelet drug-inhibits the synthesis of thromboxane A2 by IRREVERSIBLE acetylation of cyclooxygenase (inhibits platelet aggregation)
2) Stroke and MI prevention

Question 6

Clopidogrel

1) Mechanism of Action
2) Use
3) Drug Interactions

Answer 6

1) Antiplatelet drug-reduces platelet aggregation by IRREVERSIBLY blocking the ADP (P2Y12) receptor on platelets
2) Coronary Stent Placement
3) Ginko biloba
* Activated by CYP2C19*
* Can cause neutropenia*

Question 7

Ticlopidine

1) Mechanism of Action
2) Use
3) Drug Interactions

Answer 7

1) Antiplatelet drug-reduces platelet aggregation by IRREVERSIBLY blocking the ADP (P2Y12) receptor on platelets
2) Coronary Stent Placement
3) Ginko biloba
* MORE side-effects compared to Clopidogrel*

Question 8

Prasugrel

1) Mechanism of Action
2) Use
3) Drug Interactions

Answer 8

1) Antiplatelet drug-reduces platelet aggregation by IRREVERSIBLY blocking the ADP (P2Y12) receptor on platelets
2) Coronary Stent Placement
3) Ginko biloba

Question 9

Ticagrelor

1) Mechanism of Action
2) Use
3) Drug Interactions

Answer 9

1) Antiplatelet drug-reduces platelet aggregation by REVERSIBLY blocking the ADP (P2Y12) receptor on platelets
2) Combined with low-dose aspirin for antiplatelet therapy
3) Grapefruit juice, CYP34A inhibitors and inducers

Question 10

Abcixmab

1) Mechanism of Action
2) Use

Answer 10

1) Antiplatelet drug-prevents platelet aggregation and thrombus formation by inhibiting GPIIb/IIIa on the surface of platelets
2) Percutaneous Coronary Interventions
* IV agent only*

Question 11

Tirofiban

1) Mechanism of Action
2) Use

Answer 11

1) Antiplatelet drug-prevents platelet aggregation and thrombus formation by inhibiting GPIIb/IIIa on the surface of platelets
2) Percutaneous Coronary Interventions
* IV agent only*

Question 12

Heparin

1) Mechanism of Action
2) Use
3) Lab Monitoring

Answer 12

1) Indirect Thrombin Inhibitor-binds to antithrombin to increase activity causing inhibition of Intrinsic Factors IIa, IXa, and Xa
2) Anticoagulant
3) PTT

Question 13

Protamine Sulfate

1) Mechanism of Action
1) Use

Answer 13

1) Binds heparin to inhibit anticoagulant activity

2) Heparin Reversal

Question 14

Enoxaparin

1) Mechanism of Action
2) Use
3) Lab Monitoring

Answer 14

1) Indirect Thrombin Inhibitor-enhances antithrombin action on Factor X
2) Anticoagulant
3) None
* Partial reversal w/Protamine*

Question 15

Dalteparin

1) Mechanism of Action
2) Use
3) Lab Monitoring

Answer 15

1) Indirect Thrombin Inhibitor-enhances antithrombin action on Factor X
2) Anticoagulant
3) None
* Partial reversal w/Protamine*

Question 16

Fondaparinux

1) Mechanism of Action
2) Use
3) Lab Monitoring

Answer 16

1) Indirect Thrombin Inhibitor-enhances antithrombin action on Factor X
2) Anticoagulant
3) None
* NO reversal agent*

Question 17

Lepirudin
1)Mechanism of Action
2)
3)Clearance organ

Answer 17

1) Direct Thrombin Inhibitor-binds to thrombin (Factor II) and prevents the conversion of fibrinogen to fibrin
2) Anticoagulant
3) Renal Clearance

Question 18

Bivalirudin

1) Mechanism of Action
2) Use
3) Clearance organ

Answer 18

1) Direct Thrombin Inhibitor-binds to thrombin (Factor II) and prevents the conversion of fibrinogen to fibrin
2) Anticoagulant
3) Hepatic and Renal Clearance

Question 19

Argatroban

1) Mechanism of Action
2) Use
3) Clearance organ

Answer 19

1) Direct Thrombin Inhibitor-binds to thrombin (Factor II) and prevents the conversion of fibrinogen to fibrin
2) Anticoagulant
3) Hepatic Clearance
* IV administration d/t short half-life*

Question 20

Dabigatran

1) Mechanism of Action
2) Use
3) Clearance organ

Answer 20

1) Direct Thrombin Inhibitor-binds to thrombin (Factor II) and prevents the conversion of fibrinogen to fibrin
2) Anticoagulant
3) Mostly Renal Clearance
* Oral Administration*
* Reversal agent=Idarucizumab*

Question 21

Idarucizumab

Answer 21

Reversal agent for Dabigatran

Question 22

Warfarin

1) Mechanism of Action
2) Use
3) Lab Monitoring

Answer 22

1) Inhibits vitamin K metabolism which reduces the synthesis of vitamin K dependent clotting Factors II, VII, IX, X, and Protein C and Protein S
2) Anticoagulant
3) INR/PT
* Reversal achieved w/vitamin K (menadione), FFP, and recombinant Factor VIIa*

Question 23

Menadione

Answer 23

AKA vitamin K

Reversal agent for Warfarin

Question 24

Rivaroxaban

1) Mechanism of Action
2) Use

Answer 24

1) Factor Xa inhibitor

2) New Anticoagulant

Question 25

Apixaban

1) Mechanism of Action
2) Use

Answer 25

1) Direct Factor Xa inhibitor
2) Anticoagulant
* Interacts w/CYP3A4 and P-glycoprotein 1*

Question 26

Streptokinase

1) Mechanism of Action
2) Derived from _____
3) Use

Answer 26

1) Fibrinolytic drug-converts plasminogen to plasmin which causes lysis of fibrin clots
2) Derived from Streptococcus-LONG half-life w/possible allergic reaction
3) DVT, PE, MI

Question 27

Urokinase

1) Mechanism of Action
2) Derived from _____
3) Use

Answer 27

1) Fibrinolytic drug-converts plasminogen to plasmin which causes lysis of fibrin clots
2) Derived from human-SHORT half-life, NO allergic reaction
3) DVT, PE, MI

Question 28

Tissue Plasminogen Activator (tPA)

1) Mechanism of Action
2) Derived from _____
3) Use

Answer 28

1) Fibrinolytic drug-converts plasminogen to plasmin which causes lysis of fibrin clots
2) Derived from human-SHORT half-life, NO allergic reaction
3) DVT, PE, MI