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Pharmacology > Anticoagulants & thrombolytics > Flashcards

Anticoagulants & thrombolytics Flashcards

1
Q

Heparin

A

negative charge
large
bind to antithrombin III–> inactivation of thrombin & factor Xa
prevents clots from forming

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2
Q

What is used to measure heparin?

A

PTT

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3
Q

What does heparin treat?

A

DVT
prophylaxis for PE
Acutre MI

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4
Q

What are the side effects of heparin ?

A

heparin induced thrombocytopenia

hyperkalemia due to hypoaldosteronism

induce ospteoperosis

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5
Q

What is the drug that is given to prevent heparin side effects ?

A

Protamine sulfate

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6
Q

Low molecular weight heparin

A 
decrease factor Xa
increased half life and bioavailability 
safe in pregnancy 
is not affected by protein sulfate 
 is contraindicated in renal insufficiency 
decreased need for monitoring 
decrease risk for HIT
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7
Q

Fondaparinaux

A

not affected by protamine sulphate
binds antithrombin III with greater specificity
decreases factor Xa
decreased HIT

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8
Q

BiraliRUDIN

A

direct thrombin inhibitor
tx: HIT
safe in liver disease patient

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9
Q

Agatroban, Dabigatran

A

direct thrombin inhibitor

tx: HIT

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10
Q

RivaroXaban, ApiXaban

A

direct factor Xa inhibitor
decrease monitory
given orally
tx: atrial fibrillation

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11
Q

Warfarin

A

decrease vitamin K epoxide reductase –> decreased coagulation

onset is 8-12 hrs , oral administration
long half life

tx: atrial fibrillation
prophylaxis in PE & DVT

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12
Q

What are the side effects of warfarin?

A

teratogenic: decreased hemorrhage and bone formation

warfarin induced skin necrosis

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13
Q

How is warfarin effects treated ?

A

vitamin K - delayed

FFP- immediate

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14
Q

What occurs at the beginning of warfarin doses?

A

protein C is reduced leading to a hypercoaguable state

tx: heparin to decrease affects

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15
Q

What are the methods of monitoring warfarin ?

A

PT

INR -2-3

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16
Q

How are platelets recruited to an injury?

A
  1. Adhesion (VWF, GPIb-IX)
  2. Activation (degranulation )
  3. Aggregation (fibrinogen/ GPIIb/IIa)
17
Q

Aspirin

A

decrease COX 1 –> decrease TXA 2 by irreversible acetylation

18
Q

What are the side effects of aspirin ?

A

increased leukotrienes

GI upset & bleeding

19
Q

P2Y12 Antagonist

A

“grel”

block ADP from binding to P2Y12 –> increase cAMP –> decreased platelets

20
Q

What are the dual (aspirin + P2Y12) given for?

A

prevent stent thrombosis
decrease ischemic stroke
Acute MI
cardiovascular events

21
Q

What are the adverse effects of ticlopidine ?

A

aplastic anemia

agranulocytosis

22
Q

Abcixmab

A

monoclonal antibody

bind GP IIB/IIIa

23
Q

Eptificatide & Tirofiban

A

block GP IIB/IIIa

24
Q

What is the side effect of GPIIb/IIA inhibitors

A

Thrombocytopenia

increased bleeding time

25
Q

Dipyridamole & Cilostazol

A

Phosphodiesterase inhibitors

increase cAMP

26
Q

What does cilostazol cause?

A

vasodilation
claudication
coronary steal

27
Q

What are the thrombolytic drugs?

A

alteplase (TPA)
reteplase
tenecteplase
streptokinase

28
Q

What is the effect of thrombolytics?

A

plasminogen to plasmin conversion–> increase fibrin degradation products

29
Q

What is the meaning of increased D-dimers?

A

increased clot degradation

30
Q

Why are thrombolytics given?

A

ischemic stroke
DVT
PE
acute MI

31
Q

When does a thrombolytic need to be given in acute MI for it to be functional ?

A

3-4.5 hrs

32
Q

What are the adverse effects of thrombolytics?

A

hemorrhage, irregular breathing, asymmetric pupils

Anaphylaxis

33
Q

What is the preferred option before fibrinolytic ?

A

percutaneous coronary intervention

needs to be completed in the first 2 hrs

34
Q

What are the contraindication of thrombolytics?

A

surgery planned within 10 days
GI bleeds or active bleeds
previous cerebral hemorrhage
Aortic dissection

35
Q

What are the antifibrinolytics?

A

e-aminocaproic acid & tranexamic acid : competitively inhibit plaminogen activation

36
Q

What can tranexamic acid be used for?

A

dental extractions in hemophilia patients

Pharmacology (15 decks)

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