Antiplatelet And Anticoagulant Flashcards
Thromboxane synthesis inhibitor (Antiplatelet)
Acetylsalicylic acid
GP 2b3a receptor antagonist (antiplatelet)
Tirofiban
ADP receptor antagonist (antiplatelet)
Clopidogrel and ticagrelor
Antiplatelets are
Thromboxane synthesis inhibitor,GP 2b3a receptor antagonist and ADP receptor antagonist
Thromboxane synthesis inhibitor or Aspirin inhibits the enzyme
COX 1
GP 2b3a receptor are needed for
Platelets aggregation
ADP induce upregulation of
GP 2b3a receptor
Final stage of platelets aggregation
Fibrinogen binding to receptor
Use of thromboxane synthesis inhibitor
Secondary cerebrovascular and cardiovascular thrombosis prevention and ACS
Side E of Aspirin
Bleeding from GIT
GP 2b3a receptor antagonist use
ACS
ADP receptor also known as
P2Y12 receptors
Clopidogrel is a prodrug that should be activated by
CYP450 and does irreversible inhibition throughout life of PLT
Ticagrelor does
Reversible inhibition of P2Y12 receptor and also indirectly inhibit Gp2b3a receptor
Clinical use of ADP receptor antagonist
2 prevention of cerebrovascular and cardiovascular y and dual antiplatelet therapy for ACS and post ACS
In using Ticagrelor, PLT restore fn in
36 to 48 hr
Risk of bleeding in antiplatelet agents increase with
NSAIDS and GC
In case of aspirin intolerance —— is used
Clopidogrel
Non selective indirect coagulation factor inhibitor
Heparin(HMW), Enoxaparin (LMW)
Selective indirect inhibitors of factor 10a
Fondaparinux
Selective direct inhibitor of factor 2a
Dabigatran
Selective direct inhibitor of factor 10a
Rivaroxaban and apixaban
Zymogen synthesis inhibitor or vit K antagonist
Warfarin
Ischemic heart disease treatment
Anti Ischemic therapy,anti platelets agents and lipid correcting agents
Acute Coronary syndrome treatment
Nitrate, oxygen therapy, analgesia and antiplatelet therapy
In case of DVT,INR is
2 to 3
INR is
Patients clotting time to mean normalized clotting time
Antithrombin 3 is a
Physiological Inactivator of serum proteases synthesized in liver
To treat Afib
Anticoagulant can be used
INR monitoring is required for
Vit K antagonist therapy
Complications of anticoagulant therapy are
Uncontrolled bleeding
Treatment with selective factor 10 a and 2a should be discontinued
24 to 48hr before surgery
Vit K antagonist therapy should be discontinued
1 to 5 days before surgery (depends on INR)
Antidote of heparin
Protamine sulphate
SE of heparin
Hemorrhage and heparin induced Thrombocytopenia
Heparin use
DVT prevention and therapy and ACS
Heparin toxicity can cause severe bleeding from
Abdominal walls, subcutaneously,spinal hematoma, intracranial bleeding
Heparin inhibition ratio
1:1
Enoxaparin inhibition ratio
2:1 to 4:1 mainly inhibits factor 10 than 2
Rivaroxaban use
DVT and PE treatment and prevention,stroke prevention (Afib)
Rivaroxaban antidote
Andexanet alpha
Dabigatran antidote
Idarucizumab
Warfarin
Vit K epoxide reductase inhibition (inhibition of vit K conversion)inhibition of synthesis of 2,7,,9,10 factors ,inhibition of protein c and s
Therapeutic effect of warfarin reach at day
5
Vit K is required for
Glutamic acid carboxylation reaction
Max effect of warfarin reached on —days
2to 3 daya
T1/2 of warfarin
35 hrs
Warfarin toxicity
Teratogenic, ecchymoses, subconjunctival hemorrhage, gingival bleeding, internal organ bleeding like GIT, intracranial bleeding
Warfarin toxicity treatment
PCC (prothrombin complex concentrate), FFP iv and phytamenadione ( vitk) iv/po
Thrombolytic/fibrinolytic agents
Alteplase
Overdose of alteplase cause
Intracranial hemorrhage
Use of alteplase
ACS, pulmonary embolism, ischemic stroke therapy
Alteplase and streptokinase promotes the conversation of plasminogen to plasmin while ——+inhibits ot
Tranexamic acid (antifibronolytic)
Antihemorrhagic or hemostatic agents are
Fibrinolysis inhibitor (tranexamic acid) and vasopressin receptor agonist (desmopressin)
Hemophilia A
Inherited decreased factor 8
Von willebrands disease
Mucosal-skin hemorrhage
Von willebrands factor
Plasma glycoprotein involved in both primary hemostasis and coagulation process,acts as factor 8 transporter.So imp role in platelets adhesion and thrombus formation process
Tranexamic acid (reversible lysine analogue) use
Complications of fibrinolytic (thrombolytic therapy or hyperfibrinolysis;massive bleeding or it’s prognosis
Tranexamic acid SE
Seizures at high dose
Tranexamic acid interactions with oral contraceptive cause risk of
Thrombosis
Desmopressin (vasopressin analogue)V2 receptor agonists
Increase factor 8 and Von willebrands factor and increase platelets adhesion in arterial and venous endotheo
Use of desmopressin
Scheduled surgery in patients with hemophilia a and Von willebrands disease; bleeding control in patients with prolonged blood flow time