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PEBC > Antiplatelet, Anticoagulant, Thrombolytic > Flashcards

Antiplatelet, Anticoagulant, Thrombolytic Flashcards

1
Q

ASA is reversible/irreversible platelet inhibitors?

A

irreversible

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2
Q

Drugs that are P2Y12 receptor inhibitor

A

Clopidogrel, Prasugrel, Ticagrelol, Ticlopidine

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3
Q

P2Y12 receptor inhibitor which shows irreversible platelet inhibition

A

Clopidogrel, Prasugrel

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4
Q

Direct acting Reversible platelet inhibitor

A

Ticagrelor

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5
Q

If patient is allergic to Ibuprofen, can a low dose ASA is used?

A

ASA is not used if patient allergic to any of NSAIDs

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6
Q

RIng present in Ticagrelor

A

Cyclopentyl-triazolo-pyrimidines

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7
Q

RIng present in Prasugrel & Clopidogrel

A

Thienopyridine ring system

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8
Q

ASA shows antiplatelet effect for

A

7 to 10 days.

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9
Q

Drug having CYP2C19 drug interactions.

A

Clopidogrel (Prodrug activated by CYP2C19). Clopidogrel is a prodrug that requires conversion to thiol metabolite and this thiol group binds with ADP receptor. INtermediate formed is 2-oxo-clopidogrel. Proton pump inhibitor are inhibitors of CYP2C19 and produce Drug interaction. Less interaction with pantoprazole

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10
Q

Is prasugrel a prodrug?

A

Yes. Activated by hydrolysis in intestine. and metabolized by 3A4 & 2B6

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11
Q

Why Ticlopidine Not used ?

A

serious agranulocytosis and neutropenia side effects.

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12
Q

MOA of Clopidogrel, prasugrel, ticagrelor and ticlopidine?

A

1) blocks ADP induced platelet aggregation.
2) Interact with glycoprotein IIb/IIIa (a fibrinogen receptor) resulting in an inhibition of the fibrinogen to form aggregated plug

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13
Q

The minimum dose required ASA to produce antiplatelet effect ?

A

60 to 80 mg

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14
Q

Strength of schedule II aspirin

A

80 mg (chewable) behind the counter

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15
Q 
Which is Not prodrug?
Ticagrelor
Ticlopidine
Prasugrel
Clopidogrel
A

Ticagrelor

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16
Q

Antiplatelet effect of Ticagrelol last for ?

A

2 to 8 hours

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17
Q

the drug of choice in patient usually cannot tolerate ASA or in patient with allergic to ASA.

A

ADP inhibitor

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18
Q

Ticlopidine

A 
hemorrhagic complications(Agranulocytosis,thrombocytopenia ,neutropenia ), Rash and diarrhea
CBC 2 wk for 1st 3 months
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19
Q

antiplatelet agents used in stroke prophylaxis in cerebrovascular ischemia or aft er prosthetic valve replacement

A

Dipyridamole and cilostazol

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20
Q

antiplatelet agents used for intermittent claudication.

A

cilostazol

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21
Q

Contraindication of P2Y12 receptor inh.

A

hematopoietic disorders
Hemorrhagic diathesis/intracranial bleeding
severe liver dysfunction.

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22
Q

Storage conditions of P2Y12 receptor inh.

A

Store at room temperature. Dispense in light-resistant containers. Blister packs should not be exposed to light.

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23
Q

Does clopidogrel require renal dose adjustment?

A

Clopidogrel hepatic elimination, renal dose adjustment is not necessary.

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24
Q

Mechanism of action of abciximab, eptifibatide , and tirofiban

A

parenteral agents that reduce the interaction of platelets via the GPIIb/IIIa receptors to fibrinogen.

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25
Q

monoclonal antibody directed against GPIIb/IIIa

A

Abciximab is the Fab fragment of a monoclonal antibody directed against GPIIb/IIIa

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26
Q

Structure AND action of eptifibatide?

A

cyclized heptapeptide with high affi nity for the fi brinogen receptor

27
Q

Agents used after a myocardial infarction or during angioplasty and stent placement

A

Glycoprotein IIb/IIIa inhibitors

28
Q

How are Thienopyridine used?

A

are used to decrease clot formation aft er

angioplasty and stenting procedures and are oft en combined with aspirin or GPIIb/IIIa inhibitors.

29
Q

Aspirin is used for the

A

prophylaxis of myocardial

infarctions and, in conjunction with other agents, it decreases thrombosis aft er coronary stenting

30
Q

abciximab can causes hypotension, nausea, vomiting, and atrial fi brillation.

A

Tirofiban + Heparin = thrombocytopenia

31
Q

glycoprotein IIb/IIIa also known as

A

integrin alpha, beta receptors

32
Q

Antiplatelet Indicated for unstable angina

A

Eptifibatide and tirofiban

33
Q

Antiplatelet Indicated during and after coronary artery procedures to prevent platelet aggregation.

A

Eptifibatide and tirofiban

34
Q

Antiplatelet Indicated for NSTEMI

A

Eptifibatide and tirofiban

35
Q

MOA of dipyridamol

A

TXA2 Inhibitor

36
Q

mechanism of action of Acetyl Salicylic Acid (ASA) that results in greater effect as an antiplatelet drug is

A

Irreversible acetylation of cyclooxygenase

37
Q

ASA 80-162 mg daily indication

A

stable & unstable angina, NSTEMI, STEMI

38
Q

ASA 160 mg daily x 35d indication

A

Prophylaxis of VTE after total hip replacement

39
Q

ASA dose for Primary coronary events prevention, Secondary prevention of ischemic stroke

A

80-325 mg daily po

40
Q

DOC for patient allergic to Ibuprofen/ aspirin

A

CLopidogrel

41
Q

Patient with Acute Coronary Syndrome (ACS) had STENT placed.How long is the combination of ASA and Clopidogrel used

42
Q

Fibrinolytic/Thrombolytic

A

Plasmin degrades the fibrin mesh. Plasmin need to be activated form plasminogen and this is done by tissue plasminogen activator.

43
Q

Streptokinase obtained from

A

Derived from beta-hemolytic streptococci cultures.

44
Q

Both streptokinase and urokinase lack this specificity and act on free plasminogen inducing generalized thrombolytic state

A

Tissue Plasminogen Activators (tPAs) have low affinity for free plasminogen but a very high affinity for plasminogen bound to fibrin in a thrombus.

45
Q

WHich thrombolytic have greater specificity to older clots than newer clots

46
Q

Contraindiaction of thrombolytic

A 
acute stroke >3 hours of stroke
myocardial infarction >6 hours.
Recent head trauma/cranial tumor
Previous hemorrhagic stroke
Active internal bleeding
Major surgery within 2 wks
Active peptic ulcer, diabetic, blood pressure, pregnancy
47
Q

Don’t give second streptokinase within 6 months of the first treatment

A

Can produce allergic reactions (urticaria). Give antihistamine before starting the treatment. Because allergic reactions are more common with streptokinase urokinase.
Bronchospasm

48
Q

Urokinase obtained from

A

A two-chain serine protease obtained form human kidney cell culture.

49
Q

prodrug of streptokinase

A

Anistreplase

50
Q

Thrombolytic Not used for MI and Stroke

A

Streptokinase

51
Q

Thrombolytic having most Fibrin specificity

A

Tenecteplase

52
Q

fi rst orally active direct

thrombin inhibitor and is used to prevent stroke in patients with atrial fi brillation.

A

Dabigatran

53
Q

Drugs indicated for recurrent stroke prevention

A

ACE Inhibitors
Warfarin
Rivaroxaban ( direct factor Xa inhibitor)
DAbigatran ( Direct factor IIa inhibitor)

54
Q

Entacapone

A

Patients may be at increased risk for cardiovascular events such as myocardial
infarction, stroke, and cardiovascular death

55
Q

Which group blocks the catalytic site in Anistreplase?

A

anisoyl group

56
Q

Recombinant DNA-derived plasminogen activators (t-PA) with 527 and 355 amino acids.

A

Alteplase, reteplase, and Tenecteplase

57
Q

Structure of heparin responsible for heparin induced thrombocytopenia

A

long chain penta saccharides. Heparin penta saccharides are natural products

58
Q

WHat are Fractionated heparin

A 
Dalteparin sodium (Fragmin)
Enoxaparin sodium (Lovenox)
Nadroparin calcium (Fraxiparine)
Tinzaparin sodium (innohep)
59
Q

MOA of Fractionated heparin or LMWH?

A

Selective to factor Xa and IIa

60
Q

Name factor II, X,

A

Thrombin (factor II

Factor X Stuart Prower Factor

61
Q

Which type of heparin have a more predictable pharmacokinetic profile with longer half-life?

A

LMWHs ( ….parins_)

62
Q

Heparins, both LMWH and uFH are

A

mucopolysaachrides

63
Q

Drug that is a synthetic pentasaccharide

A

Fondaparinaux

PEBC (19 decks)

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