Antiplatelets, anticoagulants, fibrinolytics

Question 1

Aspirin

Answer 1

Mech: block TXA2 through COX1 receptor -> prevent platelet aggregation
Use: MI, stroke
Adverse: GI upset, bleeding

Question 2

Inhibit ADP receptors (P2Y21)

Answer 2

Clopidogrel
Pirasugrel
Ticagrelor
Ticlopidine

Question 3

Clopidogrel
Pirasugrel
Ticagrelor
Ticlopidine

Answer 3

Mech: block ADP receptor -> inhibit P2Y21-> inc cAMP -> prevent aggregation
Use: stroke on DAPT; ACS
adverse: bleeding

Question 4

Gp IIb/IIIa inhibitors

Answer 4

Abciximab
Epitifibatide
Tirofiban

Question 5

Abciximab
Epitifibatide
Tirofiban

Answer 5

Mech: block GpIIb/IIIa -> prevent aggregation
Use: ACS, PCI
adverse: bleeding

Question 6

Drugs inhibit phosphodiesterase

Answer 6

Dipyridamole
Cilostazol

Question 7

Dipyridamole

Answer 7

Mech: inhibit phosphodiesterase
use: thromboembolism prophylaxis
cardiac stress for pt who cant use treadmil

Question 8

Cilostazol

Answer 8

Mech: inhibit PDE3
use: intermittent claudication (PVD)

Question 9

Vorapaxar

Answer 9

Mech: inhibit PAR1 -> inhibit aggregation induced by thrombin and TRAP
indication: thrombotic event prevention
adverse: bleeding, depression, rash

Question 10

Warfarin

Answer 10

Mech: vit K antagonist; prevent hepatic synthesis of vit K factors 2,7,9,10.
Block the gamma carboxylation of clotting factors
adverse: bleeding
skin necrosis dt low protein C -> dermal vascular thrombosis
purple tose syndrome
teratogenic (bone defects)

Question 11

what is an antidote for warfarin

Answer 11

Phytonadione

Question 12

Unfractionated Heparin

Answer 12

Mech: activate antithrombin III by enhancing serine protease and inactivate factor 2,9,10,12
adverse: HIT, osteoporosis

Question 13

What is an antidote for Heparin?

Answer 13

Protamine Sulfate

Question 14

Enoxaparin, Dalteparin

Answer 14

Mech: against factor 10 w longer half life than heparin
less thrombocytopenia
adverse: hemorrhage, thrombocytopenia, local irritation

Question 15

contraindicated of Enoxaparin

Answer 15

prosthetic valve dt high risk of thromboembolism

Question 16

Fondaparinux

Answer 16

selective antithrombin III mediated 10 inhibition

Question 17

Hirudin family (Lepirudin, Bivalirudin)

Answer 17

Mech: direct thrombin inhibitors.
use: prevent thrombosis in pt with angina and acute MI
adverse: bleeding

Question 18

Argatroban

Answer 18

Mech: direct thrombin inhibitor, given IV
use: thrombosis in DVT

Question 19

Dabigatran (Praxada)

Answer 19

1st oral thrombin inhibitor
use: reduce stroke in afib
prevent thrombotic complication of hip, knee replacement
adverse: bleeding, gastritis like symp
interaction: substrate for Pglycoprotein

Question 20

Active Factor 10 inhibitors

Answer 20

Apixaban
Rivaroxaban

Question 21

Apixaban (Eliquis)

Answer 21

direct 10 inhibition
use: reduce stroke risk in afib
venous thromboembolism

Question 22

Rivaroxaban

Answer 22

mech: direct 10 inhibitor
use: DVT, Pulmonary embolism, afib
unstable angina undergoing PCI
adverse: bleeding

Question 23

Contraindication of Rivaroxaban

Answer 23

hypersensitivity
underlying coagulation disoerders
ulcer disease
severe thrombocytopenia, active bleeding

Question 24

Fibrinolytic drugs mechanism and use

Answer 24

activate plasminogen -> plasmin; causes lysis of fibrin clot
use: acute MI, acute PE
DVT, thromboembolic stroke

Question 25

what is plasmin?

Answer 25

plasmin - serine protease and inhibited by alpha 2 antiplasmin

Question 26

Antidote to fibrinolytics

Answer 26

aminocaproic acid
adverse: thrombosis, hypotension, arrhythmias

Question 27

drug use for heavy menstrual bleeding

Answer 27

Tranexamic acid
adverse: thrombotic events (inc in obese women that smoke and use contraceptives)