Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

4th year passmedicine by topic > Antiplatelets/Anticoagulants/Thrombolysis > Flashcards

Antiplatelets/Anticoagulants/Thrombolysis Flashcards

1
Q

hree direct oral anticoagulants (DOACs)

A

dabigatran, rivaroxaban and apixaban.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Direct factor Xa inhibitor examples

A

Rivaroxaban Apixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Direct thrombin inhibitor examples

A

Dabigatran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Excretion of DOACs

A

Majority renal - Dabigatran
Majority liver - Rivaroxaban
Majority faecal - apixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Direct factor Xa inhibitor revesal agents

A

Andexanet alfa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Direct thrombin inhibitor reversal agents

A

Idarucizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clopidogrel is an anticoagulant/antiplatelet agent

A

Clopidogrel is an antiplatelet agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Clopidogrel belongs to a class of drugs known as

A

thienopyridines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

thienopyridines examples

A

Clopidogrel
prasugrel
ticagrelor
ticlopidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Clopidogrel mechanism of action?

A

antagonist of the P2Y12 adenosine diphosphate (ADP) receptor, inhibiting the activation of platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clopidogrel interactions

A

concurrent use of proton pump inhibitors (PPIs) may make clopidogrel less effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Aspirin works by

A

blocking the action of both cyclooxygenase-1 and 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Cyclooxygenase is responsible for

A

prostaglandin, prostacyclin and thromboxane synthesis.

The blocking of thromboxane A2 formation in platelets reduces the ability of platelets to aggregate which has lead to the widespread use of low-dose aspirin in cardiovascular disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aspirin potentiates?

A

oral hypoglycaemics
warfarin
steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Aspirin should not be used in children under 16 due to

A

risk of Reye’s syndrome

An exception is Kawasaki disease, where the benefits are thought to outweigh the risks.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

NICE now recommend what first-line following an ischaemic stroke and for peripheral arterial disease.

A

NICE now recommend clopidogrel first-line following an ischaemic stroke and for peripheral arterial disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

first-line for patients with ischaemic heart disease

A

aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Heparins generally act by

A

activating antithrombin III.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

? forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa.

? however only increases the action of antithrombin III on factor Xa

A

Unfractionated heparin forms a complex which inhibits thrombin, factors Xa, IXa, XIa and XIIa.

LMWH however only increases the action of antithrombin III on factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Adverse effects of heparins include:

A

bleeding
thrombocytopenia
osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Adverse effects of heparins include hypokalemia/hyperkalemia

A

hyperkalaemia - this is thought to be caused by inhibition of aldosterone secretion

22
Q

Administration Low molecular weight heparin (LMWH)

A

Subcutaneous

23
Q

Administration Standard heparin

A

Intravenous

24
Q

which heparin has Lower risk of HIT and osteoporosis

A

LMWH

25
Q

Monitoring heparins

A

Standard - Activated partial thromboplastin time (APTT)

LMWH - Anti-Factor Xa (although routine monitoring is not required)

26
Q

Heparin-induced thrombocytopaenia (HIT) usually does not develop until after? of treatment

A

usually does not develop until after 5-10 days of treatment

27
Q

despite being associated with low platelets HIT is actually a prothrombotic condition

A

true

28
Q

Heparin overdose may be reversed by

A

protamine sulphate, although this only partially reverses the effect of LMWH.

29
Q

Heparin-induced thrombocytopaenia (HIT) mechanism

A

immune mediated - antibodies form against complexes of platelet factor 4 (PF4) and heparin
these antibodies bind to the PF4-heparin

complexes on the platelet surface and induce platelet activation by cross-linking FcγIIA receptors

30
Q

Heparin-induced thrombocytopaenia (HIT) features

A

50% reduction in platelets
thrombosis
skin allergy

31
Q

Heparin-induced thrombocytopaenia (HIT) address need for ongoing anticoagulation - what to use?

A

direct thrombin inhibitor e.g. argatroban

danaparoid

32
Q

Thrombolytic drugs mechanism

A

activate plasminogen to form plasmin

33
Q

What does plasmin do?

A

degrades fibrin and help breaks up thrombi

34
Q

Contraindications to thrombolysis

A 
active internal bleeding
recent haemorrhage, trauma or surgery (including dental extraction)
coagulation and bleeding disorders
intracranial neoplasm
stroke < 3 months
aortic dissection
recent head injury
severe hypertension
35
Q

s/e thrombolysis

A

haemorrhage
hypotension - more common with streptokinase
allergic reactions may occur with streptokinase

36
Q

thrombolysis eg

A

alteplase
tenecteplase
streptokinase

37
Q

Dabigatran is an oral anticoagulant that works by being a

A

direct thrombin inhibitor

38
Q

What are the known side-effects of dabigatran?

A

Unsurprisingly haemorrhage is the major adverse effect.

Doses should be reduced in chronic kidney disease and dabigatran should not be prescribed if the creatinine clearance is < 30 ml/min.

39
Q

dabigatran Reversing the effects

A

Idarucizumab cab be used for rapid reversal of the anticoagulant effects of dabigatran.

40
Q

Dabigatran is currently used for two main indications.

A

Firstly it is an option in the prophylaxis of venous thromboembolism following hip or knee replacement surgery.

Secondly, it is also licensed in the UK for prevention of stroke in patients with non-valvular atrial fibrillation who have one or more of the following risk factors present:

previous stroke, transient ischaemic attack or systemic embolism
left ventricular ejection fraction below 40%
symptomatic heart failure of New York Heart Association (NYHA) class 2 or above
age 75 years or older
age 65 years or older with one of the following: diabetes mellitus, coronary artery disease or hypertension

41
Q

Acute coronary syndrome (medically treated)

1st & 2nd line?

A

Aspirin (lifelong) & ticagrelor (12 months)

If aspirin contraindicated, clopidogrel (lifelong)

42
Q

Percutaneous coronary intervention

1st & 2nd line?

A

Aspirin (lifelong) & prasurgrel or ticagrelor (12 months)

If aspirin contraindicated, clopidogrel (lifelong)

43
Q

TIA

1st & 2nd line?

A

Clopidogrel (lifelong)

Aspirin (lifelong) & dipyridamole (lifelong)

44
Q

Ischaemic stroke

1st & 2nd line?

A

Clopidogrel (lifelong)

Aspirin (lifelong) & dipyridamole (lifelong)

45
Q

Peripheral arterial disease

1st & 2nd line?

A

Clopidogrel (lifelong) Asprin (lifelong)

46
Q

Fondaparinux mechansim

A

Activates antithrombin III, which in turn potentiates the inhibition of coagulation factors Xa

47
Q

Fondaparinux is given s/c

A

true

48
Q

Direct thrombin inhibitors generally given intravenously.

A

true

49
Q

Combination antiplatelet and anticoagulant therapy

Secondary prevention of stable cardiovascular disease with an indication for an anticoagulant

A

if an indication for anticoagulant exists (for example atrial fibrillation)

it is indicated that anticoagulant monotherapy is given without the addition of antiplatelets

50
Q

Combination antiplatelet and anticoagulant therapy

Post-acute coronary syndrome/percutaneous coronary intervention

A

triple therapy (2 antiplatelets + 1 anticoagulant) for 4 weeks-6 months after the event

dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months

51
Q

Combination antiplatelet and anticoagulant therapy

Venous thromboembolism (VTE)

A

HAS-BLED score should be calculated. Those with a low risk of bleeding may continue antiplatelets. In patients with an intermediate or high risk of bleeding consideration should be given to stopping the antiplatelets

4th year passmedicine by topic (96 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions