Antiplatelets/coags/thrombolytics Flashcards
Aspirin:
MOA:
inhibits thromboxane A2 synthesis by inhibition of COX 1
Aspirin: uses
prophylaxis of transient cerebral icchemia, reduce incidence of MI, decrease mortality in pre and post MI patients
aspirin is frequenty used with what?
ADRs:
other anticlotting drugs (heparin/clopidogrel)
NSAIDs/acetaminophen inhibit COX1 and can antagoinze platelet inhibition by aspirin
prasugrel, cangrelor, clopidogrel MOA:
interfere with binding of ADP to platelet receptors thus inhibiting activtion of GP IIb/IIIa
prasugrel, cangrelor, clopidogrel uses:
acute coronary syndrome, recent MI, CVA, PAD, stent insertion during MI
prasugrel, cangrelor, clopidogrel which is not effect by food?
ADRs of these drugs?
clopidogrel
prolonged bleeding time with no antidote, thrombocytopenia purpura
prasugrel, cangrelor, clopidogrel which is not effect by food?
ADRs of these drugs?
use caution clopidogrel in pts on what?
clopidogrel
prolonged bleeding time with no antidote, thrombocytopenia purpura
inhibit cyp450: interfere with metabolism of phenytoin, tolbutamide, warfarin, fluvastatin, tamoxifen
on PPIs
Ticagrelor: similar to prasugrel, clopidogrel, ticlopidine
prevention of what?
thrombiotic events in pts with acute coronary syndrome or MI with ST elevations
Abciximab: MOA?
given with what?
ADRs?
how long do antiplatelet effects last?
monoclonal AB directed against GP IIb/IIIa receptors
IV heparin/ASA as adjunct to percutaneous coronary intervention for provention of cardiac ischemic comps
bleeding
24-48 hours
eptifibatie/tirofiban: MOA
use?
effect can last for how long after d/c
major SE?
block GP IIb/IIIa receptor
decreases incidence of thrombiotic compls associated with acute coronary syndromes
4 hours
bleeding
Dipyridamole:
MOA?
use?
coronary vasodilator, phosphodiesterase inhibitor decreasing thromboxane A2 (inhibits thrombus)
prophylactic used to tx angina pectoris
Varapaxar:
MOA?
indication?
CI?
DDI?
protease activated receptor-1 antagonist
(does not effect ADP, collagen or thromboxane aggregation) (does not affect coagulation parameters or bleeding time)
reduction of thrombotic CV events in pts w/history of MI or PAD
hx of CVA, TIA or ICH, or active bleeding
ADR: bleeding
DDI- cyp3A4
Heparin: MOA:
binds to antithrombin III and potentiates its inactivation effects on serine proteases (factos IIa and Xa)
LMWH only affects Factor Xa!!
Heaprin uses:
DVT, PE, prophylactic to prevent post op VE in elective surgery, MI and a fib
reduced coronary artery rethrombosis, DOC in pregnancy for prosthetic heart valves and VE (doesnt cross placenta)
LMWH: (weight based, predictable effects very useful in outpt)
what is a dose based on for heparin?
aPTT
LMWH does not need aPTT
half life of heparin is increased when?
pts with cirrhosis, renal insufficiency and is dose related with heparin
ADRs of heparin?
bleeding (manage by admin of protamine sulfate, hypersensitivity, thrombosis (minimized with low dose), hyperkalemia, THROMBOCYTOPENIA (type 1: immunoloigc occurs within first 5 days, type 2: IgG, degradation of platelets can result in thrombocytpenia and thrombosis, occurs 5-14 days and can range fro mild to life threatening, platelets count can drop more than 50% but this is very rare)
CI of heparin:
IM injection hematoma, HSN, bleeding, ETOH, brain/eye/spinal cord surgery
Danaparoid: MOA?
uses?
ADRs?
Anti Factor Xa and antithrombin
prophylaxis of DVT in hip replacement surgery and can tx HIT type II
pork allergy, hemorrhage
Fondaparinux:
MOA?
synthetic pentasaccharide factor Xa inhibitor
low risk of HIT, renally excreted
Direct factor Xa inhibitors:
(rivaroxaban, apixaban, edoxaban, betrixaban)
MOA?
substitute for?
act directly on factor X without using antithrombin
vit K antagonists or LMWH
prophylaxis/tx for DVT/PE in adults undergoing hip/knee replacement, long term tx to prevent recurrence, CVA prophylaxis in pts with non valvular afib
Direct factor Xa inhibitors:
(rivaroxaban, apixaban, edoxaban, betrixaban)
ADRs:
no way to reverse
bleeding, fainting, itching, anemia, muscle spasms
edoxaban not to be used in pts with non valvular afib
bivalirudin: MOA? uses? half life? ADR:
direct thrombin inhibitor (potent, reversible)
unstable angina undergoing percutaenous transluminal coronary angioplasty, protein IIb/IIIa inhibitor in percutaenous coronary intervention, pts with or at risk of HIT undergoing percutaneous cocornary intervention
25 min
bleeding, HA, hypotension
Argatroban: MOA:
direct thrombin inhibitor
IV prophylaxis or tx of throbmosis in pts with HIT
bleeding, dyspnea, hypotension
Dabigatran: MOA?
direct thrombin inhibitor
reduce risk of CVA and systemic embolism in pts with non valvular a fib
reduce dose in renal impairment
bleeding
Idarucizumab:
MOA:
human monoclonal AB fragment
indicated in pts tx with dabigatran when reversal of anticoagulant effects is needed!!!!!!!!!!
for emergency procedures in life threatening uncontrolled bleeding
IV-higher affinity than the binding affinity of dabigatran to thrombin
Preacution:
thromboembolic risk, HSN, pts with heredity fructose intolerance
ADR-hypokalemia, deleirum, constipation, pyrexia, pneumonia
