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Pharmacology II Exam I CVS Drugs > Antithrombotic and Hemostatic Drugs > Flashcards

Antithrombotic and Hemostatic Drugs Flashcards

1
Q

What prevents platelet activation and aggregation

A

Nitric oxide and prostacyclins

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2
Q

When a vessel is damaged, control of bleeding is first initiated by

A

Vasospasm

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3
Q

What is responsible for creating the reinforcement of a platelet plug

A

Fibrin

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4
Q

There is usually ___________ balance between clot formation and clot inhibition

A

homeostatic

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5
Q

Where do deep vein thromboses typically form

A

Lower extremities

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6
Q

What is Virchow’s triad

A
  • Stasis
  • Defect in hemostatic mechanism
  • Endothelial injury
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7
Q

What drugs are used to treat venous clots

A

Anticoagulant drugs, thrombolytics

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8
Q

Are venous or arterial clots more painful

A

Arterial due to a block of oxygen (ischemia)

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9
Q

What are some examples of why an arterial clot would form

A

In medium sized arteries (carotid, optical)

Endothelial damage in atherosclerosis (states of low flow)

Emboli in heart in Afib; MI and Stroke

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10
Q

What drug class are you going to use to treat arterial clots or in the prevention of developing clots

A

antiplatelet drugs, thrombolytics

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11
Q

What is the medication goal of anticoagulants and antithrombotic meds

A

Prevention of heart attack and stroke, PE, or DVT

Also to prevent complications of Afib, CHF, and genetic and acquired hypercoagulability

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12
Q

How do anticoagulation agents work in slowing down clotting

A

Interference with fibrin formation

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13
Q

What extrinsic factor is binding with exposed subendothelial components as part of the clotting cascade to aid platelet adhesion to site of injury

A

Factor VIII

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14
Q

What are the intrinsic factors players of the clotting cascade?

A

VIII, XI, XI, XII,

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15
Q

After platelet aggregation takes place (and the area of injury is stabilized), the clot is fibrinolyzed by

A

plasmin

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16
Q

What are antiplatelet agents used for

A

To prevent platelet activation in arterial system

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17
Q

What are anticoagulant agents used for

A

To prevent formation of fibrin clot in venous system

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18
Q

What are the “classic” anticoagulants

A

Heparin and Warfarin

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19
Q

What are fibrinolytic agents used for

A

To break down existing clot

20
Q

What are the fibrinolytic agents

A

Alteplase (tPA)
Anisterplase
Urokinase
Reteplase

21
Q

COX-1 is a key enzyme involved in the synthesis of

A

Platelet thromboxane A2 (prostaglandin pathway)

22
Q

What is the most common indication for daily Asprin

A

Secondary prevention (after dx with CAD, DM, PVD, CVA, TIA)

23
Q

Can usually continue ASA 81 peri-operatively except with

A

Intracranial, intramedullary, or posterior eye surgeries

24
Q

What is the goal of P2Y12 ADP receptor inhibitors

A

Prevent further atherosclerotic events in MI, unstable angina, ACS and coronary angioplasty

25
Q

Generally, how long is a patient on a P2Y12 ADP receptor inhibitor taken after a stent placement and what medication is then used indefinitely?

A

12 months, Aspirin

26
Q

Can you use P2Y12 ADP receptor inhibitors during episodes of active bleeding

A

No

27
Q

Why should you not prescribe a PPI with a P2Y12 ADP receptor inhibitor

A

May interfere with antiplatelet properties (co-prescribe with caution)

28
Q

If a patient is a poor metabolizer what P2Y12 ADP receptor inhibitor would you choose

A

Ticagrelor (Brilinta)

29
Q

Why is Tricagrelor not a first line P2Y12 ADP receptor inhibitor?

A

Interferes with statin medication (increased aches) and is very expensive

30
Q

What is a severe possible risk factor of Ticlopidine?

A

Risk of thrombocytopenia, agranulocytosis and TTP (thrombotic thrombocytopenia purpura)

31
Q

What do you need to monitor when a patient is on Tirofibran?

A

Monitor aPTT (Partial thromboplastin time- blood coagulation blood test)

32
Q

When is Cilostazol’s contraindicated?

A

Heart Failure, only used for intermittent claudication (legs) in PVD

33
Q

Why is it important to ask patients about supplement use when prescribing antiplatelet drugs?

A

Some supplements decrease platelet activity creating a high risk for bleeding

Fish oil
Dong quai
Garlic
Ginger
Gincko
Ginseng
Green Tea

34
Q

What drug class should be avoided with use of Heparins because it can cause bleeding and renal dysfunction when used together

A

NSAIDs

35
Q

Do you need to dose adjust Heparins in patients with impaired kidney function?

A

Yes

36
Q

What are the side effects of unfractionated Heparin?

A

Bleeding
Osteoporosis
Hyperkalemia (aldosterone suppression)
Elevation of trasaminases
Heparin induced thromboytopenia

37
Q

What labs do you need to monitor daily when using unfractionated heparin?

A

Platelets (CBC) because of risk for heparin induced thrombocytopenia (HIT)

38
Q

When treating a DVT/PE with Enoxaparin how is it dosed?

A

Weight-based

39
Q

What is the onset of action for Warfarin?

A

3-4 days (although absorption is rapid)

40
Q

What is an absolute contraindication of Warfarin?

A

Pregnancy as it crosses the placenta

41
Q

What is the adverse effect of Warfarin and how can it be reversed?

A

Bleeding, and can be reversed by vitamin K infusion

42
Q

What are the drugs that increase bleeding/potentiate Warfarin activity

A

ASA
Heparin
Antibiotics

43
Q

What are the drugs that decrease Warfarin activity?

A

Barbituates, Phenytoin
Vitamin K
Cholestyramine

44
Q

What are the indications for Warfarin?

A

DVT/PE Treatment

Prophylaxis of thrombotic event in: Afib, atrial flutter, prosthetic heart valve, recurrant DVT, perioperative (total knee and hip replacements)

45
Q

It is important to achieve goal of INR levels and prevent bleeding or clottin, what should patients be counseled on to maintain levels?

A

Missed dose/double dose (what to do)

Changes in OTC/herbals/diet (adjust dose for current therapies and diet)

Changes in meds (abx tx warfarin should be held for 1-2 doses)

46
Q

What is the MOA of Fonduparinux

A

Direct Xa Inhibitor - binds to anti-thrombin III, potentiates naturalization Xa 300 to 1000 times, inhibits Xa pathway

47
Q

How are fibrinolytic therapies delivered?

A

Intra-arterially

Pharmacology II Exam I CVS Drugs (3 decks)

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