Antithrombotics

Question 1

The exposure of circulating blood elements to thrombogenic material, activation and aggregation of platelets, and triggering of the coagulation cascade are all elements to the formation of what?

Answer 1

A clot

Question 2

After platelets adhere to the site of injury, how do they trigger aggregation?

Answer 2

Release reaction (secretion of platelet products)

Question 3

Do collagen, thrombin, ADP, serotonin, fibrinogen, growth factor, procoagulants, and TXA2 activate or inactivate platelet aggregation?

Answer 3

Activate

Question 4

What receptors allow binding of the platelets to fibringoen molecules?

Answer 4

IIb/IIIa

Question 5

Which 4 drugs inhibit IIb/IIIa receptors, so platelets can’t aggregate?

Answer 5

ASA, thienophyridines, GP IIb/IIIa antagonists, and dipyridamole

Question 6

ASA irreversibly acetylates and inactivates COX, which reduces which pro-aggrevating factor?

Answer 6

TXA2

Question 7

Thienopyridines inhibit activation of the platelets by blocking the activation by which molecule?

Answer 7

ADP

Question 8

When activated by the liver, which enzyme does theinopyridines block?

Answer 8

P2Y12

Question 9

What are the 3 thienopyridines that are used currently?

Answer 9

clopidogrel, ticlopidine, and prasugrel

….that ADP is “-gel”ly….

Question 10

Which is the most potent antiplatelet agents because they reversibly inhibit the aggregation by inhibitng the binding of activated platelet GP IIb/IIIa recepotors to fibrinogen and vWF?

Answer 10

GP IIb/IIIa receptor antagonists

Question 11

So say your pt has an ASA intolerance, which drug can u give which increases platelet cAMP levels, which decreases Ca++ levels?

Answer 11

Dipyridamole

Question 12

This si the class of drugs that interfered with the coagulation cascade and impair secondary hemostasis (formation fo the fibrin clot).

Answer 12

Anticoagulant drugs

Question 13

What molcule is the main target for inactivation for heparin?

Answer 13

inhibits thrombin activation by factor Xa

Question 14

So given the strengths, put the following in order from strongest to weakest:

dipryidamole
thienopyridines
ASA
GP IIa/IIa antagonists
pedal pump

Answer 14

GP IIb/IIIa antagonists&raquo_space; Thienopyridines > Aspirin > pedal-pump&raquo_space;> dipyridamole

Question 15

This form of heparin is a mixture of glycosainoglycans, that, when assocated with antithrombin in the circulation, reduces thrombin ability to generate fibrin from fibrinogen.

Answer 15

Unfractionated hepatin

Question 16

This form of heparin is more predictable and has a longer 1/2 life, smaller than UFH, and when associated with antithrombin, preferntially inhibits Xa rather than thrombin.

Answer 16

Low Molecular Weight Heparin

Question 17

This is the main complication of heparin therapy, where there can be direct heparin-induced platelet aggregation or immune-mediated problems.

Answer 17

Heparin-induced thrombocytopenia (HIT)

Question 18

In HIT, if there is direct hepatin-induced platelet aggregation, do you need to stop therapy?

Answer 18

Nah. It’s not too bad.

Question 19

What are the crazy complications of immune-mediated form of HIT?

Answer 19

life-threatening bleeding and thrombosis

Question 20

Do u need to stop heparin therapy if the pt develops immune-mediated HIT?

Answer 20

YES. YOULL KILL THEM YOU DICK.

Question 21

Long term use of UFH can cause what other medical condition?

Answer 21

Osteoporosis

Question 22

Say u give too much heparin and the pt starts to bleed a shit ton. What drug can u give to combat this?

Answer 22

protamine sulfate

Question 23

This is the period of time where u overlap heparin and warfarin when treating thrombosis.

Answer 23

Anticoagulant bridging

Question 24

Under what condition do u do anticoagulant bridging?

Answer 24

only when immediate anticoagulation is necessary

Question 25

What is the delay of onset for warfarin?

Answer 25

2-7 days

Question 26

Which vitamin can be given in case ur pt starts to have massive bleeding due to warfarin use?

Answer 26

Vit K