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Pharmo for medic school > Atnicoagulant, antiplatelet, thrombolytic > Flashcards

Atnicoagulant, antiplatelet, thrombolytic Flashcards

1
Q

2 stages of hemostasis

A

Formation of platelet plug

Reinforcement with fibrin

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2
Q

Platelet plug formation

A

Platelet aggregation occurs when they come in contact with exposed collagen on damaged vessel.
Glycoprotein IIb/IIIa receptors on platelet surface form bridges with other platelets made of fibrinogen
Each IIb/IIIa receptor must first undergo activation, activation is from thromboxane A2, thrombin, collagen, platelet activation factor, ADP.
Aggregation allows for platelet plug to form, must be reinforced with fibrin to last

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3
Q

Coagulation

A

Coagulation is the production of fibrin, which is a thread like protein that reinforces platelet plug. Fibrin is produced through two pathways, intrinsic and extrinsic

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4
Q

Extrinsic factor from tissue factor (tissue thromboplastin) release

A

Tissue factor released from damaged epithelium.
TF activates VII turns into X
X causes conversion of prothrombin (factor II) to thrombin (factor IIa)
Thrombin causes 3 things to happen
Fibrinogen –> fibrin
Factor V –> Va
Factor VIII –> VIIIa

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5
Q

Intrinsic pathway (contact activation pathway)

A

Blood exposed to collagen of vessel wall. Collagen causes factor XII to be converted to XIIa
XIIa activates XI which activates IX which activates X
X converted to Xa and clotting cascade is finished
Coagulation occurs with activation of X into Xa

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6
Q

Inactivation of clots is achieved with

A

Antithrombin.

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7
Q

Enzyme used to breakdown fibrin meshwork of clot

A

Plasmin. Produced through activation of plasminogen

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8
Q

Fibrinolytic drugs work by

A

Converting plasminogen to plasmin

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9
Q

3 main categories of fibrinolytics

A

Anticoagulants: disrupt coagulation cascade, thereby suppressing production of fibrin
Antiplatelets: Inhibit platelet aggregation
Thrombolytics: Promote lysis of fibrin, causing dissolution of thrombi

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10
Q

Anticoagulants reduce

A

Formation of fibrin

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11
Q

Anticoagulant mechanisms

A

Inhibition of synthesis of clotting factors, X and thrombin

Inhibition of clotting factors Xa and thrombin

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12
Q

Heparin (unfractionated)

A 
Suppresses formation of fibrin
Enhances antithrombin (helps antithrombin to inactivate clotting factors thrombin and factor X)
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13
Q

Sources of heparin

A

Cattle lungs, pig intestines. Administered by rapid-acting anticoagulant administered IV or SQ

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14
Q

Heparin therapeutic uses

A 
Preferred during pregnancy when rapid anticoag required
PE, DVT, evolving stroke
Open heart surg, post op, renal dialysis
DIC
Adjunct to thrombolytic therapy
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15
Q

LMW heparins

A

Heparin preparations composed of molecules that are shorter than those found in unfractionated heparin
For:
DVT after surg
TX of established DVT
Prevention of ischemic complications (UA, MI, STEMI)

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16
Q

LMW pros and cons

A 
SQ based on body weight
Antidote for protamine sulfate toxicity
Costs more than unfractionated
No monitoring after
Adverse effects include bleeding (less than unfractionated heparin, immune-mediated thrombocytopenia, severe neuro injury for pts undergoing spinal epidural anesthesia)
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17
Q

Thrombocytopenia

A

Low levels of thrombocytes (platelets)

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18
Q

Three common LMWs

A

Enoxaparin
Dalteparin
Tinzaparin

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19
Q

Enoxaparin (lovenox)

A

LMW heparin, anticoag

Indications: STEMI

20
Q

Enoxaparin (lovenox) contras

A 
Hypersens to heparins or pork
Active major bleeding
Bacterial endocarditis
Thrombocytopenia
Suspected intracranial bleeding
21
Q

Enoxaparin (lovenox) dose

A 
IV - BLUE
75 or less - 30mg IV
Over 75 - withhold 
Adult SC (black)
75 or less 1mg/kg
Over 75 0.75mg/kg
22
Q

Warfarin is an

A

anticoagulant. Vit K antagonist.

23
Q

Warfarin works for

A

Blocks biosynthesis of factors VII, IX, X and prothrombin

It has a delayed onset

24
Q

Anticoagulants

A

Not useful in emergencies
Long-term prophylaxis of thrombosis
Prevention of thromboembolism (pts with prosthetic heart valves)
Prevention of thrombosis during a-fib

25
Q

Antiplatelet drugs 3 major categories

A

These drugs suppress platelet aggregation
P2Y12 ADP receptor antagonist
GP IIb/IIIa inhibitors
Cyclooxygenase inhibitor (ASA)

26
Q

ASA effects

A

ASA is a nonselective cyclooxygenase (COX) inhibitor
It reduces inflammation, fever and pain (COX 2 inhibition)
Protects against MI and ischemic stroke (COX 1 inhibition)

27
Q

ASA antiplatelet effects

A 
Suppresses aggregation by causing irreversible inhibition of COX 1 which makes TXA2.
TXA 2 (thromboxane A2) in platelets promotes aggregation
28
Q

Class and indications for ASA

A

Antiplatelet, thromboxane A2 inhibitor

ACS

29
Q

ASA contras and dose

A

Hypersens, active GI bleed, asthmatic with hx of ASA,NSAID sensitivity
Adult dose is 160mg PO

30
Q

Clopidogrel (plavix) blocks

A

P2Y12ADP receptors on platelet surface, preventing ADP-stimulated aggregation`

31
Q

Clopidogrel uses

A

Blockage of coronary artery stents
Reduces thrombotic events in pts with acute coronary syndromes
Prevents stenosis of coronary stents, also for secondary prevention of MI, ischemic stroke and other vascular events.
Similar adverse effects as ASA

32
Q

Clopidogrel (plavix) class

A

Platelet inhibitor, P2Y12ADP receptor inhibitor

Indications STEMI-VHR protocol

33
Q

Clopidogrel (plavix) conras

A

Hyper sense
Active bleed
Liver dysfunction/jaundice, cirrhosis, alcoholism
Suspected aortic dissection

34
Q

Clopidogrel (plavix) dose

A

75 or less 300mg PO

Over 75 75mg PO

35
Q

Ticagrelor (brilinta) class

A

Platelet inhibitor, P2Y12ADP receptor inhibitor

36
Q

Ticagrelor contras

A

Hypersens
HX of intracranial hemorrhage
Hepatic dysfunction
Active bleeding

37
Q

Ticagrelor dose

A

180mg PO (given if getting PCI)

38
Q

VHR if 75 or less with TNK

A

TNK weight based dose
Enoxparain 30mg IV - Blue
Clopidogrel (plavix) 300mg PO
Enoxaparin 1mg/kg sub q - black

39
Q

VHR if over 75 with TNK

A

TNK weight based dose
NO IV enoxaparin
Clopidogrel 75mg PO
Enoxaparin (lovenox) 0.75mg/kg

40
Q

VHR for PCI

A

Enoxaparin 30mg IV
Ticagrelor 180mg PO
Enoxaparin 1mg/kg sub Q

41
Q

GP IIb/IIIa receptor antagonsits

A

Most effective antiplatelet drugs
“super aspirin”
Reversible blockade of platelet GP IIb/IIIa receptors
Therapeutic uses include ACS and PCI

42
Q

Eptifibatide (integrilin)

A

Small peptide that causes reversible and highly selective inhibition of GP IIb/IIIa receptors
For:
ACS, PCI
Antiplatelet effects reverse within 4 hours of stopping infusion

43
Q

Tenecteplase (TNK)

A

Variant of human tissue plasminogen activator (tPA, alteplase)
Approved for acute MI only

44
Q

How to minimize bleeding risk

A

Minimize physical manipulation of pt
Avoid subQ and IM injections
Minimize invasive procedures
Minimizes concurrent use of anticoags (heparin, warfarin, dabigatran)
Minimize conccurent use of antiplatelet drugs (ASA, clopidogrel)

45
Q

Tenecteplase (TNKase) class

A

Thrombolytic, fibrinolytic

for STEMI

46
Q

Tenecteplase (TNKase) contras

A

Hypersen
Active bleeding
Brain tumor
Ischemic CVA within 3 months
Significant closed head/facial trauma within 3 months
Intracranial or spinal surg within 2 months
Suspected aortic dissection

47
Q

Teneceteplase (TNKase) dose

A 
30-50mg over 5 seconds
<60k 30mg
60-70kg 35mg
70-80kg 40mg
80-90kg 45mg
90kg or more 50mg

Pharmo for medic school (26 decks)

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