Blood Cardio Drugs

Question 1

Unfractionated Heraprin (UFH)

Answer 1

Anticoagulant. Occurs naturally in mast cells. Key structure = pentosaccharide; 1/3 of molecule is active. Use for treatment and prophylaxis of DVT, PE, acute MI, unstable angina, PCI. Activates antithrombin to inactivate factors Xa and IIa. Unpredictable variability between patients, requires monitoring. DRUG OF CHOICE IN PREGNANCY. Toxicities include bleeding, thrombocytopenia and thrombosis (via platelet factor IV) and osteoporosis.

Question 2

Warfarin

Answer 2

Anticoagulant. Vitamin K reductase inhibitor. 30-50% reduction in circulating factors II, VII, IX and X 3-6 days after starting therapy. Also reduces proteins C and S (at a faster rate). Drug of choice for prolonged anticoagulant action. Contraindicated in pregnancy. Bleeding = major toxicity. If severe, administer with vitamin K and fresh plasma. Interacts with every drug you could ever think of.

Question 3

Hydroxyurea

Answer 3

a

Question 4

Eculizumab

Answer 4

a

Question 5

Low molecular weight heparin (LMWH)

Answer 5

Anticoagulant. Smaller than unfractionated heparin, drug of choice for prophylaxis/treatment of DVT/PE and management of acute coronary syndrome. Acts via inhibition of factor Xa. DOES NOT BIND FACTOR IIa. Less patient-to-patient variation than UFH, less monitoring req’d. Bleeding = main toxicity.

Question 6

Protamine sulfate

Answer 6

Binds UFH and prevents its interaction with antrithrombin.

Question 7

Dabigatran

Answer 7

Anticoagulant. Newer oral alternative to warfarin. Direct thrombin inhibitor, oral. Less drug interactions than warfarin.

Question 8

Fondaparinux

Answer 8

Anticoagulant. Synthetic polysaccharide. Selective factor Xa inhibitor. Same MOA as LMWH. Long half life (17 hours)

Question 9

Aspirin

Answer 9

Antiplatelet.