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Blood Coagulation/Anticoagulants Flashcards

1
Q

what is the role of thromboxane A2 in platelet aggregation

A

stimulates aggregation

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2
Q

what is the role of prostacyclin in platelet aggregation

A

inhibition of aggregation

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3
Q

heparin and warfarin mainly target factors __ and __

A

II
X

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4
Q

what is the function of proteins C and S

A

act as anticoagulants

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5
Q

antithrombin inactivates what clotting factors

A

IIa, IXa, Xa, XIa, and XIIa

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6
Q

protein C and S inhibit coagulation by inactivation of what clotting factors

A

Va and VIIIa

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7
Q

parenteral anticoagulants can either be indirect or direct acting. indirect acting include what 2 main classes

A

unfractionated (high molecular weight) heparin
low molecular weight heparin

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8
Q

what is the mechanism of action of unfractionated (high molecular weight) heparin

A

activates antithrombin III which inactivates factors IIa, IXa, and Xa

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9
Q

thrombin is clotting factor __

A

IIa

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10
Q

what is the mechanism of action of low molecular weight heparin

A

inhibits factor Xa by activation of antithrombin III

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11
Q

heparin shouldn’t be administered by what route

A

IM injection

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12
Q

why shouldn’t heparin be administered by IM injection

A

it causes hematoma in muscles

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13
Q

what is the preferred method of delivery of heparin

A

IV

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14
Q

unfractionated heparin is preferred over low molecular weight heparins in patients with compromised __ function

A

renal

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15
Q

in a rapid onset emergency condition, is warfarin or heparin used

A

heparin

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16
Q

is high or low molecular weight heparin preferred to prevent DVT and PE during prolonged bed rest/surgery

A

low

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17
Q

if severe bleeding occurs after discontinuing heparin, what can be used to neutralize heparin anticoagulant activity

A

protamine sulfate

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18
Q

what occurs in heparin induced thrombocytopenia (HIT)

A

heparin, platelet factor, and Ab immune complex and destroy platelets leading to ischemia of limbs, MI, stroke, and skin necrosis

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19
Q

what is used for treatment of heparin induced thrombocytopenia (HIT)

A

direct thrombin inhibitor such as Argatroban

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20
Q

what are some adverse reactions of heparin usage

A

osteoporosis
aldosterone synthesis inhibition
hypersensitivity/allergic reactions
increased hair loss

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21
Q

can heparin be used in pregnancy

A

yes- doesn’t cross BBB

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22
Q

is heparin safe to use in those with kidney disease

A

yes, it is metabolized in the liver and excreted in bile

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23
Q

what are some contraindications for heparin usage

A

heparin induced thrombocytopenia
hemophilia
ulcer lesions in GIT
dissecting aortic aneurysm
recent surgery (eye, brain, or spinal cord)

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24
Q

what is the mechanism of action of the synthetic heparin derivative fondaparinux

A

inhibition of factor Xa by antithrombin III

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25
what is the preferred substitute to heparin in heparin induced thrombocytopenia
argatroban
26
what is the mechanism of action of warfarin
inhibition of synthesis of vitamin K dependent clotting factors inhibition of vitamin K epoxide reductase inhibition of anticoagulant proteins C and S
27
what are the 4 vitamin K dependent clotting factors
II, VII, IX, X (2, 7, 9, 10)
28
why is warfarin not used for emergency situations
effect is not observed until after 3-5 days
29
since warfarin effect isn't observed until 3-5 days after administration, what is given in the meantime
low molecular weight heparin
30
warfarin is metabolized by what enzyme
CYP450
31
what is the international normalized ratio for warfarin monitoring
prothrombin time observed/normal prothrombin time
32
what is recommended for the international normalized ratio for warfarin monitoring
2-3 >3= bleeding complications <2= no effect
33
what is the effect of fetal warfarin syndrome
fetal hemorrhage IUD teratogenicity
34
what is used instead of warfarin in the pregnant
heparin
35
prolonged use of warfarin suppresses the synthesis of __ and __
protein C and S
36
skin necrosis is a common effect of __ usage
warfarin
37
what is the effect of cephalosporins on warfarin activity
cephalosporins destroy vitamin K producing bacteria--> increased inhibition of vitamin K epoxide reductase by warfarin
38
what is the affect of aspirin usage with warfarin
increased warfarin activity
39
is warfarin or heparin preferred in atrial flutter and fibrillation and patients on prosthetic heart valves
warfarin
40
what is the mechanism of action of direct acting oral anticoagulants
direct factor Xa inhibitor
41
rivaroxaban, apixaban, and edoxaban are what kind of anticoagulant drugs
direct acting factor Xa inhibitors
42
what drugs can be used for both treatment and prophylactic of acute DVT, PE, and venous thromboembolic disease
rivaroxaban apixaban edoxaban (direct acting factor Xa inhibitors)
43
what is an-dexa-net alfa used for
reversal of anti factor Xa effects (to stop uncontrolled bleeding in those taking factor Xa inhibitors)
44
what is the mechanism of action of an-dexa-net alfa
it prevents factor Xa inhibiting drugs from binding to and inhibiting factor Xa
45
what is the mechanism of action of direct thrombin inhibitors
directly bind to active site of thrombin
46
what is the preferred drug for use in heparin induced thrombocytopenia
argatroban ( a direct thrombin inhibitor
47
what is the mechanism of action of dabigatran
direct inhibitor of thrombin and fibrinogen (both bound and free forms)
48
dabigatran is inhibited by what drug
ketoconazole
49
dabigatran, an oral direct thrombin inhibitor is used to reduce the risk of recurrent __
venous thromboembolic disease
50
what is the effect of idarucizumab on dabigatran
it irreversibly binds and rapidly reverses the anticoagulant effect
51
what are the advantaes of dabigatran usage over warfarin
lower bleeding rate rapid effects no monitoring required fewer drug+food interactions
52
streptokinase and urokinase are enzymes used for what type of drug
fibrinolytic drugs (thrombolytics)
53
what is the mechanism of action of fibrinolytic drugs
activate plasminogen that is bound to fibrin
54
what type of drug is alteplase
fibrinolytic (thrombolytic)
55
what is the advantage of reteplase and tenecteplase over alteplase as a fibrinolytic (thrombolytic) drugs
reteplase and tenecteplase have: longer half life a bolus dose is enough no maintenance dose is required
56
what is the mechanism of action of fibrinolytic drugs (thrombolytic)
convert plasminogen to plasmin plasmin then degrades the fibrin and fibrinogen, causing clot dissolution
57
what drug is used for clot dissolution in acute myocardial infarction
fibrinolytic agents such as streptokinase and urokinase
58
what is the benefit of using fibrinolytic agents for acute myocardial infarction
more beneficial in ST-segment elevation
59
what is an adverse effect of streptokinase use as a fibrinolytic (thrombolytic)
it can induce a hypersensitivity reaction
60
in what situations are fibrinolytics contraindicated
prior intracranial hemorrhage cerebral vascular lesion malignant intracranial neoplasm ischemic stroke within 3 months suspected aortic dissection significant closed-head trauma or facial trauma within 3 months
61
what is the function of fibrinolytic inhibitors
block the activation of plasminogen to plasmin to prevent fibrinolysis (helps blood clot)
62
what are fibrinolytic inhibitors used for
control post-surgery bleeding heavy menstrual flow
63
what is the mechanism of action of aspirin
irreversibly inhibit COX-1 inhibiting thromboxane A2 synthesis and prevents platelet activation
64
low dose aspirin is recommended for patients age __ with high risk heart issues
40-70
65
what is the mechanism of action of the antiplatelet drugs Ticlopidine, Clopidogrel, and Prasugrel
inhibition of P2Y12 ADP induced activation of GPIIb/IIIa receptors required for binding with fibrinogen and other platelets
66
what is the advantage of Clopidogrel over Ticlopidine
more potent rarely associated with neutropenia, leukopenia, and thrombocytopenia
67
what antiplatelet drug is used as prophylaxis with warfarin in patients with prosthetic heart valves
dipyridamole
68
what is the mechanism of action of dipyridamole
increases level of cAMP in platelets
69
what is the action of abciximab
it's an antibody against GPIIb/IIIa that prevents the binding of fibrinogen to GPIIa/IIIb
70
when are GPIIb/IIIa receptor antagonists used
unstable angina post MI patients undergoing percutaneous coronary intervention
71
thrombin activates platelets through _____ receptors
protease activated
72
what is the mechanism of action of vorapaxar
competitive antagonist of PAR-1 and inhibits thrombin induced platelet aggregation
73
what is the mechanism of action of cilostazol
phosphodiesterase III inhibitor
74
what is the main use of cilostazol
treatment of intermittent claudication

Pharmacology (16 decks)

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