Blood Drugs

Question 1

Anticoagulant drugs

Answer 1

1-Heparin
2-Warfarin 
3- alternative heparin 
-apixaban
-dibagatran
-rivaroxaban
-argatroban
4-low molecular weight heparin
Enoxaparin
Fundaparin
Dalteparin

Question 2

Heparin

Mechanism

Answer 2

Stimulates antithrombin Ill which inhibits thrombin and factor Xa.(So,

Question 3

Heparin

Indication

Answer 3

1-Acute anticoagulation. E.g., Ml and Stroke. D V T

2-Chronic anticoagulation in pregnancy (can’t cross placenta).

Question 4

Heparin

Main side effects

Answer 4

• Anticoagulant: Bleeding tendency.
• Anticollagen: Osteoporosis.
• Heparin-Induced thrombocytopenia (HIT):

Question 5

Heparin-Induced thrombocytopenia (HIT) 
Cause
Clinical picture
Complication
What we should do if have been Toxicity

Answer 5

• Cause: IgG against heparin bound to PF4
• C/P: Acute decrease in platelet count on heparin administration.(thrombocytopenia)
• Complication: Thrombosis (due to lysis of platelet allowing Ca** release activating thrombosis process).
• TTT: Stop heparin and start heparin alternatives.

Question 6

Heparin Antidote is

Answer 6

Protamine SO4

بروتاميين سالفيت

Question 7

 what test should follow the heparin and why?

Answer 7

PTT (Partial Thrombo time)

In case that we should check the platlet

Question 8

Low Molecular Weight Heparins drugs is

Answer 8

Enoxaparin. -Dalteparin. - Foundaparinux.

cleaxn

Question 9

Low Molecular Weight Heparins Mechanism is

Answer 9

Act more on factor Xa. Also bind and activate antithrombin III like heparin.

Question 10

Low Molecular Weight Heparins Advantages is

Answer 10

Advantages:

• Longer duration of action, so less frequently administered.
• Highly safe SC administration, so no need to monitor PTT.

Question 11

Low Molecular Weight Heparins
Disadvantages: If toxicity occurs
What will happen

Answer 11

there’s no antidote (not easily reversed).

Question 12

Heparin Alternatives drugs is

Answer 12

1-Hirudin
Argatroban, 
dabigatran and bivalirudin.
2-Non-hirudin
Apixaban and rivaroxaban.

Note\ Hirudin derivatives inhibit thrombin,
while
non-hirudins inhibit factor Xa.

Question 13

Heparin Alternatives Mechanismis

Answer 13

Direct factor Xa inhibition or thrombin inhibition.by binding to thrombin active site

Question 14

Heparin Alternatives Indication

Answer 14

Heparin Alternative in case of HIT (Thromboembolism & atrial fibrillation) DVT

Question 15

Heparin Alternatives Disadvantages:

Answer 15

If toxicity occurs, there’s no antidote (not easily reversed).

Question 16

‘Warfarin”Mechanism:

Answer 16

Mechanism:
- Decrease carboxylation step required for hepatic synthesis of factors II, VII, IX, X (1972)and proteins C and S by competing with vitamin K.

Question 17

‘Warfarin indication

Answer 17

• Chronic anticoagulation. E.g., DVT, Ml and stroke.

- Its action appears after 3 days during which heparin is given (heparin umbrella).

Question 18

Side-effect of warfarin

‘

Answer 18

• Main S/Es:
- Bleeding tendency due to its anticoagulant effect.
- Skin and Tissue necrosis due to initial hypercoagulability, as proteins C and S are destroyed faster than coag-
ulation factors (11, VI, IX, and X). Prevented by heparin umbrella.
- Teratogenicity, as warfarin can cross the placenta.

Question 19

How we treat toxicity of warfarin

Answer 19

Fresh frozen plasma. Better than cryoprecipitate. -

Vitamin K (antidote).

Question 20

What can cause toxicity of a warfarin

Answer 20

1- overdose

2-Rodentsides contain a land of wartarn (proditacoum) = accdental ingesbon can lead (O wanann toyo
3-drug interaction
Some drugs ex. sulfonamide antibiotics can displace warfarin from plasma pt precipitating toxicity

Question 21

Thrombolytics drugs

Answer 21

• Alteplase (tPA). - Reteplase (rPA).
• Tenecteplase.
• Streptokinase.

Question 22

Thrombolytics indication

Answer 22

Uses;

• Early MI within 6-8 hours.
• Early Stroke within 2-4 hours.

Question 23

Thrombolytics side-effect

Answer 23

• Active bleeding.
• Severe HTN.
• History of Intracranial hemorrhage or recent surgery.

Question 24

If toxicity happened why thrombolytic what is your response

Answer 24

Fresh frozen plasma with cryoprecipitate.
- Amino caproic acid (antidote).

كابرويك

Question 25

Desmopressin ديسموبريسين

Indication

Answer 25

Used in the treatmet, of vw disease & hemophlia A in which there is a deficiency in vWF and factor 8 causing bleeding tendency

Question 26

Desmopressin side effects

Answer 26

ma cause hypertension due to its action

as a vasoconstrictor and ADH effect

Question 27

“ANTIPLATELET DRUGS

Answer 27

1-ADP receptor blockers
2-PDE inhibitors
3-Gp IIB/IIIA inhibitors

Question 28

ADP receptor blockers drugs is?

Answer 28

• Clopidogrel.
• Prasugrel.
• Tigagrelor.
• Ticlopidine.

Question 29

ADP receptor blockers drugs Mechanism:

Answer 29

Decrease or inhibition ADP receptors,

So it will decrease or inhibition of Gp lIB/IlIA on platelet surface decreasing platelet aggregation.

Question 30

ADP receptor blockers indication?

Answer 30

Uses
• Post-operative coronary stenting (prevent Mi
• Prévention of stroke and Mi (acute coronary synorome)

Question 31

ADP receptor blockers dugs side effects

Answer 31

TClopidine causes BMS leading to neutropenia

Question 32

“‘Gp IIB/IIIA inhibitors drugs is?

Answer 32

• ABciximAB.
• EptiFIBAtide.
• TiroFIBAn.

Question 33

Gp IIB/IIIA inhibitors •Mechanism is?

Answer 33

Decrease Gp IIB/IIIA inhibitors so they prevent platelet aggregation.

Question 34

Gp IIB/IIIA inhibitors drugs indication is?

Answer 34

As ADD receptor inhibitors.

Question 35

ADD receptor inhibitors.drug side effects

Answer 35

1-Bleeding.

2-decrease platelet count due to datele, destruction.

Question 36

ADD receptor inhibitors.drug side effects

Answer 36

1-Bleeding.

2-decrease platelet count due to datele, destruction.