Blood drugs

Question 1

3 step process for primary hemostasis

Answer 1

1. adhesion: VWF
2. Activation: degranulation of ADP and TXA2
3. Aggregation: Fibrinogen

Question 2

Aspirin

Answer 2

COX-1 inhibitor–blocks production of TXA2

81mg daily dose prevents MI and is prophylactic in atrial arrhythmias and TIA’s

Question 3

Main adverse affects of aspirin

Answer 3

GI upset and bleeding

Question 4

Clopidogrel and other -grel drugs

Answer 4

P2Y12 antagonists–increases cAMP and inhibits platelet activation by inhibiting ADP receptor
Alternative to aspirin

Question 5

Abciximab

Answer 5

Glycoprotein IIb/IIIa inhibitor

Used in acute coronary syndromes

Question 6

cAMP/cGMP phosphodiesterase inhibitors

Answer 6

Inhibits breakdown of CAMP, which prevents platelet aggregation
Promotes vasodilation

Question 7

Dipyridamole

Answer 7

cAMP phosphodiesterase inhibitor
Thromboembolism prophylaxis after cardiac valve replacement
Used as alternative to treadmill for cardiac stress test

Question 8

Examples of anticoagulants

Answer 8

Heparin, Warfarin, direct thrombin inhibitors, direct factor Xa inhibitors

Question 9

Indications for anticoagulants

Answer 9

Tx or prophylaxis for DVT, atrial fibrillation, mechanical heart valves, inherited clotting factors

Question 10

Heparin

Answer 10

used for already active clotting factors 
Water soluble 
short half life
given IV
PTT monitoring 
DOC in pregnancy

Question 11

Antidote for heparin

Answer 11

Protamine sulfate

Question 12

Warfarin

Answer 12

Used as prophylaxis for clotting
Blocks activation of vitamin K : blocks 2, 7, 9, 10 clotting factors
Lipid soluble
Long half life
Given orally 
PT monitoring 
CI in pregnancy

Question 13

Antidote to warfarin

Answer 13

Fresh frozen plasma (fast)
Vit K (slow)

Question 14

Unfractionated heparin

Answer 14

Most likely to cause heparin induced thrombocytopenia

Question 15

Low molecular weight heparin

Answer 15

Enoxaparin, dalterparin
Increased bioavailability and decreased HIT
Longer half life, safer for pregnancy

Question 16

Heparin induced thrombocytopenia

Answer 16

Systemic hypercoagulable state due to antibodies against heparin and platelet factor 4

Question 17

Drug of choice for HIT

Answer 17

Direct thrombin inhibitors: Argatroban and Lepirudin

Question 18

What decreases efficacy of warfarin

Answer 18

General inducers, cholestyramine (bile acid sequestrant used for high cholesterol), antacids, vitamin K rich foods

Question 19

What increases efficacy of warfarin

Answer 19

Aspirin, heparin, cephalosporins

Question 20

Transient protein C deficiency with warfarin

Answer 20

On initiation, warfarin causes transient protein C deficiency and hypercoagulability
Must heparinize patient initially to get rid of all active clotting factors

Question 21

Rivaroxaban

Answer 21

Direct factor Xa inhibitors

Question 22

Thrombolytics use

Answer 22

For immediate, rapid dissolution of clot
Activate plasmin from plasminogen
“-teplase”

Question 23

When are thrombolytics given

Answer 23

Emergency treatment of coronary thromboses, DVT, pulmonary embolism, thromboembolitic stroke

Question 24

tPA

Answer 24

Activates plasminogen bound to fibrin

Question 25

Alteplase

Answer 25

Recombinant tPA drugs
5 minute duration
High clot specificity

Question 26

Aminocaproic acid and tranexamic acid

Answer 26

Antifibrinolytics–used to competitively inhibit plasminogen activation
Reverse effects of fibrinolytics

Question 27

When are thrombolytics contraindicated

Answer 27

Surgery within 10 days, serious GI bleed within 3 months, active bleeding

Question 28

Streptokinase

Answer 28

tpa

Question 29

When should thrombolytics be used

Answer 29

Within 3-4.5 hours of ischemic stroke if PCI not available within 1 hour