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Introduction to Pharmacology > Blood Drugs, Pt. 2 > Flashcards

Blood Drugs, Pt. 2 Flashcards

1
Q

What drugs act as thrombin and Factor Xa inhibitors?

A

THROMBIN INHIBITORS = Dabigatran

FACTOR XA INHIBITORS = Rivaroxaban, Apixaban

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2
Q

What are the 4 pros and 2 cons to using Factor Xa inhibitors?

A
  1. PKs are predictable
  2. no monitoring required
  3. not affected by dietary changes
  4. less drug-drug interactions
  • short half-life
  • inability to reverse bleeding
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3
Q

What are the 2 probs and 2 cons to using thrombin inhibitors?

A
  1. less drug-drug interactions
  2. has a reversal agent
  • bleeding
  • GI problems
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4
Q

What is hemophilia? How is it diagnosed?

A

inherited disorder in which the blood does not clot due to insufficient clotting factors

coagulation time test to measure how long it takes to form a clot

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5
Q

How is hemophilia treated? What factor can be used?

A

blood transfusion of fresh frozen plasma (FFP) that contains the needed coagulation factors

Factor VIII - antihemophilia factor that is the co-factor of Factor IX that activates Factor X

(not curable, but proper care allows animals to live long lives)

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6
Q

What are the 3 types of hemophilia?

A

A = lack (missing or defective) of factor VIII due to X-linked gene (most inherited bleeding disorder)

B = lack (missing or defective) of factor IX (Christmas factor) due to X-linked gene

C = extremely rare, non-sex link deficiency of factor XI

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7
Q

What species have an increased incidence of hemophilia B and C?

A

B = Labrador Retriever, German Shepherd, mixed-breed dogs, British short-hairs, Siamese mix

C = Springer Spaniels, Great Pyranese, Weimeraners, Kerry Blue terriers

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8
Q

What are the 4 symptoms of hemophilia A?

A
  1. spontaneous bleeding into muscles or joints (swelling)
  2. spontaneous bleeding under the skin (hematoma)
  3. hemorrhage into chest or abdominal cavity
  4. excessive bleeding from surgery site
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9
Q

In what 4 situations is hemophilia A diagnosed?

A
  1. during surgery or trauma
  2. young animals that have extreme bleeding after routine procedures
  3. abnormal bleeding of the gums
  4. still-born puppies or kittens
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10
Q

How do the symptoms of hemophilia B and C compare to hemophilia A?

A
  • same, but milder
  • spontaneous bleeding into thorax, abdomen, or brain
  • usually not noticed until an emergency (trauma or surgery)
  • C: bleeding can be delayed for up to 4 days
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11
Q

What is Von Willibrand disease?

A

NOT hemophilia - the most common inherited blood clotting disease in dogs due to a lack of vWF protein responsible for specific clotting important for platelet adhesion

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12
Q

What are the 6 steps of platelet activation?

A
  1. adhesion
  2. shape changes
  3. secretion of granule contents
  4. biosynthesis of labile mediators
  5. aggregation
  6. exposure of acidic phospholipid
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13
Q

Where do platelets adhere?

A

diseased or damaged areas of the endothelium that express negatively charged phospholipids and glycoprotein IIb/IIIa receptors that synthesize and release ADP and thromboxane A

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14
Q

What is thrombosis? What 3 disposing factors increase the risk?

A

pathological formation of a hemostatic plug within vasculature in the absence of bleeding

  1. injury to vessel wall
  2. altered blood flow
  3. abnormal coagulability of the blood
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15
Q

What is the difference between arterial and venous thrombi?

A

ARTERIAL = artherosclerosis that interrupts blood flow causing ischemia; carotid emboli can go to the brain and cause stroke/death

VENOUS = steams away in the flow into circulation forming an embolus that typically go into the pulmonary artery causing pulmonary embolism

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16
Q

What is a thrombus? Embolism? What thrombotic disease is most common in cats?

A
  • blood clot that occurs inside blood vessels
  • clot that has traveled through the blood vessel to a location far from where it was formed

aortic thromboembolism

17
Q

What 8 conditions are commonly treated with antiplatelet drugs?

A
  1. feline cardiomyopathy
  2. pulmonary endarteritis with HW disease
  3. membranous glomerulonephritis
  4. mild DIC
  5. pulmonary thromboembolism
  6. vasculitis
  7. laminitis
  8. navicular disease
18
Q

What 3 antiplatelet drugs are most commonly used?

A
  1. Aspirin
  2. Clopidogrel
  3. Abciximab

aspirin and clopidogrel require less monitoring because they have low risk for serious hemorrhage

19
Q

Platelet pathway:

A
20
Q

What is Aspirin? How is it used as an antiplatelet drug?

A

NSAID with analgesic and antipyretic effects

blocks platelet activation and aggregation in thromboembolic diseease

21
Q

What is the mechanism of action of Aspirin? How does the dosage alter this?

A

irreversibly inhibits platelet cyclooxygenase, preventing the formation of thromboxane A2

LOW DOSE inhibits COX1 responsible for the production of thromboxane A2 and vasoconstriction, resulting in a blockage of platelet aggregation

HIGH DOSE inhibits COX1 responsible for the production of prostaglandind and inflammation/anaphylaxis, resulting in analgesia and reduced inflammation

22
Q

What is Clopidogrel? How is it used in dogs and cats?

A

prodrug whose active metabolite is able to block platelet aggregation

DOGS = hypercoagulable state
CAT = thrombi, embolic events

23
Q

What is the mechanism of action of Clopidogrel?

A

active metabolite inhibits and irreversibly binds to P2Y12 class of adenosine receptors on platelets, leadint to the blocking of platelet activation and aggregation

24
Q

Is Aspirin or Clopidogrel preferred in veterinary medicine?

A

Clopidogrel - able to be used in dogs, cats, horses, rabbits, and calves, and is low cost

  • superior inhibition of platelet aggregation compares to Aspirin in dogs
25
Q

Why do some dogs have diminished responses to Clopidogrel?

A

may have varients of P2Y12 receptor

26
Q

What is Abciximab?

A

monoclonal anti-glycoprotein IIb/IIIa receptor antibody used to prevent thrombosis during percutaneous coronary intervention

27
Q

What is Abciximab’s mechanism of action?

A

inhibits platelet aggregation by reversibly binding to platelet IIb/IIIa receptor that plays a critical role in the binding of fibrinogen (Factor I) to vWF and other adhesive molecules —> blocks platelet aggregation

28
Q

What are the 3 most common uses of Abciximab?

A
  1. prevention of cardiac ischemic events in patients undergoing percutaneous coronary intervention
  2. prevents myocardial infarction
  3. thrombolysis
29
Q

Antiplatelet drugs:

A

Introduction to Pharmacology (39 decks)

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