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Pre-pharmacology > Chapter 13 (anticlotting agents) > Flashcards

Chapter 13 (anticlotting agents) Flashcards

1
Q

antiplatelet drugs

A

inhibit the initiation of a clot

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2
Q

anticoagulant drugs

A

prevent the formation of mature clots

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3
Q

thrombolytic drugs

A

dissolve clots that have already formed

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4
Q

three mechanisms of body to reduce blood loss when bleeding occurs

A
  1. vascular spasm
  2. formation of platelet plug (where platelet inhibitors work)
  3. blood clotting; coagulation (anticoagulants work here)
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5
Q

vascular spasm

A

one method of hemostasis; BVs snap back after being severed to narrow lumen of arteriols and reduce blood flow

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6
Q

formation of platelet plug

A

one method of hemostasis; platelets become activated and form spikey processes to become sticky
They can then adhere to inner walls of damaged BVs to form a platelet plug

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7
Q

coagulation

A

one method of hemostasis; blood congeals to form a clot around the platelet plug
Occurs via a cascade

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8
Q

coagulation cascades

A

extrinsic and intrinsic that both lead to a final common pathway

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9
Q

fibrinolytic system

A

body tissue and blood contain substances that activate plasminogen to plasmin, which is the enzyme that dissolves clots

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10
Q

tPA

A

tissue plasminogen activators; drugs that dissolve clots
Must be given within about 3 hours after symptoms of MI/stroke or the detriments will outweight the benefits
Works on large artery occlusions, lacunar strokes, and pts. with frosbite (reduce number of amputations)

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11
Q

thrombosis

A

abnormal formation of an intravascular clot

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12
Q

BV inner lining

A

should be smooth endothelial cells to keep platelets and RBCs from sticking
Can become roughened from atherosclerosis, trauma, or infection which can lead to thrombus formation

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13
Q

plaque atherogenicity

A

BV plaques are stimulatory to the clotting system (atherogenic) and can lead to blood clots on stop of plaque in artery

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14
Q

clot formation in veins

A

usually form from stasis of blood, allowing clotting factors to accumulate and initiate coagulation leading to DVT

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15
Q

DVT

A

deep venous thrombosis; forms from blood stasis
Often happens to people who have been sedentary for a long time or pregnant women from weight impeding venous blood flow (also cause of varicose veins and hemorrhoids)

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16
Q

vein clots often lead to problems in the…

A

lungs

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17
Q

artery clots often lead to problems in the…

A

brain

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18
Q

embolus

A

thrombus that has been dislodged and swept away in blood; can obstruct BVs and cause ischemia to tissue beds distal to obstruction (PE or stroke)

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19
Q

PE

A

pulmonary embolism; often from DVT in legs

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20
Q

thromboembolic events

A

both thrombosis and embolism make up this disease

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21
Q

most serious type of embolism

A

clot/plaque combination that breaks free

22
Q

ASVD and plaque formation can be lessened by…

A

controlling BP and lipids through NO, CCBs, B blockers, etc. to decrease metabolic heart O2 demands

23
Q

three types of anti-clotting drugs

A
  1. platelet inhibitors; hinder ability of platelets to get sticky and form platelet plug
  2. anticoagulants; hinder one or more of soluble clotting factors that lead to enzymatic conversion of fibrinogen to fibrin
  3. thrombolytics; ‘clot buster’ drugs to dissolve already formed clots
24
Q

antiplatelet drug uses

A
  1. prevent/treat superficial venous thrombosis or mild cases of DVT
  2. prevent ‘mini stroke’ TIAs (transient ischemic attacks)
  3. prevent/treat anginal chest pain
25
Q

antiplatlet drug mechanism

A

prevent platelet activation so clots cannot be initiated;

Reduce ability of platelets to aggregate, but do not affect the deep coagulation cascade (increase bruising likelihood)

26
Q

NSAIDs

A

have antiplatelet effect, but mostly just ASA has a pronounced effect

27
Q

acetylsalicylic acid

A

aspirin; used prophylactically as antiplatelet drug to relieve angina and prevent MI and stroke (81 mg baby aspirin) or in emergency by chewing two 325 mg with water

28
Q

Plavix

A

clopidogrel; thienopyrindine drug more hard core antiplatelet drug that is used if person has already had an MI (for example)
Sometimes given w/ASA but is very dangerous and must be Rx’ed with great caution

29
Q

anticoagulant drug mechanism

A

Interrupt one or more of clotting steps in coagulation cascade; works on deep bleeding cascade and so has associated mortality from stopping coagulation so much

30
Q

deep bleeding

A

bleeding into joints, abdomen, or brain; adverse effect of anticoagulants

31
Q

BT

A

bleeding time; time measured for bleeding to stop on standard incision on skin for test
Not a great test and often will just ask about bruising or nose bleeds

32
Q

anticoagulant uses

A
  1. anticoagulation for hemodialysis and cardiopulmonary bypass
  2. prevent or treat DVT or PE
  3. prevent or treat stroke or MI
33
Q

CPB

A

cardiopulmonary bypass; anticoagulants used during this procedure

34
Q

aPTT test

A

tests the intrinsic coagulation pathway

35
Q

INR (PT) test

A

international ratio test; tests extrinsic pathway by seeing how much longer pts. blood takes to clot compared to normal people

36
Q

heparins

A

Best in the moment anticoagulants (only 2 minutes for effect) and given as soon as bleeding in under control from initial injury
Stimulates antithrombin III of deep clotting cascade; inhibit the intrinsic coagulation cascade; measured by aPTT test

37
Q

Coumadin

A

warfarin, rat poison; anticoagulant inhibits formation of vitamin K-dependent clotting factors made in liver (mainly factor VII)
Can be given orally and used long-term (unlike heparin); measured by INR (PT) test
Very low TI and has hundreds of drug interactions so patients require close checking in on

38
Q

Pradaxa

A

dabigatran; direct thrombin inhibitor (inhibits the final common coagulation pathway)

39
Q

antithrombin III

A

our natural anticoagulant that increases time to clot

40
Q

unfractionated heparins

A

heparins of different molecular sizes; always required hospital stay b/c used to be given by IV and required monitoring by aPTT

41
Q

LMWH

A

low molecular weight heparins; better than unfractionated heparins b/c they can be given by IM one/two times a day and can be done at home

42
Q

Lovenox

A

enoxaparin; LMWH (low molecular weight heparin)

Stimulates antithrombin III; natural deep clotting cascade anticoagulant

43
Q

countering Coumadin

A

vitamin K injections (IM or IV) or FFP admin; since warfarin inhibits vitamin K, by giving more it can be overpowered and fresh frozen plasma has coagulation factors in it which counters the effect of the anticoagulant

44
Q

Factor Xa inhibitors

A

new group of anti-coagulants; have started to replace warfarin as standard oral outpatient anticoagulant

45
Q

Xarelto

A

rivaroxaban; oral factor Xa inhibitor (anticoagulant)

46
Q

Eliquis

A

apixaban; oral factor Xa inhibitor (anticoagulant)

47
Q

DTIs

A

direct thrombin inhibitors; new anticoagulant group

48
Q

Pradaxa

A

dabigatran; direct thrombin inhibitor (anticoagulant)

49
Q

tPA mechanism

A

after healing, it is released to convert plasminogen into active form, plasmin which breaks apart clots

50
Q

thrombolytic drugs

A

accelerate normal clot busting process by augmenting action of tPA
Used for pts. with acute MI or thrombotic/embolic stroke
But is very dangerous b/c if given to someone with a hemorrhagic (bleeding) stroke then the pt. will likely die b/c the bleeding will never stop (CT must be done to see if there is any bleeding in brain)

51
Q

streptokinase

A

earliest thrombolytic; produced naturally by beta-hemolytic streptococcal bacteria
But is highly antigenic and yields high allergic reaction rates

52
Q

Activase

A

alteplase; thrombolytic, first tissue-type plasminogen activator, which is good b/c it is a human protein, not bacterial

Pre-pharmacology (27 decks)

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