chapter 22- Hemostasis and Thrombosis Flashcards
what is the mechanism of action of aspirin
inhibit platelet cyclooxyrgenase, thereby blocking thromboxane A2 generation and inhibiting platelet granule release reaction and platelet aggregation
what is the mechanism of action of dipyridamole
inhibit platelet cAMP degradation and thereby decrease platelet aggregability
what is the mechanism of action of ticlopidine, clopidogrel, and prasugrel
covalently modify platelet ADP receptor, thereby preventing receptor signaling and irreversibly inhibiting ADP-dependent platelet activation pathway
what is the mechanism of action of eptifibatide, abciximab, tirofiban
bind to platelet receptor GPIIb-IIIa and thereby prevent binding of fibrinogen and other adhesive ligands
what is the mechanism of action of warfarin
inhibit hepatic epoxide reductase that catalyzes the regeneration of reduced vitamin K
what is the mechanism of action of unfractionated heparin
combines with antithrombin III and inhibits secondary hemostasis via nonselective inactivation of thrombin, factor Xa, factor XIa, and factor XIIa
what is the mechanism of action of LMW heparins
combine with antithrombin III and inhibit secondary hemostasis via relatively selective inactivation of factor Xa
what is the mechanism of action of fondaparinux
combine with antithrombin III and inhibit secondary hemostasis via highly selective inactivation of factor Xa
what is the mechanism of action of hirudin-related agents (lepirudin, desirudin, bivalirudin) and argatroban
bind directly to thrombin and thereby inhibit secondary hemostasis
what is the mechanism of action of recombinant activated protein C
proteolytically inactivates factors Va and VIIa
what drugs are genetically engineered variants of t-PA with increased specificity for fibrin
tenecteplase, reteplase
what is the mechanism of action of protamine
inactivates heparin by forming a stable 1:1 protamine: heparin compelx
what is the mechanism of action of aprotinin
inhibits serine proteases, including plasmin, t-PA, and thrombin
what is the mechanism of action of aminocaproic acid, tranexamic acid
analogues of lysine that bind to and inhibit plasminogen and plasmin
what is the clinical application of aspirin
prophylaxis against transient ischemic attach, MI and thromboembolic strokes
what are some adverse effects seen with aspirin
GI bleeding, acute renal insufficiency, reyes syndrome, tinnitus
what are some contraindications for aspirin use
G6Pd deficiency, children with chickenpox or flu-like symptoms
what is the clinical application of dipyridamole
prophylaxis against thromboembolic disorders, alternative to exercise in thallium myocardial perfusion imaging
what are some adverse effects seen specific with IV route dipyridamole
exacerbation of aging, hypotension
what is dipyridamole usually administered in combination with
aspirin or warfarin
how may dipyridamole paradoxically induce angina
by causing coronary steal phenomenon
what is the clinical application of ticlopidine
secondary prevention of thrombin strokes in patients intolerant of aspirin
what are some adverse effects seen with ticlopidine
aplastic anemia, abnormal LFT
what are some contraindications for ticlopidine use
active bleeding disorder, severe liver dysfunction
what is the major contraindication for clopidogrel use
active bleeding disorder
what is the clinical application of prasugrel
acute coronary syndromes; percutaneous coronary intervention; thrombosis prophylaxis
why are some adverse effects seen with prasugrel
A-fib, bradycardia, hypertension, hyperlipidemia, backspin, epistaxis
what are some contraindications for prasugrel use
active bleeding disorder, TIA, stroke
what should prasugrel be used in combination with
aspirin
what is the clinical application of eptifibatide
acute coronary syndromes, percutaneous coronary intervention
what are some adverse effects seen with eptifibatide use
major bleeding, intracerebral hemorrhage, thrombocytopenia
what is eptifibatide administered
parenteral admin
what is the clinical application of tirofiban
acute coronary syndromes in patients undergoing angioplasty or atherectomy or managed medically
what analogue is tirofiban
non peptide tyrosine analogue
what is the most serious adverse effect with warfarin
bleeding
what are some contraindications for warfarin use
pregnancy; regional/lumbar block anesthesia
how do you monitor warfarin use
Prothrombin time
what should patients who acquire severe hemorrhage due to warfarin receive
fresh frozen plasma
what are some adverse reactions seen with unfractionated heparin
overly prolonged clotting time, mucosal ulceration,hematoma
what is the clinical application of fondaparinux
prophylaxis and treatment of DVt and pulmonary embolism
what are some contraindications of fondaparinux use
active major bleeding, severe renal impairment, bacterial endocarditis
what is the clinical application of lepirudin
heparin induced thrombocytopenia
what is the clinical application of desirudin
prophylaxis against DVT
what is the clinical application of bivalirudin
anticoagulation in patients undergoing coronary angiography and angioplasty
what are some contraindications to hirudin-related agents
active major bleeding, pregnancy, severe uncontrolled HTN, severe renal impairment
what is the clinical application of argatroban
coronary artery thrombosis, prophylaxis in percutaneous coronary intervention, heparin-induced thrombocytopenia
what are some adverse reactions seen with argatroban
cardiac arrets, cerebrovascular disease, ventricular tachycardia, sepsis, hypotension
what are some contraindications or argatroban use
active major bleeding, severe liver impairment
what is the clinical application of dabigatran
prevention of thromboembolism in non-valvular atrial fibrillation
what are some adverse reactions seen with dabigatran
hemorrhage, severe hypertensive reaction
what is the clinical application of r-APC
severe sepsis with organ dysfunction and high risk of death
what is the major adverse reaction of r-APC
hemorrhage (increased risk of bleeding)
what is the clinical application of streptokinase
ST elevation MI, life-threatening pulmonary embolism
what is the clinical application of tenectaplase and reteplase
acute MI
what is the clinical application of protamine
heparin overdose
what are some adverse reactions seen with protamine
bradyarrythmia, hypotension, circulatory collapse, capillary leak
how is protamine administered
IV
what is the clinical application of aprotinin
reduce preoperative bleeding during CABG surgery
what may aprotinin inhibit at higher doses
kallikrein
what post operative condition may aprotinin increase the risk of in comparison to other anti-fibrinolytic agents
postoperative acute renal failure
what is the clinical application of aminocaproic acid and tranexamic acid
disorder involving the fibrinolytic system; hemorrhage from increased fibrinolysis
what are some adverse reactions seen with aminocaproic acid and tranexamic acid
bradyarrythmias, hypotension, thrombotic disodre, drug-induced myopathy
what are some contraindications to aminocaproic acid and tranexamic acid use
DIC
