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LECOM pharmacology notecards > chapter 22- Hemostasis and Thrombosis > Flashcards

chapter 22- Hemostasis and Thrombosis Flashcards

1
Q

what is the mechanism of action of aspirin

A

inhibit platelet cyclooxyrgenase, thereby blocking thromboxane A2 generation and inhibiting platelet granule release reaction and platelet aggregation

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2
Q

what is the mechanism of action of dipyridamole

A

inhibit platelet cAMP degradation and thereby decrease platelet aggregability

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3
Q

what is the mechanism of action of ticlopidine, clopidogrel, and prasugrel

A

covalently modify platelet ADP receptor, thereby preventing receptor signaling and irreversibly inhibiting ADP-dependent platelet activation pathway

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4
Q

what is the mechanism of action of eptifibatide, abciximab, tirofiban

A

bind to platelet receptor GPIIb-IIIa and thereby prevent binding of fibrinogen and other adhesive ligands

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5
Q

what is the mechanism of action of warfarin

A

inhibit hepatic epoxide reductase that catalyzes the regeneration of reduced vitamin K

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6
Q

what is the mechanism of action of unfractionated heparin

A

combines with antithrombin III and inhibits secondary hemostasis via nonselective inactivation of thrombin, factor Xa, factor XIa, and factor XIIa

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7
Q

what is the mechanism of action of LMW heparins

A

combine with antithrombin III and inhibit secondary hemostasis via relatively selective inactivation of factor Xa

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8
Q

what is the mechanism of action of fondaparinux

A

combine with antithrombin III and inhibit secondary hemostasis via highly selective inactivation of factor Xa

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9
Q

what is the mechanism of action of hirudin-related agents (lepirudin, desirudin, bivalirudin) and argatroban

A

bind directly to thrombin and thereby inhibit secondary hemostasis

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10
Q

what is the mechanism of action of recombinant activated protein C

A

proteolytically inactivates factors Va and VIIa

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11
Q

what drugs are genetically engineered variants of t-PA with increased specificity for fibrin

A

tenecteplase, reteplase

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12
Q

what is the mechanism of action of protamine

A

inactivates heparin by forming a stable 1:1 protamine: heparin compelx

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13
Q

what is the mechanism of action of aprotinin

A

inhibits serine proteases, including plasmin, t-PA, and thrombin

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14
Q

what is the mechanism of action of aminocaproic acid, tranexamic acid

A

analogues of lysine that bind to and inhibit plasminogen and plasmin

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15
Q

what is the clinical application of aspirin

A

prophylaxis against transient ischemic attach, MI and thromboembolic strokes

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16
Q

what are some adverse effects seen with aspirin

A

GI bleeding, acute renal insufficiency, reyes syndrome, tinnitus

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17
Q

what are some contraindications for aspirin use

A

G6Pd deficiency, children with chickenpox or flu-like symptoms

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18
Q

what is the clinical application of dipyridamole

A

prophylaxis against thromboembolic disorders, alternative to exercise in thallium myocardial perfusion imaging

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19
Q

what are some adverse effects seen specific with IV route dipyridamole

A

exacerbation of aging, hypotension

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20
Q

what is dipyridamole usually administered in combination with

A

aspirin or warfarin

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21
Q

how may dipyridamole paradoxically induce angina

A

by causing coronary steal phenomenon

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22
Q

what is the clinical application of ticlopidine

A

secondary prevention of thrombin strokes in patients intolerant of aspirin

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23
Q

what are some adverse effects seen with ticlopidine

A

aplastic anemia, abnormal LFT

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24
Q

what are some contraindications for ticlopidine use

A

active bleeding disorder, severe liver dysfunction

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25
Q

what is the major contraindication for clopidogrel use

A

active bleeding disorder

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26
Q

what is the clinical application of prasugrel

A

acute coronary syndromes; percutaneous coronary intervention; thrombosis prophylaxis

27
Q

why are some adverse effects seen with prasugrel

A

A-fib, bradycardia, hypertension, hyperlipidemia, backspin, epistaxis

28
Q

what are some contraindications for prasugrel use

A

active bleeding disorder, TIA, stroke

29
Q

what should prasugrel be used in combination with

A

aspirin

30
Q

what is the clinical application of eptifibatide

A

acute coronary syndromes, percutaneous coronary intervention

31
Q

what are some adverse effects seen with eptifibatide use

A

major bleeding, intracerebral hemorrhage, thrombocytopenia

32
Q

what is eptifibatide administered

A

parenteral admin

33
Q

what is the clinical application of tirofiban

A

acute coronary syndromes in patients undergoing angioplasty or atherectomy or managed medically

34
Q

what analogue is tirofiban

A

non peptide tyrosine analogue

35
Q

what is the most serious adverse effect with warfarin

A

bleeding

36
Q

what are some contraindications for warfarin use

A

pregnancy; regional/lumbar block anesthesia

37
Q

how do you monitor warfarin use

A

Prothrombin time

38
Q

what should patients who acquire severe hemorrhage due to warfarin receive

A

fresh frozen plasma

39
Q

what are some adverse reactions seen with unfractionated heparin

A

overly prolonged clotting time, mucosal ulceration,hematoma

40
Q

what is the clinical application of fondaparinux

A

prophylaxis and treatment of DVt and pulmonary embolism

41
Q

what are some contraindications of fondaparinux use

A

active major bleeding, severe renal impairment, bacterial endocarditis

42
Q

what is the clinical application of lepirudin

A

heparin induced thrombocytopenia

43
Q

what is the clinical application of desirudin

A

prophylaxis against DVT

44
Q

what is the clinical application of bivalirudin

A

anticoagulation in patients undergoing coronary angiography and angioplasty

45
Q

what are some contraindications to hirudin-related agents

A

active major bleeding, pregnancy, severe uncontrolled HTN, severe renal impairment

46
Q

what is the clinical application of argatroban

A

coronary artery thrombosis, prophylaxis in percutaneous coronary intervention, heparin-induced thrombocytopenia

47
Q

what are some adverse reactions seen with argatroban

A

cardiac arrets, cerebrovascular disease, ventricular tachycardia, sepsis, hypotension

48
Q

what are some contraindications or argatroban use

A

active major bleeding, severe liver impairment

49
Q

what is the clinical application of dabigatran

A

prevention of thromboembolism in non-valvular atrial fibrillation

50
Q

what are some adverse reactions seen with dabigatran

A

hemorrhage, severe hypertensive reaction

51
Q

what is the clinical application of r-APC

A

severe sepsis with organ dysfunction and high risk of death

52
Q

what is the major adverse reaction of r-APC

A

hemorrhage (increased risk of bleeding)

53
Q

what is the clinical application of streptokinase

A

ST elevation MI, life-threatening pulmonary embolism

54
Q

what is the clinical application of tenectaplase and reteplase

A

acute MI

55
Q

what is the clinical application of protamine

A

heparin overdose

56
Q

what are some adverse reactions seen with protamine

A

bradyarrythmia, hypotension, circulatory collapse, capillary leak

57
Q

how is protamine administered

A

IV

58
Q

what is the clinical application of aprotinin

A

reduce preoperative bleeding during CABG surgery

59
Q

what may aprotinin inhibit at higher doses

A

kallikrein

60
Q

what post operative condition may aprotinin increase the risk of in comparison to other anti-fibrinolytic agents

A

postoperative acute renal failure

61
Q

what is the clinical application of aminocaproic acid and tranexamic acid

A

disorder involving the fibrinolytic system; hemorrhage from increased fibrinolysis

62
Q

what are some adverse reactions seen with aminocaproic acid and tranexamic acid

A

bradyarrythmias, hypotension, thrombotic disodre, drug-induced myopathy

63
Q

what are some contraindications to aminocaproic acid and tranexamic acid use

A

DIC

LECOM pharmacology notecards (22 decks)

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