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Dental Pharmacology Exam 4 > Clotting > Flashcards

Clotting Flashcards

1
Q

Extrinsic system of clotting

A

TF > VII > VIIa > X > Xa > V Ca++ platelets > Prothrombin to Thrombin > Fibrinogen to Fibrin = clot

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2
Q

Intrinsic System of Clotting

A

Tissue Contact > XII > XIIa > XI > XIa > IX > IXa > X (VII) > Xa&raquo_space; platelets/thrombin (IIa)/ Fibrin - clot

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3
Q

Where does Antithrombin III work?

A

Activated by heparin
Blocks XIIa, IXa, and Xa.
Allows TPA to convert plasminogen to plasmin = clot destruction

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4
Q

White thrombus formation and pathology

A
  1. Forms in high-pressure arteries, result of platelet binding to damaged endothelium and aggregation w/ little involvement of fibrin
  2. local ischemia due to arterial occlusion
    * in coronary arteries: Myocardial infarction/angina pectoris
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5
Q

Red thrombus formation and pathology

A
  1. Forms in low-pressure veins and in the heart; result of platelet binding and aggregation followed by formation of bulky fibrin tails in which red blood cells become enmeshed
  2. Emboli and distal pathology - DVT = pulmonary emboli; cardiogenic emboli = embolic stroke
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6
Q

Anticoagulants vs Antithrombics vs Thrombolytics

A

Anticoag: regulate fxn and synth of clotting factors
Antithrombic/antiplatelets: inhibit platelet fxn
Thrombolytics/fibrinolytics: destroy blood clot after it forms

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7
Q

When are anti-coags used?

A

primarily used to prevent clots from forming in the venous system and heart (red thrombi)

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8
Q

When are antithrombotics and antiplatelets used?

A

primarily used to prevent clots from forming in the arteries (white)
*Heart attacks/acute MI, arterial thrombosis of limbs, thrombotic/ischemic stroke, PCIs

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9
Q

When are thrombolytics/fibrinolytics used?

A

Re-estabilsh blood flow through vessel once clot has been formed

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10
Q

2 types of anticoagulants

A
  1. Parenteral

2. Oral

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11
Q

What 2 drugs are parenteral anti-coags?

A
  1. Heparins

2. Parenteral Direct Thrombin Inhibitors (DTIs)

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12
Q

How do heparins work

A

Indirectly inhibit thrombin via anti-thrombin III

Molecular weight determines activity: low = enoxaparin

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13
Q

How do DTIs work?

A

Peptide analogs of hirudin-purified from medicinal leeches.

Directly inhibit thrombin

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14
Q

What are the oral anti-coagulants?

A
  1. Warfarin
  2. Oral nonpeptide DTI : Dabigatran
  3. Factor Xa inhibitor : Rivaroxaban, Apixaban
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15
Q

Common uses of heparins?

A

Prevention of emboli during surgery or in hospitalized patients

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16
Q

SE of heparins

A

bleeding

Heparin-induced thrombocytopenia: immune response resulting in increased clotting

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17
Q

How does warfarin work?

A

Prevents vitamin K re-activation by inhibiting Vit K epoxide reductate
(Preventing Factors VII, IX, X)

18
Q

SE and antidote to warfarin

A

SE: bleeding

tx: vit k
* many drug interactions

19
Q

Common uses of warfarin?

A

Outpatient tx of DVT, cardiac conditions that generate emboli

20
Q

What reduces warfarin metabolism and what does it do?

A

Genetic variation of CYP2C9 reduces metabolism, increased bleeding risk

21
Q

What reduces warfarin sensitivity and what does it do?

A

variation of VKORC1 subunit reduces warfarin sensitivity = increased risk

22
Q

How does Dabigatran etixilate work compared to warfarin?

A

Less bleeding risk

23
Q

How do rivaroxaban and apixaban work compared to warfarin?

A

Reduced bleeding risk

24
Q

t-PA drugs (2) and how they work?

A
  1. Alteplase : recombinant human t-PA

2. Urokinase: recombinant form of a non t-PA human protease

25
Q

Clinical uses of fibrinolytic drugs and which drugs can be used

A
  1. Embolic/thrombotic stroke = alteplase
  2. Acute MI = urokinase
  3. Pulmonary emboli
26
Q

What is the leading cause of adult disability?

A

Stroke

27
Q

Embolic Stroke vs Thrombotic Stroke

A

Embolic emboli from red thrombi (cardiogenic)

Thrombotic results from white thrombus (atherosclerosis)

28
Q

How to treat Stroke?

A

tPA
Alteplase - w/in 3 hours
*can worsen damage produced by hemorrhagic stroke

29
Q

What do anti-thrombotics target?

A
  1. Thrombaxane A2: promos aggregation and vasoconstriction
  2. ADP: released from plateltes, binds purinergic receptors on other platelets, causes aggregation
  3. Thrombin: increases fibrin production, activated PAR-1 to promote platelet activation
30
Q

What drug is PAR1 Antagonist?

A

Vorapaxar

31
Q

What drugs are ADP receptor blockers?

A
  1. Clopidogrel

2. Prasugrel

32
Q

How does aspirin work?

A

Irreversible COX1 inhibitor, decreased TXA2 production

33
Q

What is aspirin used for?

A
  1. Analgesia - 325mg
  2. NSAID - 325mg
  3. Antipyretic - 325mg
  4. Antiplatelet - 81mg
34
Q

What do we need to know about Clopidogrel?

A
  1. Prodrug (metabolized by CYP2C19)
  2. Polymorphisms = reduced metabolism = poor activators
  3. Many Drug interactions
35
Q

What do we need to know about prasugrel (effient)

A
  1. Prodrug, metabolized by different enzymes than clopidogrel
  2. Consistent effects
36
Q

PAR1 drug, and facts

A

Vorapaxar = PAR1 Antagonist (oral)
Long halflife + no antidote
Contraindicated for pt w/ history of stroke

37
Q

How to platelet receptor antagonists work and how are they administered?

A

antagonize receptors on platlet cell membranes to prevent interaction of platelets w/ fibrinogen and prevent aggregation
- admin parenterally (effective) for Percutanous Coronary Interventions (PCIs - aka angioplasty) to prevent reocclussion

38
Q

What drugs are platelet receptor antags and what to they antagonize?

A

Abciximab : anti-GPIIb/IIIa antibody

Tirofiban: GPIIbIIIa Antagonist

39
Q

What are anti-platelet drugs primarily used for?

A

Prevent coronary occlussion/reocclussion due to clot formation
-protect against heart attack, protect against thrombotic stroke

40
Q

Cox 1 vs selective Cox 2 inhibitors and CHD?

A

COX1 = platelet activation, promotes clotting, vasoconstriction
-inhibited by aspirin (reduced risk for CHD)

COX2: platelet inactivation, limits clotting, vasodilation
-inhibited by rofecoxib - promos platelet activation, increased risk for CHD

41
Q

Anticoag antidotes

A

Vit K = warfarin

Protamine Sulfate = heparins

Dental Pharmacology Exam 4 (5 decks)

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