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Eva's PHARM TEST 4 > Coagulation > Flashcards

Coagulation Flashcards

1
Q

Treatment of thromboembolism:

1.) Anticoagulant- Parenteral
2.) Anticoagulant- Oral
3.) Anti-platelets
4.) Thrombolytics (name 3 drugs)

Name drugs in each class and what we need to know them

A
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2
Q

Oh no you’re bleeding! Who’s more at risk?

Name some anti-fibrinolytic or hemostatic drugs

A

Higher risk for elderly women/ pt w renal failure - heparin bleed

Aminocaproic Acid
Tranexamic Acid (TXA)

Vitamin K, Plasma fractions
(Factor replenishers)

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3
Q

Plasminogen to Plasmin Pathway

A
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4
Q

Rivaroxaban

A

Factor 10 inhibitor

Anti-coagulant- clot prevention for DVT

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5
Q

Apixaban

A

Factor 10 Inhibitor

Anti-coagulant- clot prevention for DVT

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6
Q

Warfarin :)

A

Direct thrombin Inhibitor, target thrombin and DVT

Blocks vitamin K reductase and blocks carboxylation of glutamate residues. Reduce factor

OD/Bleed? Vitamin K, Replenish factors 2, 7, 9, 10, FFP

TOXIC:
-Birth defects, hemorrhagic disorder in fetus, cutaneous necrosis

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7
Q

Indirect Thrombin Inhibitors
What do they target, MOA?
Drugs?

A

-Unfractionated Heparin (^risk HITT)
-LMW Heparin

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8
Q

Dalteparin (Fragmin)

A

LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor

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9
Q

Enoxaparin (Lovenox)

A

LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor

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10
Q

Tinzaparin (Innohep)

A

LMW Heparin (Target venous thrombus)
More specific for factor 10
Indirect Thrombin Inhibitor

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11
Q

Fondaparinux (Arixtra)

A

Heparin

But not selective for Factor 10, no antibody response

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12
Q

What do these check for? Normal values?

INR
PT
aPTT

A

INR: Time it takes to clot compared to control (Warfarin goal 2-3, normal 0.8-1.2)

PT: Time to clot. (checking extrinsic pathway so factor 7,10, thrombin)

aPTT: activated partial thromboplastin time (checking intrinsic pathway)

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13
Q

Protamine Sulfate

A

Reversal for heparin

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14
Q

Argatroban
(Not on study guide)

A

Direct Thrombin Inhibitor
*Active thrombin Site

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15
Q

Melagatran

A

Direct Thrombin Inhibitor
*Active thrombin Site

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16
Q

Dabigatran (Pradaxa)

A

Direct Thrombin Inhibitor
*Active thrombin Site

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17
Q

Hirudin (Lepriudin)**

A

Direct Thrombin Inhibitor
*Bind to both active & substrate recognition sites of thrombin

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18
Q

Bivalirudin (Angiomax)
(not on study guide)

A

Direct Thrombin Inhibitor
*Bind to both active & substrate recognition sites of thrombin

19
Q

Streptokinase

A

Fibrinolytic (Clot bustahhh)
-Catalyze formation of plasmin
-Synthesized by streptococci

20
Q

t-PA (Altepase)

A

Fibrinolytic (Clot bustahh)

-**Preferentially activates plasminogen that is BOUND to fibrin/ confined fibrinolysis of formed thrombus

-NOT systemic activation

21
Q

Urokinase

A

Fibrinolytic, clot bustah, (# TEAM BLEED)
-Catalyze formation of plasmin
-Synthesized by kidney
-Lyses thrombus from within

22
Q

Clopidogrel*

Adverse effects?

A

Anti-platelet/ “Plavic”
-Irreversibly inhibits adenosine diphosphate receptor on platelet

Adverse:
N/D/ dyspepsia (indigestion)
Hemorrhage, leukopenia

23
Q

Ticlopidine (Ticlid)*

Adverse Effects??

A

Anti-platelet/
-Irreversibly inhibits adenosine diphosphate receptor on platelet

Adverse:
N/D/ dyspepsia (indigestion)
Hemorrhage, leukopenia

24
Q

Abciximab

A

*Monoclonal Antibody
Anti-Platelet
GPII A Receptor Blocker
GPII B Receptor Blocker

25
Q

Dipyridamole (Persantine)

A

Anti-platelet
*Inhibits cGMP phosphodiesterase activtiy
*Inhibits adenosine reuptake

26
Q

Abciximab

A

*Monoclonal Antibody
Anti-Platelet
GPII A Receptor Blocker
GPII B Receptor Blocker

27
Q

Aspirin

A

Anti-platelet
*Prevents arterial thrombus
*Decrease platelet aggregation

28
Q

Heparin Induced Thrombocytopenia (HIT)

A

Heparin induced thrombocytopenia
Body -> antibodies to heparin and platelet

only happens to some patients but ^ risk with unfractionated

29
Q

What do Protease Inhibitors do?

A

Prevent clot from forming

30
Q

Disseminated Coagulation (DIC)
MOA? Causes/ Treatments?

A

**Overstimulation of blood clotting mechanism Use up all of your clotting factors = clots and spontaneous bleeding :(

31
Q

Aminocaproic Acid

A

*Anti-Fibrinolytic Inihibitor (#team clot)
Competitively inhibits plasminogen activation

32
Q

Tranexamic Acid (TXA)

A

*Anti-Fibrinolytic Inihibitor (#team clot)

33
Q

DVT
Causes? White vs Red thrombus

A

DVT: Endothelial injury, stasis, hyper coagulability

Red thrombus: Low pressure vein/ PE
White thrombus: High pressure artery/downstream ischemia

34
Q

Process of thrombogenesis

Platelet phases?
Roles of the various mediators:
(PGI2, collagen vWF, ADP, TXA2, 5-HT)

A

Injury -> serotonin-> vasoconstriction
Injury -> collagen/vWF-> cascade

Platelet phases:
1.) Adhesion
2.) Aggregation
3.) Secretion of pro-coag proteins
4.) Cross-link of adjacent plt

35
Q
  1. Draw the coagulation cascade including the intrinsic, extrinsic, and common pathways.
A

Damage to endothelium -> Collagen/vWF/elastin (intrinsic)

Damage to tissue -> Tissue factor (Extrinsic)

36
Q

Desmopressin Acetate**

A

Increases Factor 8 activity
**TEAM CLOT!

37
Q

Coagulation Modifier Drugs. What do they each do?

1.) Anti-coagulant
2.) Anti-platelet drugs
3.) Thrombolytic Drugs
4.) Hemostatic/ Antif-ibrinolytics

A
38
Q

Anti-thrombin

A

A Protease inhibitor
-Rapidly inactivates the coagulation proteins

39
Q
A

A Protease inhibitor
-Rapidly inactivates the coagulation proteins

40
Q

Thrombotic Thrombocytopenic Purpupura (TTP)**

A

-ADAMST13: gene provides instructions for making an enzyme that is involved in regulating blood clotting

-Disorder that causes Microvascular clots to form in small blood vessels throughout body
-FFP

41
Q

Warfarin Pharmacokinetics
% Oral availability?
Half life?
Time of Delay?

A

100% Oral Bio
36 hours half life (LONG)
8-12 hours delay of action– can give hep

42
Q

Vitamin K
“Koagulation Vitamin”

Works on what factors?

A

Factor 7, 9, 10
Prothrombin

Discovered in Denmark, necessary for efficient blood coagulation

43
Q

When would you give plasma fractions?

A

Hemophilia (disorder where body cant clot properly)
AT III Deficiency
any deficiencies in plasma coagulation factors

Eva's PHARM TEST 4 (4 decks)

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