Coagulation Disorders Flashcards
Platelet activator and powerful vasoconstrictor
Thromboxane A2
Potent endothelium derived vasoconstrictor
Endothelin
Platelet adhesion is mediated by
vWF
What receptor is responsible for platelet adhesion?
gp1b
What receptor is responsible for platelet aggregation ?
gp2b3a
Proaggregation factors:
TXA2
Serotonin
ADP
Anti aggregation factors
PGI2- prostacyclin
cAMP
PGE1
Problems with gp1b receptor leads to this disease
Bernard-Soulier
Problems with gp2b3a receptor leads to this disease
Glansman disease
Factors in intrinsic pathway
5,8,9,10,11,12
Prothrombin
Fibrinogen
Factors in extrinsic pathway
5,7,10 prothrombin, fibrinogen
Nonselective, irreversible COX inhibitor that reduces TXA2
Aspirin
Salsalate
Na salicylate
Associated with Reye syndrome
Aspirin
Toxic dose of aspirin
150mg/kg
Lethal dose of aspirin
500mg/kg
Triad of asprin hypersensitivity
Samter Triad
Asthma
Aspirin sensitivity
Nasal polyps
What is the expected acid base abnormality in salicylate poisoning?
Respiratory alkalosis with HAGMA
gp2b3a inhibitor used during PCI to prevent thrombosis and adjunct to thrombolysis and ACS
Abciximab
Eptifibatide
Tirofiban
Thienopyridine, ADP inhibitor that reduces platelet aggregation
Clopidogrel
Ticlopidine
Prasugrel
PDE3 inhibitor that increases cAMP in platelets and blood vessels and causes vasodilation
Cilostazol
Dipyridamole
Antiplatelet drug used for prevention of thromboembolic complications of caridac valve replacement, intermittent claudication
Cilostazol
Dipyridamole
Contraindicated in heart failure
Cilistazol
Heparin or Warfarin?
Site of action- liver
Warfarin
Heparin or Warfarin?
Activates antithrombin III
Heparin
Heparin or Warfarin?
Monitored by PT INR
Warfarin
Heparin or Warfarin?
Monitored by PTT
Heparin
Heparin or Warfarin?
Can be used in pregnancy
Heparin
Heparin or Warfarin?
Slow onset (days)
Warfarin
Antidote for heparin
Protamine sulfate
Antidote for warfarin
Vitamin K
Anticoagulant thay can cause osteoporosis with prolonged use
Heparin
Indirect thrombin inhibitor that binds antithrombin III on factor 10a
Does not require monitoring
Enoxaparin Danaparoid Fondaparinux Dalteparin Tinzaparin
Direct thrombin inhibitor that inhibits its enzymatic action used in heparin induced thrombocytopenia
Lepirudin
Dabigatran
Argatroban
Direct thrombin inhibitors should be monitored with
PTT
Oral direct factor 10a inhibitor used in prevention of venous thromboembolism and prevention of stroke in patients with AF
Rivaroxiban
Apixaban
Rapid onset and shorter half life than warfarin
No monitoring required
Used especially after hip or knee surgery
Rivaroxiban
Apixaban
Side effect of warfarin
Warfarin induced skin necrosis
Protein C and S deficiency
Teratogen
How to avoid skin necrosis in warfarin?
Anticoagulant overlap with heparin
Cytochrome P450 inducers
Ethel Booba takes Phen Phen and Refuses Greasy Carb Shakes
Ethanol Barbiturates Phenytoin Rifampicin Griseofulvin Carbamazepine Smoking/ St. John's Wort
Cytochrome P450 inhibitors
Inhibitors Stop Cyber Kids from Eating GRApefruit Q
Isoniazid Sulfonamides Cimetidine Ketoconazole Erythromycin Grapefruit juice Ritonavir Amiodarone Quinidine
Thrombolytic (tissue plasminogen activator analog) that converts plasminogen to plasmin
Alteplase Anistreplase Streptokinase Reteplase Tenecteplase Urokinase
Antidote for streptokinase
Aminocaproic acid
Contraindications to thrombolysis
Cerebral hemorrhage at any time Cerebrovascular event within the past year Marked HTN suspicious aortic dissection Active internal bleeding
Competitively inhibits plasminogen activation by inhibiting tPA
Tranexamic acid
Prothrombotic contraindicated in DIC
Tranexamic acid
ADH agonist that increases factor 8 activity on patients with mild hemophilia A or vWF
Desmopressin
Where does desmopressin act?
Vasopressin V2 receptor
