Coagulation Disorders Flashcards
In hemostasis, vasoconstriction are due to ____
- Nervous reflexes
- Local myogenic spasm
- Local autacoid factors - TXA2 and endothelin
In hemostasis, primary hemostasis is triggered by ___
exposure of subendothelial collagen
In hemostasis, what mediates platelet adhesion?
vWF by GpIb in the platelet surface
What are the essential factors in the intrinsic pathway?
Factors 5, 8, 9, 10, 11,12, prothrombin, fibrinogen
PTT = PiTT
What are the essential factors in the extrinsic pathway?
Factos 5, 7, 10, prothrombin, fibrinogen
PeT
Drug that is both an antiplatelt and anti-inflammatory
Aspirin
Dose of aspirin for antiplatelet use
<160mg
Dose of aspirin for antipyretic, analgesic
160 to 1200mg
Dose of aspirin as anti-inflammatory
> 1200mg
How many grams of aspirin is enough for antiplatelet activity to prevent TIA and MI
80mg
What is the triad of aspirin toxicity?
Samter Triad
[Diagnose]
Asthma
Aspirin sensitivity
Nasal polyp
Samter Triad; aspirin hypersensitivity
What is the expected acid-base abnormality in salicylate poisoning?
respiratory alkalosis with HAGMA
A pure acid-base disorder due to aspirin intoxication is seen in which population?
children
Adults present with mixed-base disorder
Drug that inhibits GPIIa/IIIa
- Abciximab
- Eptifibatide
- Tirofiban
What is the drug of choice used during PCI to prevent thrombosis since it prevent vessel restenosis, reinfarction, and death
Abciximab
Cite examples of antiplatelet drugs that inhibit ADP
- Clopidogrel
- Prasugel
- Ticagrelor
- Ticlodipine
This drug specifically inhibits ADP subtype P2Y
Ticagrelor
Antiplatelet drug and also a PDE III inhibitor causing vasodilation
- Cilostazol
2. Dipyridamole
Drug used to prevent thromboembolic complications of cardiac valve replacement; prosthetic heart valves
- Cilostazol
2. Dipyridamole
Drugs used to treat refractory intermittent claudication for patients with PAD
cilostazol
Antiplatelet that also inhibit adenosine uptake by endothelial cells and RBC leading to inhibition of platelet aggregation
- Cilostazol
2. Dipyridamole
Cite examples of indirect thrombin inhibitors
- Heparin
- Enoxaparin
- LMWH
- Warfarin
Cite examples of direct thrombin inhibitors
- Argatroban
- Bivalirudin
- Dabigatran
- Desirudin
- Lepirudin
[Heparin/Warfarin]
Large, acidic polysaccharide
Rapid onset
Heparin
[Heparin/Warfarin]
small, lipid-soluble molecule
Slow onset
Warfarin
What is the MOA of heparin?
Activates antithrombin III
What is the MOA of warfarin?
Inhibit Factors 9 10 7 2
Heparin is monitored via?
PTT
Remember: HTTP
Warfarin is monitored by?
PT
What is the antidote of heparin?
Protamine
What is the antidote for warfarin
Vitamin K, FFP
[Heparin/Warfarin]
Can be used during pregnancy
heparin
During angioplasty and stent placement, heparin and this drug is given concomittantly
GPIIb/IIIa inhibitors
___ is a heparinoid consisting of 80% heparing and 20% dermatan sulfate
Sulodexide
___ is an indirect thrombin inhibitor that binds and potentiates effect of antithrombin III on Factor Xa; has less effect on thrombin
Enoxaparin
Among the indirect thrombin inhibitor, this drug is given SC once a day
Fondaparinux
Cite examples of indirect thrombin inhibitor
- EnoXAparin
- Dalteparin
- Tinzaparin
- Danaparoid
- Fondaparinux
- Nadroparin
___ binds to thrombin’s active site and inhibits its enzymatic action
Lepirudin
Used to treat heparin-induced thrombocytopenia
Lepirudin
During percutaneous coronary angioplasty, lepirudin is paired with this drug
aspirin
What is the antidote for Dabigatran?
Idarucizumab
Examples of oral direct factor Xa inhibitor
- rivaroxaban
2. apixaban
Drugs used as anticoagulants after hip or knee surgery
Rivaroxaban
Apixaban
___ inhibits vitamin K epoxide reductase (for gamma carboxylation of the vitamin K-dependent clotting)
Warfarin
Dicumarol
Anisindione
Complication of warfarin treatment in patients with protein C and S deficiencies
warfarin-induced skin necrosis
Antidote of warfarin that is fast acting
FFP
what enzyme is needed to convert vitamin K to activated vitamin K?
epoxide reductase
Cite examples of Cyt P450 inducers
Ethanol Barbiturates Phenytoin Rifampicin Griseofulvin Carbamazepine St. Johns Wort Smoking
Cite examples of Cyt P450 inhibitors
Isoniazid Sulfonamides Cimetidine Ketoconazole Erythromycin Grapefruit juice Ritonavir Amiodarone Quinidine Valproic Acid
This thrombolytic agent forms a complex with endogenous plasminogen, thus catalyzing the conversion of plasminogen to plasmin
Streptokinase
what is the antidote of alteplase?
aminocaproic acid
tPA is selective for what ___-
fibrin-bound plasminogen
What are the contraindications to thrombolysis?
- History of CV hemorrhage
- Non-hemorrhagic stroke or other CV event within the past year
- > 180/110
- suspicion of aortic dissection
- active internal bleeding excluding sepsis
This antiplasmin drug is contraindicated in DIC
Tranexamic acid
Among the type of vitamin K, which should never be used as therapeutics
Vitamin K3 (menadione)
__ an ADH agonist that increases factor VIII activity in patients with hemiphilia A
desmopressin
Drug of choice for vWF disease
desmopressin
A serine protease inhbitor, antiplasmin drig that is used for post-op or intraop bleeding; has increased risk of renal failure
Aprotinin
this was removed from the market due to mortality
___ is a hormone used to treat intestinal and pancreatic fistula
somatostatin
