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Heme > Coagulation Theaputics > Flashcards

Coagulation Theaputics Flashcards

0
Q

Unfractionated heparin

A
  • MOA: combines to antithrombin III -> thrombin, Xa, IXa, XIa, and XIIa
  • indication: DVT’s, acute coronary syndrome, anticoagulant ion during heparin, maintaining catheter patency
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1
Q

Anticoagulants e.g.

  • Heparins (3)
  • factor Xa inhibitors (3)
  • direct thrombin inhibitors (3)
  • K antagonists (1)
A
  • Heparins (unfractionated/low mol. Weight)
    ~ LMWHs: endoxaparin, delteparin, tinzaparin
  • factor Xa inhibitors (fondaparinux, rivaroxaban, apixaban)
  • direct thrombin inhibitors (leporudin, desirudin, argatroban)
  • vitamin K antagonists (warfarin)
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2
Q

Low molecular weight heparin

A
  • Enoxaparin, dalteparin, tinzaparin
  • MOA: same as unfractionated
  • indications: allows for outpatient DVT Rx
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3
Q

UF heparin vs. LMW heparin

A
  • UF much wider range of PK/PD effects
  • LMW better for outpatient
  • both are parenteral only
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4
Q

Heparin Black Box Warning

A
  • Increased risk of spinal epidermal hematoma with neuraxial anesthesia
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5
Q

Parenteral Factor Xa inhibitor

A
  • Fondparinux
    ~ MOA: combines and activates ATIII -> selectively inhibits Xa
    ~ indication: DVT, PE
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6
Q

Oral direct Xa inhibitors

A
  • rivaroxaban, apixaban
    ~ MOA: binds factor Xa’s active site
    ~ prevention of stroke in Afib and DVT prophylaxis
  • Sx: acute renal failure
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7
Q

Direct thrombin inhibitors MOA and indication

A
  • MOA: bind active site of thrombin
  • parenteral indication: acute coronary syndrome, treatment of HIT (heparin induced thrombocytopenia)
  • oral indication: prevention of stroke in DVT
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8
Q

Direct thrombin inhibitor Sx

A
  • bleeding

- interaction with dabigatran

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9
Q

Warfarin

A
  • MOA: inhibits vitamin K (epoxied reductase)
    ~ inhibits factors in intrinsic path factor (typically about 24 hrs) and protein C at about 9 hours
  • indication: prevention of stroke in Afib, trt of DVT, PE
  • Sx: cat X, bleeding, purple toe syndrome, skin necrosis
  • warfarin paradox
  • Category X
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10
Q

Warfarin monitoring

A
  • PT pt/PT control = INR
  • target 2.5
  • OD: Vitamin K admin, FFP, factors
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11
Q

Thrombolytics (streptokinase, recombinant TPA, tenecteplase)

A
  • MOA: activates plasmin
    ~ streptokinase: converts plasminogen
    ~ TPA et al: fibrin in fresh clot -> conformational change
  • indication:
    ~ ischemic stroke (TPA)
    ~ ST-elevation MI (MI)
    ~ PE (TPA, streptokinase)
  • Cind: bleeding risk, STK - previous exposure (anapalaxis)
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12
Q

Anti platelet agents classes

A
  • cox inhibitors (aspirins)
  • adp inhibitors (theinopyradines, ticargrelor)
  • GPIIa/IIIb inhibitors (eptifibatide, abciximab, tirofiban)
  • phosphodiesterase inhibitor (dipyridamole)
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13
Q

Cox inhibor: aspirin MOA and Cind

A
  • decrease TXA-2, decreases PLT granule release and aggregation
  • contraindication: ASA allergy, Reyes (encephalitis in kids with viral illness)
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14
Q

ticlopidine, clopedigrel, prasugrel (theinopyradines)

Ticargrelor

A
  • ADP inhibitors
  • MOA: prodrugs; inhibition of ADP P2Y12 -> agg inhibition
    ~ thienos: irreversible
    ~ ticargrelor: reversible and higher binding affinity
  • Cind:
    ~ prasugrel: 75+ y/o
    ~ ticargrelor: use of > 100g ASA, 3A4 inhibition
  • Sx:
    ~ ticlopidine: hemeotoxic not used
    ~ bleeding: clopedigrel lowest risk
    ~
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15
Q

GPIIb/IIIb inhibitors

A
  • MOA: blocks cross linking of platelets via fibrinogen
  • e.g. Eptifibatide, abciximab (percutanous only), tirofiban
  • indication: acute coronary syndrome
  • Cind: history if stroke, tcytopenia
  • Sx: bleeding, tcytopenia (more common with abciximab)
16
Q

dipyridamole

A
  • MOA: phosphodiesterase inhibitor
    ~ decreases (weakest of all the classes) aggregation and
    vasodilates
  • indication: stroke prevention (w/ aspirin)
  • Sx: bleeding, coronary steal, HA
17
Q

Clotting facilitators

A 
- vitamin K (oral or IV) 2-6 hr onset
    ~ req bile salts for absorption 
- factors: 7,8 and 9
- desmopressin acetate
- prothrombin complex concentrate 
- cryoprecipitate (contains fibrinogen)
18
Q

Fibrinolytic inhibitors

A
  • lysine analogues: aminocaproic acid (amicar), transexamic acid
  • MOA: bind and inhibit plasmin and plasminogen
  • indications:
    ~ transexamic: menorrahgia
    ~ aminocaproic: prevention of rebleeding after surgery
19
Q

P2Y12

A
  • target for clopedigrel, ticlopidine, prasurgel
  • irreversible
  • ticargrelor: reversible
20
Q

Trt of heparin induces thrombocytopenia

A
  • direct thrombin inhibitors

- leporudin, desirudin, argatroban

21
Q

Heparin antidote

A

Protamine sulfate

22
Q

Depotentiators of warfarin

A 
C- cholestyramine 
R- rifampin 
A- anti-seizure meds
K- K vitamin
D- diuretics

Heme (7 decks)

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