cvs - anti-clotting drugs

Question 1

name 4 antiplatelet drugs

Answer 1

1. NSAIDs
2. platelet GPIIB/IIA receptor blockers
3. ADP receptor blockers
4. PDE inhibitors

Question 2

moa of aspirin

Answer 2

inhibit COX-1 → reduce thromboxane A2 and inhibit platelet aggregation

Question 3

clinical uses of aspirin

Answer 3

• prophylaxis for transient cerebral ischemia
• reduce incidence of recurrent MI
• decrease mortality post-MI

Question 4

adverse effects of aspirin

Answer 4

• bleeding
• gastric upset and ulcers (due to reduced PGE2)
• reye’s syndrome

Question 5

name 3 platelet GP IIB/IIA receptor blockers

Answer 5

1. abciximab
2. eptifibatide
3. tirofiban

Question 6

moa of platelet GP IIB/IIA receptor blockers

Answer 6

prevent fibrinogen binding and inhibit platelet aggregation

Question 7

clinical uses of platelet GP IIB/IIA receptor blockers

Answer 7

• prevent stenosis after coronary angioplasty
• acute coronary syndromes

Question 8

adverse effects of platelet GP IIB/IIA receptor blockers

Answer 8

• thrombocytopenia
• bleeding

Question 9

name 2 ADP receptor blockers

Answer 9

1. clopidogrel
2. ticlopidine

Question 10

moa of ADP receptor blockers

Answer 10

irreversibly block ADP receptors on platelets, inhibiting activation

Question 11

name 1 PDE inhibitor

Answer 11

dipyridamole

Question 12

moa of PDE inhibitor

Answer 12

inhibit PDE → prevent breakdown of cAMP to 5’-AMP → increased cAMP → inhibit platelet aggregation

Question 13

name 4 anticoagulants

Answer 13

1. heparin derivatives
2. coumarin derivatives
3. lepirudin/hirudin
4. antithrombin III

Question 14

moa of heparin

Answer 14

1. bind to AT III and IIa → allows AT III to get close to IIa to deactivate it
2. once heparin binds to AT III, it can deactivate Xa wo binding to it
3. LMWH increases action of AT III on factor Xa (but not on thrombin)

Question 15

clinical use of heparin

Answer 15

• dvt
• pulm embolism
• acute MI
• anticoagulant for pregnancy

Question 16

how should heparin be administered

Answer 16

IV/SC

Question 17

why can’t heparin be given IM

Answer 17

haematomas

Question 18

adverse effects of heparin

Answer 18

• haemorrhage
• thrombocytopenia
• osteoporosis w LT use

Question 19

how to treat haemorrhage due to heparin use

Answer 19

stop heparin + start protamine sulfate (binds to excess heparin)

Question 20

moa of warfarin

Answer 20

vit k reductase inhibitor → inhibit vit K-dep clotting factors (II, VII, IX, X)

Question 21

clinical uses of warfarin

Answer 21

• dvt
• pulm embolism
• acute MI

Question 22

adverse effects of warfarin

Answer 22

• bleeding
• DDI (CYP450)

Question 23

contraindications for warfarin

Answer 23

pregnancy (causes haemorrhagic disorders in foetus, foetal proteins w gamma-carboxyglutamate residues affected)

Question 24

moa of lepirudin

Answer 24

directly inhibits thrombin

Question 25

moa of antithrombin III

Answer 25

enhance inactivation of thrombin and other coagulation enzymes

Question 26

name 4 thrombolytics

Answer 26

1. t-PA
2. urokinase
3. streptokinase
4. anistreplase

Question 27

moa of thrombolytics

Answer 27

directly converts plasminogen to plasmin → clot breakdown

Question 28

clinical uses of thrombolytics

Answer 28

• emergency treatment of coronary artery thrombosis
• peripheral arterial thrombosis and emboli
• ischaemic stroke

Question 29

adverse effect of thrombolytics

Answer 29

bleeding

Question 30

contraindications for thrombolytics

Answer 30

• recent surgery
• bleeding disorders
• severe uncontrolled hypertension
• pregnancy

Question 31

moa of t-PA

Answer 31

binds to fibrin in a thrombus and converts plasminogen to plasmin → clot breakdown

Question 32

clinical use of t-PA

Answer 32

dissolve blood clots in MI/stroke

Question 33

clinical use of urokinase

Answer 33

• severe dvt
• pulm embolism