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Medicine Year 1 - Semester 2 - Part 1 > Drugs affecting haemostasis and thrombosis > Flashcards

Drugs affecting haemostasis and thrombosis Flashcards

1
Q

To list the drugs used to modify blood coagulation

A

Tranexamic Acid
Warfarin
DOACs
Heparin

Aspirin
Clopidogrel

Thrombolytic drugs

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2
Q

Function of drugs used to modify blood coagulation

A

Drugs that :

  • Help clot the blood
  • Prevent/slow the clotting of blood
  • Modify platelet function
  • Help clot removal
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3
Q

Where are platelets derived from ?

A

Megakaryocytes in marrow

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4
Q

Fresh frozen plasma

A

Contains coagulation factors in normal proportions
Dose 15ml/kg

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5
Q

Cryoprecipitate

A

Pools of 5 donations using precipitate at 4C - concentrated fibrinogen, von willebrand factor and VIII

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6
Q

Specific coagulation factors

A

IX
VIII (donor derived or recombinant)
Fibrinogen

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7
Q

What is tranexamic acid ?

A

Anti-fibrinolytic drug (inhibits the process that dissolves clots)

Taken orally/IV

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8
Q

Describe the method of action of tranexamic acid

A

Inhibits the activation of plasminogen to plasmin

Used in trauma/GI bleeding/ post-op or delivery

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9
Q

Tranexamic acid

When is it effective ?

A

Effective if given within 3-4 hours

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10
Q

Method of action of warfarin

A

Inhibits the production of vitamin K in its reduced form.

Effect measured by prothrombin time - venous/capillary sample

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11
Q

Positive aspects of warfarin

A

Established for decades
Cheap
Easily measurable effects

Can be reversed with Vitamin K or factor concentrate

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12
Q

Negative aspects of warfarin

A

Lots of drug and food interactions to enhance or inhibit effect.

Slow onset- several days

Unpredictable dose needed

Needs regular blood testing

Risk of bleeding

Narrow therapeutic window

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13
Q

State the drugs that increase the effect of warfarin

A

Amoxycillin
Erythromycin, Statins
Aspirin, Clopidogrel, NSAID’s

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14
Q

Amoxycillin

A

(increase the effect of warfarin)
Reduces gut Vitamin K

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15
Q

Erythromycin, Statins, Acute Alcohol intake

A

(increase the effect of warfarin)
Enzyme Inhibition

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16
Q

Aspirin, Clopidogrel, NSAID’s

A

(increase the effect of warfarin)
Platelet function and GI mucosal damage

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17
Q

State the drugs that decrease the effect of warfarin

A

Rifampicin, Carbamazepine, Phenytoin, Chronic Alcohol intake

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18
Q

Rifampicin, Carbamazepine, Phenytoin, Chronic Alcohol intake

A

(decrease the effect of warfarin)
Enzyme induction

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19
Q

DOACs

A

Direct Oral AntiCoagulants

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20
Q

What are DOACs ?

A

Xa inhibitors
Direct thrombin inhibitors

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21
Q

Name some DOACs

Xa inhibitors

A

(Xa inhibitors)

Apixaban
Rivaroxaban
Edoxaban

22
Q

Name some DOAC’s

Direct thrombin inhibitors

A

Dabigatran

23
Q

State some points that favour warfarin

A

Established drug
Cheap- but needs monitoring
Can be reversed
Effect can be easily measured

Can be used with poor renal function

24
Q

State some points that favour DOACs

A

No monitoring needed (except renal function)

Lower bleeding risk
As effective for stroke prevention

Reversible agents recently available (but expensive)

Short half life

25
Q

State some key uses of oral anticoagulants

A
  • Treatment of DVT and PE: short/long term depending on whether recurrent and/or provoked
  • Arterial fibrillation to reduce stroke risk
26
Q

State a use for warfarin ONLY

A

Prosthetic heart valve replacement (warfarin only)

27
Q

State a use for DOACs ONLY

A

Prevention of DVT after planned hip and knee surgery

28
Q

Stroke risk reduction in atrial fibrillation

Things to be aware of

A

Absolute and Relative risk reduction

Balance of risks and benefits

Risk score for thrombosis

29
Q

State the stroke risk scoring system in AF

A

CHA2DS2 - VASc

30
Q

CHA2DS2 - VASc

A

C - Congestive heart failure
H - Hypertension
A - Age >=75
D - Diabetes Mellitus
S - Prior stroke / thromboembolism

V - Vascular disease
A - Age 65-74
Sc - Sex category

31
Q

What is the ORBIT score ?

A

For bleeding risk

32
Q

When is the ORBIT scoring system used ?

A

Age >75
Renal Impairment
Co-prescription of anti-platelet drugs
Anaemia
Bleeding history

33
Q

Mechanism of action of heparin

A

Binds to and activates anti-thrombin so reducing Xa and thrombin generation

34
Q

Where is heparin found ?

A

Can be extracted from lung and liver

35
Q

How is heparin given ?

A

IV infusion - immediate effects and wears off quickly

(un-fractioned half life <1 hour)
(LMW : half life approx 12hours )

36
Q

How is heparin monitored ?

A

APPT plasma testing and dose adjusted
(IV heparin)

37
Q

State a low molecular weight heparin

A

Dalteparin

38
Q

Dalteparin

A

Used as a fixed dose for prophylaxis

No routine monitoring unless poor renal function, extreme body weight or pregnancy

Treatment and prevention of DVT/PE

39
Q

What gives a measure of anti-coagulation ?

A

Anti-Xa levels

40
Q

State some adverse side effects of heparin

A

Pain at site of injection
Increased bleeding risk

Osteoporosis with prolonged use

Heparin induced thrombocytopenia - antibody mediated 5-10 days into treatment

41
Q

State the drugs to modify platelet function

A

Aspirin
Clopidogrel

42
Q

Mechanism of action of aspirin

A

Causes irreversible inhibition of COX-1 so less thromboxane A2 production

Less platelet aggregation

43
Q

Side effects of aspirin

A

Increases GI bleeding risk
Dyspepsia

Some effect in stroke prevention in AF

44
Q

Uses of aspirin

A

Typically used after transient ischaemic heart attack or MI

45
Q

Mechanism of action of clopidogrel

A

Inhibit ADP induced platelet aggregation

Used with aspirin to prevent recurrent myocardial infarction

46
Q

Uses of clopidogrel

A

Used in ischaemic stroke and TIAs

47
Q

Side effects of clopidogrel

A

Increased risk of :

  • Dyspepsia
  • GI bleeding
48
Q

Duration of action of aspirin and clopidogrel

A

NO reversal agents, so effect will last the duration of platelet lifespan. (5-10 days )

49
Q

What are thrombolytic drugs ?

A

Drugs to increase the activation of plasminogen to plasmin

Tissue plasminogen activators

Cause breakdown of fibrin and fibrinogen

50
Q

Side effects of thrombolytic drugs

A

Increased bleeding risk in hours after dose

51
Q

Alternative treatment to thrombolytic drugs

A

Stenting and Clot removal

Medicine Year 1 - Semester 2 - Part 1 (51 decks)

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