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Pharmacology > Drugs for Coagulation Disorders > Flashcards

Drugs for Coagulation Disorders Flashcards

1
Q

Coagulation factors

A

Intrinsic pathway (PTT): V, VIII, IX, X, XI, XII, Prothrombin, Fibrinogen -> PiTT

Extrinsic pathway (PT): V, VII, X, Fibrinogen -> PeT

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2
Q

Mechanism of hemostasis

A
  1. Vasoconstriciton
  2. Formation of platelet plug
  3. Formation of clot via coagulation
  4. Fibrous organization
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3
Q

Most common cause of acute MI, ischemic stroke and limb gangrene

A

Arterial thrombosis

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4
Q

Nonselective, irreversible COX1 and COX2 inhibitor used for prevention of arterial thrombosis and inflamm disorders

AE: Reye syndrome (nausea and vomiting, irritability, confusion, convulsions, LOC), HAGMA

A

Aspirin

SimD: Salsalate, sodium salicylate

Toxic dose: 150mg/kg
Lethal dose: 500mg/kg

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5
Q

Triad of Aspirin hypersensitivity

A

Asthma, Aspirin sensitivity, Nasal polyps

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6
Q

Acid-base abnormality in salicylate poisoning

A

Adults: Respi alkalosis with HAGMA
Children: HAGMA only

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7
Q

Inhibitors vs. Uncouplers

A

Inhibitors: halt ETC
Uncouplers: dissipate proton gradient, not halt ETC

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8
Q

GPIIB/IIIA inhibitor used to prevent thrombosis, ACS (UA and NSTEMI), also prevents restenosis, reinfarction and death

AE: bleeding, thrombocytopenia

A

Abciximab

SimD: Eptifibatide, Tirofiban

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9
Q

Irreversible ADP inhibitor used to prevent and treat arterial thrombosis (stroke, TIA, UA), prevents restenosis and ACS

A

Clopidogrel

SimD: Ticlodipine, Prasugel

additive effects with aspirin

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10
Q

Phosphodiesterase III inhibitor (antiplatelet) and vasodilator used to prevent thromboembolic complications of cardiac valve replacement, intermittent claudication and ischemic stroke

AE: Headache, palpitations

A

Dypridamole

SimD: Cilostazol - contraindicated in HF

has LITTLE or NO BENEFIT

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11
Q

Heparin vs. Warfarin

A

Heparin: parenteral, affects intrinsic pathway (PTT), activates antithrombin III, site: blood, rapid onset
Hi PRad PiTT! (Heparin, PRotamine sulfate, intrinsic, PTT)

Warfari: oral, affects extrinsic pathway, affects factors 1972 (Vit. K dep factors), site: liver, slow onset
What PeT? (Warfarin, extrinsic, PT)

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12
Q

Anticoagulant (indirect thrombin inhibitor) used in DVT, UA, MI and DOC for anticoagulation during PREGNANCY

A

Heparin

Antidote: Protamine sulfate

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13
Q

Anticoagulant (indirect thrombin inhibitor) used in DVT, UA, MI, AF and PCI
PTT monitoring NOT required
Protamine sulfate only partially effective

A

Enoxaparin

SimD: dalteparin, tinzaparin, danaparoid, FONDAPARINUX

LESS RISK OF THROMBOCYTOPENIA

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14
Q

Anticoagulant (direct thrombin inhibitor) used in patients with heparin-induced thrombocytopenia (HIT) and PCA
PTT monitoring needed

A

Lepirudin

SimD: Desirudin, bivalirudin, argatroban

CAUTION USE FOR PXS WITH RENAL INSUFFICIENCY
NO reversal agent

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15
Q

Anticoagulant (indirect thrombin inhibitor) used in chronic anticoagulation, DVT, AF, valve replacement, EXCEPT in PREGNANCY

AE: WARFARIN-INDUCED SKIN NECROSIS (Prot C and S deficiency), TERATOGEN!
PT monitoring needed

A

Warfarin

SimD: Dicumarol

Antidote: Vit. K (slow) or FFP (fast)
NARROW therapeutic window
present in MOST RAT POISONS

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16
Q

Cytochrome P450 inducers

A 
ETHel Booba takes PHEN-Phen and RIFuses GRIsy CARB Shakes
ETHanol
Barbiturates
PHENytoin
RIFampicin
GRIseofulvin
CARBamazepine
Smoking/St. John's Wort
17
Q

Cytochrome P450 inhibitors

A 
Inhibitors Stop Cyber Kids from Eating GRApefruit Q
Isoniazid
Sulfonamides
Cimetidine
Ketoconazole
Erythromycin
Grapefruit
Ritonavir
Amiodarone
Quinidine
18
Q

Thrombolytic (Tissue Plasminogen activator analog) used in acute MI, ischemic stroke and pulmo embo

AE: bleeding, cereb hmg, reperfusion arrhythmias

A

Alteplase

SimD: anistreplase, reteplase, STREPTOKINASE, urokinase, tenecteplase

LOSS OF EFFECTIVEMENSS ON 2ND USE, allergic rxn
Antidote: Aminocaproic acid (Tranexamic acid)

19
Q

Antiplasmin drug used to prevent and treat acute bleeding

CI: DIC and genitourinary bleeding

A

Aminocaproic acid

SimD: Tranexamic acid

20
Q

Endogenous vitamin used as antidote for warfarin overdose and for Vit. K deficiency

AE: severe infusion reaction (too fast) - dyspnea, chest and back pain

A

Vitamin K1 (Phytonadione)

SimD: K2 (menaquinone), K3 (menadione)

Vitamin K3 (menadione) should NEVER be used in therapeutics (ineffective).

21
Q

ADH agonist used in Hemophilia A, Von Willebrand’s dse, central diabetes insipidus

A

Desmopressin

Inc factor VIII activity of pxs with mild hemophilia A or VW dse

Pharmacology (23 decks)

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