Drugs for Improvement of Coronary Flow

Question 0

Warfarin

Answer 0

Anticoagulant, Oral
Blocks synthesis of clotting factors (Factors II, VII, IX, X and proteins C and S) Epoxide Reductase
Tox: bleeding; Reverse by Vit K (the missing co-factor for clotting factor syn)
PT

Question 1

Heparin

Answer 1

Anticoagulant, IV
Potentiates Antithrombin III
Decreases Factor Xa and Thrombin
Tox: bleeding (reverse by Protamine Sulfate (binds Heparin)), heparin-induced THROMBOCYTOPENIA 
Check PTT 
Safe in pregnancy

Question 2

Streptokinase, Alteplase, Urokinase

Answer 2

Fibrinolytics, IV
Promote conversion of plasminogen -> plasmin (digests fibrin, lyse clots)
Contra: pts with bleeding
Antidote: Aminocaproic acid

Question 3

Aspirin

Answer 3

Antiplatelet
Irreversibly acetylates (inhibits) COX 1&2 -> blocks syn of thromboxane (platelet aggregant)
Tox: GI distress, bleeding

Question 4

Ticlopidine and Clopidogrel

Answer 4

Antiplatelets
Inhibits ADP-mediated platelet activation pathway
Prevent MI in unstable angina; also benefit TIA and stroke
Tox: Aplastic anemia, TTP and NEUTROPENIA in ticlopidine -> replace by Clopidogrel, GI, N/V, bleeding

Question 5

Abciximab

Answer 5

Antiplatelet, monoclonal Ab
Binds platelet surface recognition molecules (IIb/IIIa) = block platelet adhesion
Tox: bleeding, thrombocytopenia