Drugs For Thromboembolic Disorders (Konorev)

Question 1

What pathologic conditions are associated with white thrombi?

Answer 1

Local ischemia d/t arterial occlusion (in coronary arteries: MI/unstable angina)

Question 2

This type of thrombus forms in low-prssure veins and in the heart; result of platelet bidning and aggregation followed by formation of bulky fibrin tails in which RBCs become enmeshed.

Answer 2

Red thrombus (fibrin-rich with trapped RBCs)

Question 3

What are pathologic conditions associated with red thrombi?

Answer 3

Pain and severe swelling, embolism and distal pathology (embolic stroke)

Question 4

This type of drug regulates the function and synthesis of clotting factors and is primarily used to prevent clots from forming in the venous system and heart (RED THROMBI)

Answer 4

Anticoagulants

Question 5

This type of drug inhibits platelet function and is primarily used to prevent clots from forming in the arteries (white thrombi)

Answer 5

Antiplatelet drugs

Question 6

This type of drug destroys blood clots after they are formed. These re-establish blood flow through vessels once clots have formed

Answer 6

Thrombolytic

Question 7

Heparin sodium is this type of anticoagulant

Answer 7

Parenteral –> Indirect thrombin and FXa inhibitor –> HMW or UFH

Question 8

Enoxaprin, Tinzaparin, and Dalteparin are this type of anticoagulant:

Answer 8

Parenteral –> Indirect thrombin and FXa inhibitor –> LMW

Question 9

Fondaparinux is this type of anticoagulant:

Answer 9

Parenteral –> Indirect thrombin and FXa inhibitor –> Synthetic pentasaccharide

Question 10

Lepirudin, Bivalirudin, and Argatroban are this type of anticoagulant:

Answer 10

Parenteral –> Direct thrombin inhibitors

Question 11

What is the MOA of indirect thrombin and FXa inhibitors?

Answer 11

Bind plasma serine protease inhibitor ANTITHROMBIN III

Antithrombin III inhibits several clotting factor proteases, esp Thrombin (IIa), IXa, and Xa. Heparin increases antithrombin III activity 1000fold

Question 12

This anticoagulant inhibits the activity of both thrombin and FXa

Answer 12

HMW heparin

Question 13

This anticoagulant inhibits FXa with little effect on thrombin

Answer 13

LMW heparin

Question 14

This anticoagulant inhibits FXa activity with no effect on thrombin

Answer 14

Fondaparinux

Question 15

What is the MOA of DIRECT thrombin inhibitors (Parenteral)?

Answer 15

Direct inhibition of the protease activity of thrombin

Question 16

The MOA of these anticoagulants is bivalent direct thrombin inhibitors (bind at both active site and substrate recognition site)

Answer 16

Lepirudin and Bivalirudin

Question 17

The MOA of this anticoagulant is an inhibitor binding only at the thrombin active site

Answer 17

Argatroban

Question 18

Warfarin (coumadin) is this type of anticoagulant:

Answer 18

Oral –> Coumarin anticoagulant

Question 19

Rivaroxaban, Apixaban, Edoxaban are these types of anticoagulant:

Answer 19

Oral –> Novel oral anticoagulants (NOAC) –> Factor Xa inhibitors

Question 20

Dabigatran is this type of anticoagulant:

Answer 20

Oral –> NOAC –> Direct thrombin inhibitor

Question 21

What is the MOA of warfarin?

Answer 21

Inhibits reactivation of Vit K by inhibiting Vit K epoxide reductase. Inhibits carboxylation of GGCX in prothrombin and factors VII,IX, and X, making them inactive

Question 22

What makes warfarin dosing so difficult?

Answer 22

Narrow therapeutic window of the drug and high individual variability, i.e., genetics, disease states, drug-drug interactions, diet

Question 23

What is the INR for pts on warfarin?

Answer 23

2.0-3.0

Question 24

Rivaroxaban, Apixaban, and Edoxaban inhibit ___

Answer 24

Xa

Question 25

Dabigatran inhibits ___

Answer 25

IIa (thrombin)

Question 26

Who gets parenteral anticoagulants?

Answer 26

Pts with DVT, atrial arrhythmias and other conditions that predispose towards RED THROMBI Tx/prevention of embolic stroke, PE Prevent emboli during surgery or in hospitalized pts Heparin locks

Question 27

Who gets oral anticoagulants?

Answer 27

Used to prevent thrombosis or prevent/treat thromboembolism A Fib Prosthetic heart valves

Question 28

What is the antidote for HMW and LMW heparin?

Answer 28

Protamine sulfate

Question 29

What is the antidote for warfarin?

Answer 29

Vit K, prothrombin complex concentrate

Question 30

What is the antidote for NOAC-DTI?

Answer 30

Idarucizumab

Question 31

Which coagulation test is specific for heparin?

Answer 31

PTT, anti-Xa --> the intrinsic pathway

Question 32

Which coagulation test is specific for warfarin?

Answer 32

PT-based (INR) --> Extrinsic pathway

Question 33

What blood coagulation test is specific for NOAC-FXa inhibitors?

Answer 33

Anti-Xa

Question 34

What blood coagulation test is specific for NOAC-DTI?

Answer 34

Diluted thrombin time (TT)

Question 35

What type of antiplatelet drug is aspirin?

Answer 35

Inhibitor of TxAs synthesis

Question 36

What type of antiplatelet drug is Clopidogrel, Prasugrel, Ticlopidine, and Ticagrelor?

Answer 36

ADP receptor blocker

Question 37

What type of antiplatelet drug is Abciximab, Eptifibatide, and Tirofiban?

Answer 37

Platelet glycoprotein receptor blocker

Question 38

What type of antiplatelet drug is Dipyridamole and Cilostazol?

Answer 38

Phosphodiesterase inhibitor

Question 39

What is the MOA of aspirin?

Answer 39

Inhibit COX | Decreased TxA2 production

Question 40

What is the MOA of ADP receptor blockers?

Answer 40

Inhibition of AC by ai is relieved Increased production of cAMP Clopidogrel, ticlopidine, and prasugrel

Question 41

What is the MOA of phosphodiesterase inhibitors?

Answer 41

Inhibit cAMP degradation Levels of cAMP in platelets are increased Dipyramidole and cilostazol

Question 42

Platelet GP receptor antagonists target this sequence to prevent binding of ligands to the GP IIb/IIIa receptor to inhibit platelet aggregation

Answer 42

RGD Abciximab, Tirofiban, Eptifibatide

Question 43

What are clinical uses of antiplatelet drugs?

Answer 43

Prevent thrombosis in unstable angina and other acute coronary syndromes Prevent ischemic stroke and arterial thrombosis in peripheral vascular disease Pts undergoing percutaneous coronary angioplasty and stunting

Question 44

This combo can be used to prevent cerebrovascular ischemia:

Answer 44

Dipyridamole (PDE inhibitor) with aspirin

Question 45

This combo can be used to tx pts with prosthetic heart valves

Answer 45

Dipyridamole (PDE inhibitor) with warfarin

Question 46

This drug can be used to tx intermittent claudication

Answer 46

Cilostazol

Question 47

What is the MOA of thrombolytic drugs?

Answer 47

Activate endogenous fibrinolytic system by converting plasminogen into plasmin

Question 48

Alteplase, Reteplase, and Tenecteplase are these types of thrombolytics:

Answer 48

tPA drugs

Question 49

Urokinase is this type of thrombolytic drug:

Answer 49

uPA activator

Question 50

Streptokinase is this type of thrombolytic drug:

Answer 50

Streptokinase preparation purified from bacteria

Question 51

What are clinical uses of thrombolytic drugs?

Answer 51

``` Acute embolic/thrombotic stroke (within 3 hr) Acute MI (within 3-6 hr) PE DVT Ascending thrombophlebitis ```

Question 52

This type of thrombus forms in high-pressure arteries and is the result of platelet binding to the damaged endothelium and aggregation with little involvement of fibrin.

Answer 52

White (platelet-rich) thrombus