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Pharm > Drugs Used in Disorders of Coagulation > Flashcards

Drugs Used in Disorders of Coagulation Flashcards

1
Q

What are the 4 phases of hemostasis?

A
  1. Vascular spasm
  2. Platelet plug formation (primary hemostasis)
  3. Blood coagulation (secondary hemostasis)
  4. Dissolution of the fibrin clot (tertiary hemostasis)
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2
Q

What chemical mediators released by the healthy endothelium act as inhibitors of platelet aggregation?

A

Prostacyclin and nitric oxide

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3
Q

Binding of _____ and ___ to their platelet receptors results in ____ ______, leading to the relase of contents of cells’ granules: ___, ___, ___, ____, ___, and ___ are secreted from platelet granules

A

Binding of collagen and vWF to their platelet receptors results in platelet activation, leading to the realse of the contents of the cells’ granules: ADP, Ca2+, ATP, serotonin, vWF, and platelet factor 4

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4
Q

Explain the result of ADP release and mechanism?

A

Platelet aggregation through action on 2 G-protein-coupled recptors

  1. P2Y1 > couples Gq and mobilzed intracellular Ca2+
  2. P2Y12 > coupled to Gi inhibition of adenylyl cyclase
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5
Q

What is the function of thromboxane A2 (TXA2)

A
  • Potent platelet aggregating agonist and vasoconstrictor
  • TXA2 receptor couples to Gq and leads to mobilization of intracellular Ca2+
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6
Q

Explain the mechanism of thrombin during primary hemostasis?

A

Binds thrombin receptors which are protease-activated G protein receptors results in activation of PLC and inhibition of adenylyl cyclase

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7
Q

What is the function of fibrinogen in primary hemostasis?

A

Binds GPIIb/GPIIIa receptors on two seperate activated platelets (activated display high-affinity receptor)

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8
Q

What is the function of thrombin in secondary hemostasis?

A

Thrombine is a serine protease catalyzes the conversion of fibrinogen to fibrin which crosslink forming hemostatic plug

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9
Q

What is the role of vitamin K?

A
  • Cofactors of gamma-gutamyl carboxylase which is needed for activation of clotting factors II, VII, IX, and X along with proteins C and S
  • Vitamin K is regenerated by vitamin K epoxide reductase (warfarin)
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10
Q

What re the main anticoagulant factors that regulate hemostasis and their function?

A
  • PGI2: increased cAMP levels within platelets to inhibit activation
  • Antithrombin III: inactivates thrombin and Factors IXa, Xa, XIa, and XIIA by forming complex with them
  • Protein C: serine proteins activated by thrombin that degrades Factors Va and VIIIa
  • Tissue Factor Pathway Inhibitor: limits action of TF-mediated activation of Factors IX and X
  • Plasmin: proteolytically degrades fibrin
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11
Q

Differentiate venous thrombosis vs arterial thrombosis?

A
  • Venous Thrombosis: triggered by inappropriate activation of coagulation cascade or blood stasis and is rich in fibrin.
  • Arterial Thrombosis: surface lesions of endothelial cells caused by atherosclerosis and platelet rich clot
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12
Q

What are the 3 types of drugs used to reduce clotting?

A
  1. Platelet aggregation inhibitors
  2. Anticoagulants
  3. Thrombolytics
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13
Q

What are the 4 types of drugs used to treat bleeding?

A
  1. Plasminogen activiation inhibitors
  2. Protamine sulfate
  3. Vitamin K
  4. Plasma fractions
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14
Q

What are the types of platelet aggregation inhibitors?

A
  1. Cyclooxygenase Inhibitors
  2. ADP Receptor Blockers
  3. Phosphodiester Inhibitors
  4. Blockers of Platelet GP IIb/IIIa Receptors
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15
Q

Aspirin (MOA, Uses, HL)

A

MOA: irreversible acetylation of COX which inhibits TXA2 synthesis

Uses: prophylactic treatment of TIA, reduce incidence of recurrent MI, and decrease mortality in post MI pts

HL: other salicyclates and other NSAIDs are reversible

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16
Q

Clopidogrel and Ticlipidine (MOA, Uses, AE, HL)

A

MOA: irreversibly inhibits P2Y12 which is on of two subtypes of ADP receptors on platelet surface

Uses: prevent cerebrovascular, cardiovascular, and peripheral vascular disease

AE: thrombocytopenic purpura, neutropenia for ticlopidine which is why clopidogrel is most commonly used

HL: clopidogrel is prodrug metabolized by CYP2C19 which is not to have poor metabolizers and is inhibited by Omeprazole

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17
Q

What are the phosphodiester inhibitor drugs?

A

Dipyridamole and Cilostazol

18
Q

Dipyridamole (MOA, Uses, HL)

A

MOA: increased cAMP levels by inhibiting phosphodiesterase and/or blocking uptake of adenosine (activate adenylyl cyclase)

Uses: adjunct to warfarin p/o to prevent thromboembolic events or combined with aspirin for prophylaxis of CVD

HL: little to no beneficial effect alone

19
Q

Cilostazol (MOA, Uses)

A

MOA: phosphodiesterase inhibitor that promotes vasodilation and inhibitor of platelet aggregation

Uses: treat intermittent claudication

20
Q

What the drugs for blockers of platelet GP IIb/IIIa receptors their function and uses?

A
  • Abciximab: chimeric mouse-human monoclonal antibody that irreversibly inhibits
  • Eptifibatide: cyclic peptide reversible antagonist
  • Tirofiban: nonpeptide tyrosine analogue reversible antagonist

Uses: prevent thromoblytic cardiovascular events in pts with NSTE-ACS and adjuncts to percutaneous coronary intervention

21
Q

What is Glanzmann’s thrombasthenia?

A

Person lacking GPIIb/IIIa receptors

22
Q

Name the 4 groups of anticoagulants?

A
  1. Indirect Thrombin and Factor X inhibitors
  2. Direct Thrombin Inhibitors
  3. Vitamin K antagonists
  4. Direct Factor Xa inhibitors
23
Q

Heparin (MOA, Uses, AS, HL)

A

MOA: binding antithrombin III making it a better protease to inhibit thrombin, IXa, and Xa.

Uses: injectable anticoagulant to acutely interfere with formation of thrombi

AE: bleeding, hypersensitivity reactions, and Heparin Induced Thrombocytopenia (platelet factor 4)

HL: monitored by aPTT, reversed by protamine sulfate

24
Q

Fondaparinux (MOA)

A

MOA: binding to antithrombin III to act as selective, indirect, inhibitor of factor Xa

25
Q

Warfarin (MOA, Uses, AE, HL)

A

MOA: inhibits vitamin K epoxide reductase affecting Factors II, VII, IX, and X along with protein C and S

Uses: prevent progression of recurrence of acute DVT or PE following initial course of heparin

AE: hemorrhage, cutaneous necrosis (protein C), and crossing the placenta

HL: numerouse drug interactions

26
Q

What are the 3 paraenternal DTIs?

A
  • Desirudin (recombinant peptide analog from leeches)
  • Bivalirudin (synthetic polypeptide alternative to heparin for pts undergoing PCI
  • Argatroban (derived from L-arginine)
27
Q

What is the oral DTI?

A
  • Dabigatran Etexilate (prodrug)
28
Q

What are the Direct Factor Xa Inhbitors?

A

Apixaban and Rivaroxaban

29
Q

What is the MOA of thrombolytic drugs and the uses?

A

MOA: convert inactive zymogen plasminogen to the active protease plasmin

Uses: reduce the mortality of acute MI and used in situation when PCI not readily available

30
Q

What is the MOA of streptokinse?

A

Combine with plaminogen then catalyzes conversion to plasmin

31
Q

What is the MOA of Urokinase?

A

conversion of plasminogen to plasmin

32
Q

What is the MOA of Alteplase, Reteplase, and Tenecteplase?

A

MOA: acts as Tissue plasminogen activator (t-PA) that rapidly activates plasminogen bound to fibrin “fibrin selective”

33
Q

What is the treatment of Venous Thrombosis?

A

Initiate with UFH or LMWH for 5-7 days with overlap of Warfarin for 3-6 months

34
Q

What is the treatment for arterial thrombosis such as TIA, strokes, unstable angina, or acute MI?

A

Platelet inhibiting drugs such as aspirin and clopidogrel (could also add Beta Blockers)

35
Q

What are the Plasminogen Activation Inhibitor drugs?

A
  • Aminocaproic Acid and Tranexamix Acid
36
Q

What is the MOA of Aminocaproic Acid and Tranexamic Acid?

A

Competetive inhibition of plasminogen activation leading to inhibition of fibrinolysis

37
Q

What is the MOA of Protamine Sulfate?

A

MOA: chemcial antagonist of heparin because of its high content of positiely charged arginine

38
Q

What is the MOA of Vitamin K?

A

MOA: corrects bleeding tendencies or hemorrhage related to deficiency

39
Q

What is given to all newborns for prevention?

A

Vitamin K1 IM

40
Q

What causes Hemophilia A (classic)

A

Factor VIII deficiency

41
Q

What causes hemophilia B (Christmas disease)

A

Factor IX deficiency

Pharm (14 decks)

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