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AU14 Pharmacology > Exam 3; Agents that Affect the Clotting System > Flashcards

Exam 3; Agents that Affect the Clotting System Flashcards

1
Q

The initial activation of platelets leads to what

A

platelet plugs

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2
Q

When ADP binds to the platelets, they activated what

A

glycoprotein receptors

GPIIb and GPIIIa

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3
Q

This binds to GPIIb and GPIIIa and leads to platelet aggregation

A

fibrinogen

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4
Q

This inhibits platelet aggregation

A

cAMP

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5
Q

The clot consist primarily of what

A

fibrin

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6
Q

All of the clotting factors are circulating proteins, and when activated become what

A

proteolytic enzymes

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7
Q

What does Xa stimulate

A

prothrombin to thrombin (IIa)

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8
Q

What two things does thrombin stimulate

A

fibrinogen to fibrin

activates platelets, factors VII, VIII, XIII

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9
Q

What is the purpose of fibrinogen

A

cross-linkning platelets

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10
Q

What is the purpose of fibrin

A

to form the clot

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11
Q

What does XIII to XIIIa assist in

A

stabilizing the clot

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12
Q

Which factors require Ca to work

A 
XI to XIa
X to Xa
prothrombin to thrombin
fibrinogen to fibrin
XIII to XIIIa
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13
Q

What are the steps to reverse clot formation

A

plasminogen → plasmin → clot lysis

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14
Q

What is the step to localize clotting

A

antithrombin III → causes inactivation of thrombin, factors IX, X, XI, XII

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15
Q

This is a genetic disorder that causes inadequate clotting

A

hemophilia

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16
Q

Which is more common, too little clotting or too much clotting

A

too much clotting

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17
Q

This is a clot that adheres to a blood vessel wall

A

thrombus

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18
Q

What is it when there is a thrombus in the arteries

A

white thrombi

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19
Q

What is a white thrombi associated with

A

atherosclerotic plaques

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20
Q

What is it when there is a thrombus in the veins

A

red thrombi

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21
Q

What is a red thrombi associated with

A

pooling of blood in the extremities

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22
Q

This is when a thrombus breaks off and travels through the blood stream; it will stop one it can no longer fit through the vessels clogging it

A

thromboembolus

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23
Q

In which four conditions are anti-coagulates are used

A

thromboembolic disease
after most kinds of surgery
during transfusions
in patients with heart disease

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24
Q

What are the three calcium chelators anti-coagulates

A

Citric acid
EDTA
EGTA

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25
Q

Why do you generally not give people calcium chelators

A

due to Ca being widespread-ly used in the body; unless hypercalcemia

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26
Q

This anti-coagulate is not synthetic and is purified from animal tissues with a strong negative charge

A

heparin

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27
Q

What is the mechanism behind heparin

A

binds to anti-thrombin, a protease inhibitor

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28
Q

At low doses, what does heparin do

A

inhibits Xa

thus decreasing the formation of thrombin

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29
Q

At high doses, what does heparin do

A

inhibits thrombin, IXa, IXa, and XIIa

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30
Q

After thrombin is inactivated, heparin does what

A

is released and moves on to catalyze another reaction

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31
Q

True or False

Heparin is able to lyse existing clots

A

False; it is not

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32
Q

Heparin must be given by which method

A

Injection; usually subQ

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33
Q

Why can heparin not be given orally

A

It is such a large molecule that is will not be absorbed by the gut

34
Q

True or False

Heparin easily passes the placenta and can cause major damage to the fetus

A

False; it cannot pass the placenta

35
Q

What is the half life of heparin

A

1 hour; immediate onset

36
Q

What degrades heparin

A

Heparinase

37
Q

What is the dose response of heparin

A

It is somewhat unpredictable because it can bind to a variety of proteins

38
Q

What is the toxicity level of heparin

A

Relatively non-toxic

Major toxicity is bleeding

39
Q

What can be used to treat an overdose of heparin

A

Strongly positive protnine sulfate

40
Q

What three things can result from long term use of heparin

A

Osteoporosis; due to lack of osteoclasts
Thrombocytopenia; loss of platelets
Hypersensitivity; because it is an animal product

41
Q

What are two low molecular weight heparins

A

Enoxaparin

Dalteparin

42
Q

What is the half live of enoxaparin and dalteparin

A

4 hours; longer than heparin

43
Q

Which molecule does enoxaparin and dalteparin have more of an effect on, Xa or thrombin?

A

Xa

44
Q

What are some differences between enoxaparin/dalteparin and heparin

A

less osteoproosis and HIT
more predictable dose response
more expensive
not readily reversed by protiminie sulfate

45
Q

What is a side effect of enoxaparin and dalteparin

A

may cause spinal hematoma in patients who have had a spinal tap or spinal anesthesia

46
Q

This is a purely synthetic heparin-like drug with a half life of 17hrs, given subQ

A

fondaparinux

47
Q

What is the mechanism of fondaparinux

A

works only on factor Xa

48
Q

The saliva of a leech contains this drug

A

hirudin; anticoagulate

49
Q

What is the mechanism of hirudin

A

works by directly inhibiting thrombin

50
Q

These are two synthetic analogs of hirudin

A

bivalirudin

desirudin

51
Q

This is a peptide derived from hirudin

A

agratroban

52
Q

When are the analogs of hirudin used

A

when the patient has heparin induced thrombocytopenia

53
Q

What is the mechanism of warfarin

A

inhibition of the enzyme that allows vitamin K to be recycled
K-oagulation

54
Q

What is vitamin K essential for

A

synthesis of factors VII, IX, X, and pro-thrombin

55
Q

What is warfarin metabolized by

A

P450

can be affected by other drugs and grapefruit juice

56
Q

What are three toxicities of warfarin

A

many drug interactions
hemorrhage
can pass the placenta (cat. X)

57
Q

This is a pro-drug that is a direct thrombin inhibitor (enzyme inhibitors)

A

diabigatran

58
Q

What are two factor Xa inhibitors (enzyme inhibitors)

A

rivaroxaban

apixaban

59
Q

This is a thrombin receptor blocker

A

vorapaxar

60
Q

In which type of patient do you need to be care administrating vorapaxar to

A

patients with a history of intracranial bleeding

61
Q

What are four ADP inhibitors (inhibits ADP from binding to receptor)

A

ticlopidine
clopidogrel
prasugrel
ticagrelor

62
Q

This ADP inhibitor can cause neutropenia and agranulocytosis

A

ticlopidine

63
Q

What is the main difference between all the ADP inhibitors

A

pharmacokinetics

64
Q

These are three fibrinogen receptor inhibitors

A

abciximab
tirofiban
eptifibatide

65
Q

The fibrinogen inhibitors prevent what

A

platelet aggregation

66
Q

The fibrinogen inhibitors can cause what

A

thrombocytopenia

67
Q

Which method are the fibrinogen inhibitors given

A

IV

68
Q

This is a COX inhibitor which inhibits thromboxane synthesis via cyclooxyrgenase inhibitor (enzyme inhibitor)

A

aspirin

69
Q

What are two phosphodiesterase inhibitors

A

cilostazol

dipyradiamole

70
Q

What is the mechanism behind cilostazol and dipyradiamole

A

inhibits the enzyme that breaks down cAMP (phosphodiesterase)

71
Q

This drug decreases platelet formation, maturation, and number; decreasing platelet count

A

anagrelide

72
Q

What are three contradictions for oral anti-coagulants

A

anyone with a bleeding disorder
severe hypertension
after surgery in the eye, brain, or spinal cord

73
Q

Why is anyone with a bleeding disorder, contraindicative of oral anti-coagulants

A

could have a hidden bleeding disorder; 25% of all deaths due to GI bleeding were because they didn’t know it

74
Q

Why is anyone with hypertension, contraindicative of oral anti-coagulants

A

small vessels are damaged and if you remove the clotting mechanism then you will “sprout leaks”

75
Q

What are three agents that dissolve formed clots

A

streptokinase
urokinase
tissue plasminogen activator

76
Q

What is the mechanism behind streptokinase, urokinase, and tissue plasminogen activator

A

converts plasminogen to plasmin

77
Q

plasmin hydrolyzes fibrin and degrade what

A

fibrinogen and factors V and VII

78
Q

When will you use the agents that dissolve formed clots

A

if someone ocomes into the hospital having a heart attack due to a clot; given IV

79
Q

What is the mechanism behind hemostatic agents

A

inhibits plasminogen activation (enzyme inhibitor)

80
Q

What are the two hemostatic agents

A

aminocaproic acid

tranexamic acid

AU14 Pharmacology (29 decks)

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