Fibrinolytics Flashcards
What are the adverse effects of Thrombolytic agents?
bleeding complications (systemic fibrinolysis, lysis of normal clots, bleeding often at catheter sites, GI & cerebral hemorrhages may occur)
What do Thrombolytic (Fibrinolytic) Agents treat?
Acute MI Cerebrovascular thrombotic stroke (stroke caused by clot in brain blood vessel) Peripheral artery occlusion deep venous thrombosis (DVT) pulmonary embolism (PE)
Which of the following adverse effects is associated with ticlopidine as compared to other antiplatelet agents? A. Bleeding B. Gastric Irritation C. N/V or diarrhea D. Neutropenia
D
Overdose of heparin is treated with. . . A. Vitamin K1 B. Protamine Sulfate C. Aminocaproic acid D. Aprotinin
What is the answer’s mechanism of action?
B. Protamine Sulfate
Heparin is (-) charged and protamine sulfate is very (+) charged and binds heparin to inhibit it from working
(it also used to make the insulin slow acting formulation)
Which P2Y12 inhibiting drug is NOT a prodrug?
Brilinta
Factor IIa
Thrombin
The following agents are administered orally except. . . A. warfarin B. ticagrelor C. fondaparinux D. eptifibatide E. tenecteplase F. aspirin
C, D, E
How do thrombolytic agents work?
Activate plasminogen → plasmin (plasmin degrades fibrin)
they degrade ALL clots (nonspecific)
Because thrombolytic agents are non-specific, what can occur?
hemorrhaging
Which fibrinolytic agent is derived from ß-hemolytic streptokinase?
streptokinase
Which fibrinolytic agents are derived from recombinant t-Pa?
Alteplase (Activase)
Reteplase (Retavase)
Tenecteplase (TNKase)
What is the half life of Streptokinase? A. 5 min B. 10 min C. 20 min D. 30 min
D. 30 min when given as IV infusion
What is the half life of Alteplase? A. 5 min B. 10 min C. 20 min D. 30 min
A. 5 min (when given as IV bolus + infusion)
What is the half life of Reteplase? A. 5 min B. 10 min C. 15 min D. 20 min
C. 15 min when given as 2 IV bolus doses
What is the half life of Tenecteplase? A. 5 min B. 10 min C. 15 min D. 20 min
D. 20 min when given as an IV bolus dose
Which thrombolytic agent can cause hypotension during infusion?
streptokinase
Why is streptokinase rarely used as a thrombolytic agent?
Allergic rxns & Bleeding
[SATA] Which thrombolytic agents are clot specific? A. Streptokinase B. Alteplase C. Reteplase D. Tenecteplase
B, C, D
Which thrombolytic agent is resistant to PAI? A. Streptokinase B. Alteplase C. Reteplase D. Tenecteplase
D
What is PAI?
Plasminogen activator inhibitor
How does aminocaproic acid work as a reversal agent?
aminocaproic acid works by binding to lysine in the active site on fibrinogen activators and keeps the drug from binding there
What are contraindications of thrombolytic agents?
trauma injury
history of cerebral hemorrhagic stroke
Tenecteplase (TNKase) causes the \_\_\_\_\_\_\_\_ of blood clots by activating \_\_\_\_\_\_\_\_\_\_. A. degradation, protein C B. degradation, plasminogen C. formation, fibrinogen D. formation, thrombin
B. degradation, plasminogen
Which of the following adverse effects is associated with ticlopidine use compared to other antiplatelet agents? A. bleeding B. N/V/D C. Gastric irritation D. neutropenia
D
An antiplatelet drug is a member of a class of pharmaceutical agents that ________________.
block activation and aggregation of platelets
Overdose of heparin is treated with: A. vitamin K1 B. Protamine sulfate C. Aminocaproic acid D. aprotinin
B
How does protamine sulfate work?
It is very positively charged and it binds to the negatively charged heparin to keep it from working
Which of the following statements regarding the use of ibuprofen by a patient taking low-dose aspirin to prevent a second heart attack is/are true?
A. ibuprofen reduces the antiplatelet effect of aspirin
B. both agents irreversibly inhibit the formation of thromboxane A2 (TXA2)
C. Aspirin should be taken 2 hours before ibuprofen
D. A and C
E. A, B and C
D. A & C
- The syndrome where pts develop antibodies to a hapten created when heparin molecules bind to platelets causing platelet depletion is known as ______________.
HIT (heparin-induced thrombocytopenia)
What is a hapten?
a small molecule that can elicit an immune response only when attached to a large carrier such as a protein; the carrier may be one that also does not elicit an immune response by itself.
- [SATA] Which of the following agents are used for continued coagulation therapy in a patient that develops HIT?
A. argatroban
B. enoxaparin
C. lepirudin
A, C
Which of the following drug::pharmacological target is/are incorrectly paired? A. argatroban :: thrombin B. enoxaparin :: antithrombin C. dabigatran :: factor X D. warfarin :: vitamin K Reductase E. dipyridamole :: P2Y12 F. aspirin :: COX G. abciximab :: GPIIb/IIIa receptor
C, E
Name one agent that DIRECTLY targets GPIIb/IIIa receptor.
Abciximab
Name one agent that targets P2Y12.
plavix
Name an agent that targets Factor X, IX, and II.
Warfarin
Name an agent that DIRECTLY targets Factor IIa.
. . .
Name one agent that INDIRECETLY targets Factor IIa.
. . .
Name an agent that DIRECTLY targets factor Xa.
xarelto (rivaroxiban), eliquis (apixaban), pradaxa (dabigatran)
Name an agent that INDIRECTLY targets factor Xa.
heparin
LMWH
Fondaparinux
Name an agent that activates tPA.
streptokinase
The following agents are administered orally except: A. warfarin B. ticagrelor C. eptifibatide D. tenecteplase E. aspirin
C, D
What does tPA do?
Catalyzes the conversion of plasminogen to plasmin
What does plasmin do?
- Degrades fibrin clots
- Degrades fibrinogen, Factor V & Factor VIII in the blood
- Does not discriminate between pathologic & normal clots
tPA is most effective when bound to _____ ______
fibrin mesh
t-PA is inhibited by ___________.
Plasminogen Activator Inhibitor (PAI)
What increase the release of plasminogen activator inhibitor (PAI)?
Thrombin and inflammatory cytokines increase the release of PAI
What inactivates circulating plasmin?
Alpha-2-antiplasmin
How does Vorapaxar work?
blocks PAR-1 and keeps thrombin from activating platelets
