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Week 3 - haematology > Fibrinolytics and anti-platelets > Flashcards

Fibrinolytics and anti-platelets Flashcards

1
Q

What are the main actions of the fibrinolytic drugs?

A

Enhancement of fibrinolysis - breakdown of a fibrin thrombosis

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2
Q

What are the 2 classes of fibrinolytics?

A
  • Kinases

* Tissue plasminogen activators (tPA)

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3
Q

Give two examples of kinases

A
  • Streptokinase

* Urokinase

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4
Q

Give three examples of tissue plasminogen activators

A
  • Alteplase
  • Tenecteplase
  • Reteplase
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5
Q

What are the uses of fibrinolytic drugs?

A

The breakdown of pathological thrombosis either systemically or locally (catheter directed)

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6
Q

How do tPA derivatives cause the breakdown of a thrombus?

A

They activate plasminogen, plasmin is then cleaved from plasminogen and breaks down fibrin

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7
Q

How do kinases cause the breakdown of a thrombus?

A

Bind to plasminogen, releasing plasmin, resulting in the enhanced breakdown of fibrin

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8
Q

Why do kinases pose a significant bleeding risk?

A
  • They act on both the clot bound and free plasminogen

* Causing both fibrinolysis and systemic fibrinogenolysis

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9
Q

What is the issue with streptokinase, which is not an issue with urokinase?

A
  • It is antigenic

* A recent strep infection/ previous use of streptokinase can render streptokinase ineffective

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10
Q

What is the route of administration for kinases?

A

Bolus dose then infusion

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11
Q

What is the route of administration for alteplase and tenecteplase?

A

Given as bolus then infusion

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12
Q

What is the route of administration of reteplase?

A

Bolus only

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13
Q

What are the indications for tPA derivatives?

A
  • Acute myocardial infarction for patients not suitable for primary coronary interventions e.g. angioplasty, within 12 hours of onset of symptoms
  • Ischaemic stroke (alteplase), within 4.5 hours of onset of symtoms
  • Massive pulmonary embolism with haemodynamic instability (alteplase)
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14
Q

What increases the bleeding risk in those taking tPA derivatives?

A
  • Large ischaemic stroke
  • Elderly
  • Later administration
  • Uncontrolled diabetes
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15
Q

What are the pros of catheter directed thombolysis?

A
  • Smaller doses
  • Administered directly into vessel containing thrombosis
  • Less systemic effect (although not nay less bleeding)
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16
Q

What are the uses of catheter directed thrombolysis?

A
  • Acute limb ischaemia
  • Massive DVT (deep vein thrombosis)
  • Blocked CVC (central venous catheter)
17
Q

What are the actions of anti platelet drugs?

A
  • Inhibits platelet activation

* Inhibit platelet aggregation

18
Q

How does aspirin work as an anti platelet drug?

A

Irreversible inhibition of cyclooxygenase, blocking the conversion of arachidonic acid to thromboxane A2, decreasing the platelet activation

19
Q

How does clopidogrel and ticlodipine work as an anti platelet?

A

Irreversible blockage of the ADP receptor, deceasing the expression of GPIIb/IIIa, reducing the binding of fibrinogen

20
Q

What is the mechanism of action of abciximab and tirofiban?

A
  • GPIIb/IIIa antagonists - monoclonal antibodies antagonise the receptor
  • Reduced platelet aggregation
  • Reduced binding of fibrinogen
21
Q

What is the mechanism of action of dipyridamole?

A
  • Phosphodiesterase III inhibitor
  • Increased platelet concentration of cAMP
  • Leading to the decreased platelet responsiveness to ADP
  • Reducign the platelet aggregation
22
Q

What are the indications of anti-platelets?

A
  • Cardiovascular disease
  • Acute MI
  • Secondary prevention of cardiovascular disease
  • Cerebrovascular disease (without AF)
  • Acute stroke/TIA/Secondary prevention
  • Peripheral vascular
23
Q

What anti-platelets are used in acute myocardial infarction?

A
  • Aspirin indefinitely
  • Ticagrelor/clopidogrel for up to 12 moths
  • +/- tirofiban acutely
24
Q

What anti-platelet is used in secondary prevention of CVD?

A

Aspirin

25
Q

What anti-platelet is used in acute stroke/TIA/secondary prevention?

A
  • Clopidogrel

* Dipyridamole + aspirin if clopidogrel not tolerated

Week 3 - haematology (17 decks)

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