Fibrinolytics-Block2

Question 1

At low doses what does aspirin block? At higher doses what does aspirin block?

Answer 1

Causes TXA2 platelet aggregation, low doses Reduce PGI2 anti-thrombotic action

Question 2

What drug irreversible binds to ADP receptors on platelets? Alternate to what drug?

Answer 2

Ticlopidine

Aspirin

Question 3

What is an ADR to Ticlopidine?

Answer 3

Neutropenia, thrombocytopenic purpura, and rash

Question 4

Clopidogrel is called what? Prasugrel is called what? What is there mechanism of action?

Answer 4

Plavix Effient Shout out to the Cath lab ADP receptor blocking

Question 5

Clopidogrel must be activated by an isoenzyme form of CYP450, called what? What interferes with said drug from above?

Answer 5

CYP2C19 Omeprazole and Esomeprazole

Question 6

What does clopidogrel have less of than Ticlopidine?

Answer 6

Neutropenia (side effects)

Question 7

What drug inhibits phosphodiesterase enzyme, blocks ADP-induced platelet aggergation, makes more cAMP? Is given usually given with what other two drugs?

Answer 7

Dipyridamole Usually given with warfarin and aspirin, not good on its own

Question 8

Abciximab, Eptifibatide, Tirofiban are what types of drugs? Where are they used?

Answer 8

Glycoprotein IIb/IIIa CATH LAB!!!!!!!!!!!

Question 9

Heparin, Hirudin, Lepirudin, and Danaparoid are what type of drugs?

Answer 9

Parenteral Anticoagulants

Question 10

Heparin activates antithrombin III which inactivates factors what?

Answer 10

IIa, IXa, Xa, XIa, and XIIa

Question 11

What blood test allows unfractionated heparin to be adjusted?

Answer 11

aPTT

Question 12

What types of drugs are Enoxaparin, Dalteparin, and Tinzaparin? What is the main mechanism of action?

Answer 12

Low molecular weight heparin Xa inactivation

Question 13

Low molecular weight heparin does need to be monitored by what test? LMWH has enhanced activity against what and less what compared to unfractionated heparin?

Answer 13

aPTT Less Thrombocytopenia and factor Xa

Question 14

What can reverse unfractionated heparin? Can this drug reverse LMW heparin?

Answer 14

Protamine Sulfate No

Question 15

What are three other ADR of the heparins?

Answer 15

Hypoaldosteronism, Osteoporosis, and HSR, baldness

Question 16

A patient has H.I.T. what drug should be given instead? Where is it metabolized? Does it need dose change for renal dysfunction?

Answer 16

Agatroban, not cheap Metabolized in Liver, reduce in liver disease, can be used in patients with renal dysfunction

Question 17

What are the contraindications for heparin? Can heparin cross the placenta?

Answer 17

Bleeding, Dissecting Aortic Aneurysm, Recent Surgery, and Hypersensitivity Cannot cross the placenta

Question 18

What types of drugs are hirudin, Desirudin, and Lepirudin? What patients use this medication?

Answer 18

Direct thrombin inhibitors Patient has H.I.T.

Question 19

Desirudin is used for what?

Answer 19

prevention of venous thromboembolism after hip arthroplasty

Question 20

What is Danaparoid different than? What activity does it have?

Answer 20

Different from heparin Has anti-factor Xa

Question 21

What heparin derivative is used in prevention of DVT? It does not cause?

Answer 21

Fondaparinux Does not cause thrombin inhibition

Question 22

What are natural anticoagulants that your body all ready has?

Answer 22

Proteins C and S

Question 23

What platelet factors does warfarin block? What vitamin dependent reductase does it stop?

Answer 23

II, VII, IX, and X Vitamin K

Question 24

What is warfarin’s half life? How long will it take to show effects?

Answer 24

25-30 hours half life 3-5 days to show effect

Question 25

Warfarin is or is not teratogenic? Heparin is or is not teratogenic? Can warfarin cause necrotic skin?

Answer 25

Warfarin is teratogenic Heparin is not teratogenic Yes can cause necrotic skin

Question 26

What factors do Protein C work on?

Answer 26

Va and VIIIa

Question 27

What is INR? What is the recommended value?

Answer 27

PT observed / PT control INR 2-3

Question 28

When warfarin interacts with chloestyramine, antacids, and enzyme inhducers, what happens to their activity?

Answer 28

decreased oral absorption and activity

Question 29

What happens when warfarin interacts with Aspirin, sulfonamides, and enzyme inhibitors?

Answer 29

Increased anticoagulant effect and activity

Question 30

What drug is a direct thrombin inhibitor, irreversible, is safer than warfarin?

Answer 30

Dabigatran

Question 31

Rivaroxaban, apixaban, and edoxaban are orally given, dont need monitoring, but inhibit what? Use in what treatment?

Answer 31

Xa Venous thromboembolism, stroke, and systemic embolism in non-valvular atrial fibrillation

Question 32

Heparin catalyzes the binding of what location?

Answer 32

Antithrombin III

Question 33

What can reverse warfarin?

Answer 33

Vitamin K or fresh frozen plasma

Question 34

Where does streptokinase act?

Answer 34

Activates Plasminogen to become plasmin

Question 35

What type of allergic reaction can happen with Streptokinase?

Answer 35

HSR or allergic rx, S. Pyogenous has streptokinase as a virulence factor, ppl will have antibodies against it, will see it as a pathogen

Question 36

What are thrombolytics used for? What are the ADR of thrombolytics?

Answer 36

DVT, Cornary thromboses, stroke, decrease problems by 60% Hemorrhagagic stroke

Question 37

What are the contraindication of Fibrinolytics?

Answer 37

Peptic ulcer, healing wounds, recent surgery, pregnancy

Question 38

Aminocaproic Acid and Tranexamic Acidare used for what? which one is stronger?

Answer 38

Stops fibrinolysis, stops plasminogen activation into plasmin, post surgical bleeding Tranexamic acid is more potent