Fibrinolytics-Block2 Flashcards
At low doses what does aspirin block? At higher doses what does aspirin block?
Causes TXA2 platelet aggregation, low doses Reduce PGI2 anti-thrombotic action
What drug irreversible binds to ADP receptors on platelets? Alternate to what drug?
Ticlopidine
Aspirin
What is an ADR to Ticlopidine?
Neutropenia, thrombocytopenic purpura, and rash
Clopidogrel is called what? Prasugrel is called what? What is there mechanism of action?
Plavix Effient Shout out to the Cath lab ADP receptor blocking
Clopidogrel must be activated by an isoenzyme form of CYP450, called what? What interferes with said drug from above?
CYP2C19 Omeprazole and Esomeprazole
What does clopidogrel have less of than Ticlopidine?
Neutropenia (side effects)
What drug inhibits phosphodiesterase enzyme, blocks ADP-induced platelet aggergation, makes more cAMP? Is given usually given with what other two drugs?
Dipyridamole Usually given with warfarin and aspirin, not good on its own
Abciximab, Eptifibatide, Tirofiban are what types of drugs? Where are they used?
Glycoprotein IIb/IIIa CATH LAB!!!!!!!!!!!
Heparin, Hirudin, Lepirudin, and Danaparoid are what type of drugs?
Parenteral Anticoagulants
Heparin activates antithrombin III which inactivates factors what?
IIa, IXa, Xa, XIa, and XIIa
What blood test allows unfractionated heparin to be adjusted?
aPTT
What types of drugs are Enoxaparin, Dalteparin, and Tinzaparin? What is the main mechanism of action?
Low molecular weight heparin Xa inactivation
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?
aPTT Less Thrombocytopenia and factor Xa
What can reverse unfractionated heparin? Can this drug reverse LMW heparin?
Protamine Sulfate No
What are three other ADR of the heparins?
Hypoaldosteronism, Osteoporosis, and HSR, baldness
A patient has H.I.T. what drug should be given instead? Where is it metabolized? Does it need dose change for renal dysfunction?
Agatroban, not cheap Metabolized in Liver, reduce in liver disease, can be used in patients with renal dysfunction
What are the contraindications for heparin? Can heparin cross the placenta?
Bleeding, Dissecting Aortic Aneurysm, Recent Surgery, and Hypersensitivity Cannot cross the placenta
What types of drugs are hirudin, Desirudin, and Lepirudin? What patients use this medication?
Direct thrombin inhibitors Patient has H.I.T.
Desirudin is used for what?
prevention of venous thromboembolism after hip arthroplasty
What is Danaparoid different than? What activity does it have?
Different from heparin Has anti-factor Xa
What heparin derivative is used in prevention of DVT? It does not cause?
Fondaparinux Does not cause thrombin inhibition
What are natural anticoagulants that your body all ready has?
Proteins C and S
What platelet factors does warfarin block? What vitamin dependent reductase does it stop?
II, VII, IX, and X Vitamin K
What is warfarin’s half life? How long will it take to show effects?
25-30 hours half life 3-5 days to show effect
Warfarin is or is not teratogenic? Heparin is or is not teratogenic? Can warfarin cause necrotic skin?
Warfarin is teratogenic Heparin is not teratogenic Yes can cause necrotic skin
What factors do Protein C work on?
Va and VIIIa
What is INR? What is the recommended value?
PT observed / PT control INR 2-3
When warfarin interacts with chloestyramine, antacids, and enzyme inhducers, what happens to their activity?
decreased oral absorption and activity
What happens when warfarin interacts with Aspirin, sulfonamides, and enzyme inhibitors?
Increased anticoagulant effect and activity
What drug is a direct thrombin inhibitor, irreversible, is safer than warfarin?
Dabigatran
Rivaroxaban, apixaban, and edoxaban are orally given, dont need monitoring, but inhibit what? Use in what treatment?
Xa Venous thromboembolism, stroke, and systemic embolism in non-valvular atrial fibrillation
Heparin catalyzes the binding of what location?
Antithrombin III
What can reverse warfarin?
Vitamin K or fresh frozen plasma
Where does streptokinase act?
Activates Plasminogen to become plasmin
What type of allergic reaction can happen with Streptokinase?
HSR or allergic rx, S. Pyogenous has streptokinase as a virulence factor, ppl will have antibodies against it, will see it as a pathogen
What are thrombolytics used for? What are the ADR of thrombolytics?
DVT, Cornary thromboses, stroke, decrease problems by 60% Hemorrhagagic stroke
What are the contraindication of Fibrinolytics?
Peptic ulcer, healing wounds, recent surgery, pregnancy
Aminocaproic Acid and Tranexamic Acidare used for what? which one is stronger?
Stops fibrinolysis, stops plasminogen activation into plasmin, post surgical bleeding Tranexamic acid is more potent
