Haematological drugs Flashcards
1
Q
Aspirin
A
COX inhibitor
2
Q
Aspirin MoA
A
- Blocks conversion of arachidonic acid to thromboxane A2, PGE2, PGI2 and PGF2 - this stops platelet aggregation
- Low-dose:
- This will inhibit platelet aggregation via thromboxane A2 - will not affect PGI2, PGE2, PGF2
3
Q
Contraindications for aspirin
A
- NSAIDs
- Warfarin
- Low vitamin K
- Anaemia
- Haemophilia
- vWF disease
- Low platelets
4
Q
Indications for aspirin
A
- Prevention of stroke
- Prevention of MI
- Post MI
- Post surgery
5
Q
Adverse effects of aspirin
A
- GI irritation
- Asymptomatic blood loss
- Increased bleeding time
- Overdose
6
Q
Clopidogrel
A
P2Y12 antagonist
7
Q
Clopidogrel MoA
A
- Inhibits ADP-induced activation of platelets by inhibiting ADP binding to the platelet P2Y12 receptor - prolongs bleeding time
8
Q
Contraindications of clopidogrel
A
- Clotting disorder
- Thombotic thrombocytopenia purpura
- Stomach/intestinal ulcer/bleeding
9
Q
Indications for clopidogrel
A
- Prevention of thromboembolism atrial fibrillation
- Symptomatic carotid artery stenosis
10
Q
Clopidogrel adverse effects
A
- Bleeding
- Diarrhoea
- Rash
11
Q
What are abciximab and tirofiban?
A
They are glycoprotein 2b/3a antagonists
12
Q
Abciximab and tirofiban MoA
A
- Block receptor of glycoprotein 2b and 3a which stops fibrinogen binding to platelets - no clot can be formed
13
Q
Abciximab and tirofiban adverse effects
A
- Nausea
- Vomiting
- Back pain
- Vision changes
- Stomach upset
- Abdominal pain
14
Q
What is heparin?
A
Anti-thrombin III accelerator
15
Q
Heparin MoA
A
- Binds to antithrombin III to accelerate activity and to inhibit factors 2, 9, 10, 12
16
Q
Contraindications for heparin
A
- Heparin-induced thrombocytopenia
- Active bleeding
- Bleeding disorders
17
Q
Indications for heparin
A
- Acute treatment
- Pregnant woman
- VTE prevention
18
Q
Heparin adverse effects
A
- Bleeding, haemorrhage, bruising
- Epistaxis, melena
- Hyperkalaemia
- Thrombocytopenia
NOTE: antidote = protamine
19
Q
What are dalteparin and enoxaparin?
A
Low-molecular weight heparins; antithrombin III accelerator
20
Q
Contraindications of dalteparin and enoxaparin
A
- Active major bleeding
- Hx of heparin-induced thrombocytopenia
21
Q
Indications for dalteparin and enoxaparin
A
- DVT prophylaxis
- Treatment of VTE in pregnancy
- Treatment of DVT in pregnancy
22
Q
Dalteparin and enoxaparin adverse effects
A
- Bleeding, haemorrhage, bruising
- Epistaxis, melena
- Hyperkalaemia
- Thrombocytopenia
23
Q
What is warfarin?
A
Vitamin K antagonist
24
Q
Warfarin MoA
A
- Inhibits vit K to inhibit hepatic production of 2, 7, 9, 10
25
Warfarin contraindications
* Alcoholism
* Pregnancy (teratogen)
* Oesophageal varices
26
Warfarin indications
* Atrial fibrillation
* Venous thromboembolism
* Prosthetic heart valve
27
Warfarin adverse effects
* Bleeding
* Teratogenicity
* Red/brown urine
* Black/bloody stool
* Coughing/vomiting blood
28
What is dabigatran?
Direct thrombin inhibitor
29
Dabigatran MoA
* Binds directly and reversibly to active site of free and fibrin-bound thrombin
* Prevents conversion of fibrinogen to fibrin and stops a stable clot forming
30
Dabigatran contraindications
* Pregnancy
* Breastfeeding
* Bleeding disorders
* Active bleeding
31
Dabigatran indications
* DVT
* Pulmonary embolism
* Reduce risk of DVT and PE reccurrence
32
Dabigatran adverse effects
* Gastritis
* Dyspepsia
* GI bleeding
* Increased liver enzymes and bilirubin
33
Rivaroxiban MoA
It is a factor 10a inhibitor - blocks commencement of the common pathway
34
What is alteplase?
It is a recombinant human tissue plasminogen activator
35
Alteplase MoA
* Binds to fibrin-bound plasminogen and catalyses its conversion to protease plasmin
* This dissolves the clots and inhibits factors V, VIII and fibrinogen
36
Alteplase contraindications
* Disease states with increased bleeding risk
* Severe active bleeding disorders
37
Alteplase indications
* Pulmonary embolism
* Myocardial infarction (STEMI)
* Ischemic stroke
38
Alteplase adverse effects
* Bleeding
* GI bleeding
* Genitourinary bleeding
* Bruising
* Epistaxis
* Hypotension
* Dizziness, fever, nausea, vomiting
* Stroke
39
What is streptokinase?
It is a fibrinolytic
40
Streptokinase MoA
* Will bind to plasminogen and promotes to cleavage of the peptide to form the proteolytic enzyme plasmin
41
Streptokinase contraindications
* Active internal bleeding
* Recent cerebrovascular accident
* Intracranial neoplasm
* Severe uncontrolled hypotension
42
Streptokinase indications
* AMIs
* PE
* DVT
* Arterial thrombosis or embolism
* Occlusion of arteriovenous cannula
43
Streptokinase adverse effects
* Nauseas
* Headache
* Dizziness
* Hypotension
* Mild fever
* Bleeding
* Rash
* Itching
44
Tranexamic acid MoA
* It is an anti-fibrinolytic
* Works by inhibiting plasmin to stop the breakdown of the clot
* Also stops inhibition of factors V and VIII
45
