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Year 2 Pharma > Haemostasis and Thrombosis > Flashcards

Haemostasis and Thrombosis Flashcards

1
Q

Give examples of pro-coagulants

A

Prothrombin, F5, F7-13, fibrinogen

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2
Q

Give examples of anti-coagulants

A

Plasminogen, TFPI (tissue factor pathway inhibitor), protein S and C, and antithrombin

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3
Q

What’s the difference between venous and arterial thomboses?

A

Venous - red thrombi with high fibrin. The thrombus forms within blood vessel lumen
Arterial - white thrombi with high platelets. The thrombus forms within atherosclerotic plaque

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4
Q

What is virchow’s triad?

A
  1. rate of blood flow
  2. consistency of blood
  3. blood vessel wall integrity
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5
Q

What are the different stages of cell based theory of coagulation?

A
  1. initiation - small scale production of thrombin
  2. amplification - large scale production of thrombin on platelet surfaces
  3. propagation - generation of fibrin strands by thrombin
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6
Q

What molecules target each of the stages of cell based theory of coagulation?

A
  1. initiation is targeted by anti-coagulants
  2. amplification is targeted by anti-platelets
  3. propagation is targeted by thrombolytics
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7
Q

What happens in the initiation step of coagulation?

A

Small scale thrombin production where:

  • tissue factor bearing cells activate F10 and F5 forming the prothombinase complex
  • this prothombinase complex activates F2 (prothrombin) forming thrombin
  • antithrombin (AT-III) inactivates F10a and thrombin
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8
Q

What are examples of anticoagulant drugs?

A

Dabigatran
Rivaroxaban
Heparin
Warfarin

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9
Q

What does Dabigatran do? how is it administered?

A

Inhibits thrombin

Oral

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10
Q

What does Rivaroxaban do? How is it administered?

A

inhibits F10a

oral

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11
Q

What does Heparin do? How is it administered?

A

Activates AT III

IV, SC

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12
Q

What is a low molecular weight version of heparin and how is it administered?

A

Dalteparin

SC

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13
Q

Why would you use dalteparin instead of heparin?

A

Dalteparin is a LMW heparin and LMWHs have a more predictable response, a greater bioavailability, and a longer anti-Xa half life than unfractionated heparin

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14
Q

What does warfarin do? How is it administered?

A

Vitamin K antagonist
Vitamin K creates F2, 7, 9 10
Oral

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15
Q

Why would aspirin have a limited affect on DVTs during long haul flights?

A

Because they treat ARTERIAL thrombi

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16
Q

What happens in the amplification stage of coagulation?

A

Large scale production of thrombin:
Thombin activates platelets in a +ve feedback effect
Activated platelets change shape and become ‘sticky’ and attach to other platelets

17
Q

How are platelets activated in coagulation?

A
  1. thrombin binds to the protease activated receptor (PAR)
  2. PAR activation -> rise in intracellular [Ca2+]
    Liberates arachidonic acid which turns into TXA2 by COX enzymes
    TXA2 induces expression of Glp2b/3a which aids platelet aggregation
  3. raised [Ca2+] lead to exocytosis of ADP dense granules
  4. ADP binds to another platelet’s P2Y to activate the platelet
18
Q

What are examples of antiplatelet drugs?

A

Clopidogrel
Aspirin
Abciximab

19
Q

How does clopidogrel work? how is it administered?

A

ADP/P2Y12R antagonist

Oral

20
Q

How does aspirin work? How is it administered?

A

Irreversible COX1 inhibitor

oral

21
Q

How does abciximab work? How is it administered?

A

Glp2b/3a antagonist

IV/SC

22
Q

What are indications for use of anticoagulant drugs?

A

DVT/Pe
Thrombosis during surgery
Atrial fibrillation - prophylactic to strokes]
VTE

23
Q

What are indications for use of antiplatelet drugs?

A

Acute coronary syndromes - MI
Atrial fibrillation - prophylaxis of strokes
ARTERIAL THROMBI

24
Q

What happens in the propagation step of coagulation?

A

Thrombin mediated generation of fibrin -
Activated platelets make a large scale production of thrombin
Thrombin then binds to fibrinogen and converts it to fibrin strands

25
Q

How are pre-formed clots removed using drugs

A

Use thrombolytics - anticoagulants and antiplatelets won’t remove them

26
Q

What is an example of a thrombolytic drug and how does it work? How is it administered?

A

Recombinant tissue type plasminogen activator
(rt-PA)
A plasminogen analogue that converts plasminogen to plasmin and then degrades fibrin and dissolves the clot
Oral

27
Q

What are indications for thrombolytic use?

A

Arterial thombi
VTE
Stroke - first line
ST elevated MI

28
Q

What is a DVT? How is it caused?

A

A red thrombus of the deep veins of the leg eg a popliteal vein caused by stasis of blood and damage to the endothelium

29
Q

What is a PE

A

Thrombus attachment - pulmonary embolism causing a blood clot in the lungs

30
Q

What are ways to manage a DVT or PE

A

Reduce levels of anti-coagulant factors using anticoagulants eg dabigatran, rivaroxaban, heparin, warfarin

31
Q

What are NSTEMI and how are they caused?

A

Non ST Elevated MI caused by a white thrombus due to a partially occluded coronary artery leading to:

  • damage to endothelium
  • platelet aggregation
  • atheroma formation
32
Q

How are NSTEMI managed?

A

reduce the lipid formation and platelet aggregation/activation - antiplatelets eg clopidogrel, aspirin, abciximab

33
Q

What are STEMI and how are they caused?

A

ST Elevated MI due to a white thrombus and a fully occluded coronary artery due to:

  • damage to endothelium
  • atheroma formation
  • platelet aggregation
34
Q

How are STEMI managed?

A

Reduce lipid formation, platelet aggregation/activation and dissolve thrombus - antiplatelet and thrombolytics
AP - clopidogrel, aspirin, adciximab
TL - alteplase

35
Q

What are diseases associated with arterial thrombosis?

A

Brain - stroke
Heart - acute coronary synromes eg AF
Arteries - aortic aneurysm, peripheral arterial disease

36
Q

What are diseases associated with venous thrombosis?

A

DVT and PE

37
Q

What are treatment options of thrombosis if you think there is a clot?

A

Thrombolytic

38
Q

What are the treatment options of thrombosis if you suspect a clot in the future in venous system

A

Anticoagulant

39
Q

What are treatment options of thrombosis if you suspect a clot in the future in the arterial system

A

Antiplatelets

Year 2 Pharma (34 decks)

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