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20003 > haemostasis and thrombosis pharmacology > Flashcards

haemostasis and thrombosis pharmacology Flashcards

1
Q

what is haemostasis

A

the arrest of blood loss from damaged vessels

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2
Q

how does the body stop/ reduce blood loss

A
  • vascular spasm
  • platelet plug formation
  • clotting/ coagulation
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3
Q

what is the mechanism of action of antiplatelets (aspirin)

A
  • irreversibly inactivates COX1
  • stops thromboxane A2 synthesis
  • 7 days
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4
Q

what are the adverse effects of asprin

A

increase haemorrhagic stroke and GI bleeding

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5
Q

what is the mechanism of action of ADP-induced platelet aggregation inhibition

A
  • P2Y12 = purine receptor of ADP
  • inhibits activation of GP IIb/IIIa receptors
  • needed for platelets and fibrinogen to bind
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6
Q

why are clopidogrel and aspirin used together

A
  • anticoagulants
  • work in conjunction with one another
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7
Q

what is the mechanism of action of GP IIb/IIIa receptor blockers

A
  • bind to GP IIb/IIIa
  • block fibrinogen binding
  • stops aggregation
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8
Q

when are GP IIb/IIIa receptor blockers used

A
  • with aspirin
  • prevent clotting before invasive heart procedures
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9
Q

what are the side affects of GP IIb/IIIa receptor blockers

A
  • bleeding
  • thrombocytopenia
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10
Q

what are the 2 different ways that anticoagulants can work

A
  1. inhibiting action of coagulation factors
  2. inhibiting synthesis of coagulation factors
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11
Q

what anticoagulants inhibit synthesis of coagulation factors

A

vitamin K antagonists

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12
Q

what are parental anticoagulants that inhibit action of coagulation factors

A
  1. thrombin inhibitors (direct & indirect)
  2. factor x inhibitors
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13
Q

what are direct oral anticoagulants that inhibit action of coagulation factors

A
  1. thrombin inhibitor
  2. factor X inhibitors
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14
Q

what are examples of parental indirect thrombin inhibitors

A
  • heparin
  • low molecular weight heparins
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15
Q

what is the mechanism of action of parental indirect thrombin inhibitors

A
  • speed up antithrombin interaction
  • inhibits thrombin and factor X
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16
Q

what is the pharmacokinetics of parental indirect thrombin inhibitors

A
  • renal elimination
  • LMWH half life > heparin half life
  • IV and subcut
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17
Q

what are the adverse effects of parental indirect thrombin inhibitors

A
  • bleeding
  • hypersensitivity
  • thrombocytopenia
  • thrombosis
  • osteoporosis
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18
Q

what are the reversal agents of heparin

A
  • protamine sulfate
  • ciraparantag
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19
Q

what are the reversible agents of low molecular weight heparins

A
  • andexanet
  • ciraparantag
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20
Q

what is an example of parental direct thrombin inhibitors

A

bivalirudin

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21
Q

what is the mechanism of action of parental direct thrombin inhibitors

A

direct thrombin inhibitor

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22
Q

what is the pharmacokinetics of parental direct thrombin inhibitors

A

IV administration

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23
Q

what are the adverse effects of parental direct thrombin inhibitors

A

bleeding

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24
Q

what is an example of parental factor X inhibitor

A

fondaparinux

25
what is the mechanism of action of parental factor X inhibitors
1. binds to antithrombin III 2. selectively neutralises factor Xa by antithrombin III
26
what is the pharmacokinetics of parental factor X inhibitors
- SC administration - eliminated unchanged in urine
27
what are the adverse effects of parental factor X inhibitors
bleeding
28
what is dabigatran etexilate
prodrug of active moiety dabigatran to overcome poor bioavailability
29
what is the therapeutic use of dabigatran etexilate
- prevention of stroke & systemic embolism in af - DVT and PE treatment
30
what are the adverse effects of dabigatran etexilate
- bleeding - GI effects
31
what are the reversal agents of dabigatran etexilate
- idarucizumab - ciraparantag
32
what are examples of direct oral anticoagulant thrombin inhibitors
- dabigatran etexilate - edoxaban - apixaban - rivaroxaban - betrixaban
33
what is the mechanism of action of vitamin K antagosist
- inhibit factors 2,7,9,10 - need vit K for synthesis - reductase inhibited > reduced vitamins > no vit K > no clotting of factors needing K
34
what is an example of vitamin K antagonists
warfarin
35
what is the therapeutic use of vitamin K antagonists
- prevent & treat DVT, PE - stroke prevention in af - venous thromboembolism prevention
36
what is the pharmacokinetics of warfarin
- 99% bound to plasma - crosses placental barrier - low therapeutic index
37
what are the adverse effect of vitamin K antagonists
bleeding
38
what is the reversal agent to vitamin K antagonists - warfarin
vitamin K1
39
what does a low therapeutic index mean
high levels can be reached very quickly and become toxic
40
what is the international normalized ration
INR = (patient PT/ mean normal PT)^ISI
41
what is the international sensitivity index
sensitivity of the thromboplastin reagent compare to WHO standards
42
what is the action of thrombolytic drugs
- fibrinolysis 1. activates plasminogen 2. activated to plasma 3. degrades fibrin
43
when is reperfusion therapy used
- STEMI pts - aims to restore blood flow to infarct
44
what is alteplase
tissue plasminogen activator
45
how doe alteplase and Tenecteplase work
activate plasminogen bound to the fibrin clot
46
what is the therapeutic use of alteplase
- STEMI - acute ischemic stroke - massive PE
47
what is the therapeutic use of Tenecteplase
STEMI
48
what are the adverse effects of firbrinolytics
- bleeding complications - angioedema
49
what are the reversable agents for firbinolytics
TXA
50
what may cause bleeding problems
- haemophilia - VW disease - severe liver disease - reduce vit K absorption - GI surgery - fibrinolytic state - anticoagulants
51
what does TXA do
inhibits plasminogen activation
52
what is TXA used to treat
- bleeding conditions - menorrhagia - life threatening bleeding
53
why is desmopressin used as an antifibrinolytic agent
increase plasma concentration for factor VIII and vWF
54
why is vitamin K used as an anti-fibrinolytic agent
- fat soluble vitamin - forms clot factors II, VII. IX, X
55
what does factor VIII do
accelerates the process of fibrin formation
56
what does vWF do
enhances platelet adhesion to subendothelial tissue
57
what drugs can be used as anti-fibrinolytic agents
- desmopressin - vitamin K - TXA
58
what are thrombolytic drugs
- alteplase - tenecteplase

20003 (17 decks)

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