Hematology Week 2: Pharmacology of Hemostasis Flashcards
Know these drugs

Question 1

D Thromboxane A2 levels
Question 2

Severe hypocalcemia can occur during transfusion or a liver transplant which can decrease the ability to form a clot

Thromboxane A2 pathway
10 steps

Aspirin MOA

Aspirin Clinical Use
2 listed

Aspirin Adverse Effects
2 listed

Abciximab MOA
2 listed
- blocks fibrinogen receptor (GPIIb/IIIa, noncompetitively) on activated platelets
- Blocks platelet aggregation

Abciximab Clinical Use
2 listed

Abciximab Adverse Effects
2 listed

Abciximab Pathway

Question 3

A Reduce the maximum level of platelet aggregation produced by the GPIIb-IIIa agonist (fibrinogen) but not alter the EC50 for fibrinogen
Competitive antagonist

Platelet ADP receptor pathway

Ticagrelor MOA
- Blocks ADP (PSY12) receptors
- Prevents expression of GIIb/IIIa on platelet surface
Clopidogrel MOA
- Blocks ADP (PSY12) receptors
- Prevents expression of GIIb/IIIa on platelet surface
Prasugrel MOA
- Blocks ADP (PSY12) receptors
- Prevents expression of GIIb/IIIa on platelet surface
Ticagrelor Clinical Use
2 listed
- Acute coronary syndrome
- Coronary stenting, decrease recurrence of thrombotic stroke
Clopidogrel Clinical Use
2 Listed
- Acute coronary syndrome
- Coronary stenting, decrease recurrence of thrombotic stroke
Prasugrel Clinical Use
2 Listed
- Acute coronary syndrome
- Coronary stenting, decrease recurrence of thrombotic stroke
Ticagrelor Adverse Effects
2 Listed
- Bleeding
- Thrombocytopenia (rare)
Clopidogrel Adverse Effects
2 Listed
- Bleeding
- Thrombocytopenia (rare)
Prasugrel Adverse Effects
2 Listed
- Bleeding
- Thrombocytopenia (rare)
Cilostazol MOA
- PDE (type 3) inhibitor = increase cAMP
- Prevents platelet aggregation
- vasodilation
Dipyridamole MOA
- PDE (type 3) inhibitor = increase cAMP
- Prevents platelet aggregation
- vasodilation
Cilostazol Clinical Use
3 listed
- Intermittent claudication
- Coronary vasodilation
- thrombotic stroke prevention or TIA (aspirin combo)
Dipyridamole Clinical Use
3 listed
- Intermittent claudication
- Coronary vasodilation
- thrombotic stroke prevention or TIA (aspirin combo)
Cilostazol Adverse Effects
3 listed
- Bleeding
- Nausea, headache
- hypotension, abdominal pain
Dipyridamole Adverse Effects
3 listed
- Bleeding
- Nausea, headache
- hypotension, abdominal pain
PDE 3 type 3 inhibitor pathway

PDE Type 3 inhibitors
Cilostazol and Dipyridamole
Question 4

C Decrease Aggregation

Vorapaxar MOA
2 listed

Vorapaxar Clinical Use
3 listed

Vorapaxar is contraindicated in?
patients who have an intracerebral hemorrhage or stroke and TIA
Vorapaxar Adverse Effects
2 listed

With platelets Decreased PKA leads to?
Platelet activation

Platelet inhibitors

Summary of platelet activation mechanisms

Warfarin MOA
2 listed

Warfarin Clinical Use
2 listed

Warfarin Adverse Effects
4 listed

Vitamin K epoxide reductase gene polymorphisms
change how Warfarin works
Warfarin w/ heparin or dorect thrombin inhibitors in patients with low protein C or S
can cause skin necrosis
Question 5

B Increased
Vitamin K Cycle & mechanism of Warfarin

Warfarin Timeline
not for rapid anticoagulation

Question 6

C Administer 4 Factor prothrombin complex concentrate
can also administer Vitamin K but this would be slow
Heparin MOA
3 listed

What is this?

Heparin Clinical Use

Heparin Adverse Effects
4 listed

Low Molecular Weight heparins mainly inhibits
Factors 2a and 10a
Warfarin is given how?
oral
Heparin is given how
IV
Warfarin and Heparin can have this side effect
Bleeding
Osteoporosis
Heparin Pathway
binds to anti-thrombin III and increases its enzymatic activity by 1000x by holding it in a stable conformation

Problems with Heparin
poor availability because of natural heparinases and a risk for heparin-induced thrombocytopenia

MOA for LMWH
Low Molecular Weight Heparin

Question 7

E Thrombocytopenia
Heparin vs Warfarin

Heparin-induced Thrombocytopenia

Management of Heparin-induced Thrombocytopenia
4 listed

Hirudin MOA

Hirudin Clinical Use

Hirudin Adverse Effects

Bivalirudin MOA
2 listed

Bivalirudin Clinical Use
3 listed

Bivalirudin Adverse Effects
2 listed

Argatroban MOA
2 Listed

Argatroban Clinical Use
3 Listed

Argatroban Adverse Effects
2 Listed

Dabigatran MOA
2 Listed

Dabigatran Clinical Use
2 Listed

Dabigatran Adverse Effects
2 Listed

Hirudins
4 listed
- Hirudin
- Bivalirudin
- Argatroban
- Dabigatran
Hirudin Bleeding Antidotes
3 listed
- Idarucizumab
- PCC
- antifibrinolytic (tranexamic acid)

Apixaban, Rivaroxaban and Edoxaban do what?
Inhibit Factor Xa

Dabigatran does what?
Inhibits Factor IIa

Fondaparinux MOA
2 listed

Rivaroxiban MOA
2 listed

Apixaban MOA
2 listed

Fondaparinux Clinical Use
3 listed

Rivaroxiban Clinical Use
3 listed

Apixaban Clinical Use
3 listed

Fondaparinux Adverse Effects
2 listed

Rivaroxiban Adverse Effects
2 listed

Apixaban Adverse Effects
2 listed

Question 8

Anticoagulant Reversal Agents for life-threatening bleeding

Alteplase (tPA) MOA
3 listed

Alteplase (tPA) Clinical Use
2 listed

Alteplase (tPA) Adverse Effects
2 listed

Reteplase (rTPA) MOA
3 listed

Reteplase (rTPA) Clinical Use
2 listed

Reteplase (rTPA) Adverse Effects
2 listed

Tenecteplase (TNK-tPA) MOA
3 listed

Tenecteplase (TNK-tPA) Clinical Use
2 listed

Tenecteplase (TNK-tPA) Adverse Effects
2 listed

The Fibrinolytic pathway

Question 9

Fibrinolytic inhibitors
Tranexamic Acid
Aminocaproic Acid

Fibrinolytic Inhibitors AKA
Antiplasmin Drugs
Question 10

heparin antidote
Protamine Sulfate