Hemostatic Pharmacology Flashcards
Reversal Agents for Antiplatelet Drugs
- There arent any
-Blood product alternative by ___
- this works best for ____
-more commonly used for ____
Not effective in this case is ?
This is bc it treats ____ from other causes
platelet transfusion
irreversible inhibitors
thrombocytopenia
desmopressin
platelet dysfunction
Desmopressin (DDAVP)
-Triggers release of ?
-This leads to ? (3)
-treats bleeding from various causes … name 3
VWF (Von Willebrand Factor)
-platelet activation via GP1b receptor
-platelet cross linking via GP2b/3a
-prolongs half life of factor VIII
- VWF deficiency (Von Willebrand’s Disease)
- Factor VIII deficiency (Hemophilia A)
- Platelet dysfunction (uremia)
Hemostasis Clotting Factors
State what the following single factor products are used to treat
Factor 2 –> _____
Factor VII –>
Factor VIII –>
Factor IX –>
Topical admin only
hemophilia A, bleeding from warfarin
hemophilia A
Hemophilia B
Multiple Factor Products
- Prothrombin Complex Concentrates (PCC)
-May be ___ or ___ from ___
-Mix of several factors
A. 3 factor PCC is primarily ?
B. 4 factor PCC is primarily ?
-may contain other factors such as ?
recombinant , derived , human plasma
2, 9 , 10
2,7, 9, 10
protein S and C
Aka all the vitamin K dependent factors
Fresh frozen plasma (FFP) and Cryoprecipitate (Cryo) include which factors?
2,9,10,7, proteins S and C AND Factor 1(Fibrinogen)
ANTI-COAG Reversal AGENTS
General approaches
1. ?
2.?
- overwhelm the anticoag with PCC
works for factor 10 inhibs (Rivaroxaban), maybe not factor 2 inhibs (Dabigatran)
- Neutralize the anticoag
Effect of PCC Is limited by?
Why is the reversal of Dabigatran or factor 2 inhibs not very effective?
the factor duration
Factor 2 inhibs have a v long half life of 72 hrs
REVERSAL OF DABIGATRAN
- what drug is used?
-It is a ___
-Binds and _____
-Has NO EFFECT on any other ___
Idarucizumab
monoclonal antibody
inactivates dabigatran
anticoag
Reversal of FACTOR 10A Inhibs
1. what drug?
2. What is it?
3. Binds and inactivates ?
4. duration and cost?
5. May also inhibit?
6. What’s the risk of thrombosis after use as compared to PCC?
- andexanet alfa
- recombinant factor Xa decoy protein
- factor Xa inhibitors
- short duration of 4 hrs, high cost
- tissue factor pathway inhibitor (TFPI)
- 10% as compared to 5% for PCC
reversal of HEPARIN
1. WHat drug
2. on its own , has a WEAK ____ (inhibs ___)
3. Chemically _____. better at neutralizing __ than ___
4. heparin is an ___, ___ charged
5. Protamine is a ___
6. together they bind each other and no longer activate ___
- protamine
- anticoag effect , thrombin
- neutralizes heparin . UFH, LMWH
- acid, negatively
- base , positively charged
- ATIII
Reversal of Almost Everything
- What drug?
- Synthetic molecule capable of?
- Binds and inactivates __ and ___ and ____
- NOT FDA APPROVED YET
- Ciraparantag
- hydrogen bonding
- heparin, factor Xa, factor 2a inhibitors
what do you use to reverse warfarin?
Why is this fast but temporary?
PCC or FFP
Warfarin only depletes your clotting factors, it doesnt all the way eliminate them. As soon as u give pt more factors, they are back to normal. However, this is only temp because warfarin has a long half life, so your liver is still not making factors at the rate that’s needed to keep up with body’s needs
To combat fast+temporary reversal, use ____ to reverse warfarin in a SLOW but DURABLE manner
- Admin restores?
- Allows synthesis of ??
phytonadione (Vitamin K)
- Vitamin K reserve
- Functional clotting factors 2,7,9,10, s, c
Anti-Fibrinolytics : Inhibition of Fibrinolysis (break down blood clots –>bleeding)
Name 2 drugs that block the activity of plasmin
MOA? (2)
Clinical use?
Can be administered?
Aminocaproic acid + Tranexamic Acid
Competitive inhibitors of plasminogen and plasmin
-stabilizes clots in all patients, even if not taking anticoags
control of bleeding from various causes (surgical, dental, traumatic)
- IV, PO, topically
