Hemostatics and Anticoagulants Flashcards
Aspirin
antiplatelet used as prophylaxis in patients at risk for clot formation…irreversibly
inhibits COX-1 formation of TxA2…risk for bleeding is increased when combined
with SSRIs or NSRIs; low dose = antiplatelet, high dose = NSAID
Clopidrogel
antiplatelet irreversibly inhibits binding of ADP to its P2Y12 receptor;
TTP possible side effect; prodrug metabolized by CYP2C19
Ticlopidine
antiplatelet irreversibly inhibits P2Y12R…combined with ASA, nonlinear pharmacokinetics; prodrug activated by CYP…side effect is severe neutropenia
Abciximab
antiplatelet Fab Ab inhibitor of fibrinogen binding of GpIIb/IIIA receptor
Ebtifibatide
antiplatelet peptide inhibitor of fibrinogen binding of GPIIb/IIIA receptor
Dipyridamole
antiplatelet PDE inhibitor (cAMP), inhibits adenosine reuptake; vasodilator…combine with ASA to prevent cerebrovascular ischemia
Dabigatran
anticoagulant binds thrombin (IIa) to prevent fibrin formation…less monitoring than with warfarin; stroke prevention in patients with A-fib, DVT, PE
Hirudin
anticoagulant irreversible thrombin inhibitor (isolated from leeches)…used for patients with heparin induced thrombocytopenia
Argatroban
anticoagulant reversible thrombin inhibitor…used for patients with heparin induced thrombocytopenia
Bivalirudin
anticoagulant reversible thrombin inhibitor…used for patients with coronary angioplasty
Heparin
anticoagulant works by ENHANCING (1000x) Antithrombin-III binding of Factors
IIa (thrombin), IXa, & Xa as well as TFPI binding of TF-FVII complex…does NOT cross placenta (vs. Coumadin); OD treated with protamine sulfate…HMW given IV/SC (too large for GI to absorb); LMW (Dalteparin) inhibits only Factor Xa
Rivaroxaban
anticoagulant blocks factor Xa to modulate thrombin generation…used for prevention of thromboembolism & DVT
Warfarin
anticoagulant blocks carboxylation of glu residues by Vitamin K epoxide reductase (II, VII, IX, X)…crosses placenta and causes fetal warfarin syndrome…requires continuous monitoring of PT, treat OD with vit K; increased by aspirin, antibiotics, vit K def., hypoglycemics; decreased by alcohol abuse, contraceptives, OCPs, barbiturates
Antithrombin III
inactivates Factors II, VII, IX, X, XII; enhanced by heparin
Tissue Factor Pathway Inhibitor
forms complex with TF-FVII, inactivating it
enhanced by heparin
Thrombomodulin
promotes thrombin-mediated activation of Protein
C/S, leading to inactivation of Factors V and VIII
Protein C/S
cleave Factors V and VIII
Prostacyclin
prevents platelet aggregation, degranulation, and vasoconstriction
t-PA
tissue plasminogen activator, promotes conversion of
plasminogen to plasmin which can then cleave fibrin
Strept(okin)ase
thrombolytic catalyzes conversion of plasminogen to plasmin throughout circulation (not just at clot)…used for acute MI, stroke, DVT, PE
Alteplase (t-PA)
thrombolytic activates conversion of plasminogen bound to fibrin @ the site of clot
Reteplase
thrombolytic less fibrin (clot)-specific than tPA
Tenecteplase
thrombolytic more fibrin(clot)-specific than tPA
Vitamin K1
counteracts excess warfarin or vit K def. (esp. in newborns)
Lyophilized Factor VIII
used for Factor VIII Deficiency (Hemophilia A)
Desmopressin acetate
used to increase factor VIII activity in Hemophilia A
Fibrinogen cryoprecipitate
used in fibrinogen deficiency
Ferrous sulfate, gluconate, fumarate
used for iron deficiency anemia…treatment should be continued for 3-6 months after anemia resolves to replenish
iron stores…antacids INHIBIT absorption of iron whereas Vitamin C PROMOTES absorption of iron
Cyanocobalamin
vit. B12 supplement injected IM every 4 weeks
Hydroxocobalamin
vit. B12 supplement injected IM as a single dose to maintain plasma B12 for months
Folic acid
oral tablets given for folate def. anemia and sickle cell
anemia
Folinic acid
used to counter adverse effects of antifolate therapy in cancer patients
Erythropoietin (EPO)
stimulates production of RBCs, normally made in kidneys
