L 18 Anti Coagulants

Question 1

What is Blood Hemostasis?

Answer 1

regulated process of maintaining blood fluidity

Question 2

What is primary hemostasis?

Answer 2

platelet plug

Question 3

What is secondary coagulation?

Answer 3

thrombus

-> fibrin containing blood clot

Question 4

What is Fibrinolysis?

Answer 4

degradation of blood clot

Question 5

What is TXA2?

Answer 5

synthesized from arachidonic acid by COX1

potent vasoconstrictor
platelet activator

Question 6

What results in fibrinogen binding?

Answer 6

conformational change in Glycoprotein 2b/3a receptor

Question 7

What role does Vitamin K play?

Answer 7

secondary hemostasis

cofactor in the maturation of clotting factors

Question 8

What is Secondary Hemostasis?

Answer 8

thrombin activation

deposition of fibrin fibers to stabilize platelet plug

Question 9

What role does Thrombin play in coagulation cascade?

Answer 9

final target

stabilizes the clot

Question 10

What is t-PA?

Answer 10

secreted by endothelial cells

converts
plasminogen > plasmin

Question 11

What do thrombolytic drugs do?

Answer 11

mimic pathway

t-PA
Plasminogen
Plasmin
Plasmin degrades fibrin
break up clots

Question 12

What is Thrombomodulin?

Answer 12

binds thrombin

inactivation of Factors 10, 13

Question 13

What is Prostacyclin?

Answer 13

inhibits

platelet degranulation
aggregation
vasoconstriction

Question 14

What is Antithrombin 3?

Answer 14

inactivates clotting factors

Question 15

What is the main SE of Anti-thrombotic drugs?

Answer 15

hemorrhage risk

Question 16

What do Antiplatelet drugs do?

Answer 16

prevent primary hemostatic plug formation

Question 17

What do Anticoagulant drugs do?

Answer 17

inhibit clotting cascade

prevent fibrin clot formation

Question 18

What do Thrombolytics do?

Answer 18

digest fibrin to break up existing clot

Question 19

What are the Antiplatelet drugs?

Answer 19

Aspirin

Clopidogrel
Ticlopidine

Abciximab
Eptifibatide

Dipyridamole

Question 20

What is Aspirin MOA?

Answer 20

selectively inhibits TXA2 synthesis

by

irreversible acetylation of COX-1 enzyme

Question 21

What does a high dose of Aspirin do?

Answer 21

inhibition of prostacyclin

Dec efficacy of ASA therapy

Question 22

What is the Antiplatelet drug of choice?

Answer 22

Aspirin

Question 23

What are Aspirin SE?

Answer 23

resistance

inc incidence of hemorrhagic stroke

GI bleed

tinnitus

Question 24

What is Aspirin’s contraindications?

Answer 24

in children and adolescents accompanying viral illnesses

leads to Reyes syndrome

Question 25

What is Clopidogrel MOA?

Answer 25

irreversible inhibitor of P2Y12 receptor

Question 26

Clopidogrel therapeutic uses?

Answer 26

``` reduction rate of: stroke MI unstable angina death in pt w/ recent MI or stroke ``` PAD Acute Coronary Syndrome

Question 27

What drug is Clopidogrel equivalent to?

Answer 27

Apririn in prevention of stroke

Question 28

Clopidogrel adverse effects?

Answer 28

hemorrhage TTP CYP2C19 poor metabolizers have Inc risk of tx failure

Question 29

What is Ticlopidine MOA?

Answer 29

P2Y12 irreversible inhibitor

Question 30

Ticlopidine therapeutic uses?

Answer 30

standard in combo w/ ASA to prevent stent thrombosis

Question 31

Ticlopidine adverse effects?

Answer 31

nausea/ vomit diarrhea hemorrhage neutropenia severe TTP

Question 32

What is | Abciximab & Epitifbatide MOA?

Answer 32

GP 2b/3a inhibitors

Question 33

What are therapeutic uses of Abciximab & Epitifbatide?

Answer 33

w/ ASA & heparin tx coronary thrombosis or during coronary angioplasty reduces restenosis recurrent MI

Question 34

Abciximab & Epitifbatide adverse effects?

Answer 34

hemorrhage thrombocytopenia

Question 35

Between Abciximab & Epitifbatide, what drug is preferred? Why?

Answer 35

Abciximab is preferred in renal disease Eptifibatide is eliminated by kidney

Question 36

What is Dipyridamole MOA?

Answer 36

inhibits PDE - > inhibits thrombus formation - > inhibits adenosine uptake

Question 37

What is Dipyridamole therapeutic use?

Answer 37

combo w/ ASA prevent cerebrovascular ischemia

Question 38

What drugs are Anticoagulants?

Answer 38

Direct Thrombin Inhibitors HMW Heparin LMW Heparin Fondaparinux

Question 39

What can't Anticoagulants do?

Answer 39

dissolve a thrombus that has already formed like anti platelets

Question 40

What drug is a Direct Thrombin Inhibitor?

Answer 40

Dabigatran Etexilate

Question 41

What is Dabigatran Etexilate MOA?

Answer 41

converted to active form binds to exosite 1 on thrombin -> prevents fibrinogen cleavage to mature fibrin

Question 42

Dabigatran Etexilate therapeutic uses?

Answer 42

prevent stoke in pt w/ atrial fib DVT Pul Embolism equal efficacy to warfarin

Question 43

What are the benefits of Dabigatran Etextilate?

Answer 43

no pt monitoring rapid onset less SE

Question 44

Dabigatran Etexilate adverse effects?

Answer 44

hemorrhage heartburn stomach upset