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Haematology and Immunology Block > L28 - Anticoagulant therapy > Flashcards

L28 - Anticoagulant therapy Flashcards

1
Q

Name the three classes of antiplatelet drugs

A

Cyclooxygenase inhibitor
ADH receptor antagonist
Glycoprotein IIb, IIIa receptor inhibitors

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2
Q

What is the mode of action of aspirin

A

Inhibits cyclooxygenase
Decrease TXA2
Decresae platelet aggregation

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3
Q

What is the clinical usage of aspirin

A

Myocardial infaction and stroke

Use in combination with ADH receptor anatgonist in stenting and coronary angioplasty

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4
Q

What are the side effects of aspirin

A

Risk of prolonged bleeding and increase incidence of gastric irritation and bleeding

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5
Q

What are the two examples of ADH receptor antagonist

A

Clopiogrel

Prasugrel

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6
Q

What is the mode of action of ADH receptor anatogonist

A

Inhibit ADH pathway

Decrease platelet aggregation

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7
Q

What is the clinical usage of ADH receptor anatgonist

A

Use in patient who can’t tolerant aspirin

Use in combination with aspirin for stenting and coronary angioplasty

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8
Q

What are the examples of glycoprotein IIb, IIIa receptor inhibitors

A

Abciximab

Eptifitabine, tirofiban

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9
Q

What is abciximab?

A

It is a monoclonal antibodies binding IIb/ IIIa receptor

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10
Q

What are eptifibatine and tirobatine

A

reversible inhibitors for IIb and IIIa receptor

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11
Q

What are the mode of action of IIb/ IIIa receptor antagonist

A

IIb/ IIIa are finial commmon pathway for activation of platelets (binding to fibrinogen)
IIb/ IIIa inhibit that

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12
Q

What is the clinical usage of glycoprotein IIb/ IIIa receptor antagonist

A

Stenting and coronary angioplasty

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13
Q

What are APTT and PT used for in monitoring drug usuage

A

APTT: heparin
PT: warfin

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14
Q

What are the pharmacological properties of heparin (short term? long term? cross placenta?)

A

Intermediate - short term use

Doesn’t cross placenta

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15
Q

What are the usuage of heparin?

A

Stenting and coronary angioplasty

Myocardial infarction

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16
Q

What are the side effects and contraindication of heparin

A

Bleeding
Haemophilia
Hypersensitivity reaction

17
Q

What is the pathogenesis of HIT

A

Antibody development
Target against heparin
Decrease in paltelet, thrombosis

18
Q

What is the treatment for HIT

A

Removal of heparin treatment
Protamine sulphate -> combined with heparin as a stable complex
Direct thrombin inhibitor

19
Q

What is the mode of action of heparin

A

It allow stronger binding of antithrombin to factor X and thrombin
Inhibit the coagulation pathway

20
Q

Give two other relatives of heparin

A

Exonaparin

Fondaparinux

21
Q

Give three examples of direct thrombin inhibitor

A

Oral - dabigatron

Parenteral - hirudin, lepirudin, argatroban

22
Q

What is the mode of action of thrombin inhibitor

A

Inhibition of thrombin -> decrease fibrin production and platelet activation -> no clot is produced

23
Q

Give an example of direct factor Xa inhibitor

A

Rivaroxaban, apixaban

24
Q

What is the mode of action of warfin

A

It is structually similar to vitamin K, acting as an antagonist

25
Q

How is warfin metabolised

A

Heavily protein bound an by liver cytochrome P450 enzmye

26
Q

What are the clinical uses of Warfin

A

Short term: prevent venous thrombosis and pulmonary embolism
Long term: atrial fibrillation –> reduction of thrombosis
prosthetic heart valve –> clot formation

27
Q

What are the adverse effects of warfin

A

Bleeding
Cross placenta
Interaction with significant number of drugs

28
Q

How to reverse warfin toxicity

A

Dtop using the drugs

Prescribe vitamin K1

29
Q

Name the four types of thrombolytic drugs and their pharmacological properties/ mode of action

A

Streptokinase - form comple with proactivator complex => conversion of plasminogen to plasmin => plasmin break down fibrin
Anitreplase - streptokinase plasminogen complex
Urokinase -enzymatic activity -> convert plasminogen to plasmin
tPa -> direct activation of plasminogen -> plasminogen to plasmin -> plasmin breaks down fibrin

30
Q

What are the therapeutic use of thrombolytic drugs

A

Multiple pulmoanry emboli, central deep venous thrombosis, acute myocardial infarction

31
Q

What is the adverse effect of thrombolytic drugs

What can the side effect be treated with

A

Bleeding

Tranexamic acid or fresh plasma or coagulation factor

32
Q

What are the source of vitamin K

A

K1 - green vegetables

K2 - bacteria in the human gut

33
Q

Give two examples of fibrinolytic inhibitors

A

Aminocaproic acid

Tranexamic acid

34
Q

What is the mode of action of fibrinolytic inhibitors

A

competitor inhibitor of plasminogen activation

Haematology and Immunology Block (8 decks)

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