Lec 11-12 Pharm anti-coagulants

Question 1

What is action of unfractionated heparin?

Answer 1

binds antithrombin [AT] –> makes it more active in its ability to inactivate thrombin [II], IX, X, XI, XII

mostly thrombin and X

Question 2

How is unfractionated heparin administered?

Answer 2

parenterally [IV or subQ]

Question 3

What is half life of heparin?

Answer 3

1 hours

Question 4

Do you have to monitor unfractionated heparin? how?

Answer 4

monitor by PTT

Question 5

What are complications of heparin?

Answer 5

• bleeding
• heparin induced thrombocytopenia –> thrombosis
• osteopenia + osteoporosis
• allergy

Question 6

What is antidote to unfractionated heparin?

Answer 6

protamine sulfate

Question 7

How does HIT happen?

Answer 7

get antibodies against heparin - platelet factor 4 complex

Question 8

How can you test for HIT?

Answer 8

heparin-platelet factor 4 antibody

serotonin release assay

Question 9

What is action of low molecular weight heparin [LMWH]?

Answer 9

inhibit factor X rather than thrombin [II]

Question 10

Do you have to monitor LMW heparin? how?

Answer 10

nope!

Question 11

What is half life of LMWH?

Answer 11

3-18 hrs = longer than unfractionated

Question 12

Can you get HIT with LMWH?

Answer 12

yep but less likely

Question 13

Can you use protamine to reverse the effects of LMWH?

Answer 13

nope

Question 14

What is fondaparinux?

Answer 14

synthetic inhibitor of factor X

Question 15

What is warfarin?

Answer 15

oral anti-coagulant –> inhibits epoxide reductase and thus creates vit K deficiency

Question 16

What is 1/2 life of warfarin?

Answer 16

36-42 hours

Question 17

How do you monitor warfarin?

Answer 17

PT/INR

Question 18

What are 3 complications of warfarin?

Answer 18

• bleeding
• warfarin skin necrosis
• teratogen

Question 19

What are the 2 direct thrombin inhibitors?

Answer 19

lepirudin

argatroban

Question 20

What is lepirudin?

Answer 20

derived from leeches; binds directly to thrombin at catalytic site

direct thrombin inhibitor

Question 21

Who should you give lepirudin?

Answer 21

pts with HIT

Question 22

What drugs are safe for HIT?

Answer 22

• lepirudin

- argatroban

Question 23

What is argatroban?

Answer 23

synthetic thrombin inhibitor

direct thrombin inhibitor

Question 24

What is the use of new oral anticoagulants [NOACs]?

Answer 24

treatment of non-valvular Afib, deep venous thrombosis, pulmonary thrombosis

Question 25

What is the mech of action dabagitran?

Answer 25

thrombin IIa inhibitor

Question 26

What are the 3 factor Xa inhibitors?

Answer 26

edoxaban apixaban riveroxaban

Question 27

Do the new oral anticoagulants require monitoring?

Answer 27

nope!

Question 28

WHat is use of thrombolytic agents?

Answer 28

dissolve existing thrombi - treat acute MI - massive PE - peripheral artery occlusion

Question 29

What is action of thrombolytics?

Answer 29

convert plasminogen to plasmin

Question 30

What are the 3 thrombolytics?

Answer 30

- streptokinase - urokinase - tPA

Question 31

What are the 4 drugs that inhibit ADP receptor P2Y12 on platelets and thus prevent aggregation?

Answer 31

- ticlopidine - clopidogrel - prasugrel - ticagrelor

Question 32

What are the 3 drogs that block the a2b3 platelet receptor and thus preven fibrinogen binding platelets?

Answer 32

- abciximab - eptifibitide - tirofiban

Question 33

What is the mech of action aspirin?

Answer 33

irreversible inhibitor of cyclooxygenase --> impaired TXA2 production and platelet aggregation