Lec 31 : Fibrinolytics, Anticoagulants, Antiplatelets Flashcards
What are the two management options for immediate initiation of reperfusion therapy in MI patients?
percutaneous coronary intervention (PCI)
fibrinolysis
The following are true regarding MI therapeutics EXCEPT
a. Antithrombotic therapy is given to prevent rethrombosis
b. Beta-blocker therapy is given to prevent recurrent ischemia
c. ACE inhibitor therapy is given to promote compensatory remodeling.
d. B & C
e. NOTA
c.
ACE inhibitors are given to PREVENT remodeling.
What are the usual components of dual antiplatelet therapy?
aspirin + clopidogrel
Fibrin-specific fibrinolytic with a short half-life
a. streptokinase
b. alteplase
c. reteplase
d. tenecteplase
e. rivaroxaban
b. alteplase - tissue-type plasminogen activator
What are the differences of reteplase (recombinant PA) with alteplase (tissue PA)
reteplase
- less fibrin selective
- longer half-life
- lacks kringle-1, finger, and growth factor domains
Dosage administration of streptokinase
1.5 million units over 60 minutes
True of tenecteplase EXCEPT
a. longer plasma half-life
b. requires multiple dosage administration
c. 14x more fibrin specific
d. 80x higher resistance to inhibition
e. NOTA
b.
Since it has longer HL, only a single IV bolus injection is required.
List 4 indications of fibrinolysis.
acute MI
acute ischemic stroke
severe DVT
pulmonary embolism
The following can be given in case of fibrinolytic overdose EXCEPT.
a. aminocaproic acid
b. aprotinin
c. tranexamic acid
d. protamine
e. NOTA
d. protamine
Protamine is a heparin inhibitor and is used to control bleeding.
Contraindications of fibrinolytic inhibitors
disseminated intravascular coagulation
genitourinary tract bleeding
T/F: Direct thrombin inhibitors binds to antithrombin.
F
Indirect TIs are the ones that bind to antithrombin to inactivate factor IXa, factor Xa, or thrombin.
The following are direct thrombin inhibitors EXCEPT
a. enoxaparin
b. lepirudin
c. argatroban
d. coumadin
e. NOTA
a. enoxaparin
Enoxaparin is a low molecular weight heparin that indirectly inhibits thrombin.
The two most common side effects of heparin-derived anticoagulants
thrombocytopenia
hemorrhage
This is the first oral factor Xa inhibitor.
rivaroxaban
This is an L-arginine analogue used for patient with heparin-induced thrombocytopenia.
a. lepirudin
b. argatroban
c. bivalirudin
d. dicumarol
e. warfarin
b. argatroban
lepirudin & bivalirudin - hirudin analog
dicumarol & warfarin - vitamin K analog / vitamin K depleter
