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Pharmacology > Lecture 22: Anticoagulants and Hemostatic Agents > Flashcards

Lecture 22: Anticoagulants and Hemostatic Agents Flashcards

1
Q

A functional clotting system depends on what 3 things

A
  1. Production of clotting factors
  2. Functional platelets
  3. Fibrinolysis
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2
Q

Describe the intrinsic coagulation pathway to the common pathway

A
  1. Factor XII
  2. Factor XI
  3. Factor IX
  4. Factor VIII
  5. Factor X (start of common pathway), forms complex with factor V
  6. Factor II-thrombin
  7. Factor I-fibrinogen
  8. Clot formation
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3
Q

Describe the extrinsic pathway to the common pathway

A
  1. Tissue factor
  2. Factor VII
  3. Factor X, forms complex with factor V (start of common)
  4. Factor II-thrombin
  5. Factor I- fibrinogen
  6. Clot formation
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4
Q

What are the 4 vitamin K dependent clotting factors

A

II, VII, IX, X

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5
Q

What are some indications for anticoagulants in hyeprcoaguable/ thromboembolic states

A
  1. Cats with hypertrophic cardiomyopathy
  2. Dogs with IMHA
  3. Dogs with Cushing disease
  4. Animals with acute phase inflammation
  5. Protein losing nephropathy
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6
Q

How do cats with HCM initiate hypercoaguable states

A

Form blood clots in Left atrium—> left ventricle and can enter circulation causing saddle thrombi or even travel to the brain

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7
Q

How do dogs with IMHA cause hypercoaguable states

A

Activate coagulation system

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8
Q

How do animals with Cushing disease cause a hypercoaguable state

A

More fibrinogen floating around

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9
Q

How do animals with acute phase inflammation cause hypercoaguable states

A

More clotting factors

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10
Q

How do animals with protein losing nephropathy cause hypercoaguable states

A

Podocytes damaged causing anti-thrombin III to leak out

Antithrombin III important to keep thrombin from spontaneously going off in blood

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11
Q

What are some indications for coagulants in hypocoaguable states

A
  1. Post sx trauma
  2. Intoxication
  3. Genetic bleeding disorders
  4. Liver dysfunction
  5. Liver failure
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12
Q

How does liver dysfunction and failure lead to hypocoaguable states

A

Can’t make clotting factors

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13
Q

What part of coagulation system does warfarin sodium impact

A

Production of clotting factors

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14
Q

What is warfarin sodium indicated for

A

Prophylactic treatment of thrombotic conditions (HIGHLY CONTROVERSIAL)

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15
Q

What is the mechanism of action for warfarin

A

Blocks vitamin K reductive so can’t properly form clotting factors

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16
Q

Warfarin is associated with ___ with anemia

A

Fatal hemorrhage

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17
Q

___ can form in any system when patient is treated with warfarin sodium

A

Hematomas

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18
Q

Warfarin sodium requires frequent monitoring of ___

A

Prothrombin time

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19
Q

T or F: dogs easily develop tolerance with warfarin sodium

A

True

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20
Q

Where in the coagulation system does vitamin K1 impact

A

Clotting factors- promotes clotting

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21
Q

What are some indications for Vitamin K1

A
  1. Rodenticide or moldy sweet clover
  2. Prolonged sulfonamide to of birds with coccidosis
  3. Congenital vitamin k dependent coagulopathy
  4. Porcine hemorrhagic syndrome
22
Q

Will vitamin K1 help with chronic liver failure, why or why not

A

It won’t, liver failure patients don’t make clotting factors so vitamin K can’t activate them

23
Q

What are the pharmacodynamics of vitamin K

A

Conjugated to newly synthesized y-glutamyl carboxylase in liver by enzyme dl-diaphorase that makes new y-glutamyl carboxylase which is needed to form clotting factors

24
Q

What is the Vd of vitaminK1 like

A

Low, binds to chylomicrons and concentrates in liver

25
Q

What is enoxaparin sodium and dalteprin sodium

A

Low molecular weight heparin fraction

26
Q

Where does heparin, enoxaparin sodium and datleparin sodium act in coagulation system

A

Prevent clotting factors from clotting

27
Q

what is the reversal agent for heparin

A

Protamine sulfate

28
Q

IM and deep SQ administration of heparin can cause __

A

Hematomas

29
Q

Heparin requires the presence of __ to work

A

Anti-thrombin III

30
Q

What is the bleeding risk associated with heparin use

A

10% of dogs with IMHA (promotes hypercoagulation) had bleeding incidents after treatment with low molecular weight heparin fraction

31
Q

Nonspecific binding of heparin to platelets can cause what

A
  1. Immune mediated thrombocytopenia and platelet activation
  2. RBC agglutination in horses
32
Q

What is the mechanism of action of rivaroxaban

A

Competitively inhibits Factor Xa

33
Q

T or F: rivaroxaban, unlike heparin, does not require anti-thrombin III to work

A

True

34
Q

Where in the coagulation system does acetylsalicyclic acid affect

A

Platelet function

35
Q

What is the pharmacodynamics of acetylsalicyclic acid

A

Irreversible inhibition of COX1 preventing thromboxane A2 (TxA2) production

36
Q

What are some toxicities associated with acetylsalicyclic acid

A
  1. Overdose- life threatening metabolic acidosis, depression, vomiting, hyperventilation, hyperthermia
  2. GI ulceration (block PG synthesis)
  3. Nephrotoxicity (especially in horses with colic or on antibiotics)
37
Q

What are some contraindications for acetylsalicyclic acid

A
  1. Cats
  2. Bleeding disorders
  3. Kidney insufficiency
  4. Liver insufficiency
  5. Upcoming sx
38
Q

Where in coagulation system does clopidogrel bisulfate act

A

Platelet formation

39
Q

What are the pharmacodynamics of clopidogrel bisulfate

A

Irreversible inhibition of the platelet ADP receptor

40
Q

In order for clopidogrel bisulfate to be absorbed it requires a __ pH

A

Low

41
Q

What are the general pharmacodynamics of topical platelet forming drugs

A
  1. Activate patient platelets
  2. Inject fibrinogen and activating agent to cause quick clot/gel formation
42
Q

What is collasate

A

Topical type I collagen foam to activate platelets

43
Q

How does collasate work

A

Activates platelets by binding to their collagen receptor

44
Q

At what point in the coagulation system does tissue plasminogen activator act

A

Fibrinolysis

45
Q

What is tissue plasminogen activator indicated for

A
  1. Pulmonary thromboembolism
  2. Arterial thromboembolism
46
Q

What are 2 examples of anti-fibrinolytic drugs

A
  1. Aminocaproic acid
  2. Tranexamic acid
47
Q

What is aminocaproic acid used for

A

Post surgical bleeding in dogs and guttural pouch bleeding in horses

48
Q

What is tranexamic acid used for

A

Post sx bleeding in dogs and cats

49
Q

T or F: tranexamic acid is more effective than aminocaproic acid

A

True

50
Q

Are the following hemostatics or anticoagulants: collasate, vitamin K, aminocaproic acid, tranexamic acid

A

Hemostatics

51
Q

Are the following hemostatics or anticoagulants: tissue plasminogen activator, clopidogrel, aspirin, heparins, rivaroxaban, warfarin

A

Anticoagulants

Pharmacology (14 decks)

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