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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
What is enoxaparin sodium and dalteprin sodium
Low molecular weight heparin fraction
26
Where does heparin, enoxaparin sodium and datleparin sodium act in coagulation system
Prevent clotting factors from clotting
27
what is the reversal agent for heparin
Protamine sulfate
28
IM and deep SQ administration of heparin can cause __
Hematomas
29
Heparin requires the presence of __ to work
Anti-thrombin III
30
What is the bleeding risk associated with heparin use
10% of dogs with IMHA (promotes hypercoagulation) had bleeding incidents after treatment with low molecular weight heparin fraction
31
Nonspecific binding of heparin to platelets can cause what
1. Immune mediated thrombocytopenia and platelet activation 2. RBC agglutination in horses
32
What is the mechanism of action of rivaroxaban
Competitively inhibits Factor Xa
33
T or F: rivaroxaban, unlike heparin, does not require anti-thrombin III to work
True
34
Where in the coagulation system does acetylsalicyclic acid affect
Platelet function
35
What is the pharmacodynamics of acetylsalicyclic acid
Irreversible inhibition of COX1 preventing thromboxane A2 (TxA2) production
36
What are some toxicities associated with acetylsalicyclic acid
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
What are some contraindications for acetylsalicyclic acid
1. Cats 2. Bleeding disorders 3. Kidney insufficiency 4. Liver insufficiency 5. Upcoming sx
38
Where in coagulation system does clopidogrel bisulfate act
Platelet formation
39
What are the pharmacodynamics of clopidogrel bisulfate
Irreversible inhibition of the platelet ADP receptor
40
In order for clopidogrel bisulfate to be absorbed it requires a __ pH
Low
41
What are the general pharmacodynamics of topical platelet forming drugs
1. Activate patient platelets 2. Inject fibrinogen and activating agent to cause quick clot/gel formation
42
What is collasate
Topical type I collagen foam to activate platelets
43
How does collasate work
Activates platelets by binding to their collagen receptor
44
At what point in the coagulation system does tissue plasminogen activator act
Fibrinolysis
45
What is tissue plasminogen activator indicated for
1. Pulmonary thromboembolism 2. Arterial thromboembolism
46
What are 2 examples of anti-fibrinolytic drugs
1. Aminocaproic acid 2. Tranexamic acid
47
What is aminocaproic acid used for
Post surgical bleeding in dogs and guttural pouch bleeding in horses
48
What is tranexamic acid used for
Post sx bleeding in dogs and cats
49
T or F: tranexamic acid is more effective than aminocaproic acid
True
50
Are the following hemostatics or anticoagulants: collasate, vitamin K, aminocaproic acid, tranexamic acid
Hemostatics
51
Are the following hemostatics or anticoagulants: tissue plasminogen activator, clopidogrel, aspirin, heparins, rivaroxaban, warfarin
Anticoagulants

Pharmacology (14 decks)

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