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Pharmacology I > Lecture 29 - Anticoagulants + Hemostatic > Flashcards

Lecture 29 - Anticoagulants + Hemostatic Flashcards

1
Q

What are examples of hypercoaguable states?

A 
Hypertrophic cardiomyopathy 
IMHA 
Cushing's disease 
Acute phase inflammation 
Protein-losing nephropathy
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2
Q

What are examples of a hypocoaguable state?

A

post-surgery
Genetic bleeding disorders
Liver failure

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3
Q

What are the three necessary components of a functional clotting system?

A

Production of clotting factors
Functional platelets
Break down of clots

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4
Q

What is the breaking down of blood clots called

A

Firbinolysis

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5
Q

What interacts with blotting factors to induce the coagulation cascade?

A

Platelets

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6
Q

What are the factors within the intrinsic pathway?

A

12 - 11 - 9 - 8

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7
Q

What are the factors within the extrinsic pathway?

A

Tissue factor - 7

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8
Q

Where are the extrinsic molecules located?

A

Wall of the blood vessel

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9
Q

What tests the extrinsic pathway?

A

PT

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10
Q

What tests the intrinstic pathway?

A

aPTT

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11
Q

What is part of the common pathway?

A

Factor 10

2 - 1

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12
Q

What is factor 2 known as?

A

Thrombin

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13
Q

What is factor I known as?

A

Fibrinogen

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14
Q

What does fibrinogen do?

A

Polymerizes into a clot

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15
Q

What are the factors that depend on Vitamin K?

A

2 - 7 - 9 - 10

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16
Q

How does vitamin K activate certain Factors in the coag pathway?

A

Reduced –> Oxidized state

with y-glutamyl carboxylase

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17
Q

What recycles y-glutamyl carboxylase back to reduced form?

A

Vitamin K epoxide reductase

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18
Q

What is warfarin used in, in an extra-label use manner?

A

Food animals + Horses

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19
Q

how is warfarin distributed throughout the body?

A

Via plasma protein

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20
Q

What are the differences that you see in 1/2 life of warfarin?

A

extremely long in cats

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21
Q

How is warfarin metabolized?

A

Hepatic

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22
Q

How is warfarin excreted?

A

Urine + Feces

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23
Q

Why is the use of warfarin complicated?

A

Very small theraputic index

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24
Q

What is seen with warfarin toxicity?

A

Fatal hemorrhade w/ anemia
Hematomas all over
Congenital malformation in dogs + cats

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25
Q

What are therapeutic complications seen with warfarin use?

A

Dogs tolerant within a month
Need frequent testing of PT
Drug interactions

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26
Q

When do you see warfarin toxicity?

A

Antirodenticides

Moldy sweet clover + Sweet vernal hay

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27
Q

What is the biggest problem when it comes to warfarin toxicity in AZ?

A

Sweet clover

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28
Q

Where does warfarin affect the coag pathway?

A

Vit. K epoxide reductase

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29
Q

Why does giving Vitamin K in Warfarin toxicity help the animal?

A

Concentration of Vitamin K now high enough it can bypass the reductase and use DL-diaphorase instead

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30
Q

When, besides warfarin toxicity, is Vitamin K used for treatment?

A

Chronic sulfonamide treatment of birds for coccidiosis
Congenital, vit. K dependent coagulopathy
Porcine hemorrhagic syndrome

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31
Q

Why wont Vitamin K adminstration help animals in chronic liver failure?

A

The enzyme used to bypass the system is no longer being made in high enough quantities to help

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32
Q

How should Vitamin K be given?

A

Dogs - with fatty meal PO

Food animals/Horses - IM/SC

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33
Q

Why is Vd of vitamin K low?

A

Bind to chylomicrons + concentrating in the liver

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34
Q

How long does it take for a therapeutic effect of Vitamin K to occur?

A

6 ot 12 hours

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35
Q

What adverse reactions are seen with vitamin K adminstration?

A

Anaphylaxis

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36
Q

What are the three types of blood products?

A

Fresh/Fresh frozen plasma
Whole blood
Packed RBC’s

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37
Q

Which of the blood products does not help with hemostasis?

A

Packed RBC’s

38
Q

What is contained within whole blood?

A

Coagulation factors, platelets, + RBC’s

39
Q

What is contained within FFP?

A

All Coagulation factors

40
Q

What is the ranking of shelf life within the blood products?

A

FFP > WB ~ Fresh plasma

41
Q

What is the risk, comparatively, of transfusion reactions wtih blood products?

A

FFP ~ FP

42
Q

What are the two types of heparin?

A

Sulfate + LMW heparin

43
Q

What is the structure of Heparin Sulfate?

A

Large glycosaminoglycan

44
Q

What is the route of administration for heparin?

A

IV

45
Q

What is the distribution of heparin?

A

Confined to the ciruclation

46
Q

What is heparin metabolized by?

A

Liver + Reticuloendothelial cells

47
Q

What is the length of therapeutic efficacy after a single dose in a dog?

A

5 to 6 hours

48
Q

What happens with IM or deep admin of heparin?

A

Hematomas

49
Q

What can cause thrombocytopenia with heparin administration?

A

Nonspecific binding of heparin to platelets

50
Q

What happens as an adverse reaction in horses due to heparin admin?

A

RBC agglutination

51
Q

What is the reversal agent for heparin?

A

Prothamine sulfate

52
Q

What are the adverse effects of prothamine?

A

Pulmonary hypertension + Hypersensitivity rxn + Vascular hypotension + Bradycardia

53
Q

What are the four steps to clot activation?

A

Injury + Initiation + Extension + Stabilization

54
Q

At what step in clot activation does thrombin come in?

A

Extension

55
Q

What is released by endothelial cells when injury occurs?

A

PGI + NO

CD39 on surface

56
Q

With aspirin administration what do you have to keep in mind when giving it to a wind range of animals?

A

Only works in monogastrics

57
Q

What is the distribution of acetylsalicylic acid within the body?

A

Plasma protein binding

58
Q

What is acetylsalicylic acid converted to once in the body?

A

Salicylate

59
Q

What time of metabolism does acetylsalicylic acid go through?

A

Modified by 2nd pass mechanisms

60
Q

What occurs in cats given acetylsalicylic acid ?

A

Prolonged half life due them lacking the glucoronylation pathway

61
Q

How is acetylsalicylic acid eliminated?

A

Renal

62
Q

Acetylsalicylic acid 1/2 life: Dogs

A

8 hours

63
Q

Acetylsalicylic acid 1/2 life: Cats

A

38 hours

64
Q

Acetylsalicylic acid 1/2 life: Horses

A

30 min

65
Q

What happens with Acetylsalicylic acid overdose?

A

Metabolic acidosis

Depression + Vomiting + Hyperventilation + Hyperthermia

66
Q

What adverse reaction can be seen in horses with colic when given Acetylsalicylic acid ?

A

Nephrotoxicity

Even more so when horse is on aminoglycoside AB’s

67
Q

What drugs does Acetylsalicylic acid interaction?

A

Furosemide + Spironolactone
Increase clearance of corticosteroids
Increase or decrease secretion if urine pH is changed

68
Q

What is Clopidogrel being found to be great to treat?

A

Cardiogenic embolism in cats - survival rate DOUBLEd

69
Q

Where does Clopidogrel work in the pathway?

A 
Blocks receptor for platelet activation = no plug formation 
NO ADP, can't bind to R on platelet anymore
70
Q

What does Clopidogrel require to work?

A

Low pH

71
Q

What are the characteristics of the metabolism of Clopidogrel?

A

Inactive until 1st pass metabolism

72
Q

Clopidogrel 1/2: Cats

A

3 days

73
Q

Clopidogrel 1/2 life: dogs

A

3 hours

74
Q

Clopidogrel 1/2 life: horses

A
75
Q

What drug interactions are seen with Clopidogrel?

A

Proton pump inhibitors
– and –
Histamine inhibitors

76
Q

What are the two types of topicals used for the coag pathway?

A

Type 1: Activate patients platelets

Type 2: Fibrinogen + Activating agent = Quick clot/gel formation

77
Q

Describe: Collasate

A

Type I collagen foam

Activates platelets by binding to collagen receptor

78
Q

What protein is responsible for fibrinolysis?

A

Plasmin

79
Q

What activates plasmin?

A

Tissue plasminogen activators

80
Q

What are the indications for using TPa?

A

Pulmonary thormboembolism
– and –
Arterila thromboembolism

81
Q

What does the drug E-aminocaproic acid affect?

A

stops tPA from activating plasminogen

82
Q

How is E-aminocaproic acid used in horses?

A

Guttural pouch bleeding

83
Q

How is E-aminocaproic acid used in dogs?

A

Post-sx bleeding in sighthounds

84
Q

How is E-aminocaproic acid admin?

A

IV

85
Q

What are the hemostatic drug groups?

A

Topical
Systemic
Anti-fibrinolytic

86
Q

Drugs within: Topical

A

Collasate

87
Q

Drugs within: Hemostatic Systemic

A

Vitamin K
– and –
Blood + Blood components

88
Q

Drugs within: Anti-fibrinolytic

A

E-aminocaproic acid

89
Q

What are the anticoagulant drug groups?

A

Fibrinolytics
Antiplatelet drugs
Systemic

90
Q

Drugs within: Fibrinolytics

A

tPA

91
Q

Drugs within: Anti-platelet

A

Clopidogrel
– and–
Asprin

92
Q

Drugs within: Anti-coagulant Systemic

A

Heparin
– and –
Warfarin

Pharmacology I (21 decks)

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