Lecture 32 - Anticoagulants Flashcards
Of the drug classes used for thrombosis management ______ and _____ are used prohylactically, while ______ are used to dissolve thrombi.
Anticoagulants
Antiplatelets
Thrombolytics
______ drugs are used to decrease the risk of Arterial thrombus, while ______ drugs are used to decrease the risk of Venous thrombus. Keep in mind ______ is an activator of Platelets, so the drug used to prevent venous thrombi can decrease platelet activity as well.
Antiplatelet
Anticoagulant
Thrombin
_____ acting anticoagulants act immediately upon contact with blood, even in a test tube, so no clot will form. This is not true for _____ acting.
Direct acting
Indirect acting
_____ is a direct acting anticoagulant that binds antithrombin, increasing its activity. It is a water soluble molecule comprised of repeat units of d-glucaronic acid and d-glucosamine.
Heparin
Heparin undergoes ____ order elimination, so it must be frequently monitored as it is administered.
Zero order
_____ sulfate is used as an antidote to prevent hemorrhage following excess Heparin administration.
Protamine sulfate
Heparin-induced thrombocytopenia can occur in two types. Type ___ is less severe and is transient. Type ___ is much more severe and occurs about 7-10days after heparin administration –> this type results from the formation of Abs to the Heparin-Factor IV complex. These immune complexes bind receptors on _____, thereby activating them and inducing systemic thrombi formation. Treatment for this type is immediate cessation of heparin and administration of the antithrombin, ______.
Type I –> less severe
Type II –> more severe
Platelets
Argatroban
____ molecular weight Heparin (fractionated) follows First order elimination (changes in dosing are directly proportional to the bioavailable amount in the body.) Another benefit is that it is less likely to cause Type ____ heparin induced thrombocytopenia. However, this Heparin does NOT inactivate ______.
Low molecular Weight
Type II heparin-induced thrombocytopenia
Thrombin (Factor IIa)
_______ is a direct acting anticoagulant that inhibits Factor Xa. Factor Xa combines with Factor ___, and this complex acts as a Prothrombinase that cleaves Prothrombin into Thrombin. This anticoagulant can be administered ______ and does not need to be monitored.
Rivaroxaban
Factor V
Orally
______ is an anticoagulant consisting of 5 repeating Heparin units. Remember that Low molecular weight Heparin (about 15 repeating units) facilitated antithrombin inhibition of coag factors EXCEPT for thrombin. Well, this drug with even fewer Heparin repeats enhances ONLY Factor ___a inhibition by antithrombin. If it’s a heparin derivative, is it water or liposoluble?
Fondaparinux
Factor Xa
Water Soluble –> so must be injected!
Like Argatroban, _____ is an antithrombin, but unlike argatroban, it CAN be given orally.
Dabigatran
______ alpha is a Factor Xa inhibitor Antidote, and Idarucizumab is a _______ inhibitor Antidote. These are used to treat hemorrhage that results from the inhibitors. These antidotes should not be used in patients with _____ disease, and keep in mind they have short ____-___, so missing a dose could be a big issue.
Andexanet Alpha
Thrombin
Renal disease
Half-Lives
______ is the most prescribed anticoagulant in the U.S. It is an Indirect acting anticoagulant (taken orally) that inhibits production of Vit __ dependent clotting factors. It does so by inhibiting the Epoxide reductase that acts on this Vitamin. Recognize this is an indirect anticoag bc it acts in the _____, not directly on the blood.
Warfarin
Vit K
Liver
Given what Warfarin inhibits, it should make sense that reduced Vit ___ is given as an antidote. _____ time is used to monitor a patient’s coagulation when on Warfarin.
Vit K
Prothrombin time
