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BL Unit 3 > Leslie anticoag review excel > Flashcards

Leslie anticoag review excel Flashcards

1
Q

What are the 3 major classes of anti-thrombotic drugs?

A

1.) heparin and oral anticoagulants 2.) fibrinolytic agents 3.) anti-platelet agents

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2
Q

What do heparin and oral anticoagulants do?

A

interfere with coag cascade and prevent thrombin formation

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3
Q

What do the fibrinolytic agents do?

A

Lyse clots by increasing formation of plasmin

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4
Q

What do anti-platelet agents do?

A

Inhibit formation of platelet products or block platelet adhesion

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5
Q

What are the 3 types of heparins?

A

Unfractionated, low molecular weight, fondaparinux

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6
Q

What is heparin made from?

A

Pig intestines

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7
Q

What does heparin do?

A

Binds to antithrombin III and greatly increases the inactivation of thrombin. Also accelerates the decay of Factor IXa, Xa, XIIa by antithrombin III.

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8
Q

What is the difference between unfractionated, high MW heparin and low MW heparins/fondaparinux?

A

High MW heparin bind to antithrombin III/thrombin complexes. Low MW heparins bind only to anti-thrombin III/Factor Xa complexes

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9
Q

How is unfractionated heparin administered?

A

IV or SQ

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10
Q

How is low MW heparin administered?

A

SQ

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11
Q

What are the problems with unfractionated heparin?

A

IV use, poor pharmacokinetics, short half life, unpredictable, requires hospital monitoring.

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12
Q

What are the benefits with unfractionated heparin?

A

can be given to pregnant women because do not cross placenta

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13
Q

What are the benefits with LMW heparin?

A

longer half-life, better bioavailability, more predictable responses, less monitoring (outpatient)

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14
Q

What are the side effects of heparin?

A

Bleeding, heparin-induced thrombocytopenia syndrome (autoantibodies to heparin complexes resulting in thromboses), allergic events

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15
Q

T or F: Heparin-induced thrombocytopenia is more common with low MW heparin.

A

FALSE. high MW

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16
Q

What does warfarin do?

A

Inhibits enzymes that use vitamin K as a cofactor, prevents recycling of vitamin K

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17
Q

Describe warfarin?s pharmacokinetics?

A

Absorbed rapidly, good bioavailability, begin to see results of warfarin after 2-3 days

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18
Q

What are the problems with warfarin?

A

can cause hemorrhage, cannot be used during pregnancy, several food and drug interactions

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19
Q

What are the advantages of new oral anticoagulants?

A

Rapid, absence of food interactions, no monitoring

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20
Q

What are the disadvantages of new oral anticoagulants?

A

cannot be used with kidney disease, greater GI bleeding risk, short half-life, cost a lot more, no antidote to reverse effects

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21
Q

What can be given to reduce the effects of heparin?

A

protamine sulfate, positive charge neutralizes heparin

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22
Q

What can be given to reduce the effects of warfarin?

A

stop warfarin, give Vit K, can transfuse clotting factors

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23
Q

What is dabigatran etexilate?

A

Approved for atrial fibrillation, direct inhibitor of thrombin

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24
Q

What is apixaban?

A

Approved for atrial fibrillation, inhibits factor Xa, lower rates of stroke and embolism than warfarin

25
Q

What is rivaroxaban?

A

Approved for atrial fibrillation and VTE, inhibits factor Xa, superior to warfarin in preventing stroke and embolin in a fib

26
Q

What is Alteplase?

A

Tissue plasminogen activator, binds to fibrin and increases cleavage of plasminogen to plasmin

27
Q

What is Urokinase?

A

Converts plaminogen to plasmin

28
Q

What is streptokinase?

A

Forms a complex with plasminogen and converts it to plasmin

29
Q

What are fibrinolytic agents used to treat?

A

Acute MI, ischemic stroke, DVT, pulmonary embolism

30
Q

What are the adverse effects of fibrinolytic agents?

A

hemorrhage, induce a systemic lytic state which destroys coag factors V and VIII, allergic reactions and antibody formation to the drugs themselves (esp streptokinase)

31
Q

What is warfarin used for?

A

Prevent venous thromboembolism, systemic embolism, stroke, MI

32
Q

What is heparin used for?

A

prevent venous thromboemboli, manage unstable angina or acute MI, during and after coronary angioplasty/stent, during heart surgery, kidney dialysis.

33
Q

What are antiplatelet drugs used for?

A

Treat acute coronary syndrome (angina, MI) characterized by atherosclerotic plaque rupture and platelet-mediated thrombosis

34
Q

What are the three classes of anti-platelet drugs?

A

1.) inhibit formation of platelet products 2.) prevent aggregation 3.) block adhesion

35
Q

What drug prevents the formation of platelet products?

A

Aspirin

36
Q

What are the ADP receptor antagonists?

A

Thienopyridines clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel - all less rapid; Ticagrelor - more rapid

37
Q

What are the adhesion blockers?

A

Gp2b/3a inhibitors abciximab, eptifibatine (Integrilin), tirofiban (aggrastat)

38
Q

What do ADP antagonists do?

A

irreversibly block ADP receptor, block alpha granule secretion of adhesion proteins (thienopyridines only)

39
Q

What are ADP antagonists used for?

A

Prevent AMI, stroke in combo with aspirin

40
Q

What are adhesion inhibitors used for?

A

After angioplasty to prevent AMI (with aspirin and heparin), treat AMI, and treat unstable angina

41
Q

Which drugs will increase the action of warfarin?

A

Aspirin, antibiotics (dec vit k), clofibrate and phenytoin (displace from plasma proteins), cimetidine (dec metabolism)

42
Q

Which drugs will decrease the action of warfarin?

A

Rifampin and barbiturates like phenobarbital (inc metabolism), cholestramine (dec absorption)

43
Q

What is the platelet ADP receptor called?

A

P2Y12

44
Q

Heparin

A

antithrombin III inhibitor

45
Q

Warfarin

A

blocks enzymes that use Vit K as a cofactor

46
Q

Dagatriban

A

blocks thrombin

47
Q

Apixaban

A

blocks factor Xa

48
Q

Rivaraxiban

A

blocks factor Xa

49
Q

Alteplase

A

Tissue plasminogen activator

50
Q

Urokinase

A

Converts plaminogen to plasmin

51
Q

Streptokinase

A

Converts plaminogen to plasmin

52
Q

Aspirin

A

Prevents formation of platelet products

53
Q

Clopidogrel (Plavix)

A

ADP receptor antagonist, block alpha granule secretion of adhesion receptors

54
Q

Ticlopidine

A

ADP receptor antagonist, block alpha granule secretion of adhesion receptors

55
Q

Pasugrel

A

ADP receptor antagonist, block alpha granule secretion of adhesion receptors

56
Q

Ticagrelor

A

ADP receptor antagonist

57
Q

Abciximab

A

Gp2b/3a (adhesion) blocker

58
Q

Eptifibatine

A

Gp2b/3a (adhesion) blocker

59
Q

Tirofiban

A

Gp2b/3a (adhesion) blocker

BL Unit 3 (9 decks)

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