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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
What is rivaroxaban?
Approved for atrial fibrillation and VTE, inhibits factor Xa, superior to warfarin in preventing stroke and embolin in a fib
26
What is Alteplase?
Tissue plasminogen activator, binds to fibrin and increases cleavage of plasminogen to plasmin
27
What is Urokinase?
Converts plaminogen to plasmin
28
What is streptokinase?
Forms a complex with plasminogen and converts it to plasmin
29
What are fibrinolytic agents used to treat?
Acute MI, ischemic stroke, DVT, pulmonary embolism
30
What are the adverse effects of fibrinolytic agents?
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
What is warfarin used for?
Prevent venous thromboembolism, systemic embolism, stroke, MI
32
What is heparin used for?
prevent venous thromboemboli, manage unstable angina or acute MI, during and after coronary angioplasty/stent, during heart surgery, kidney dialysis.
33
What are antiplatelet drugs used for?
Treat acute coronary syndrome (angina, MI) characterized by atherosclerotic plaque rupture and platelet-mediated thrombosis
34
What are the three classes of anti-platelet drugs?
1.) inhibit formation of platelet products 2.) prevent aggregation 3.) block adhesion
35
What drug prevents the formation of platelet products?
Aspirin
36
What are the ADP receptor antagonists?
Thienopyridines clopidogrel (Plavix), ticlopidine (Ticlid), prasugrel - all less rapid; Ticagrelor - more rapid
37
What are the adhesion blockers?
Gp2b/3a inhibitors abciximab, eptifibatine (Integrilin), tirofiban (aggrastat)
38
What do ADP antagonists do?
irreversibly block ADP receptor, block alpha granule secretion of adhesion proteins (thienopyridines only)
39
What are ADP antagonists used for?
Prevent AMI, stroke in combo with aspirin
40
What are adhesion inhibitors used for?
After angioplasty to prevent AMI (with aspirin and heparin), treat AMI, and treat unstable angina
41
Which drugs will increase the action of warfarin?
Aspirin, antibiotics (dec vit k), clofibrate and phenytoin (displace from plasma proteins), cimetidine (dec metabolism)
42
Which drugs will decrease the action of warfarin?
Rifampin and barbiturates like phenobarbital (inc metabolism), cholestramine (dec absorption)
43
What is the platelet ADP receptor called?
P2Y12
44
Heparin
antithrombin III inhibitor
45
Warfarin
blocks enzymes that use Vit K as a cofactor
46
Dagatriban
blocks thrombin
47
Apixaban
blocks factor Xa
48
Rivaraxiban
blocks factor Xa
49
Alteplase
Tissue plasminogen activator
50
Urokinase
Converts plaminogen to plasmin
51
Streptokinase
Converts plaminogen to plasmin
52
Aspirin
Prevents formation of platelet products
53
Clopidogrel (Plavix)
ADP receptor antagonist, block alpha granule secretion of adhesion receptors
54
Ticlopidine
ADP receptor antagonist, block alpha granule secretion of adhesion receptors
55
Pasugrel
ADP receptor antagonist, block alpha granule secretion of adhesion receptors
56
Ticagrelor
ADP receptor antagonist
57
Abciximab
Gp2b/3a (adhesion) blocker
58
Eptifibatine
Gp2b/3a (adhesion) blocker
59
Tirofiban
Gp2b/3a (adhesion) blocker

BL Unit 3 (9 decks)

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