MOA - Bleeding

Question 1

Inhibits Vit K cofactors to synth Vit K which effects Factors II, VII, IX, X & protein C/S

Answer 1

Warfarin

Question 2

W/in 5 min of IV infusion forms stable salt complex in the presence of heparin and the anticoagulant activity is lost

Answer 2

Protamine Sulfate

Question 3

Binds ATIII and selectively inhibits/neutralizing Factor Xa

Answer 3

Fondaparinux

Question 4

Fat Soluble Vit-K

Answer 4

Phytonadione

Question 5

Enzyme synth by kidney that converts uncomplexed plasminogen to plasmin which degrades fibrin and clotting factors V and VII

Answer 5

Thrombolytic Enzymes

Question 6

Binds AT-III = speeds up AT-III ability to inhibit thrombin & other factors.

Answer 6

UFH - req aPTT monitoring

Question 7

Dissolve clots by converting plasminogen to plasmin which hydrolyzes fibrin thus lysing thrombus

Answer 7

Fibrinolytics / Thrombolytics (IV)

Question 8

Reversibly inhibits fibrin binding to GPIIb/IIIa receptors. w/out monoclonal antibodies. (not immunogenic)

Answer 8

Eptifibatide (IV)

Tirofiban (IV)

Question 9

Binds directly to free/clot-bound thrombin (factor IIa) active site which inhibits thrombin downstream effects.
-Prevents Fibrinogen to Fibrin conversion

Answer 9

Direct Thrombin Inhibitors

• Bivalirudin
• Argatroban
• Dabigatran - Prodrug

Question 10

Reversibly inhibits PLT aggregation by inhibiting Adenosine binding to P2Y-12 Receptor which inhibits GPIIb/IIIa receptors

Answer 10

Ticagrelor (PO)

Question 11

• Inhibits cAMP breakdown = increase in cAMP causes less SVR=(V-dil)
• Reversibly inhibits platelet aggregation

Answer 11

Cilostazol (Pletal) PO

Question 12

• Irreversibly inhibits COX-1 and 2 = decreased TXA2 synthesis from arachidonic acid
• Also to a lesser extent inhibits prostacyclin activity in endothelial cells.

Answer 12

Aspirin

Question 13

Monoclonal antibody fragment binds dabigatran with higher affinity then thrombin neutralizing it

Answer 13

Idarucizumab (IV)

Question 14

• Inactivates factor Xa

- Also binds AT-III w/ less affinity

Answer 14

LMWH - does not need aPTT test

Question 15

Irreversibly inhibits PLT aggregation by inhibiting Adenosine binding to P2Y-12 Receptor which inhibits GPIIb/IIIa receptors.

Answer 15

Clopodogrel (PO)

Prasugrel (PO)

Question 16

Activates plasminogen bound to fibrin in a thrombus, which initiates fibrinolysis

Answer 16

Tissue Plasminogen Activators (tPA)

Question 17

Prevents fibrin, vWF, and other contents from binding to PLT’s by monoclonal antibody fragments hindering GPIIb/IIIa receptors.

Answer 17

Abciximab (IV)

Question 18

Forms a reversible complex that displaces plasminogen from fibrin and inhibits fibrinolysis
-Also inhibits proteolytic activity of plasmin

Answer 18

Tranexamic Acid

Question 19

• Stimulates prostacyclin synthesis
• Inhibits the uptake of adenosine into (PLT’s, RBC’s, endothelial cells) = Increased Adenosine Conc then stimulates cAMP which inhibits PLT aggegration

Answer 19

Dipyridamole (Persantine) PO/IV

Question 20

Prevents prothrombin to thrombin w/ no effect on PLT’s by selectively blocking factor Xa.
- no co-factor AT-III req for activity

Answer 20

Direct Oral Factor Xa Inhibitors

Question 21

Inhibits ADP binding to P2Y-12 receptior which inhibits GPIIb/IIIa receptors.

Answer 21

Cangrelor (IV)