Pharm II: Hemostasis Drugs Flashcards
3 Classes of Anti-Hemostatsis Drugs
- Anti-Coagulants
- Fibrinolytic
- Anti-platelet
Anti-Platelet Drugs
Target thrombus (arterial clot) formation
White Clots
Arterial clots form around activated platelets
Red Clots
Venous clots form around activated fibrin & RBCs
Factor II
Prothrombin
- Vit. K dependent
- Target for Heparin, Warfarin
Factor IIa
Thrombin
What are the Indirect Thrombin Inhibitors?
- Unfractionated Heparin
- LMWH
- Fondaparinux: Binds to anti-thrombin & enhances its inactivation of Factor X.
Indirect Thrombin Inhibitors - MoA
Increase Anti-Thrombin Activity, thus Decreasing Activity of Thrombin
Heparin, unfractionated:
Class, Indications, MoA
Class - Indirect Thrombin Inhibitors
Indications - Thrombotic Disorders; prevents clots
MoA- Accelerates degradation of Xa, and IIa (Thrombin)
Heparin, unfractionated:
SE/ADRs
SE/ADRs - Bleeding, Allergic Rxn, Alopecia
—Long-term use SE/ADRs: Osteoporosis, HIT (after 7 days), Skin Necrosis
Heparin, unfractionated
Contraindications, Dx-Dx
Contraindications: Prior HIT, pre-exsisiting severe thrombocytopenia, intra-cranial bleeding
Dx-Dx: Other Anti-coagulants; tNSAIDs; NTG decreases effectiveness
Heparin, unfractionated
Monitor, Other
Monitor: aPTT, platelet counts, H&H, fecal occult blood
Other: Pork intestinal mucosa and bovine lung tissue source; no fibrinolytic activity (cannot lyse est clot)
Low-molecular Weight Heparin (LMWH)
Class, Indications, MoA
Class - Anticoagulant
Indications - Acute Coronary Syndrome, DVT prevent & treat
MoA - Increased Degradation of Xa
LMWH
SE/ADR, Contraindications, Dx-Dx
SE/ADR - Injection site hematoma, fever, increase in AST/ALT; bleeding, hypersensitivity reaction
Contraindications - Active major bleeding, hypersensitivity to pork or heparin, thrombocytopenia
Dx-Dx - N/A
LMWH
Monitor, Other
Monitor - Platelet count, CrCl
Other - Pork product; renal elimination; no renal adjustment at CrCl >30ml/min
Fondaparinux
Class, Indications, MoA
Class - Indirect Thrombin Inhibitor
Indications - DVT prophylaxis, Treat acute PE, or acute DVT without PE
MoA - Accelerates Factor Xa degradation
Fondaparinux
SE/ADRs, Contraindications, Dx-Dx
SE/ADRs - Moderate thrombocytopenia, bleeding, rash, fever, nausea, anemia, edema
Contraindications - Hypersensitivity, CrCl
Fondaparinux
Monitor, Other
Monitor - CBC, CrCl, fecal occult blood
Other - Synthetic, not animal origin; administer Sub-q only
Protamine Sulfate
Class - Antagonist of Indirect Thrombin Inhibitors
MoA - Binds to heparin and neutralizes its anticoagulant effect
Indications - Excess heparin impact (w/ resulting bleeding)
Other - IV Admin, Mix of polypeptides isolated from salmon sperm, Less effective with LMWH than HMWH, does NOT affect Fonaparinux
