Pharm Thrombosis

Question 1

Anticoagulants used for? Examples

Answer 1

venous thrombosis (heparins, Vit K antagonist, direct thrombin inhibitors, direct Xa inhibitors)

Question 2

Antiplatelet drugs used for? Examples

Answer 2

arterial thrombosis (Cox inhibitor, P2Y12 (ADP receptor) inhibitors, GPIIbIIIa (fibrinogen receptor) inhibitors, phosphodiesterase inhibitors)

Question 3

Fibrinolytic drugs used for? Examples

Answer 3

acute thrombosis - both venous and arterial (plasminogen activators)

Question 4

Heparin used for?

Answer 4

immediate-acting - used initially for anticoagulation (parenteral)

Question 5

Warfarin used for?

Answer 5

long term therapy - slow-acting (oral)

Question 6

Heparins MOA

Answer 6

bind to and activate antithrombin - heparin-AT comblex inactivates IIa, Xa, IXa, XIa, XIIa

Question 7

Disadvantage to herparin and major effects

Answer 7

requires hospitalization - effects: bleeding, HIT, osteoporosis in long term use

Question 8

Low-molecular weight heparins

Answer 8

less non-specific binding - longer half-life - lower risk of HIT - mostly inhibits Xa but less effective against thrombin

Question 9

Which anticoagulant is best for pregnancy?

Answer 9

low molecular weight heparin - enoxaparin

Question 10

What is given for HIT?

Answer 10

fondaparinux

Question 11

How is warfarin-induced thrombosis avoided?

Answer 11

always started while on heparin

Question 12

Adverse effects of warfarin

Answer 12

teratogen and bleeding

Question 13

Why is dosing of warfarin difficult?

Answer 13

competes with vit K which is influenced by diet, diarrhea, laxatives, antibiotics, fat absorption ALSO 99% is bound to albumin (interference by other drugs) - NARROW THERAPEUTIC WINDOW

Question 14

How is warfarin monitored?

Answer 14

using international normalized ratio (INR) - used to standardized (PT/normal PT)^ISI
ISI determined by manufacturer

Question 15

How is warfarin therapy reversed?

Answer 15

1. stop giving it
2. give vit K
3. give prothrombin factor concentrate
4. give fresh frozen plasma

Question 16

Dabigatran

Answer 16

oral, competitive inhibitor of thrombin, few drug interactions, safe over large range of doses, renal clearance, but NO reversal

Question 17

What are the direct Xa inhibitors?

Answer 17

-xabans

Question 18

Fibrinolytic drugs mechanism

Answer 18

activate plasminogen to plasmin

Question 19

What are the fibrinolytic drugs?

Answer 19

-teplases

Question 20

What are the fibrinolytic drugs based off of?

Answer 20

streptokinase - bacterial protein which was non thrombus selective (-teplases more clot-specific with teneceteplase being most specific)

Question 21

Aspirin mechanism

Answer 21

irreversibly binds to COX-1 - low dose is a more effective antiplatelet agent

Question 22

P2Y12 blockers

Answer 22

block ADP receptor. -grels

Question 23

GPIIb/IIIa inhibitors

Answer 23

fibrinogen receptor inhibitor. have -fib in name and also ABCiximab