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S2 Case 6 - stroke & anticoagulation > Pharmacology of Anticoagulants + Antiplatelets > Flashcards

Pharmacology of Anticoagulants + Antiplatelets Flashcards

1
Q

What are the 3 drugs?

A

Anticoagulants
Antiplatelets
Fibrinolytic agents

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2
Q

What are examples of anticoagulants?

A

Factor Xa inhibitors
Antithrombins
Heparin + Vit K antagonists

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3
Q

What do anticoagulants do?

A

Modify clotting mechanisms

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4
Q

What is an example of an antiplatelet?

A

Aspirin

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5
Q

What do antiplatelets do?

A

Inhibit Cox-1 activity
= inhibit platelet aggregation

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6
Q

What is an example of a fibrinolytic agent?

A

Alteplase

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7
Q

What do fibrinolytic agents do?

A

Break down fibrin

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8
Q

What are the classes of anticoagulants?

A

Factor Xa inhibitors
Direct thrombin inhibitors
Heparin + LMW heparins
Vitamin K antagonists

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9
Q

What is an example of a factor Xa inhibitor?

A

Apixaban

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10
Q

What a direct thrombin inhibitor?

A

Dabigatran

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11
Q

What is an example of a vitamin K antagonist?

A

Warfarin

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12
Q

What is the 1st choice treatment for DVT or PE?

A

Apixaban
Rivaroxaban

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13
Q

What can be used to treat DVT if apixaban + rivaroxaban are contraindicated?
1st

A

LWMH
Followed by dabigatran etexilate or edoxaban

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14
Q

What can be used to treat DVT if apixaban + rivaroxaban are contraindicated?
2nd

A

LMWH with vitamin K antagonist for 5 days
Followed by vitamin K antagonist on its own

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15
Q

What does a DVT look like?

A

Swollen red inflamed leg

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16
Q

How does DVT happen?

A

Big blood clot prevents venous drainage from leg
BUT still get arteriole flow = oedema

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17
Q

What are the DOACs?

A

Apixaban
Rivaroxaban
Dabigatran
Edoxaban

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18
Q

What is the mechanism of action for dabigatran?

A

Reversible inhibitor of free thrombin

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19
Q

What is the mechanism of action for apixaban, edoxaban + rivaroxaban?

A

Reversible inhibitor of factor Xa

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20
Q

What is the indication of ALL DOACs?

A

Prevention of stroke + systemic embolism in patients with non-vascular AF
Secondary prevention DVT

21
Q

What is the indication for ALL DOACs except for edoxaban?

A

Prevention of venous thromboembolism following elective hip or knee replacement surgery

22
Q

What is the indication for rivaroxaban?

A

Prevention of atherothrombotic events

23
Q

What are the contra-indications of apixaban?

A

Risk of significant bleeding

24
Q

Which conditions can cause a risk of significant bleeding with apixaban?

A

GI ulceration
Malignant neoplasms
Oesophageal varices

25
Q

What is the STOPP criteria for apixaban?

A

Elderly
= risk of bleeding
eg. severe hypertension

26
Q

What are the side effects of apixaban?

A

Anaemia
Haemorrhage

27
Q

How does heparin inhibit coagulation?

A

Activating antithrombin III (AT III)

28
Q

What are examples of LMWH?

A

Dalteparin sodium
Enoxaparin sodium
Tinzaparin sodium

29
Q

What do LMWH do?

A

Inactivate factor Xa + thrombin

30
Q

What do both heparin + LMWH have?

A

Immediate onset of action

31
Q

What is the problem with LMWH + heparin?

A

Inactive if given orally
= must be administered IV or SC (for LMWH)

32
Q

What is the half life of heparin + what does this mean?

A

SHORT
= must be given frequently, continuously

33
Q

What is good about LMWH compared to heparin?

A

Longer duration of action
= allows once daily dosing

34
Q

How are heparins + LMWH eliminated?

A

Renally
= need to be careful with patients with low kidney function

35
Q

How are heparins + LMWH eliminated?

A

Renally
= need to be careful with patients with low kidney function

36
Q

What are the side effects of heparin + LMWH?

A

Bleeding
Hypersensitivity

37
Q

How is the overdose of heparin + LMWH treated?

A

IV protamine

38
Q

What is an example of a vitamin K antagonist?

A

Warfarin

39
Q

How does Warfarin work?

A

Inhibitors Vitamin K1 dependent clotting factors
= II, VII, IX + X

40
Q

What is problem with Warfarin?

A

At least 2-3 days for anticoagulant effects to develop

41
Q

What are the side effects of Warfarin?

A

Haemorrhage
Skin necrosis

42
Q

What is the advantage of Warfarin?

A

Can be given orally

43
Q

What does Warfarin block?

A

Vitamin K reductase

44
Q

How does aspirin work?

A

Inhibits COX-1
= inhibits the synthesis of TXA2

45
Q

Aspirin further explained

A

Platelets do not contain DNA or RNA
= cannot synthesise new COX-1
= inhibition irreversible

46
Q

What is the clinical use of aspirin?

A

Use prophylactically to prevent arteriole thrombosis which lead to…
TIA
Stroke
MI

47
Q

What is Ticlopidine + Clopidogrel?

A

Antiplatelets

48
Q

What is Ticlopidine + Clopidogrel given for?

A

MI
= blocks effect of ADP

S2 Case 6 - stroke & anticoagulation (7 decks)

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