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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
What is the STOPP criteria for apixaban?
Elderly = risk of bleeding eg. severe hypertension
26
What are the side effects of apixaban?
Anaemia Haemorrhage
27
How does heparin inhibit coagulation?
Activating antithrombin III (AT III)
28
What are examples of LMWH?
Dalteparin sodium Enoxaparin sodium Tinzaparin sodium
29
What do LMWH do?
Inactivate factor Xa + thrombin
30
What do both heparin + LMWH have?
Immediate onset of action
31
What is the problem with LMWH + heparin?
Inactive if given orally = must be administered IV or SC (for LMWH)
32
What is the half life of heparin + what does this mean?
SHORT = must be given frequently, continuously
33
What is good about LMWH compared to heparin?
Longer duration of action = allows once daily dosing
34
How are heparins + LMWH eliminated?
Renally = need to be careful with patients with low kidney function
35
How are heparins + LMWH eliminated?
Renally = need to be careful with patients with low kidney function
36
What are the side effects of heparin + LMWH?
Bleeding Hypersensitivity
37
How is the overdose of heparin + LMWH treated?
IV protamine
38
What is an example of a vitamin K antagonist?
Warfarin
39
How does Warfarin work?
Inhibitors Vitamin K1 dependent clotting factors = II, VII, IX + X
40
What is problem with Warfarin?
At least 2-3 days for anticoagulant effects to develop
41
What are the side effects of Warfarin?
Haemorrhage Skin necrosis
42
What is the advantage of Warfarin?
Can be given orally
43
What does Warfarin block?
Vitamin K reductase
44
How does aspirin work?
Inhibits COX-1 = inhibits the synthesis of TXA2
45
Aspirin further explained
Platelets do not contain DNA or RNA = cannot synthesise new COX-1 = inhibition irreversible
46
What is the clinical use of aspirin?
Use prophylactically to prevent arteriole thrombosis which lead to... TIA Stroke MI
47
What is Ticlopidine + Clopidogrel?
Antiplatelets
48
What is Ticlopidine + Clopidogrel given for?
MI = blocks effect of ADP

S2 Case 6 - stroke & anticoagulation (7 decks)

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