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HLB Cardiac > Pharmacotherapy of Haemostasis and Thrombosis > Flashcards

Pharmacotherapy of Haemostasis and Thrombosis Flashcards

1
Q

In the platelet ativation and adhesion pathway, what is the role of the receptor GP 1b and Von Willebrand factor?

A
  • GP1b receptor on platelets
  • Von Willebrand factor (vWF) binds to collagen
  • vWF then binds to GP1b
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2
Q

In the platelet ativation and adhesion pathway, what is the role of the receptor GP2b3a?

A
  • GP2b3a is present on platelets
  • binds to fibrinogen
  • fibrinogen becomes fibrin
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3
Q

In the platelet ativation and adhesion pathway, what is the role of the receptor Tx receptor on platelets?

A
  • activates platelets and leads to adhesion
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4
Q

In the platelet ativation and adhesion pathway, what is the role of the receptor P2Y12 receptor on platelets?

A
  • activates platelets and adhesion of platlets
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5
Q

If this common drug is given to children as it can cause Reyes syndrome, which is brain and liver damage. What is the drug that causes this if given to children?

A
  • aspirin
  • DO NOT GIVE TO CHILDREN
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6
Q

How does aspirin inhibit platelet activation?

A
  • inhibits cyclo-oxygenase (COX-1)
  • inhibits conversion of Arachidonic acid to Thromboxane A2
  • receptor Tx on platelets is then not activated
  • platelets are then not activated
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7
Q

In addition to inhibiting COX-1, what else can higher doses of aspriin inhibit?

A
  • prostocyclin
  • prostocyclin normally inhibits platelet activation
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8
Q

Is the inhibition of COX-1 by aspirin permanent or reversible?

A
  • permanent
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9
Q

Why can a low dose of aspirin inhibit COX-1, but not prostocyclin?

A
  • platelets cannot produce more COX-1
  • prostocyclin is produced by epithelial cells that can reproduce it
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10
Q

Does aspirin improve all arterial disease?

A
  • yes, used all the time as its cheap
  • IHD (MI, angina)
  • Cerebrovascular disease
  • Peripheral vascular disease
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11
Q

What is the action of clopidogrel that is used to inhibit platelet activation?

A
  • bind with P2Y12 receptor
  • inhibits platelet activation
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12
Q

What is one of the main drugs used in patients with peripheral artery disease?

A
  • clopidogral
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13
Q

Warfarin is an oral anticoagulant. How does it affect the coagulation cascade?

A
  • 1972 was era of diSCo
  • inhibits factors 10, 9, 7 and 2
  • inhibits anti-coagulant proteins S and C
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14
Q

Why is Warfarin not used routinely?

A
  • small therapeutic window
  • lots of interactions - alcohol, vitamin K, drugs
  • inhibits anti-coagulant proteins S and C
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15
Q

How is Warfarin monitored?

A
  • prothrombin time (PT)
  • international normalized ratio (INR)
  • normally 2-3 time slower than normal
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16
Q

What 2 cases is warfarin still the maion drug of choice?

A
  • mechanical heart valves
  • mitral stenosis with atrial fibrilation
17
Q

What are the most common side effects of warfarin?

A
  • bleeding
  • teratogenic - causes birth defects
  • warfarin induced skin necrosis
18
Q

What are direct acting oral anticoagulants (DOAC) medication?

A
  • oral drugs acting directly on the clotting pathway
19
Q

Which direct acting oral anticoagulants (DOACs) drug acts on factor Xa (10a) in the coagulation cascade?

A
  • RivaroXAban
  • we know this as it contains factor Xa (10a) in the name
20
Q

The second direct acting oral anticoagulants (DOAC) is called Dabigitran. What is its mechanism of action on the coagulation cascade?

A
  • inhibition of thrombin
  • converts fibrinogen to fibrin
21
Q

What are the 3 cardiac conditions conditions where direct acting oral anticoagulants (DOACs) are routinely used?

A
  • DVT
  • PE
  • AF
22
Q

What is heparin?

A
  • anticoagulant (blood thinner) that prevents the formation of blood clots
  • the name heparin comes from where is was found - liver = hepatic
23
Q

What is the mechanims of action of heparin, and what factors in the coagulation cascade does it affect?

A
  • binds to anti-thrombin III and activates it
  • IX, VII, II, X, XI, XII
  • 9, 7, 7, 10, 11, 12
  • 2+7=9….10, 111, 12
24
Q

How is heparin efficacy measured?

A
  • activated partial thromboplastin time (APTT)
25
Q

What is unfractionated heparin?

A
  • physiological heparin
  • contains high and low molecular weight heparin
26
Q

What are some of the common problems with unfractionated heparin?

A
  • variable efficacy
  • variable dose response
  • can cause bleeding
27
Q

What is fractionated heparin?

A
  • unfractioned heparin that has been spun
  • high molecular weight heparins removed
28
Q

Is fractionated or unfractionated heparin used more commonly?

A
  • fractionated
  • better efficacy
29
Q

What are some common areterial diseases that fractionated heparin is used to treat?

A
  • MI (think blood to pass a thrombus)
  • PE (think blood to pass embolism)
  • AF (reduce risk of clot in arrythmias)
  • VTE (reduce risk of venous thromboembolism)
30
Q

What are the 2 fractionated drugs that we need to know?

A
  • Enoxaparin and Tinzaparin
  • both end in aparin
31
Q

What is one of the most dangerous problems in patients who are taking direct acting oral anticoagulants and have a major bleed?

A
  • there is no antidote, so difficult to stop bleeding
32
Q

When would we tend to use unfractionated heparin instead of the more efficous fractionated heparin?

A
  • in patients with chronic kidney disease
33
Q

What is the major side effect of heparin, other than bleeding?

A
  • Heparin-induced thrombocytopenia (HIT)
34
Q

Heparin-induced thrombocytopenia (HIT) is a potentially dangerous side effect of heparin. What can HIT cause?

A
  • heparin dependent IgG antibodies bind to heparin/platelet factor 4 complexes and activate platelets
  • this causes a hypercoagulable state
  • platelet numbers drop
  • can cause skin necrosis
35
Q

Haemophilia is an inability to form blood clots and then bleed to death. What is the most common treatment for Haemophilia?

A
  • recombinant DNA to produce clotting factors
36
Q

Von Willebrand disease is an inability to form blood clots and then bleed to death. What is the most common treatment for Von Willebrand disease?

A
  • Desmopressin (DDAVP) - increases synthesis/release of vWF
  • Anti-fibrinolytics - reduces thrombus breakdown
  • Plasma products- replaces vWF and Factor VIII
37
Q

What factors in the coagulation cascade are vitamin K dependent?

A
  • X (10), IX (9), VII (7) and II (2)
  • anticoagulant proteins S and C
  • 1972 was the era of diSCo

HLB Cardiac (24 decks)

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