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Pharmocolgy > Thrombolysis > Flashcards

Thrombolysis Flashcards

1
Q

how are venous thrombus usually formed ?

what is its contents usually ?

A

Stasis of blood / damages to veins

high RBC and fibrin with low platelet content

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2
Q

how are arterial thrombus usually formed?

contents ?

A

site of atherosclerosis following plaque rupture

lower fibrin and higher platelet content

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3
Q

what type of drugs would you use for arterial thrombi ?

A

anti-platelet and fibrinolytic

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4
Q

what type of drugs would you use for venous thrombi ?

A

anticoagulants

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5
Q

What leads to platelet aggregation ?

A

damaged endothelium leads to activation / aggregation of platelets via GPIIb/IIIa receptors at site of injury

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6
Q

how does aspirin work at low doses ?

what is its half life ? what is it converted to ?

A

Reduction of TXA2 synthesis by COX-1 inhibition. TXA2 is potent platelet aggregation
20 mins, salicyclic acid

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7
Q

name 2 side effects of aspirin

A

haemorrhagic stroke , GI bleeding (peptic ulcers)

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8
Q

why doesn’t aspirin work on everybody ?

A

COX-1 gene polymorphisms

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9
Q

how long does aspirin last ?

A

lifespan of platelet = 7-10 days

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10
Q

when should you use aspirin ?

A

secondary prevention of stroke , TIA if other agents are contraindicated
ACS, post PPCI and secondary prevention of MI ins stable angina

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11
Q

how do P2Y12 antagonists work ?

A

Anti-platelet

irreversibly inhibits ADP binding to P2Y12 receptor which inhibits activation of GP11b//IIIa

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12
Q

what is the half life of clopidogrel ?

what about its onset of action ?

A

7-8 hours

slow onset

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13
Q

what is the half life of prasugrel ?

A

8 days

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14
Q

name 2 P2Y12 inhibitors

A

Clopidogrel , prasugrel and ticagrelor

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15
Q

what would you use clopidogrel for ?

A

post thromboembolic stroke
, MI
prophylaxis for patients intolerant to aspirin

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16
Q

how to abciximab work ?

A

antibody that irreversibly blocks GIIb/IIIa receptor preventing fibrinogen binding and VWF

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17
Q

what is the half life of abciximab and what must you be aware of this drug ?

A

short half life = 30 mins

bound antibody takes long time to clear = 12-36 hours

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18
Q

what are the side effects of Glycoprotein IIB/IIa inhibitors?

A

thrombocytopenia

bleeding

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19
Q

name 2 GPIIb/IIIa inhibitors

A

abciximab , tirofiban and eptifibatide

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20
Q

what are the 2 MOAs of dipyridamole ?

A

inhibits cellular reuptake of adenosine = increased plasma adenosine = inhibits platelet aggregation via A2 receptors
Phosphodiesterase inhibitor = less cAMP and cGMP degradation = inhibit expression of GPIIB/IIIa

21
Q

what are side effects of dipyridamole ?

A

flushing , headaches and hypersensitivity

22
Q

how does streptokinase work ?

A

activates plasminogen to plasmin which breaks downs fibrin

23
Q

name 2 plasminogen activators

A

Alteplase
reteplase
tenecteplase

24
Q

how does warfarin work?

A

Inhibits Vit K dependant clotting factors
- 2 (prothrombin), 9, 7 and 10
1972

25
Q

what can we use instead of fibrinolytics?

A

PPCI

26
Q

why is there delayed onset of action in warfarin ?

A

existing clots have to be cleared

27
Q

what should you use warfarin for ?

A 
DVT/PE prophylaxis and treatment
AF leading to stroke 
Protein S/C deficiency
post ortho surgery 
slow onset may not be good for acute
28
Q

what must you do with patients on warfarin ?

A

monitor INR

29
Q

why does it vary for person to person? why is it good ?

A 
Racemic mix (t1/2 =36-48 hours) , Functional 2C9 polymorphisms
almost 100% bioavailabilty but highly protein bound
30
Q

what does the plasma conc of warfarin tell you about clinical effect?

A

nothing, plasma conc does not correlate with clinical effect

31
Q

what can effect response of warfarin ?

A

CYP2C9 variants
other drugs
vit k intake and coag proteins

32
Q

what is used for INR ?

A

Factor 8 - the most sensitive to warfarin

33
Q

what are the main? ADR of warfarin ? how can we stop this

A

bleeding
give Vit K , prothrombin complex and fresh frozen plasma
Tetragenic in 1st trimester
increased brain haemorrhage

34
Q

What elevated INR mean ? what does decreased INR mean ?

A 
elevated = too thin
decreased = Too thick
35
Q

why cant you use cephlasporins with warfarin ?

A

they destroy gut bacteria that synthesise Vit K leading to a double effect = more chance of bleeding

36
Q

Name 3 CYP2C9 inhibitors?

what is the effect on INR?

A

Amiodarone , Quinolone, metrondiazole, clopidogrel and large dose of EtOH
increase INR due to less metabolism

37
Q

Name 3 CYP inducers ?

what is the effect on INR?

A

Barbiturates, phenytoin, rifampicin and st johns wort

decrease INR

38
Q

What is the effect of NSAIDs with warfarin?

A

NSAIDs stop GI absorption of Vit K = increase risk of bleeding

39
Q

how does unfractionated heparin work ?

A

speeds up reaction with antithrombin 3 = inactivates thrombin 2a(needs both AT3 and 2a at same time) , 10a, 11a, 9a and 12a

40
Q

why would you use LMW heparin over unfractionated?

A

better bioavab, longer T1/2 = 2 hours and predictable dose repsonse as does not bind as much and abosrbed more uniformly , cleared by kindeys

41
Q

name 2 LMW heparins

A

Dalteparin, Enoxaparin

42
Q

what is the main difference between LMW heparin and UFH?

A

LMWH only stops factor Xa not prothrombin 2a

look up table

43
Q

what is heparin used for ?

A

administered before warfarin due to quicker onset
ACD
During pregnancy
prevention of VTE

44
Q

what are ADRs of heparin ?

A

bruising bleeding, epistaxis, renal damage , thrombocytopenia, hypersensivity , osteoporosis

45
Q

why can heparin lead to thrombosis ?

A

ADR casues auto immune response 5-14 days after as more platelets are activated

46
Q

what can reverse heparin ? how does it do it ?

A

protamine sulphate

disassociates it from AT3

47
Q

how fondaparinux work ?

why is it being used instead of UFH?

A

synthetic protein inhibts Xa by binding to ATIII

T1/2 = 18 Hours and less monitoring required

48
Q

What do Direct Xa drugs do?
half life ?
name 2

A

inhibts Free Xa and that bound with ATIII
t1/2 = 10 hours po
Apixaban , edoxaban and rivaroxaban

49
Q

What do direct thrombin inhibtors do ? name 2

A

inhibit competitively both free and bound IIa
short half life = 30-60mins po
Argatroban and dabigartran

Pharmocolgy (22 decks)

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