Thrombosis Flashcards
What is the mechanism of action for unfractionated heparin?
Bind antithrombin–potentiating formation of antithrombin-coagulation factor complex (Xa, IIa)
What indirect thrombin inhibitor is used for the treatment and prevention of venous thromboembolism?
Unfractionated heparin
What are the major side effects of unfractionated heparin?
HIT
Bleeding
Osteoporosis-with long term use
How is dosing of unfractionated heparin monitored?
PTT
What is given to reverse the effects of unfractionated heparin?
Protamine
What is the mechanism of action for Dalteparin and Enoxaparin?
LMWH that inhibits thrombin less effectively than Xa
What class is Dalteparin in?
Indirect thrombin inhibitor
Name the 4 indirect thrombin inhibitors…
Unfractionated heparin
Dalteparin
Enoxaparin
Fondaparinux
What indirect thrombin inhibitor is the drug of choice in pregnancy and is used to treat and prevent venous thromboembolism?
Enoxaparin
How is Dalteparin and enoxaparin monitored?
Heparin assay–anti-factor Xa
How are the actions of dalteparin and enoxaparin reversed?
Protamine
A synthetic polysaccharide that binds active site of antithrombin-inhibiting Xa?
Fondaparinux
What is the use for fondaparinux, an indirect thrombin inhibitor?
Given for HIT
Can the actions of fondaparinux be reversed?
No
What is the mechanism of action for warfarin?
Blocks vitamin K-dependent gamma carboxylation of factors–2, 7, 9, 10, protein C and S
What is warfarin used for?
Long-term anticoagulation
What is the major side effect of warfarin?
Thrombosis–beginning of therapy Protein C depression
How is warfarin monitored?
PT/INR
How is the action of warfarin reversed?
Vitamin K and factor concentrates
What are the 3 direct thrombin inhibitors?
Bivalirudin
Argatroban
Dabigatran
What is the mechanism of action of the direct thrombin inhibitors (Bicalirudin, Argatroban, Dabigatran)?
Inactivate fibrinogen-bound and unbound thrombin
Which of the 3 direct thrombin inhibitors binds irreversibly?
Bivalirudin
Which of the 3 direct thrombin inhibitors binds reversibly?
Dabigatran – competitive
Direct thrombin inhibitor used for the treatment/prevention of DVT/PE, Afib?
Dabigatran
Direct thrombin inhibitor used for the treatment/prevention of percutaneous coronary intervention and HIT?
Argatroban
Direct Thrombin inhibitor used for the treatment/prevention of percutaneous coronary intervention?
Bivalirudin
How are the direct thrombin inhibitors monitored?
PTT
What are the 2 Direct Xa inhibitors?
Rivaroxaban
Apixaban
What is the mechanism of action for the direct Xa inhibitors, rivaroxaban and apixaban?
reversibly bind active site of Xa
What are the direct Xa inhibitors, rivaroxaban and apixaban used for?
DVT/PE prophylaxis
Name the 3 fibrinolytic drugs used to lyse already formed clots by activating plasminogen…
Alteplase
Reteplase
Tenecteplase
What do the fibrinolytic drugs activate in order to lyse already formed clots?
Plasminogen
What are the fibrinolytic drugs used for? (alteplase, Reteplase, Tenecteplase)
STEMI
Alteplase–also acute stroke and PE
An anti platelet drug the irreversibly inhibits platelets by preventing thromboxane A2 formation?
Aspirin
PDE inhibitors that are anti platelet drugs used to increase platelet cAMP
Dipyridamole
Cilostazol
Anti platelet drugs that inhibit platelet ADP receptors and prevent/treat ACS, stroke, peripheral vascular disease, angina, stent?
Clopidogrel
Prasugrel
Ticagrelor
How are the anti platelet, inhibitors of platelet ADP receptors, reversed?
Platelet transfusion
An anti platelet drug that is a monoclonal antibody against GP IIb/IIIA?
Abciximab
An anti platelet drug that is a fibrinogen analog that competes with endogenous fibrinogen for IIb/IIIa?
Eptifibatide
An anti platelet drug that is a fibrinogen analog that competes with endogenous fibrinogen and vWF for IIb/IIIa?
Tirofiban
