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Cardio Exam 2 > Pharm: Antithrombotics > Flashcards

Pharm: Antithrombotics Flashcards

1
Q

Describe thrombi that form in the arteries vs. the veins.

A

Arteries:
lots of platelets, little fibrin, white thrombi

Veins
low platelets, lots of fibrin, red thrombi

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2
Q

Name and describe the 3 steps in platelet plug formation.

A
  1. Platelet Adhesion: Von Willebrand Factor on endothelium binds to glycoprotein 1-b on platelets
  2. Platelet Activation and Secretion: production of serotonin, ADP, and platelet-derived growth factor. Also secretion of Thromboxane A2 for PG synthesis.
  3. Platelet Aggregation: platelets bind to each other using fibrinogen to link glycoprotein IIb-IIIa receptors.
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3
Q

Activation of platelets causes the expression of the glycoprotein IIb-IIIa for plug formation. What are the two biggest stimulants for platelets to express this receptor?

A

Thrombin: produced in the blood in response to endothelial injury

Collagen: exposed due to endothelial injury.

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4
Q

Test used to measure the extrinsic (tissue specific) coagulation cascade pathway.

A

Prothrombin Time (PT time)

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5
Q

Test used to measure the intrinsic (contact activation) coagulation cascade pathway.

A

Activated Partial Thromboplastin Time (aPTT time)

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6
Q

What is the International Normalized Ratio?

A

Different labs use different reagents for PT and aPTT times. So the times can vary from lab to lab for the same person. The INR corrects for differences in the thromboplastin reagents used by different laboratories.

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7
Q

What tests are run to assess the efficacy of warfarin, unfractionated heparin, and for low molecular weight heparin?

A

Warfarin: PT time
UF heparin: aPTT time
LMWH: Factor Xa inhibition assay

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8
Q

Aspirin (ASA)

A

Platelet Inhibitor
MOA: irreversibly inhibits COXs to prevent thromboxane A2 formation.

Ind: acute MI, used for lifetime in Coronary Artery Syndrome

AE: GI upset, asthma aggravation (esp w/ nasal polyps), Tinnitus

Contra: ASA allergy, asthma

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9
Q

Ticlopidin

A 
Platelet Inhibitor (Theinopyridine)
MOA: inhibits ADP-mediated platelet activation

Ind: secondary prevention after MI, coronary stenting, acute coronary syndrome

AE: bleeding, severe neutropenia, thrombocytopenic purpura

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10
Q

Clopidogrel

A 
Platelet Inhibitor (Theinopyridine)
MOA: inhibits ADP-mediated platelet activation

Ind: secondary prevention after MI, coronary stenting, acute coronary syndrome

AE: bleeding

Metabolized by CYP 2C19 and 30% of population don’t have this enzyme functioning well

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11
Q

Prasugrel

A 
Platelet Inhibitor (Theinopyridine)
MOA: inhibits ADP-mediated platelet activation

Ind: acute coronary syndrome for which percutaneous coronary intervention is planned

AE: more severe bleeding than clopidogrel

CI: age>75, previous TIA or CVA, weight <60kg

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12
Q

Ticagrelor

A 
Platelet Inhibitor (Non-theinopyridine)
MOA: reversibly binds ADP receptors to inhibit platelet activation

Ind: acute coronary syndromes (has less composite endpoints: recurring or serious cardiovascular issues like MI, CVA, CABG surgery)

AE: bleeding but not as severe as theinopyridines

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13
Q

Abciximab

A

Platelet Inhibitor
MOA: GP IIb-IIIa inhibitor to prevent aggregation

Ind: acute coronary syndrome with anticipation percutaneous coronary intervention

AE: bleeding, thrombocytopenia

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14
Q

Eptifibatide

A

Platelet Inhibitor
MOA: GP IIb-IIIa inhibitor to prevent aggregation

Ind: acute coronary syndrome with anticipation percutaneous coronary intervention

AE: bleeding, thrombocytopenia

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15
Q

Tirofiban

A

Platelet Inhibitor
MOA: GP IIb-IIIa inhibitor to prevent aggregation

Ind: acute coronary syndrome with anticipation percutaneous coronary intervention

AE: bleeding, thrombocytopenia

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16
Q

Dipyridamole

A

Platelet Inhibitor
MOA: increases cAMP to decrease calcium leading to decreased aggregation

Ind: adjunct to other antithrombotic, not very effective alone

17
Q

Cilostazol

A

Platelet Inhibitor
MOA: phosphodiesterase inhibitor for vasodilation

Ind: ambulatory claudication (impairmed walking or pain with walking)

18
Q

Warfarin

A

Anti-coagulant
MOA: inhibits epoxide reductase (no reduction of Vit. K for coagulation cascade)
Long half-life and should always be dosed with heparin for a few days.

Ind: hypercoagulable states, anticoagulant in atrial fib or artificial valves

AE: bleeding, skin necrosis, Teratogenic

CI: avoid large loading dose due to inhibition of Protein C (natural anticoagulant). Creates paradoxical hypercoagulable state.

avoid in pregnancy

19
Q

Treatment for excessive bleeding due to warfarin use.

A
  1. Stop Warfarin

2. Vit. K supplementation

20
Q

Unfractionated (UF) Heparin

A

Anti-coagulant
MOA: Combines with Antithrombin IIIa to inhibit Factor Xa, also inhibits thrombin formation

Ind: anticoagulant, used in atrial fib, artificial heart valves, prevents hypercoagulation with warfarin use

AE: bleeding, osteoporosis, skin necrosis, Heparin-Induced Thrombocytopenia (HIT)

21
Q

Enoxaparin

A

Anti-coagulant (LMWH)
MOA: combines with Antithormin IIIa to inhibit Factor Xa

Ind: anticoagulant used in atrial fib, artificial heart valves

AE: bleeding, osteoporosis, skin necrosis, alopecia

CI: renal insufficiency

22
Q

Dalteparin

A

Anti-coagulant (LMWH)
MOA: combines with Antithormin IIIa to inhibit Factor Xa

Ind: anticoagulant used in atrial fib, artificial heart valves

AE: bleeding, osteoporosis, skin necrosis, alopecia

CI: renal insufficiency

23
Q

Tinzaparin

A

Anti-coagulant (LMWH)
MOA: combines with Antithormin IIIa to inhibit Factor Xa

Ind: anticoagulant used in atrial fib, artificial heart valves

AE: bleeding, osteoporosis, skin necrosis, alopecia

CI: renal insufficiency

24
Q

Treatment of bleeding due to heparin use.

A
  1. Stop Heparin

2. If serious use Protamine Sulfate

25
Q

What are the two types of Heparin Induced Thrombocytopenia and Tx for each.

A
  1. Non-immune mediated: self-limiting, stop heparin

2. Immune-Mediated: stop heparin and a direct thrombin inhibitor

26
Q

Lepirudin

A

Anti-coagulant (direct thrombin inhibitor)
MOA: inhibit thrombin activity

Ind: anticoagulant for atrial fib, stent placement, artificial valves, HIT

AE: bleeding

27
Q

Bivalirudin

A

Anti-coagulant (direct thrombin inhibitor)
MOA: inhibit thrombin activity

Ind: anticoagulant for atrial fib, stent placement, artificial valves, HIT

AE: bleeding

28
Q

Argatroban

A

Anti-coagulant (direct thrombin inhibitor)
MOA: inhibit thrombin activity

Ind: anticoagulant for atrial fib, stent placement, artificial valves, HIT

AE: bleeding

29
Q

Dabigatran

A

Anti-coagulant (direct thrombin inhibitor)
MOA: inhibit thrombin activity

Ind: anticoagulant for atrial fib, stent placement, artificial valves, HIT

AE: bleeding, rebound hypercoagulability when suddenly stopped = stroke, pulmonary embolism

30
Q

Fondaparinux

A

Anti-coagulant (Factor Xa inhibitor)
MOA: binds antithrombin III to inhibit Factor X activation

Ind: DVT prophylaxis, DVT treatment, pulmonary embolism treatment

AE: bleeding (no antidote)

31
Q

Rivaroxaban

A

Anti-coagulant (Factor Xa inhibitor)
MOA: prevents Factor X activation

Ind: DVT prophylaxis, reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation

AE: bleeding (no antidote), rebound hypercoagulable state if stopped suddenly (use LMWH)

32
Q

Apixaban

A

Anti-coagulant (Factor Xa inhibitor)
MOA: binds antithrombin III to inhibit Factor X activation

Ind: reduce stroke and PE in patients w/ non-valvular atrial fib,

AE: rebound hypercoagulability when stopped suddenly

33
Q

Which drugs bind antithrombin III to inhibit factor Xa?

A
  1. All Heparins
  2. All drugs with X in the name for factor X
    (exception Abciximab)

Cardio Exam 2 (12 decks)

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