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3b_Boards - SketchyPharm > (3) Blood & Inflammation: Anti-coagulants & Thrombolytics (1.1-1.4) > Flashcards

(3) Blood & Inflammation: Anti-coagulants & Thrombolytics (1.1-1.4) Flashcards

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1
Q

What enzyme catalyzes the final step of the coagulation cascade?

A

Thrombin

(Factor II, and crosslinking of fibrin occurs via Factor XIII)

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2
Q

What coagulation factor activates thrombin?

A

Factor Xa

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3
Q

ROA: Direct factor Xa inhibitors

A

Oral

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4
Q

What protein mediates Heparin’s effects?

A

Antithrombin III

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5
Q

Which coagulation factors does Heparin inhibit?

A

(1) Factor IIa
(2) Factor Xa

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6
Q

Which clotting time does heparin most affect?

A

PTT

(activated partial thromboplastin time)

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7
Q

Indications (3) : Heparin

A

(1) DVT prophylaxis
(2) Pulmonary embolism prophylaxis
(3) Acute MI

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8
Q

ROA: Heparin

A

IV

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9
Q

What is the antigenic target in Heparin-Induced Thrombocytopenia?

A

Platelet Factor 4

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10
Q

Adverse Effects (4) : Heparin

A

(1) Heparin-induced thrombocytopenia
(2) Hypoaldosteronism
(3) Osteoporosis
(4) Type IV RTA
* (Type 4 renal tubular acidosis)*

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11
Q

What drug reverses the effects of Heparin?

A

Protamine sulfate

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12
Q

What is the difference LMWH and Heparin?

A

LMWH is more specific for Factor Xa

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13
Q

Does LMWH or Heparin have a longer half life?

A

LMWH

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14
Q

How is LMWH eliminated?

A

Renally

(Whereas Heparin is eliminated by the liver)

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15
Q

Which anticoagulant is indicated in pregnancy?

A

Heparin

(or LMWH)

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16
Q

Why doesn’t LMWH require routine monitoring?

A

↓ Risk of HIT

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17
Q

MOA: Fondaparinux

A

≅ LMWH

(Although even more specific for ATIII)

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18
Q

Which indirect thrombin inhibitor has the lowest risk of HIT?

A

Fondaparinux

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19
Q

Suffix: Direct thrombin inhibitors

A

(1) “-rudin”
(2) “-gatro-“

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20
Q

Suffix: Direct factor Xa inhibitor

A

“-xaban”

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21
Q

Other than Warfarin, what class of anticoagulant is used in long term therapy of atrial fibrillation?

A

Direct factor Xa inhibitors

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22
Q

Treatment: Heparin-induced thrombocytopenia

A

Direct thrombin inhibitors

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23
Q

What’s the goal INR value in Warfarin therapy?

A

2-3

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24
Q

Indications (2) : Warfarin

A

(1) Prophylaxis in atrial fibrillation
(2) DVT prophylaxis

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25
Which anticoagulant is a teratogen?
Warfarin
26
What causes an initially hypercoagulable state in Warfarin therapy?
Early inhibition of Protein C
27
Why do we need to monitor patients early in Warfarin therapy?
Warfarin induced skin necrosis *(Common initial presentation of Protein C/S deficiency)*
28
What drug should be coadministered early in Warfarin therapy?
Heparin
29
How is Warfarin reversed?
(1) _Delayed_: Administer Vitamin K (2) _Immediate_: Plasma transfusion
30
How is Warfarin metabolized?
CYP-450
31
What does the damaged vascular endothelium expose which activates platelets?
(1) vWF (2) Collagen
32
Which platelet receptor does vWF bind?
GP1b
33
Which platelet receptor does ADP bind?
P2-Y12
34
What effect does serotonin release from platelets have?
(1) ↑ Platelet aggregation (2) Vasoconstriction
35
Which COX isozyme is responsible for synthesizing TXA2?
COX-1
36
Which COX isozyme is only active during inflammation?
COX-2
37
**MOA**: Aspirin
Irreversibly inhibits COX-1 and COX-2
38
**Suffix**: ADP receptor inhibitors
"-grel"
39
Which cardiovascular diseases are antiplatelet drugs used in?
(1) Peripheral artery disease (2) MI and Acute coronary syndromes
40
What route of administration should Aspirin be given in the setting of acute MI?
Chewable aspirin
41
What is dual antiplatelet therapy used for?
Prevent coronary stent thrombosis
42
What ADP receptor inhibitor does NOT have the suffix "-grel"?
Ticlopidine
43
Which antiplatelet agent is associated with **granulocytopenia**?
Ticlopidine
44
What platelet receptor does Fibrinogen bind?
GP IIb/IIIa
45
Name 3 drugs which block GP IIb/IIIa
(1) Abciximab (2) Eptifibatide (3) Tirofiban * (Ab-6-imab = gp2 x gp3)*
46
**Adverse Effect**: GP IIb/IIIa inhibitors
Thrombocytopenia
47
Name 2 PDE inhibitors used as antiplatelet agents
(1) Dipyridamole (2) Cilostazol
48
What effect does Cilostazol have on vasculature?
Arterial vasodilation
49
**Indication**: Cilostazol
Claudication symptoms
50
**Adverse Effect**: Cilostazol
Coronary steal *(a phenomenon where an alteration of circulation patterns leads to a reduction in the blood flow directed to the coronary circulation)*
51
What are the fibrinolytic agents?
(1) tPA (2) Streptokinase
52
**Suffix**: Recombinant tPA drugs
"-teplase"
53
What effect on clotting time do fibrinolytic agents have?
↑ PT and PTT
54
What circulating product is formed as a result of clot degradation?
D-dimer
55
When can fibrinolytics be used to treat acute ischemic stroke?
Within 3-4.5 hours
56
Indications (4) : Fibrinolytics
(1) Acute ischemic stroke (2) Deep venous thrombosis (3) Pulmonary embolism (4) Acute myocardial infarction
57
What is the time frame for percutaneous coronary intervention?
Within 2 hrs
58
**Adverse Effect**: Thrombolytic therapy
Hemorrhagic stroke
59
**Contraindications** (3) : Thrombolytic therapy
(1) Recent head trauma (2) Recent intracranial surgery (3) Severe hypertension
60
Which thrombolytic can cause anaphylaxis?
Streptokinase *(Derived from Streptococcus ∴ foreign protein ∴ immunogenic)*
61
What drugs can be used to reverse fibrinolytic therapy?
(1) Aminocaproic acid (2) Tranexamic acid
62
**MOA**: Aminocaproic Acid
Inhibits plasminogen activation

3b_Boards - SketchyPharm (32 decks)

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