Anticoagulants, thrombolytic agents, anti-platelet drugs

Question 1

Name the thrombolytics:

Answer 1

t-PA, alteplase

Question 2

Thrombolytics MOA:

Answer 2

Plasminogen activator that is modestly fibrin specific (works in a clot). Initiates local fibrinolysis by binding to fibrin in a thrombus and converts entrapped plasminogen to plasmin.

Question 3

Thrombolytics contraindications:

Answer 3

active peptic ulcer, recent stroke, recovering from recent surgery, uncontrolled HTN, **UA or NSTEMI.

Question 4

Heparin

Answer 4

inactivates both thrombin and factor Xa.

Not given orally (large and negatively charged).

Question 5

Name the LMWHs:

Answer 5

Enoxaparin, dalteparin

Question 6

LMWH & fondaparinux MOA:

Answer 6

Inactivate ONLY factor Xa.

Advantage over UFH is longer half-life and more predictable F.

Fondaparinux advantage over LMWHs is that it is much less likely to trigger heparin-induced thrombocytopenia.

Question 7

Bivalirudin MOA and use:

Answer 7

Direct thrombin inhibitor.

**Inhibits coagulation independently of antithrombin, works on both circulating and clot-bound thrombin.

Used as an alternative to heparin in patients undergoing coronary angioplasty or cardiopulmonary bypass surgery.

Question 8

Oral anticoagulants:

Answer 8

Warfarin: vitamin K antagonist.

Dabigatran: direct thrombin inhibitor.

Rivaroxaban: direct-acting factor Xa inhibitor.

Question 9

Aspirin:

Answer 9

Irreversibly inhibits COX, blocks the synthesis of TXA2.

Prostacyclin will keep working.

Question 10

ADP blockers (4):

Answer 10

Clopidogrel, Ticlopidine, Prasugrel, Ticagrelor.

Ticagrelor is reversible - makes it helpful in during surgery (life of a platelet is 8-9 days).

Question 11

IIb-IIIa receptor antagonists:

Answer 11

Abciximab, eptifibatide.

Used to prevent platelet aggregation and thrombosis in patients undergoing percutaneous coronary interventions, including coronary angioplasty and stent placement.