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Cardiovascular Week 3 2016/17 > 5: Anti-platelet, anticoagulant and thrombolytic drugs > Flashcards

5: Anti-platelet, anticoagulant and thrombolytic drugs Flashcards

1
Q

What is haemostasis?

A

Arrest of blood loss from a damaged vessel

(stopping bleeding)

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2
Q

What is the sequence of events of haemostasis?

A

Vasodilation at site of injury

Platelets arrive at site of injury

Formation of fibrin (blood coagulation)

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3
Q

What is exposed when a vascular wall is damaged?

A

Collagen

Tissue factor (receptor)

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4
Q

Which protein helps with the adhesion, activation and aggregation of platelets to damaged blood vessels?

A

Fibrinogen

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5
Q

When fibrinogen triggers the aggregation of platelets, what forms in the blood vessel?

A

Soft plug

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6
Q

What is fibrinogen converted into during coagulation?

A

Fibrin

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7
Q

What is thrombosis?

A

Pathological haemostasis i.e a clot forms without prior bleeding

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8
Q

Virchow’s triad shows the predisposing factors for ___.

A

thrombosis

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9
Q

What are the three prothrombotic factors of Virchow’s triad?

A

Injury to vessel wall

Abnormal blood flow

Increased coagulability of blood

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10
Q

An arterial thrombus is also known as a ___ thrombus.

A

white

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11
Q

What does a white thrombus consist of?

A

Platelets in a fibrin mesh

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12
Q

When a white thrombus detaches from its site of origin, it may form an ___.

A

embolus

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13
Q

Which drugs are used to treat white thrombi?

A

ANTIPLATELET DRUGS

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14
Q

A venous thrombus is also known as a ___ thrombus.

A

red

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15
Q

Which drugs are used to treat red thrombi?

A

ANTICOAGULANT DRUGS

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16
Q

Where do emboli from white thrombi usually lodge?

A

Coronary arteries

Carotids

Subarachnoid

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17
Q

Where do emboli from red thrombi usually lodge?

A

Pulmonary arteries

(PE)

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18
Q

Which drug blocks modification of factors X and II?

A

Warfarin

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19
Q

What drug directly inhibits activated factor X (Xa)?

A

Rivaroxiban

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20
Q

Which drugs indirectly block activated factor X (Xa)?

A

Heparins

Fondaparinux

21
Q

Which drug directly inactivates activated factor II (IIa), which is responsible for thrombin production?

A

Dabigatran

(Heparin also does, indirectly)

22
Q

___ factors act as precursors for ___ factors.

A

inactive , active

23
Q

Which sort of enzyme do inactive precursor factors act as?

A

Serine proteases

24
Q

Which process do precursor factors undergo to become active factors?

A

gamma carboxylation

25
Q

What is required for gamma carboxylation of inactive precursor factors to active factors?

A

Vitamin K

26
Q

Which enzyme, important in gamma carboxylation of inactive precursor factors, does warfarin act on?

A

Vitamin K reductase

27
Q

What acts (with a delay) on vitamin K reductase to bring about an anticogulative effect?

A

Warfarin

28
Q

How long does it take for warfarin to produce an anticoagulative effect?

A

2-3 days

29
Q

Which type of thrombosis are anticoagulants used to treat?

A

Venous / red thrombosis

30
Q

Give an example of a case where an anticoagulant drug would be used to prevent venous thrombosis and embolism.

A

DVT

Post-surgery

Artificial heart valves

Atrial fibrillation

31
Q

What is a significant risk when using anticoagulative drugs like warfarin?

A

Haemorrhage

32
Q

How is warfarin administered?

A

Oral

33
Q

Which drug produces a rapid anticoagulant effect?

A

Heparin (or a LMWH)

34
Q

How many half-lives would you clear a drug (e.g heparin) for before commencing a procedure which required its absence?

A

5 half-lives (200 hrs in case of warfarin)

35
Q

What property of warfarin makes it difficult to strike a balance between desired anticoagulant effect and haemorrhage?

A

Low therapeutic index

36
Q

Which factors increase the risk of haemorrhage when using warfarin?

A

Liver disease

High metabolic rate (hyperthyroidism?)

Loads of drug interactions

37
Q

Which factors increase the risk of thrombosis when using warfarin?

A

Pregnancy

Hypothyroidism

Vitamin K consumption

Loads of drug interactions

38
Q

If someone took too much warfarin and haemorrhaged, what would you give them?

A

Vitamin K

plasma clotting factors

39
Q

What does antithrombin III resist the effect of?

A

Thrombin

40
Q

What process does antithrombin III inhibit?

A

Coagulation

41
Q

Which drug binds to antithrombin III to increase its effect?

A

Heparin

42
Q

Which factors does antithrombin III act on to produce an anticoagulative effect?

A

Xa and IIa

43
Q

Name a low molecular weight heparin (LMWH).

A

Dalteparin

Enoxaparin

Fondaparinux

Idrabiotaparinux

44
Q

LMWHs act on antithrombin III to inhibit activated factor __.

A

Xa

45
Q

How is heparin administered?

A

IV (immediate onset)

Subcutaneously (works within an hour)

46
Q

Heparin is the preferred anticoagulant in which type of organ failure?

A

Renal failure

47
Q

Name two other anticoagulative drugs (other than warfarin and heparin).

A

Dabigatran

Rivaroxaban

48
Q

Which drug blocks ADP channels on platelets?

A

Clopidogrel

49
Q

Which drug blocks COX-1? lol

A

Aspirin

Cardiovascular Week 3 2016/17 (6 decks)

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