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CPT > 6. Antiplatelet And Fibrinolytic Drugs > Flashcards

6. Antiplatelet And Fibrinolytic Drugs Flashcards

1
Q

Which drugs are used in platelet rich ‘white’ arterial thrombi?

A

Antiplatelet and fibrinolytic drugs

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2
Q

Which drugs are used in lower platelet content, ‘red’ venous thrombi?

A

Parenteral anticoagulants and oral anticoagulants

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3
Q

Name a cyclo-oxygenase inhibitor

A

Aspirin

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4
Q

What is the action of cyclo-oxygenate inhibitors?

A

Inhibits COX-1 mediated production of TXA2 and reduces platelet aggregation - irreversible

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5
Q

What are the adverse affects of aspirin?

A

GI irritation, GI bleeding, haemorrhage, hypersensitivity

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6
Q

What are the contraindications of aspirin?

A 
Reye’s syndrome - avoid <16 years
Hypersensitivity 
3rd trimester (premature closure of ductus arteriosus)
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7
Q

What are the important drug interactions with aspirin?

A

Other antiplatelet and anticoagulants

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8
Q

What are some indications of aspirin?

A

Antithrombotic
Atrial fibrillation
Secondary retention of stroke and TIA
Secondary prevention of acute coronary syndromes
Often co prescribed with other antiplatelet drugs
NSTEMI/STEMI
Acute ischaemic stroke

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9
Q

What is required in long term use of aspirin?

A

Gastric protection - proton pump inhibitor

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10
Q

Name some ADP receptor antagonists

A

Clopidogrel
Prasugrel
Ticagrelor

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11
Q

What is the action of ADP receptor antagonists?

A

Inhibit dining of ADP to P2Y12 receptor, therefore inhibiting activation of GPIIb/IIIa receptors

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12
Q

Which ADP receptor antagonists have slow onset of action and which have fast?

A

Clopidogrel has slow onset of action without a loading dose

Ticagrelor and prasugrel have a more rapid onset of action

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13
Q

What are the adverse effects of ADP receptor antagonists?

A

Bleeding
GI upset - dyspepsia, diarrhoea
Rarely thrombocytopenia

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14
Q

What are the contraindications of ADP receptor antagonists?

A

Caution in high bleed risk patients with renal and hepatic impairment

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15
Q

What are the important drug reactions wit ADP receptor antagonists?

A

Clopidogrel requires CYPs for activation therefore:
- CYP inhibitors (omeprazole, ciprofloxacin, erythromycin, some SSRIs
Ticagrelor can interact with CYP inhibitors and inducers
Caution when co prescribed with other antiplatelet and anticoagulant agents or NSAIDs

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16
Q

When would clopidogrel need to be stopped?

A

7 days prior to surgery

17
Q

When are ADP receptor antagonists used?

A

Clopidogrel as mono therapy when aspirin is contraindicated
NSTEMI patients up to 3 months
STEMI patients up to 4 weeks
Ischaemic stroke and TIA long term secondary prevention

18
Q

Name a phosphodiesterase inhibitor

A

Dipyridamole

19
Q

What is the action of phosphodiesterase inhibitors?

A

Dipyridamole inhibits cellular reuptake of adenosine, this increases [adenosine], which inhibits platelet aggregation via adenosine receptors
Also prevents cAMP degradation which inhibits expression of GPIIb/IIIa

20
Q

What are the adverse effects of phosphodiesterase inhibitors?

A

V and D

Dizziness

21
Q

What are the important drug reactions with phosphodiesterase inhibitors?

A

Antiplatelets and anticoagulants, adenosine

22
Q

When are phosphodiesterase inhibitors used?

A

Antiplatelet
Secondary prevention of ischaemic stroke and TIAs
Adjunct for prophylaxis of thromboembolism following valve replacement
Stroke

23
Q

Give an example of glycoprotein IIb/IIIa inhibitors

A

Abciximab

24
Q

What is the action of glycoproteins IIb/IIIa inhibitors?

A

Blocks binding of fibrinogen and vWF

Target final common pathway leading to more complete platelet aggregation

25
Q

What are the adverse effects of glycoprotein IIb/IIIa inhibitors?

A

Bleeding

26
Q

What are the important drug interactions with abciximab?

A

Caution with other antiplatelet and anticoagulant agents

27
Q

When is abciximab used?

A

Specialist use in high risk percutaneous transluminal coronary angioplasty patients with other drugs

28
Q

How do fibrinolytic agents work?

A

Dissolve the fibrin mesh work of thrombus

29
Q

What are the adverse effects of fibrinolytic agents?

A

Bleeding

30
Q

What are the important drug reactions with fibrinolytic agents?

A

Antiplatelets and anticoagulants

31
Q

What are some fibrinolytic agents?

A

Streptokinase
Alteplase
Tranexamic acid - stops bleeding

32
Q

Why can streptokinase not be used more than once?

A

Antibodies develop

CPT (30 decks)

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