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Anti-coagulants Flashcards

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1
Q

What are absolute contraindications for thrombolysis?

A 
Haemorrhagic/ischaemic stroke <6months 
CNS neoplasia 
Recent trauma/surgery 
GI bleed <1month 
Bleeding disorder
Aortic dissection
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2
Q

What are relative contraindications for thrombolysis?

A

Warfarin
Pregnancy
Advanced liver disease
Infective endocarditis

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3
Q

What are the main types of anti-coagulants?

A

Anti-platelets
Anti-coagulants
Fibrinolytics

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4
Q

What are examples of anti-platelets?

A 
Aspirin
Dipyridamole
Clopidogrel
Ticagrelor 
Abciximab
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5
Q

What is the route of administration of aspirin?

A

Oral

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6
Q

What are the indications of aspirin?

A

Management of ACS
Suspected TIA
Acute ischaemic stroke

Secondary prevention

  • CVS disease
  • stroke/TIA if other agents contraindicated
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7
Q

What is the mechanism of aspirin as an anti-platelet?

A

Reduction of TXA2 synthesis by COX-1 inhibition

Inhibits platelet aggregation

Reduces platelets forming clots

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8
Q

What are the side effects of aspirin?

A

Prolonged bleeding time

Dyspepsia

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9
Q

What are the indications of Clopidogrel?

A

Prevention in patients intolerant to aspirin

Reduces morbitity/mortality post thromboembolic stroke

Reduces secondary events post MI

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10
Q

What are the routes of administration of Clopidogrel?

A

Oral

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11
Q

What is the mechanism of Clopidogrel?

A

Inhibits binding of ADP to P2Y12 receptor

Inhibits activation GPIIb/IIIa receptors

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12
Q

What are the side effects of Clopidogrel?

A

Diarrhoea
GI discomfort
Haemorrhage
Skin reactions

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13
Q

What are the indications for ticagrelor?

A

Prevention of atherothrombotic events in patients with history of MI/ACS

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14
Q

What are the routes of administration of ticagrelor?

A

Oral

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15
Q

What is the mechanism of ticagrelor?

A

Inhibits binding of ADP to P2Y12 receptor

Inhibits activation GPIIb/IIIa receptors

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16
Q

What are the side effects of ticagrelor?

A 
Constipation 
Diarrhoea
Dyspepsia
Gout
Haemorrhage
Hypotension
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17
Q

What is the mechanism of abciximab?

A

Monoclonal antibody irreversibly blocks GPIIb/IIa receptors

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18
Q

What is the effect of blocking GPIIb/IIIa receptors?

A

Prevents binding of fibrinogen and VWF

Prevents platelet aggregation

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19
Q

What is a side effect of abciximab?

A

thrombocytopenia

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20
Q

What are the indications of dipyramidole?

A

Secondary prevention

  • ischaemic strokes
  • TIAs
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21
Q

What is the route of administration of dipyramidole?

A

Oral

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22
Q

What is the mechanism of dipyramidole?

A

Inhibits cellular uptake of adenosine
Increased plasma adenosine
Inhibits platelet aggregation

Phosphodiesterase inhibitor
Prevents cAMP + cGMP degradation
Inhibits expression of GPIIb/IIIa

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23
Q

What are the side effects of dipyramidole?

A 
Angina 
Flushing
Headache 
Hypersensitivity 
V+D
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24
Q

What are examples of fibrinolytics?

A

Alteplase
Reteplase
Streptokinase

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25
What is the function of fibrinolytics?
Breakdown clots
26
What are the indications for Alteplase/reteplase?
Acute MI PE Acute ischaemic stroke
27
What are the routes of administration of Alteplase/reteplase?
IV
28
What is the mechanism of Alteplase/reteplase?
Bind to + activate plasminogen Plasminogen converted to plasmin which degrades the clot
29
What are the side effects of Alteplase?
``` Cardiac arrest Bleeding Heart failure Hypotension Nausea ```
30
What are the indications for streptokinase?
``` Acute MI DVT Central retinal/arterial thrombosis PE Occlusive peripheral arterial disease ```
31
What are the routes of administration of streptokinase?
IV
32
What is the mechanism of streptokinase?
Activates plasminogen Plasminogen converted to plasmin which degrades the clot
33
What are the side effects of streptokinase?
``` Anaphylactic reaction Cardiac arrest Haemorrhafe Hypotension N+V ```
34
What is the mechanism of anticoagulant agents?
Prevent thrombus formation and thrombus growing
35
What are the types of anticoagulants?
``` Vitamin K antagonists Unfractioned heparin Low molecular weight heparin DOACs Fondaparinux ```
36
What is the vitamin K antagonist?
Warfarin
37
What are the indications of warfarin?
DVT prophylaxis/treatment PE prophylaxis + treatment AF Protein C + S deficiency
38
What is the route of administration of warfarin?
Oral
39
What is the mechanism of warfarin?
Inhibits production of vitamin K dependent clotting factors - Prothrombin - VII - IX - X
40
What is the half life of warfarin?
40 hours
41
What are the side effects of warfarin?
Haemorrhage | N+V
42
What drugs does warfarin interact with?
Inhibition of hepatic metabolism - Amiodarone - Clopidogrel - Quinolones - Metronidazole Inhibit platelet function - Aspirin Reduce vitamin K by eliminating gut flora - Cephalosporins Displacement of warfarin from albumin - NSAIDs Acceleration of warfarin metabolism - Barbiturates - Phenytoin - rifampicin - St John's wort
43
What blood test is used to monitor warfarin?
INR
44
What INR is required for those on warfarin due to DVT?
2.5
45
What INR is required for those on warfarin due to PE?
2.5
46
What INR is required for those on warfarin due to AF?
2.5
47
What INR is required for those on warfarin due to recurrent DVT/PE?
3.5
48
What INR is required for those on warfarin due to mechanical valve?
3.5
49
What are the indications for Unfractioned heparin?
``` PE Unstable angine Acute peripheral arterial occlusion DVT Thromboprophylaxis ```
50
What are the routes of administration of UFH?
IV | SC
51
What is the mechanism of UFH?
Binds to antithrombin Inactivates - Thrombin IIa - Xa - IXa - XIa - XIIa
52
What are the side effects of UFH?
Haemorrhage Heparin-induced thrombocytopenia Skin reactions
53
What are examples of LMWHs?
Dalteparin | Enoxaparin
54
What are the indications for Dalteparin?
Unstable coronary artery disease Thromboprophylaxis DVT/PE treatment
55
What are the routes of administration of Dalteparin?
SC
56
What is the mechanism of Dalteparin?
Inhibits factor Xa
57
What are the side effects of Dalteparin?
Haemorrhage Heparin-induced thrombocytopenia Skin reactions
58
What are the indications for enoxaparin?
Treat VTE in pregnancy Thromboprophylaxis ACS
59
What are the routes of administration of enoxaparin?
SC
60
What is the mechanism of enoxaparin?
Inhibits factor Xa
61
What are the side effects of enoxaparin?
Haemorrhage Heparin-induced thrombocytopenia Skin reactions
62
What is used to reverse heparin?
Protamine sulphate
63
What is the route of administration of heparin?
IV
64
What is the mechanism of protamine sulphate?
Dissociates heparin from antithrombin III
65
What are the side effects of protamine sulphate?
Hypertension | Hypercoagulability
66
What are examples of DOACs?
Apixaban Rivaroxaban Dabigatran
67
What are the indications for apixaban?
VTE prophylaxis | Treatment of DVT/PE
68
What is the route of administration of apixaban?
Oral
69
What is the mechanism of apixaban?
Inhibits factor Xa
70
What are the side effects of apixaban?
Anaemia Haemorrhage Nausea Skin reactions
71
What are the indications of rivaroxaban?
VTE prophylaxis Treatment of DVT/PE Prophylaxis of atherothrombotic events
72
What is the mechanism of rivaroxaban?
Inhibits factor Xa
73
What are the routes of administration of rivaroxaban?
Oral
74
What are the side effects of rivaroxaban?
Anaemia D+V Haemorrhage Menorrhagia
75
What are the indications of dabigatran?
VTE prophylaxis | DVT/PE treatment
76
What is the route of administration of dabigatran?
Oral
77
What is the mechanism of dabigatran?
Direct competitive thrombin inhibitor
78
What are the side effects of dabigatran?
Abnormal hepatic function | Haemorrhage
79
What is fondaparinux?
Synthetic pentasaccharide
80
What are the indications for fondaparinux?
VTE prophylaxis ACS treatment DVT/PE treatment
81
What is the route of administration of fondaparinux?
SC
82
What is the mechanism of fondaparinux?
Selectively inhibits factor Xa by binding to antithrombin III
83
What are the side effects of fondaparinux?
Anaemia | Haemorrhage

Pharmacology (27 decks)

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