Anti-coagulent drugs Flashcards by aderonke adesanoye

Q

Warfarin

A

Vitamin K antagonist- therefore prevents gamma coagulation of factors 2, 7, 9, 10.

Increases extrinsic pathway- higher PT

Inhibits protein C and S

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Q

Target INR for warfarin in PE/DVT and AF

A

2.5

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Q

Target INR for warfarin in recurrent VTE or metal heart valves

A

3.5

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Q

Warfarin interactions

A

Cytochrome P450

Some enzyme inhibitors increase effects of warfarin

Some enzyme inducers inhibit warfarin

Warfarin interacts with alcohol

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Q

Enzymes inducers that inhibit warfarin (4)

P R A C

pigs race across the city

A

Rifampicin

Amiodarone

Citalopram

Phenytoin

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Q

Rifampicin

A

Enzymes inducers that inhibits warfarin

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Q

Amiodarone

A

Enzymes inducers that inhibits warfarin

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Q

Citalopram

A

Enzymes inducers that inhibit warfarin

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Q

Phenytoin

A

Enzymes inducers that inhibit warfarin

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Q

Enzyme inhibitors that potentiate warfarin

A

Carbamazepine

Azathioprine

Allopurinol

Erythromycin

Ciprofloxacin

Metronidazole

Fluconazole

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Q

Carbamazepine

A

Enzyme inhibitor that potentiates warfarin

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Q

Azathioprine

A

Enzyme inhibitor that potentiates warfarin

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Q

Allopurinol

A

Enzyme inhibitor that potentiates warfarin

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Q

Erythromycin

A

Enzyme inhibitor that potentiates warfarin

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Q

Ciprofloxacin

A

Enzyme inhibitor that potentiates warfarin

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Q

Metronidazole

A

Enzyme inhibitor that potentiates warfarin

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Q

Fluconazole

A

Enzyme inhibitor that potentiates warfarin

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Q

Heparin

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A

Mucopolysaccharide that potentiates antithrombin

Irreversibly inactivates 2a and Xa

Unfractionated IV
LMW injections

Q

Unfractionated heparin

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A

Only used due to inconvenience- i.e cancer patients.

APTT monitored 1.5-2.5 x of normal

Reversed with protamine sulphate

Safe in renal failure

Q

What compound partially reverses the effect of unfractionated heparin

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A

Protamine sulphate

Q

LMW heparin

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A

Given once daily via s.c injections- according to patient’s weight

Used as thromboprophylaxis for hospital in-patients

Q

LMW heparin formulations

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A

Tinzaparin

Enoxaparin

Dalteparin

Q

Hirudin

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A

Anticoagulant derived from snake venom that is used to create drug Lepirudin.

Directly inhibits 2a

Q

Lepirudin

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A

Anticoagulant drug derived from hirudin

Inhibits 2a, used as heparin alternate method.

Heparinoids

Heparin-like compounds, used as anticoagulant alternative to heparin. Includes: danaparoid

Danaparoid

A heparinoid that is heparin-like.

Fondaparinux

Anticoagulant, alternative to warfarin and heparin. Includes arixtra

Arixtra

A fondaparinux Potentiates anti-thrombin and inhibits Xa.

NOAC

Anticoagulant drugs alternative to warfarin. Orally available and no monitoring needed Classes; Dabigatran- inhibits 2a Rivaroxaban- inhibits 10a

Dabigatran

Directly inhibits 2a. Example- argatroban

Indications of dabigatran

VTE prophylaxis: DVT and PEs Stroke prevention in AF

Argatroban

A Dabigatran that directly inhibits thrombin. Used in renal failure and given IV

Rivaroxaban

A NOAC that directly inhibits 10a.

Aspirin

Anti-platelet drug cyclooxygenase inhibitor

Clopidogrel

Anti-platelet ADP receptor inhibitor

Prostacyclin

Anti-platelet Stimulates adenylate cyclase production

Abciximab

Glycoprotein IIb/IIIa inhibitor A monoclonal antibody.

Eptifibatide

Glycoprotein IIb/IIIa inhibitor Derived from snake venom

Tirofiban

Glycoprotein IIb/IIIa inhibitor Blocks platelet aggregation

tPA

Tissue plasminogen activator Fibrinolytic agent that lyses fresh thrombin

Streptokinase

Fibrinolytic agent that lyses fresh thrombin

Side effects of warfarin

Teratogenic- affects fetal development. Alopecia Skin necrosis Haemorrhage

Reversing warfarin

Load with vitamin K- 2-10 mg i.v If life threatening, give Octaplex- contains factors 2,7,9 and 10.