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Gen Med (Haem) > Anti-Platelet and Anti-Coagulant Drugs > Flashcards

Anti-Platelet and Anti-Coagulant Drugs Flashcards

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1
Q

What is the mechanism of action of aspirin?

A

Works by inhibiting the cyclo-oxygenase enzyme which inhibits thromboxane A2 and reduces platelet aggregation

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2
Q

What are some common side effects of aspirin?

A

Bleeding, bronchospasm and peptic ulceration

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3
Q

Aspirin should not be used in individuals of less than what age and for what reason?

A

Those aged < 16 due to risk of Reye’s syndrome (the exception to this is Kawasaki’s disease)

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4
Q

The use of aspirin can potentiate the effects of which other drugs?

A

Oral hypoglycaemics, warfarin and steroids

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5
Q

What is the mechanism of clopidogrel, prasugrel and ticagrelor?

A

ADP receptor antagonists causing inhibition of platelet activation

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6
Q

When using a PPI alongside clopidogrel, which specific PPI is it best to use?

A

Lansoprazole

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7
Q

What is the mechanism of action of dipyridamole?

A

Phosphodiesterase inhibitor

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8
Q

Give an example of a GP IIa/IIIb inhibitor, a type of anti-platelet drug?

A

Abciximab

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9
Q

How long before an elective operation should anti-platelet drugs be stopped?

A

7 days

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10
Q

How can the action of anti-platelet drugs be ‘reversed’ if someone who is taking them suffers serious bleeding?

A

Platelet transfusion

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11
Q

What is the first-line anti-platelet drug regime to be offered following an ACS?

A

Aspirin (lifelong) and ticagrelor (12 months)

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12
Q

What is the second-line anti-platelet drug regime to be offered following an ACS?

A

Clopidogrel (lifelong)

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13
Q

What is the first-line anti-platelet drug regime to be offered following an ischaemic stroke or TIA?

A

Clopidogrel (lifelong)

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14
Q

What is the second-line anti-platelet drug regime to be offered following an ischaemic stroke or TIA?

A

Aspirin and dipyridamole (lifelong)

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15
Q

What is the first-line anti-platelet drug regime to be offered for peripheral arterial disease?

A

Clopidogrel (lifelong)

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16
Q

What is the second-line anti-platelet drug regime to be offered for peripheral arterial disease?

A

Aspirin (lifelong)

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17
Q

What are the two most common indications for long-term use of anti-coagulant drugs?

A

Venous thrombosis and atrial fibrillation

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18
Q

The appropriate dose of heparin is based on what?

A

Weight

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19
Q

How are unfractionated and LMW heparin administered?

A

Unfractionated is given IV, LMW is given SC

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20
Q

What is the mechanism of action of heparin?

A

Potentiates anti-thrombin III

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21
Q

LMWH potentiates the effect of anti-thrombin III on which clotting factor?

A

Factor Xa

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22
Q

What investigation is used for monitoring the use of unfractionated heparin?

A

APTT

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23
Q

Though not used routinely, what investigation is used for the monitoring of the use of LMWH?

A

Anti-factor Xa assay

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24
Q

What electrolyte abnormality is most likely to arise as a result of heparin use?

A

Hyperkalaemia

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25
What are the three main adverse effects of the use of heparin?
Bleeding, heparin induced thrombocytopenia and osteoporosis
26
How soon after treatment does heparin induced thrombocytopenia typically present?
5-10 days after starting treatment
27
What are the three main features of heparin induced thrombocytopenia?
Greater than 50% reduction in platelets, thrombosis and skin allergy
28
What medication can occasionally be used to reverse the anti-thrombin effect of heparin, and allow complete reversal of unfractionated heparin and partial reversal of LMWH?
Protamine sulphate
29
Which has a longer duration of action- unfractionated or LMW hepatin?
LMWH
30
Which has a lower risk of side effects- unfractionated or LMW heparin?
LMWH
31
What is the target INR for VTE?
2.5
32
What is the target INR for recurrent VTE?
3.5
33
What is the target INR for AF?
2.5
34
Use of which antiplatelet/anticoagulant would cause an isolated rise in PT, with no change in APTT, bleeding time or platelet count?
Warfarin
35
Use of which antiplatelet/anticoagulant would cause an isolated rise in APPT, with no change in PT, bleeding time or platelet count?
Heparin
36
Use of which antiplatelet/anticoagulant would cause an isolated rise in bleeding time, with no change in APTT, PT or platelet count?
Aspirin
37
What is the mechanism of action of warfarin?
Antagonist of vitamin K
38
Warfarin use causes a deficiency of which clotting factors?
II, VII, IX and X
39
What investigation is used to monitor the use of warfarin?
INR
40
After starting warfarin, how long may it take to achieve a stable INR?
Several days
41
What is the major adverse effect of warfarin use?
Bleeding
42
Can warfarin be used in pregnancy/breastfeeding?
It can't be used in pregnancy but can in breastfeeding
43
What can be used to reverse the action of warfarin in around 6 hours time?
Vitamin K
44
What can be used to reverse the action of warfarin immediately, but only works for a short period of time?
Prothrombin complex concentrate
45
What are some factors that can potentiate the effect of warfarin?
Liver disease, cranberry/grapefruit juice, NSAID use
46
If a person's INR is too low, this means they are at risk of what?
Thrombus formation
47
If a person's INR is too high, this means they are at risk of what?
Bleeding
48
What effect do cytochrome P450 inducers have on warfarin?
Reduced INR
49
What effect do cytochrome P450 inhibitors have on warfarin?
Increased INR
50
When patients are started on warfarin, they should also be given what other drug for a short period of time?
Heparin
51
What is the mechanism of action of dabigatran?
Oral direct thrombin inhibitor
52
What is the mechanism of rivaroxaban, apixaban, edoxaban?
Oral factor Xa inhibitor
53
Which NOAC is excreted renally?
Dabigatran
54
Is any monitoring required for patients on NOACs?
No
55
If a patient is taking an antiplatelet for stable CV disease, but for some reason also need an anticoagulant, what should be done?
Anticoagulant monotherapy
56
How long are anticoagulants given for after ACS?
12 months
57
If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, what scoring system is used to determine if they should continue their antiplatelet or not?
HASBLED
58
If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, and they are deemed low-risk of bleeding, what should be done?
Continue anti-platelet and start anti-coagulant
59
If an individual is on an antiplatelet and needs to be started on an anticoagulant for VTE, and they are deemed moderate to high-risk of bleeding, what should be done?
Consider stopping anti-platelet and start anti-coagulant
60
If a patient on warfarin has an INR of 5-8 but no active bleeding, what should be done?
Withhold 1 or 2 doses, and reduce the maintenance dose of warfarin
61
If a patient on warfarin has an INR of 5-8 but is bleeding, what should be done?
Stop warfarin and give IV vitamin K
62
If a patient on warfarin has an INR of > 8 but no active bleeding, what should be done?
Stop warfarin and give oral vitamin K
63
If a patient on warfarin has an INR of > 8 but is bleeding, what should be done?
Stop warfarin and give IV vitamin K
64
Following management of a raised INR, warfarin should be restarted when the INR falls below what value?
5
65
If a patient on warfarin has major bleeding, what should be done?
Stop warfarin, give IV vitamin K and prothrombin complex concentrate

Gen Med (Haem) (12 decks)

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