Anti-thrombotics Pharmacology Flashcards Preview

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Flashcards in Anti-thrombotics Pharmacology Deck (22)
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1

Accelerate lysis of thrombus in STEMI (patients with UA and NSTEMI do not benefit)

Fibrinolytic therapy

2

Transform inactive plasminogen to plasmin

Alteplase Streptokinase

3

When does fibrinolytic therapy need to be administered?

Within 30 minutes of presentation to the hospital

4

What are some adverse effects of fibrinolytic therapy?

Bleeding Systemic lytic state

5

In what patients is fibrinolytic therapy contraindicated?

Active peptic ulcers Recent stroke Recent surgery

6

Interfere with coagulation cascade; goal is to inhibit thrombin activation by Xa, directly inhibit thrombin or decrease functional thrombin production

Anti-coagulants

7

What is unique about heparin (UFH)?

It can inactivate Xa and inactivate free thrombin

8

Inactivate Xa

Low MW heparin Enoxaparin Dalteparin Fondaparinux

9

What is a possible severe side effect of thrombin?

Thrombocytopenia

10

Why would you use LMWH over UFH?

It has a longer 1/2 life and more predictable bioavailability than UFH.

11

Direct thrombin inhibitor; inhibits independently of antithrombin; acts on circulating and clot-bound thrombin

Bivalirudin

12

Irreversibly acetylates COX-1 in platelets; blocks production of thromboxane. Permanent effect.

Aspirin

13

What patients is aspirin used in?

Patients with UA, acute MI, history of MI; chronic stable angina w/o history of MI; minor stroke; Coronary artery bypass surgery

14

Inhibit ADP-mediated activation of platelets; ADP activates P2Y1 and P2Y12 -- drugs inhibit P2Y12

Thienopyridines: Clopidigrel, Ticlopidine, Prasugrel, Ticagrelor

15

Which Thienopyridine is reversible and when is this an advantage?

Ticagrelor -- prevents perioperative bleeding complications w/o a waiting period (lifespan of platelets is 7-10 days)

16

What are some side effects of Ticagrelor?

Severe neutropenia and thrombotic thrombocytopenic purpura

17

Used in patients that cannot tolerate aspirin; relatively ineffective; increase platelet cAMP

Dipyridamole

18

Reversible inhibit the final common pathway of platelet aggregation -- binding of GPIIa/IIIb to fibrinogen and vWF

Abciximab Eptifibatide

19

Chimeric human mouse antibody; blocks access of fibrinogen and vWF to GPIIa/IIIb receptor; non-competitive; IV

Abciximab

20

Synthetic peptide; motif that binds GPIIb/IIIa receptors; competitive; IV; renal clearance

Eptifibatide

21

New drug, inhibits free and fibrin bound thrombin

Dabigatran

22

New drug, direct Xa inhibitor

Rivaroxaban