Anticoagulants Flashcards
(22 cards)
Unfractionated Heparin
Anticoagulant
Template mechanism, inhibits thrombin (IIa) via antithrombin. IV or SQ
Unpredictable bio availability - need to monitor via APTT
Short Half life
Can reverse via protamine
Can use in pregnancy
Risk HIT: platelet activation by Abs against heparin -PF4 complex. Occurs 5-10d after, DVT, PE, MI, stroke, Skin necrosis.
Low Molecular Weight Heparin
Anticoagulant
Newer, smaller
Inhibit Xa
not as unpredictable - do NOT monitor with APTT, can monitor was assay , renal metabolism
Short Half life
Can reverse via protamine
Can use in pregnancy
Less Risk HIT: platelet activation by Abs against heparin -PF4 complex. Occurs 5-10d after, DVT, PE, MI, stroke, Skin necrosis.
Fondaparinux
Synthetic LMWH, doesn’t cross-react with HIT Abs - use to treat HIT.
Warfarin
Anticoagulant
Vit K antagonist - inhibit vit K epoxide reductase, inhibit glutamic carboxylation - inhibit synthesis of factors 2, 7, 9, 10. Inhibit synth of Prot C and S
Slow onset, Monitor with INR of PT, many interactions, Narrow therapeutic window, polymorphic
Teratogenic
Purple toe syndrome (rare)
argatroban
Anticoagulant
Direct Thrombin (IIa) Inhibitor
Parenteral - IV
Treat HIT, short half life
Liver metabolism
lepirudin
Anticoagulant
Direct Thrombin (IIa) Inhibitor
Parenteral - IV
Treat HIT, short half life
Renal metabolism
Made from leaches
bivalirudin
Anticoagulant
Direct Thrombin (IIa) Inhibitor
Parenteral - IV
Treat HIT, short half life
Renal metabolism
Made from leaches
dabigatran
Anticoagulant Direct Thrombin (IIa) Inhibitor Oral Treat HIT, short half life Fast onset, no monitoring, No antidote!
80% renal metabolism
rivaxaban
Anticoagulant Direct Factor Xa Inhibitor short half life Fast onset, no monitoring, No antidote! Less renal metabolism
apaxiban
Anticoagulant Direct Factor Xa Inhibitor short half life Fast onset, no monitoring, No antidote! Less renal metabolism
Aspirin
Anti - Platelet
Inhibits COX I , II –> decreases synthesis of thromboxane A2 which is a platelet agonist
Prevents arterial thrombosis
Bad: GI ulcers, allergy, Reye’s Syndrome in kids
clopidegrel
Anti - Platelet
P2Y12 Receptor Antagonist - block activation of platelets by decreasing ADP activation of P2Y12 receptor
Oral
High affinity –> essentially irreversible
ticlopidine
Anti - Platelet
P2Y12 Receptor Antagonist - block activation of platelets by decreasing ADP activation of P2Y12 receptor
Oral
High affinity –> essentially irreversible
prasugrel
Anti - Platelet
P2Y12 Receptor Antagonist - block activation of platelets by decreasing ADP activation of P2Y12 receptor
Oral
High affinity –> essentially irreversible
ticagrelor
Anti - Platelet
P2Y12 Receptor Antagonist
Oral
Noncompetitive inhibitor of receptor –> reversible
abciximab
Anti - Platelet
Glycoprotein IIb/IIIa Antagonist: inhibit binding of fibrinogen to platelet receptor IIb/IIIa
IV
bad: thrombocytopenia
tirofiban
Anti - Platelet
Glycoprotein IIb/IIIa Antagonist: inhibit binding of fibrinogen to platelet receptor IIb/IIIa
IV
bad: thrombocytopenia
small molecule
eptifibitide
Anti - Platelet
Glycoprotein IIb/IIIa Antagonist: inhibit binding of fibrinogen to platelet receptor IIb/IIIa
IV
bad: thrombocytopenia
cyclic heptapeptide
dipyradmole
Anti - Platelet Multiple mechanims: stimulate prostacyclin synthesis, inhibit adenosis deaminase and phosphodiesterase Vasodilator Oral or IV Used in combo with Aspirin
streptokinase
Fibrolytic Agent: activate plasminogen which degrades fibrin
IV or catheter
NOT fibrin specific (also cleaves fibrinogen)
derived from beta-hemolytic streptococus
bad: allergic Abs, hypotension
urokinase
Fibrolytic Agent: activate plasminogen which degrades fibrin
IV or catheter
NOT fibrin specific (also cleaves fibrinogen)
protease, cleaves plasminogen to plasmin
t-PA
Fibrolytic Agents: activate plasminogen which degrades fibrin
= tissue plasminogen activator
IV
Class of drugs: alteplase, reteplase, tenecteplase
Fibrin specific!!!
short half life - use with heparin
