anticoagulants

Question 1

thrombotic disorder

Answer 1

tx with anticoagulants, fibrinolytic

Question 2

bleeding/hemorrhage

Answer 2

hemophilia tx with coagulation factor and transfusion

vit k def tx with vit k

thrombocytopenia

Question 3

response to injury

Answer 3

VC
platelet plug
clot formation (secondary hemostasis)
fibrinolysis

Question 4

keeps platelets in inactive state

Answer 4

NO
prostacylin
ADPase

all inc cAMP in platelets which act. Ca efflux pump to lower Ca

Question 5

primary hemostasis

Answer 5

collagen and von willebrand leads to platelet adhesion

dec cAMP and inc Ca activates platelets

Question 6

platelet act.

Answer 6

platelet release thromboxane A2
adenosine diphosphate
serotonin
thrombin

Question 7

platelet aggregation

Answer 7

inc in GPIIb/IIIa rec on surface of platelet
bind to cirullating fibrinogen
creates platelet plug

Question 8

anti-platelet drugs targers

Answer 8

inhibition of TxA2 synthesis
inhibition of ADP receptors
blockage of GPIIb/IIIa rec
phosphodiesterase inhibitors/vasodilators

Question 9

inhibition of TxA2 synthesis

Answer 9

oral aspirin
irreversible inhibition of COX-1
platelet life is 7-10 days

NSAIDS-reversible

dont give at same time

Question 10

inhibition of ADP receptors

Answer 10

oral clopidogrel

irreversible inhibition of P2Y12 receptor

Question 11

blockage of GPIIb/IIIa rec

Answer 11

IV abciximab monoclonal Ab

irreversible inhibition of fibrin receptor

Question 12

phosphodiesterase inhibitors/vasodilators

Answer 12

oral dipryridamole
vasodilator
reversible PDE inhibition inc. cAMP and dec Ca

given in combo w/aspirin to prevent cerebrovascular ischemia

Question 13

secondary hemostasis

Answer 13

several minute
fibrin stabilizes
PL produce negatively charged polyphosphates that trigger intrinsic pathway

tissue factor triggers extrinsic pathway

Xa act factor II (prothrombin) into factor IIa (thrombin)

cleaves next factor that is Zymogen

Question 14

factor XIIIa

Answer 14

transglutaminase

Question 15

antithrombin

Answer 15

AT is a serine protease inhibitor and inactivates the serine proteases of the intrinsic pathway

Question 16

4 classes of anticoagulant

Answer 16

vit k antagonist
indirect thrombin inh
direct thrombin inh
dircect inh of factor Xa

Question 17

vit k antagonist

Answer 17

oral warfarin

dicoumarol in clover silage, hemorrhagic disease in cattle

Wisconsin Alumni Research Foundation coumARIN

attacks vit k reductase

SNP can lead to high risk of bleeding so need to monitor

Question 18

phytonadione (mephyton)

Answer 18

oral vitamin K1

Question 19

warfarin R isomer

Answer 19

cyp1a2/3A4 inhibitors
ciprofloxacin
most statins
fenofibrate
macrolide AB
CYP inducers
phenytoin

Question 20

warfarin S isomer

Answer 20

CYP2C9
Metronidazole
Amiodarone
Azole antifungals
Sulfamethoxazole/trimethoprim

Question 21

indirect thrombin inh

Answer 21

IV unfractionated heparin

SC, IV LMW heparins: Enoxaparin

Question 22

IV unfractionated heparin

Answer 22

Pentasaccharide sequence binds to AT and exposes it leading to Xa inactivation

short half, continued infusion

Question 23

SC, IV LMW heparins: Enoxaparin

Answer 23

2,000 to 9,000 daltons

longer half life, infected ONCE daily, NO monitoring needed

Question 24

protamine sulfate

Answer 24

antidote to heparin
basic, positively charged
Inj
monitored

Question 25

direct thrombin inh

Answer 25

``` oral dabigatran DOAC large prodrug reversible inh thrombin serine protease half life of 12-24 hr, once daily ``` better than warfarin, heparin, and inj thrombin inhibitors b/c there is NO NEED TO MONITOR

Question 26

dircect inh of factor Xa

Answer 26

oral Rivaroxaban most recent DOAC all better choices than warfarin because NO MONITORINg

Question 27

positive regulators of fibrinolysis

Answer 27

damaged endothelium releasing tissue Plasminogen Activator tPA binds to plasminogen bound to fibrin rather than circulating plasminogen tPA cleaves plasminogen into plasmin

Question 28

fibrinolytic or thrombolytic drugs

Answer 28

IV tPA alteplase tPAs prefer plasminogen bound to fibrin, fibrinolysis will only occur in the formed thrombus and avoids act in the systemic flow

Question 29

alteplase

Answer 29

recombinant full length glycosylated human tPA very fibrin selective efficient in dissolving older clots

Question 30

management of DOACS

Answer 30

anti factor Xa assay before sx no reversal agents so consider cessation of DOAC medication before sx

Question 31

collagen plug/sponge

Answer 31

acc aggregation of platelets and forms physical barrier ``` microfibrillar collagen (avitene) collagen sheets ```

Question 32

topical thrombin

Answer 32

added to matrix, gelfoam CAUTION if allergic rx from bovine thrombin

Question 33

fibrin sealant (fibrin glue)

Answer 33

mix of thrombin and CaCl2 in one syringe, conc of thrombin determines rate of clot fibrinogen, factor XIII, fibrinogen determines strength of clot

Question 34

astringents or styptics

Answer 34

``` VC, induce platelet aluminum chloride (plugs incapillaries) tannic acid (CAUTION incompatible with metal salts) ```

Question 35

vasoconstrictor agents

Answer 35

epinephrine short term bleeding long term use is ischemia nd tissue necrosis

Question 36

fibrinolytic inhibitors

Answer 36

maintain clot stability, comp inh plasminogen act aminocaproic acid tranexamic acid cover risk of hemorrhage in ptwith hemophilia (replace with coag factor)