Anticoagulants II Flashcards Preview

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Flashcards in Anticoagulants II Deck (26):
1

what is the coumarin anticoagulant and how does it work

warfarin, an oral anticoagulant (unlike heparin)

inhibits vit K epoxide reductase leading to production of inactive clotting factors II, VII, IX, X since they lack the gamma carboxyl glutamic side chain

2

warfarin's effect on thrombus

has no effect on pre established thrombus but will further prevent increase in the size of the thrombus

3

how to overcome warfarin

give vitamin K and see reversed changes in 24 hours

4

why must warfarin be monitored and how is it monitored

has a narrow therapeutic window

measured using PT which measure extrinsic and common pathway of coagulation

5

uses of warfarin

- warfarin used to prevent progression or recurrence of DVT or PE after initial heparin use

-prevent venous thromboembolism

- given with initial heparin, fondaparinux, or LMWH which is discontinued once INR is in therapeutic range for two straight days

6

adverse effects of warfarin

-hemorrhage
-cutaneous necrosis due to reduced activity of protein C
-crosses placenta and cause hemorrhagic disorder in fetus and abnormal bone formation

SO DO NOT GIVE TO PREGGOS

7

drugs that inhibit warfarin metabolism and what they cause

Cimetidine, Chloramphenicol, Disulfarim, Fluconazole, Metronidazole, Phenylbutazone, Sulfinpyrazone, TMP-SMX (trimethoprim-sulfamethoxazole)

CC-DF-MP-ST

potentiate anticoagulation --> bleeding

8

drugs that stimulate warfarin metabolism and what they cause

barbiturates, carbamazepine, phenytoin, rifampin

RiP CB

reduce anticoagulation

9

what are the thrombolytic drugs

STUART
Streptokinase, Thrombolytics, Urokinase, Alteplase, Reteplase, Tenecteplase

10

mechanism of thrombolytics

convert inactive zymogen plasminogen to active protease plasmin which then digests fibrin --> lysing of already formed blood clots

11

who are thrombolytics contraindicated in

healing wounds
pregnancy
history of cerebrovascular accident
metastatic cancer

12

what is streptokinase produced by and what does it catalyze the degradation of

produced by beta hemolytic strep
degrades fibrinogen, factor V and VII

13

what is streptokinase used for

acute MI
acute PE
arterial thrombosis
occluded access shunts

14

what is Urokinase found and what is it used for

- since it is synthesized by kidney, it is found in urine

- used for lysis of PE

15

how does Alteplase, Reteplase, and Tenecteplase work

they are tissue plasminogen activator (t-Pa) (serine protease) that rapidly activate plasminogen already bound to fibrin in a thrombus

poor activators of free plasminogen

16

what does higher concentration of tissue plasminogen (t-Pa) lead to

activation of circulating plasminogen --> hemorrhage

17

uses of alteplase, reteplase, and tenecteplase

alteplase: acute MI and acute ischemic stroke
reteplase and tenecteplase: acute MI

18

how do you prevent and treat venous thrombosis

with LMWH, UFH, or fondaparinux
-could also use warfarin but must monitor

19

drugs used to treat arterial thrombosis

aspirin and clopidogrel

20

what are the drugs used to treat bleeding

VAPP
Vit K, Aminocaproic acid, Protamine sulfate, plasma fractions

all plasminogen activation inhibitors

21

how does aminocaproic acid and tranexamic acid work

synthetic inhibitors of fibrinolysis which competitively inhibit plasminogen activation

22

what is aminocaproic acid and tranexamic acid used for

adjunct therapy in hemophilia
therapy for bleeding from fibrinolytic therapy

23

adverse effect of aminocaproic acid and tranexamic acid

intravascular thrombosis

24

mechanism of protamine sulfate

chemical antagonist of heparin hence inactive against fondaparinux

25

adverse effects of protamine sulfate

hypersensitivity
dyspnea
flushing
bradycardia
hypotension

26

when is vit k an excellent choice to stop bleeding

if vit K deficiency
on warfarin therapy

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