Anticoagulants & thrombolytics

Question 1

Heparin

Answer 1

negative charge
large
bind to antithrombin III–> inactivation of thrombin & factor Xa
prevents clots from forming

Question 2

What is used to measure heparin?

Answer 2

PTT

Question 3

What does heparin treat?

Answer 3

DVT
prophylaxis for PE
Acutre MI

Question 4

What are the side effects of heparin ?

Answer 4

heparin induced thrombocytopenia

hyperkalemia due to hypoaldosteronism

induce ospteoperosis

Question 5

What is the drug that is given to prevent heparin side effects ?

Answer 5

Protamine sulfate

Question 6

Low molecular weight heparin

Answer 6

decrease factor Xa
increased half life and bioavailability 
safe in pregnancy 
is not affected by protein sulfate 
 is contraindicated in renal insufficiency 
decreased need for monitoring 
decrease risk for HIT

Question 7

Fondaparinaux

Answer 7

not affected by protamine sulphate
binds antithrombin III with greater specificity
decreases factor Xa
decreased HIT

Question 8

BiraliRUDIN

Answer 8

direct thrombin inhibitor
tx: HIT
safe in liver disease patient

Question 9

Agatroban, Dabigatran

Answer 9

direct thrombin inhibitor

tx: HIT

Question 10

RivaroXaban, ApiXaban

Answer 10

direct factor Xa inhibitor
decrease monitory
given orally
tx: atrial fibrillation

Question 11

Warfarin

Answer 11

decrease vitamin K epoxide reductase –> decreased coagulation

onset is 8-12 hrs , oral administration
long half life

tx: atrial fibrillation
prophylaxis in PE & DVT

Question 12

What are the side effects of warfarin?

Answer 12

teratogenic: decreased hemorrhage and bone formation

warfarin induced skin necrosis

Question 13

How is warfarin effects treated ?

Answer 13

vitamin K - delayed

FFP- immediate

Question 14

What occurs at the beginning of warfarin doses?

Answer 14

protein C is reduced leading to a hypercoaguable state

tx: heparin to decrease affects

Question 15

What are the methods of monitoring warfarin ?

Answer 15

PT

INR -2-3

Question 16

How are platelets recruited to an injury?

Answer 16

1. Adhesion (VWF, GPIb-IX)
2. Activation (degranulation )
3. Aggregation (fibrinogen/ GPIIb/IIa)

Question 17

Aspirin

Answer 17

decrease COX 1 –> decrease TXA 2 by irreversible acetylation

Question 18

What are the side effects of aspirin ?

Answer 18

increased leukotrienes

GI upset & bleeding

Question 19

P2Y12 Antagonist

Answer 19

“grel”

block ADP from binding to P2Y12 –> increase cAMP –> decreased platelets

Question 20

What are the dual (aspirin + P2Y12) given for?

Answer 20

prevent stent thrombosis
decrease ischemic stroke
Acute MI
cardiovascular events

Question 21

What are the adverse effects of ticlopidine ?

Answer 21

aplastic anemia

agranulocytosis

Question 22

Abcixmab

Answer 22

monoclonal antibody

bind GP IIB/IIIa

Question 23

Eptificatide & Tirofiban

Answer 23

block GP IIB/IIIa

Question 24

What is the side effect of GPIIb/IIA inhibitors

Answer 24

Thrombocytopenia

increased bleeding time

Question 25

Dipyridamole & Cilostazol

Answer 25

Phosphodiesterase inhibitors | increase cAMP

Question 26

What does cilostazol cause?

Answer 26

vasodilation claudication coronary steal

Question 27

What are the thrombolytic drugs?

Answer 27

alteplase (TPA) reteplase tenecteplase streptokinase

Question 28

What is the effect of thrombolytics?

Answer 28

plasminogen to plasmin conversion--> increase fibrin degradation products

Question 29

What is the meaning of increased D-dimers?

Answer 29

increased clot degradation

Question 30

Why are thrombolytics given?

Answer 30

ischemic stroke DVT PE acute MI

Question 31

When does a thrombolytic need to be given in acute MI for it to be functional ?

Answer 31

3-4.5 hrs

Question 32

What are the adverse effects of thrombolytics?

Answer 32

hemorrhage, irregular breathing, asymmetric pupils Anaphylaxis

Question 33

What is the preferred option before fibrinolytic ?

Answer 33

percutaneous coronary intervention | needs to be completed in the first 2 hrs

Question 34

What are the contraindication of thrombolytics?

Answer 34

surgery planned within 10 days GI bleeds or active bleeds previous cerebral hemorrhage Aortic dissection

Question 35

What are the antifibrinolytics?

Answer 35

e-aminocaproic acid & tranexamic acid : competitively inhibit plaminogen activation

Question 36

What can tranexamic acid be used for?

Answer 36

dental extractions in hemophilia patients