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Antiplatelet, anticoagulant and fibrinolytic drugs Flashcards

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1
Q

Arterial thrombosis is most common cause of ?

A

acute myocardial infarction, ischemic stroke and limb gangrene

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2
Q

Venous thrombosis can lead to?

A

post thrombotic syndrome and pulmonary embolism(leads to chronic thromboembolic pulmonary hypertension)

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3
Q

arterial thrombi are mostly formed at?

A

disrupted atherosclerotic plaque–> platelet aggregation & fibrin formation

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4
Q

Arterial thombi are rich in ?

A

platelets

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5
Q

venous thrombi are composed of ?

A

fibrin and trapped red cells

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6
Q

what’s the treatment for arterial thrombosis?

A

antioplatelet agents

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7
Q

low dose rivaroxaban (10a inhibitor) + antiplatelet therapy reduces what?

A

ischemic events and stent thrombosis in pxs w coronary syndrome

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8
Q

low dose rivaroxaban (10a inhibitor) + antiplatelet therapy + aspirin reduces what?

A

coronary and limb events in pxs w stable coronary or peripheral artery dis

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9
Q

what is mainstay tx for prevention and tx of venous thromboembolism.?

A

anticoagulants

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10
Q

tx for massive PE?

A

systemic or catheter directed fibrinolytic therapy

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11
Q

Healthy vascular releases & expresses what?

A

NO & prostacyclin,CD39

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12
Q

what are platelet agonists?

A

ADP, thrombin and thromboxane A2

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13
Q

Aspirin inhibits what?

A

COX -1

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14
Q

which drugs inhibit ADP?

A

clopidogrel, prasugrel, ticagrel, cangrelor

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15
Q

what inhibits ADP receptor

A

Clopidogrel, prasugrel, ticagrelor, cangrelor

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16
Q

what are parenteral anticoagulants?

A

Heparin, LMWH, fondaparinux , lepirudin, desirudin, bivalirudin, argatroban

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17
Q

what are oral anticoagulants?

A

warfarin, Direct oral anticoagulants - dabigatran etexilate, rivaroxaban, apixaban and edoxaban

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18
Q

What’s the MOA of heparin?

A

activates antithrombin, inhibits fact 2a and 10a l

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19
Q

what’s the dosage of heparin ?

A

fixed doses of 5000 units SC 2-3 x daily

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20
Q

Heparin can be used in which disease states ?

A

Acute coronary syndromes and venous thromboembolism

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21
Q

Whats the dosage of heparin in acute coronary syndromes?

A

IV 5000 units or 70units/kg at the rate of 12-15 units/kg/hr

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22
Q

what’s the dosage for venous thromboembolism ?

A

Heparin - 5000 units or 80 units/kg, infusion of 18units/kg/hr

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23
Q

how do you monitor anticoagulant effect of heparin

A

Activated partial thromboplastin time (aPTT)

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24
Q

What are the side effects of anticoagulants?

A

bleeding (most common), thrombocytopenia, osteoporosis, inc transaminases

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25
in heparin induced thrombocytopenia platelet count is dec to?
<100,000/ >50%
26
In HIT platelet count is dec in how many days ?
5-14 days
27
HIT is more common in?
unfractionated HIT
28
HIT is common in which patients ?
Surgical pxs, cancer and women
29
What are some advantages of LMWH ?
Better bioavailability and longer life after SQ injection, dose dep clearance, predictable anticoagulant resp, lower risk of hep induced thrombocytopenia, low risk of osteoporosis
30
What are the consequences of using LMWH?
SQ once or twice a daily for both prophylaxis and tx, coagulation monitoring is unnecessary for most of the pxs, safe than hep for long short and extended admin
31
which are direct oral anticoagulants?
dabigatran, rivaroxaban, apixaban, edoxaban
32
Is warfarin vit-k antagonist?
Yes
33
Warfarin is most commonly monitored using?
Prothrombin time
34
direct oral anticoagulants inhibits what?
Factor 10a
35
which is more convenient to administer DOACs or warfarin? why?
DOACs bc they are given in fixed doses
36
which drugs degrade thrombi and are administered systematically?
Fibrinolytic drugs
37
Fibrinolytic drugs can be administered in which cases?
Acute MI, acute ischemic stroke and massive PE
38
what are examples of fibrinolytic drugs?
streptokinase, urokinase (alteplase or activase)
39
which are recombinant derivatives of fibrinolytic drugs ?
rtPA, tenecteplase and reteplase
40
What's the mechanism of action of fibrinolytic drugs ?
Converts plasminogen to plasmin
41
which causes platelet activation ?
adhesion to VWF and collagen
42
___ is a dynamic process in which platelet and vessel wall play key roles
Hemostasis
43
Platelet are activated upon adhesion to ?
von willebrand factor ,collagen, shear forces, inflammation
44
___ provides major physiologic site for coagulation factor activation
Activated platelet surface
45
What is the normal platelet count?
150,000-450, 000
46
What's the life span of platelets?
7-10 days
47
What's the major regulator of platelet production?
TPO
48
TPO's synthesis inc w?
Inflammation and IL-6
49
1/3rd of the platelets reside in?
Spleen
50
Platelet adhesion results in generation of signals through activation of which receptors?
Gp2b/3a
51
Which is endothelium derived vasodilator that inhibits platelet formation?
NO
52
Which is endothelium derived vasoconstrictor inhibiting platelet plug formation?
Endothelin
53
Thrombocytopenia results from?
1. Dec bone marrow prod 2.sequestration in spleenomgealy 3. Inc platelet destruction
54
What is is pseudo thrombocytopenia?
Platelet agglutination via antibodies via IgG when Ca content is dec in blood collection in EDTA
55
Dec platelet count usually results from?
56
Bone marrow should be evaluated in which patients?
Myelodysplasia, >60 yrs or who do not respond to initial therapy
57
In thrombocytopenia physical examination reveals what?
Enlarged spleen and chronic liver disease
58
Platelet count of what maintains vascular integrity?
5000-10000
59
When the platelet count is dec petechiae appears where?
Areas of inc venous pressure --> the ankles and feet in an ambulatory patients
60
What denotes an Inc risk of life-threatening hemorrhage in the thrombocytopenic patient?
Wet purpura, blood blisters on oral mucosa
61
What's the most common cause of iatrogenic thrombocytopenia?
Infection-induced thrombocytopenia
62
Which infections can cause thrombocytopenia?
Infectious mononucleosis , DIC, HIV & COVD-19
63
Drug dependant antibodies reacting w platelet surface antigens are common w which durgs
Quinine and sulfonamide
64
This drug inhibits Gp2b/3a causes thrombocytopenia
Abciximab
65
When is heparin induced thrombocytopenia severe?
<20, 000/uL
66
HIT is not associated w bleeding but it can inc risk of
Thrombosis
67
In HIT antibody is formed against what?
Platelet-specific protein platelet factor 4
68
HIT occurs in which heparin LMWH OR UFH
UFH
69
Most of the patients develop HIT after exposure to heparin after how many days?
5-14 days
70
What is delayed-onset HIT?
Thrombocytopenia and thrombosis develops after all heparin has been stopped
71
What is 4T scoring for diagnosis of thrombocytopenia
Thrombocytopenia, timing of platelet drop, thrombosis and other causes not evident
72
ELISA measures what?
Antibodies
73
Platelet activation assay/ serotonin rel assay measures what?
Ability to activate platelets
74
Direct thrombin inhibitor_ is effective in HIIT
Argatroban
75
What's the most common complication of HIT
Thrombosis
76
If there's thrombosis anticoagulants should be given for how many months?
3-6 mos
77
ITP cause?
Immune mediated destruction of platelets and inhibition of platelet rel from the megakaryocyte
78
Secondary ITP is associated w which disorders?
Autoimmune SLE, infections (HIV, hep C), helicobactor pyramid
79
ITP is characterized by?
Mucocutaneous bleeding, low platelet count, ecchymoses and petechiae, incidental thrombocytopenia
80
In ITP if anemia is present which test should be done to rule out hemolytic anemia w ITP (Evan's syndrome)
Coombs test
81
W/O bleeding, severe thrombocytopenia (<5000/uL) what's the TOC?
Prednisone at 1mg/kg or a 4-day course of dexamethasone, 40mg /d, RHO immune globin 50-75ug/kg, IV gamma globulin-1-2 g/kg over 1-5 days
82
What's the TX for severe ITP
Hospital admission, high dose glucocorticoids w IVIG or anti-RHO therapy, TPO agonist (Romiplstim/ Eltrombarg), glucocorticoids+ mycophenolate motefil
83
In severe ITP when splenectomy should be done?
Relapse after tapering glucocorticoids
84
TTP & Hemolytic uremic syndrome is characterized as?
Micrangiopathic hemolytic anemia defined by thrombocytopenia and fragmented RBCs

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