Antithrombic pharm for ischemic HD

Question 1

indications bivalirudin

Answer 1

UA pt ungergoin percutaneous coronary intervention

Question 2

lifespan of platelet

Answer 2

7-10 days

Question 3

indications aspirin

Answer 3

UA acute MI, hx of MI

decreases futur MI and mortality

Question 3

pharmacokinetics clopidogrel, ticlopidine, prasugrel

Answer 3

clopidrogrel, ticlopidine and prasugrel metabolized to active metabolite (prasugrel more readily metab, stronger)

clopidrogrel metabolized by CYPC19

Question 3

side effects ticlopidine

Answer 3

life threathening AE - neutropenia, thrombotic thrombocytopenic purpura

Question 4

conversion of extrinsic and intrinsic pathway

Answer 4

Xa

Question 4

warfarin inhibits ___ synthesis

Answer 4

prothrombin, VII IX, X,

Question 5

general treatment for NSTEMI and UA

Answer 5

antiplatelet/antithrombotic

statin

aspirin

B block

nitrates

Question 6

antithrombotic agens

Answer 6

unfractionated heparin

low MW heparin

direct thrombin inhibitors

Question 7

general reperfusion therapy+therapy for STEMI

Answer 7

Mechanical or thromboyltic reperfusion

and

antiplatelet/antithrombotic, statin, aspin, beta blockers, nitrates

Question 7

Alteplase mechanism

Answer 7

activates plasminogen into active protease to lyse fibrin clots

Question 8

mechanism of thienpyridines (ticlopidine, prasugrel, ticagrelor)

Answer 8

inhibit ADP meidated activaion of platelets (at PY12 receptor to block decrease in cAMP and subsequnet increase in calcium)

Question 10

mediates fibrinogen to fibrin

Answer 10

thrombin

Question 11

pharmacokinetics Abciximab and Eptifibatide

Answer 11

Abciximab is IV admin and non-competitive

Eptifibatide is IV admin, competiive, renal clearance

Question 12

Glycoprotein IIb/IIIa inhibitors

Answer 12

Abciximab

Epitifabatide

Question 13

new oral anticoagulants,

reduce risk of stroke and Syst. embolism in pt with nonvalvular Afib,

reduce risk of recurrent ischemia after ACS event (thrombin remains elevated following ACS event)

Answer 13

dabigitran

rivaroxaban

Question 14

prothrombin factor

Answer 14

(II)

Question 14

aspirin impact on endothelial

Answer 14

inhibits COX1, but endothelial have nucleus and can regenerate and can produce prostacyclin to work against platelet aggregation (against thromboxane and clotting)

Question 15

Cox inhibitor

Answer 15

Aspirin

Question 16

digest fibrin, other plasma proteins

Answer 16

Plasmin

Question 17

patients do not benefit from fibrinolytic therapy

Answer 17

UA or STEMI

Question 18

factors inactivated by heparin

Answer 18

XII

XI

IX

X

VII

Thrombin

Question 19

exception to antirombotic/antiplatelet treatment rule: ___ may also be treated with thrombolytic

Answer 19

STEMI

Question 20

activates plasminogen

Answer 20

t-PA

Question 21

heparin inactivates

Answer 21

only circulating thrombin (not bound)

Question 22

factors dependent of vitK for synth

Answer 22

II IX X VII

Question 24

recombinant tissue type plasminogen activators for fibrinolytic therapy

Answer 24

Alteplase

Question 26

LMWH and fondaparinux advantage over UFH

Answer 26

more predictable bioavail longer half life

Question 27

reversible thienopyridine

Answer 27

ticagrelor

Question 28

adverse effects alteplase

Answer 28

bleeding systemic lytic state

Question 29

indications abciximab

Answer 29

PCI (angioplasty,stent) combo with aspirin or heparin/LMWH with alteplase for thrombolysis

Question 30

ADP receptor inhibtors

Answer 30

Clopidogrel Prasugrel Ticagrelor

Question 31

mechanism Abciximab and eptifibatide

Answer 31

inhibit common pathway of platelet aggregation (binding GPIIb/IIIa receptors to fibrinogen and vWF)

Question 32

birect thrombin inhibitor

Answer 32

bivalirudin (independent of anatithrombin) (clotted and free thrombin)

Question 33

indications epitifibatide

Answer 33

PCI (angioplasty or stent) UA and MI, often along with LMWH

Question 35

UFH and LMW heparins pharomacokinetics

Answer 35

parentally admin (not absorbed from GI)

Question 36

mechanism, indication Dipyridamole

Answer 36

inclrease platelet cAMP blocking phosphodiesterase and blocking cell uptake+destruction of adenosine little therapeutic use alone, Pts with aspriin intollerance