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Pharmacology II Exam I CVS Drugs > Antithrombotic and Hemostatic Drugs > Flashcards

Antithrombotic and Hemostatic Drugs Flashcards

(47 cards)

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1
Q

What prevents platelet activation and aggregation

A

Nitric oxide and prostacyclins

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2
Q

When a vessel is damaged, control of bleeding is first initiated by

A

Vasospasm

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3
Q

What is responsible for creating the reinforcement of a platelet plug

A

Fibrin

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4
Q

There is usually ___________ balance between clot formation and clot inhibition

A

homeostatic

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5
Q

Where do deep vein thromboses typically form

A

Lower extremities

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6
Q

What is Virchow’s triad

A
  • Stasis
  • Defect in hemostatic mechanism
  • Endothelial injury
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7
Q

What drugs are used to treat venous clots

A

Anticoagulant drugs, thrombolytics

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8
Q

Are venous or arterial clots more painful

A

Arterial due to a block of oxygen (ischemia)

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9
Q

What are some examples of why an arterial clot would form

A

In medium sized arteries (carotid, optical)

Endothelial damage in atherosclerosis (states of low flow)

Emboli in heart in Afib; MI and Stroke

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10
Q

What drug class are you going to use to treat arterial clots or in the prevention of developing clots

A

antiplatelet drugs, thrombolytics

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11
Q

What is the medication goal of anticoagulants and antithrombotic meds

A

Prevention of heart attack and stroke, PE, or DVT

Also to prevent complications of Afib, CHF, and genetic and acquired hypercoagulability

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12
Q

How do anticoagulation agents work in slowing down clotting

A

Interference with fibrin formation

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13
Q

What extrinsic factor is binding with exposed subendothelial components as part of the clotting cascade to aid platelet adhesion to site of injury

A

Factor VIII

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14
Q

What are the intrinsic factors players of the clotting cascade?

A

VIII, XI, XI, XII,

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15
Q

After platelet aggregation takes place (and the area of injury is stabilized), the clot is fibrinolyzed by

A

plasmin

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16
Q

What are antiplatelet agents used for

A

To prevent platelet activation in arterial system

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17
Q

What are anticoagulant agents used for

A

To prevent formation of fibrin clot in venous system

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18
Q

What are the “classic” anticoagulants

A

Heparin and Warfarin

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19
Q

What are fibrinolytic agents used for

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A

To break down existing clot

20
Q

What are the fibrinolytic agents

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A

Alteplase (tPA)
Anisterplase
Urokinase
Reteplase

21
Q

COX-1 is a key enzyme involved in the synthesis of

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A

Platelet thromboxane A2 (prostaglandin pathway)

22
Q

What is the most common indication for daily Asprin

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A

Secondary prevention (after dx with CAD, DM, PVD, CVA, TIA)

23
Q

Can usually continue ASA 81 peri-operatively except with

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A

Intracranial, intramedullary, or posterior eye surgeries

24
Q

What is the goal of P2Y12 ADP receptor inhibitors

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A

Prevent further atherosclerotic events in MI, unstable angina, ACS and coronary angioplasty

25
Generally, how long is a patient on a P2Y12 ADP receptor inhibitor taken after a stent placement and what medication is then used indefinitely?
12 months, Aspirin
26
Can you use P2Y12 ADP receptor inhibitors during episodes of active bleeding
No
27
Why should you not prescribe a PPI with a P2Y12 ADP receptor inhibitor
May interfere with antiplatelet properties (co-prescribe with caution)
28
If a patient is a poor metabolizer what P2Y12 ADP receptor inhibitor would you choose
Ticagrelor (Brilinta)
29
Why is Tricagrelor not a first line P2Y12 ADP receptor inhibitor?
Interferes with statin medication (increased aches) and is very expensive
30
What is a severe possible risk factor of Ticlopidine?
Risk of thrombocytopenia, agranulocytosis and TTP (thrombotic thrombocytopenia purpura)
31
What do you need to monitor when a patient is on Tirofibran?
Monitor aPTT (Partial thromboplastin time- blood coagulation blood test)
32
When is Cilostazol's contraindicated?
Heart Failure, only used for intermittent claudication (legs) in PVD
33
Why is it important to ask patients about supplement use when prescribing antiplatelet drugs?
Some supplements decrease platelet activity creating a high risk for bleeding Fish oil Dong quai Garlic Ginger Gincko Ginseng Green Tea
34
What drug class should be avoided with use of Heparins because it can cause bleeding and renal dysfunction when used together
NSAIDs
35
Do you need to dose adjust Heparins in patients with impaired kidney function?
Yes
36
What are the side effects of unfractionated Heparin?
Bleeding Osteoporosis Hyperkalemia (aldosterone suppression) Elevation of trasaminases Heparin induced thromboytopenia
37
What labs do you need to monitor daily when using unfractionated heparin?
Platelets (CBC) because of risk for heparin induced thrombocytopenia (HIT)
38
When treating a DVT/PE with Enoxaparin how is it dosed?
Weight-based
39
What is the onset of action for Warfarin?
3-4 days (although absorption is rapid)
40
What is an absolute contraindication of Warfarin?
Pregnancy as it crosses the placenta
41
What is the adverse effect of Warfarin and how can it be reversed?
Bleeding, and can be reversed by vitamin K infusion
42
What are the drugs that increase bleeding/potentiate Warfarin activity
ASA Heparin Antibiotics
43
What are the drugs that decrease Warfarin activity?
Barbituates, Phenytoin Vitamin K Cholestyramine
44
What are the indications for Warfarin?
DVT/PE Treatment Prophylaxis of thrombotic event in: Afib, atrial flutter, prosthetic heart valve, recurrant DVT, perioperative (total knee and hip replacements)
45
It is important to achieve goal of INR levels and prevent bleeding or clottin, what should patients be counseled on to maintain levels?
Missed dose/double dose (what to do) Changes in OTC/herbals/diet (adjust dose for current therapies and diet) Changes in meds (abx tx warfarin should be held for 1-2 doses)
46
What is the MOA of Fonduparinux
Direct Xa Inhibitor - binds to anti-thrombin III, potentiates naturalization Xa 300 to 1000 times, inhibits Xa pathway
47
How are fibrinolytic therapies delivered?
Intra-arterially

Pharmacology II Exam I CVS Drugs (3 decks)

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