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Pharmacology > Antithrombotics + Anticoagulants > Flashcards

Antithrombotics + Anticoagulants Flashcards

1
Q

What is hemostasis?

A

The process of stopping blood loss from injured vessels

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2
Q

How is a hemostatic plug formed and stabilized?

A

It is formed by aggregated platelets and then stabilized by cross-linked fibres

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3
Q

What is thrombosis?

A

Unwanted formation of a hemostatic plug/clot inside a blood vessel or heart chamber

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4
Q

What is an emboli?

A

A portion of the thrombus that breaks away and may get stuck in capillaries

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5
Q

What does an arterial clot look like?

A

Platelet rich (more white) bc platelets are attracted to specific injury site

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6
Q

What does a venous clot look like?

A

Red blood cell rich

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7
Q

What stimulates thrombus formation?

A

Atherosclerosis damages the arteriole endothelial layer, which stimulates thrombus formation

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8
Q

What are 2 possible causes of arteriole physical damage?

A

1) balloon angioplasty

2) stenting

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9
Q

Why are anti platelet drugs less effective in veins?

A

Bc venous thrombosis involves RBCs (not so much platelets)

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10
Q

What is venous thrombosis due to?

A

Stagnant flow in veins and/or atria

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11
Q

Name 3 platelet inhibitors:

A

1) Aspirin
2) Clopidogrel
3) Abiciximab

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12
Q

Aspirin MOA:

A

1) Blocks COX irreversibly
2) Vascular endothelial cells have nucleus and can produce more COX –> PG12
3) Platelets do not have a nucleus and cannot produce more COX
* Balance is shifted towards PG12*

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13
Q

What are 2 functions of COX?

A

1) Platelets: produces thromboxane A2, which promotes aggregation
2) Vascular endothelium: produces PGI2, which makes platelets less likely to aggregate (stabilization)
* Balance bw TXA2 and PGI2 determines how sticky platelets will be*

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14
Q

Clopidogrel = prodrug that is converted into active form by CYP2C19

A

CYP2C19 genetic variation decreases effect

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15
Q

Clopidogrel MOA:

A

1) Prevents ADP from binding to platelets (irreversible)
2) GPIIb/GPIIIa receptor activation inhibited
3) Fibrinogen cannot link platelets –> aggregation is decreased

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16
Q

Clopidogrel AEs:

A

1) Neutropenia
2) Thrombotic thrombocytopenia purpura
3) Hemorrhage: GI, cerebral
4) Rash
5) Respiratory: URI, rhinitis, SOB, cough

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17
Q

Clopidogrel indication:

A

1) Prevention of ischemic stroke and MI

2) Routine use during stent insertion during MI

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18
Q

Clopidogrel prolongs bleeding for ___ days

A

7-10

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19
Q

Abciximab MOA:

A

Monoclonal antibody against GPIIb/IIIa receptor that prevents fibrinogen from binding and linking platelets (platelet aggregation cannot occur)

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20
Q

Abciximab administration:

A

IV

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21
Q

Look at medchem notes

A

for heparin

22
Q

Heparin indication:

A

1) Arterial and venous thrombosis prevention (eg: post-op hip replacement, thrombolytic tx)
2) Pulmonary embolism and acute MI tx

23
Q

What are the anti-coagulation DOCs in pregnancy?

A

1) heparin
2) LMWH
bc does not cross placenta

24
Q

What is the antidote for heparin induced hemorrhage?

A

Protamine sulfate (give IV)

25
Q

Protamine sulfate AE:

A

Anaphylaxis in pts previously treated with protamine

26
Q

Heparin and LMWH adminsitration:

A
  • IV
  • SC (LMWH not as deep)
  • LMWH has more predictable effects*
27
Q

Warfarin MOA:

A

Vitamin K antagonist

28
Q

Why is warfarin losing popularity?

A

Bc needs constant monitoring for INT

29
Q

Warfarin adminsitration:

A

PO

30
Q

Warfarin anticoagulation effects is seen after ___:

A

8-12 hours (management: if immediate effect is needed, heparin is also administered)

31
Q

What is the antidote for warfarin induced hemorrhage/warfarin OD?

A

Vitamin K

32
Q

Name a LMWH:

A

Enoxaparin

33
Q

Enoxaparin MOA:

A

1) Increases effects of anti-thrombin III (has higher specificity for Factor X vs Factor II)
* not orally active*

34
Q

Enoxaparin indication:

A

1) Prevention of post-op DVT/PE
2) Unstable angina
3) Ischemic stroke
4) Maintenance of extracorporeal circulation during surgery/dialysis

35
Q

Name 2 AEs of warfarin:

A

1) Bleeding disorders

2) MANY DIs (including dietary Vitamin K)

36
Q

Can warfarin be taken during pregnancy?

A

No - teratogenic and may cause abortion

37
Q

What is pro-thrombin time?

A

Measurement (in seconds) of extrinsic pathway

38
Q

What is the target INR?

A

2-3

INR ≤2 may lead to thrombotic complications, INR ≥ 3 may lead to bleeding

39
Q

Name 2 novel oral anticoagulants (NOACs):

A

1) Dabigatran: direct, irreversible thrombin imhibitor

2) Rivaroxaban: direct factor Xa inhibitor

40
Q

Why are NOACs gaining popularity?

A

Bc they are

  • Orally active
  • More predictable than warfarin
  • Have greater TI than warfarin and heparin
41
Q

NOACs indication:

A

1) Percutaneous cardiac interventions
2) VT prevention and management
3) Post-op hip/knee replacement

42
Q

What enhances bleeding effect of dabigatran?

A
  • NSAID (also seen in rivaroxaban)

- SSRI/SNRI

43
Q

What is the antidote for dabigatran induced haemorrhage and how does it work?

A

Idarucizumab - monoclonal antibody that binds dabigatran with greater affinity than

44
Q

Rivaroxaban indication:

A

1) VT prevention in adults undergoing hip/knee replacement surgery
2) Stroke and embolism prevention in adults w/ non-valvular atrial fibrillation
3) Recurrent DVT/PE prevention following acute DVT in adults

45
Q

What is the antidote for rivaroxaban induced haemorrhage and how does it work?

A

Andexanet alfa IV - modified Factor Xa that binds direct factor Xa inhibitor

46
Q

What is the physiological action of plasminogen/plasmin?

A

Plasminogen bound to fibrin is converted to plasmin via tissue plasminogen activator (tPA) –> plasmin breaks down fibrin –> clot is dissolved and is handled by body

47
Q

tPA indication:

A

1) mi
2) massive PE
3) acute ischemic stroke

48
Q

When is tPA tx most beneficial?

A

When given 4.5 hours after sx onset

49
Q

What is one drawback of fribinolytic drugs?

A

They cannot distinguish bw fibrin of a good hemostatic plug and fibrin of unwanted thrombosis (therefore may cause bleeding in unknown lesion - peptic ulcers)

50
Q

Name 2 fibrinolytic inhibitors:

A

1) Tranexamic acid

2) Aminocaproic acid

51
Q

Fibrinoytic inhibitors MOA:

A

1) Lysine analogues that bind to and inhibit plasminogen and plasmin
2) Clot is stabilized

52
Q

Fibrinolytic inhibitors indication:

A

1) Reduction of peri- and post- op bleeding esp in pts with bleeding disorders

Pharmacology (9 decks)

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