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Pre-pharmacology > Chapter 13 (anticlotting agents) > Flashcards

Chapter 13 (anticlotting agents) Flashcards

(52 cards)

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1
Q

antiplatelet drugs

A

inhibit the initiation of a clot

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2
Q

anticoagulant drugs

A

prevent the formation of mature clots

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3
Q

thrombolytic drugs

A

dissolve clots that have already formed

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4
Q

three mechanisms of body to reduce blood loss when bleeding occurs

A
  1. vascular spasm
  2. formation of platelet plug (where platelet inhibitors work)
  3. blood clotting; coagulation (anticoagulants work here)
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5
Q

vascular spasm

A

one method of hemostasis; BVs snap back after being severed to narrow lumen of arteriols and reduce blood flow

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6
Q

formation of platelet plug

A

one method of hemostasis; platelets become activated and form spikey processes to become sticky
They can then adhere to inner walls of damaged BVs to form a platelet plug

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7
Q

coagulation

A

one method of hemostasis; blood congeals to form a clot around the platelet plug
Occurs via a cascade

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8
Q

coagulation cascades

A

extrinsic and intrinsic that both lead to a final common pathway

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9
Q

fibrinolytic system

A

body tissue and blood contain substances that activate plasminogen to plasmin, which is the enzyme that dissolves clots

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10
Q

tPA

A

tissue plasminogen activators; drugs that dissolve clots
Must be given within about 3 hours after symptoms of MI/stroke or the detriments will outweight the benefits
Works on large artery occlusions, lacunar strokes, and pts. with frosbite (reduce number of amputations)

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11
Q

thrombosis

A

abnormal formation of an intravascular clot

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12
Q

BV inner lining

A

should be smooth endothelial cells to keep platelets and RBCs from sticking
Can become roughened from atherosclerosis, trauma, or infection which can lead to thrombus formation

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13
Q

plaque atherogenicity

A

BV plaques are stimulatory to the clotting system (atherogenic) and can lead to blood clots on stop of plaque in artery

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14
Q

clot formation in veins

A

usually form from stasis of blood, allowing clotting factors to accumulate and initiate coagulation leading to DVT

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15
Q

DVT

A

deep venous thrombosis; forms from blood stasis
Often happens to people who have been sedentary for a long time or pregnant women from weight impeding venous blood flow (also cause of varicose veins and hemorrhoids)

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16
Q

vein clots often lead to problems in the…

A

lungs

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17
Q

artery clots often lead to problems in the…

A

brain

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18
Q

embolus

A

thrombus that has been dislodged and swept away in blood; can obstruct BVs and cause ischemia to tissue beds distal to obstruction (PE or stroke)

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19
Q

PE

A

pulmonary embolism; often from DVT in legs

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20
Q

thromboembolic events

A

both thrombosis and embolism make up this disease

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21
Q

most serious type of embolism

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A

clot/plaque combination that breaks free

22
Q

ASVD and plaque formation can be lessened by…

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A

controlling BP and lipids through NO, CCBs, B blockers, etc. to decrease metabolic heart O2 demands

23
Q

three types of anti-clotting drugs

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A
  1. platelet inhibitors; hinder ability of platelets to get sticky and form platelet plug
  2. anticoagulants; hinder one or more of soluble clotting factors that lead to enzymatic conversion of fibrinogen to fibrin
  3. thrombolytics; ‘clot buster’ drugs to dissolve already formed clots
24
Q

antiplatelet drug uses

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A
  1. prevent/treat superficial venous thrombosis or mild cases of DVT
  2. prevent ‘mini stroke’ TIAs (transient ischemic attacks)
  3. prevent/treat anginal chest pain
25
antiplatlet drug mechanism
prevent platelet activation so clots cannot be initiated; | Reduce ability of platelets to aggregate, but do not affect the deep coagulation cascade (increase bruising likelihood)
26
NSAIDs
have antiplatelet effect, but mostly just ASA has a pronounced effect
27
acetylsalicylic acid
aspirin; used prophylactically as antiplatelet drug to relieve angina and prevent MI and stroke (81 mg baby aspirin) or in emergency by chewing two 325 mg with water
28
Plavix
clopidogrel; thienopyrindine drug more hard core antiplatelet drug that is used if person has already had an MI (for example) Sometimes given w/ASA but is very dangerous and must be Rx'ed with great caution
29
anticoagulant drug mechanism
Interrupt one or more of clotting steps in coagulation cascade; works on deep bleeding cascade and so has associated mortality from stopping coagulation so much
30
deep bleeding
bleeding into joints, abdomen, or brain; adverse effect of anticoagulants
31
BT
bleeding time; time measured for bleeding to stop on standard incision on skin for test Not a great test and often will just ask about bruising or nose bleeds
32
anticoagulant uses
1. anticoagulation for hemodialysis and cardiopulmonary bypass 2. prevent or treat DVT or PE 3. prevent or treat stroke or MI
33
CPB
cardiopulmonary bypass; anticoagulants used during this procedure
34
aPTT test
tests the intrinsic coagulation pathway
35
INR (PT) test
international ratio test; tests extrinsic pathway by seeing how much longer pts. blood takes to clot compared to normal people
36
heparins
Best in the moment anticoagulants (only 2 minutes for effect) and given as soon as bleeding in under control from initial injury Stimulates antithrombin III of deep clotting cascade; inhibit the intrinsic coagulation cascade; measured by aPTT test
37
Coumadin
warfarin, rat poison; anticoagulant inhibits formation of vitamin K-dependent clotting factors made in liver (mainly factor VII) Can be given orally and used long-term (unlike heparin); measured by INR (PT) test Very low TI and has hundreds of drug interactions so patients require close checking in on
38
Pradaxa
dabigatran; direct thrombin inhibitor (inhibits the final common coagulation pathway)
39
antithrombin III
our natural anticoagulant that increases time to clot
40
unfractionated heparins
heparins of different molecular sizes; always required hospital stay b/c used to be given by IV and required monitoring by aPTT
41
LMWH
low molecular weight heparins; better than unfractionated heparins b/c they can be given by IM one/two times a day and can be done at home
42
Lovenox
enoxaparin; LMWH (low molecular weight heparin) | Stimulates antithrombin III; natural deep clotting cascade anticoagulant
43
countering Coumadin
vitamin K injections (IM or IV) or FFP admin; since warfarin inhibits vitamin K, by giving more it can be overpowered and fresh frozen plasma has coagulation factors in it which counters the effect of the anticoagulant
44
Factor Xa inhibitors
new group of anti-coagulants; have started to replace warfarin as standard oral outpatient anticoagulant
45
Xarelto
rivaroxaban; oral factor Xa inhibitor (anticoagulant)
46
Eliquis
apixaban; oral factor Xa inhibitor (anticoagulant)
47
DTIs
direct thrombin inhibitors; new anticoagulant group
48
Pradaxa
dabigatran; direct thrombin inhibitor (anticoagulant)
49
tPA mechanism
after healing, it is released to convert plasminogen into active form, plasmin which breaks apart clots
50
thrombolytic drugs
accelerate normal clot busting process by augmenting action of tPA Used for pts. with acute MI or thrombotic/embolic stroke But is very dangerous b/c if given to someone with a hemorrhagic (bleeding) stroke then the pt. will likely die b/c the bleeding will never stop (CT must be done to see if there is any bleeding in brain)
51
streptokinase
earliest thrombolytic; produced naturally by beta-hemolytic streptococcal bacteria But is highly antigenic and yields high allergic reaction rates
52
Activase
alteplase; thrombolytic, first tissue-type plasminogen activator, which is good b/c it is a human protein, not bacterial

Pre-pharmacology (27 decks)

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