cvs - anti-clotting drugs

Question 1

name 4 antiplatelet drugs

Answer 1

1. NSAIDs
2. platelet GPIIB/IIA receptor blockers
3. ADP receptor blockers
4. PDE inhibitors

Question 2

name 1 NSAID

Answer 2

aspirin

Question 3

moa of aspirin

Answer 3

inhibit COX-1 → reduce thromboxane A2 and inhibit platelet aggregation

Question 4

clinical uses of aspirin

Answer 4

• prophylaxis for transient cerebral ischemia
• reduce incidence of recurrent MI
• decrease mortality post-MI

Question 5

adverse effects of aspirin

Answer 5

• bleeding
• gastric upset and ulcers (due to reduced PGE2)
• reye’s syndrome

Question 6

name 3 platelet GP IIB/IIA receptor blockers

Answer 6

1. abciximab
2. eptifibatide
3. tirofiban

Question 7

moa of platelet GP IIB/IIA receptor blockers

Answer 7

prevent fibrinogen binding and inhibit platelet aggregation

Question 8

clinical uses of platelet GP IIB/IIA receptor blockers

Answer 8

• prevent stenosis after coronary angioplasty
• acute coronary syndromes

Question 9

adverse effects of platelet GP IIB/IIA receptor blockers

Answer 9

• thrombocytopenia
• bleeding

Question 10

name 2 ADP receptor blockers

Answer 10

1. clopidogrel
2. ticlopidine

Question 11

moa of ADP receptor blockers

Answer 11

irreversibly block ADP receptors on platelets, inhibiting activation

Question 12

name 1 PDE inhibitor

Answer 12

dipyridamole

Question 13

moa of PDE inhibitor

Answer 13

inhibit PDE → prevent breakdown of cAMP to 5’-AMP → increased cAMP → inhibit platelet aggregation

Question 14

name 4 anticoagulants

Answer 14

1. heparin derivatives
2. coumarin derivatives
3. lepirudin/hirudin
4. antithrombin III

Question 15

moa of heparin

Answer 15

1. bind to AT III and IIa → allows AT III to get close to IIa to deactivate it
2. once heparin binds to AT III, it can deactivate Xa wo binding to it
3. LMWH increases action of AT III on factor Xa (but not on thrombin)

Question 16

clinical use of heparin

Answer 16

• dvt
• pulm embolism
• acute MI
• anticoagulant for pregnancy

Question 17

how should heparin be administered

Answer 17

IV/SC

Question 18

why can’t heparin be given IM

Answer 18

haematomas

Question 19

adverse effects of heparin

Answer 19

• haemorrhage
• thrombocytopenia
• osteoporosis w LT use

Question 20

how to treat haemorrhage due to heparin use

Answer 20

stop heparin + start protamine sulfate (binds to excess heparin)

Question 21

moa of warfarin

Answer 21

vit k reductase inhibitor → inhibit vit K-dep clotting factors (II, VII, IX, X)

Question 22

clinical uses of warfarin

Answer 22

• dvt
• pulm embolism
• acute MI

Question 23

adverse effects of warfarin

Answer 23

• bleeding
• DDI (CYP450)

Question 24

contraindications for warfarin

Answer 24

pregnancy (causes haemorrhagic disorders in foetus, foetal proteins w gamma-carboxyglutamate residues affected)

Question 25

moa of lepirudin

Answer 25

directly inhibits thrombin

Question 26

moa of antithrombin III

Answer 26

enhance inactivation of thrombin and other coagulation enzymes

Question 27

name 4 thrombolytics

Answer 27

1. t-PA 2. urokinase 3. streptokinase 4. anistreplase

Question 28

moa of thrombolytics

Answer 28

directly converts plasminogen to plasmin → clot breakdown

Question 29

clinical uses of thrombolytics

Answer 29

- emergency treatment of coronary artery thrombosis - peripheral arterial thrombosis and emboli - ischaemic stroke

Question 30

adverse effect of thrombolytics

Answer 30

bleeding

Question 31

contraindications for thrombolytics

Answer 31

- recent surgery - bleeding disorders - severe uncontrolled hypertension - pregnancy

Question 32

moa of t-PA

Answer 32

binds to fibrin in a thrombus and converts plasminogen to plasmin → clot breakdown

Question 33

clinical use of t-PA

Answer 33

dissolve blood clots in MI/stroke

Question 34

clinical use of urokinase

Answer 34

- severe dvt - pulm embolism