CVS - anticlotting drugs

Question 1

3 groups of anticlotting drugs

Answer 1

1. antiplatelets
2. anticoagulants
3. thrombolytics

Question 2

4 groups of antiplatelets

Answer 2

1. NSAIDs (Aspirin)
2. platelet GPIIB/IIIA receptor inhibitors
3. ADP receptor blockers
4. PDE inhibitor

Question 3

Aspirin MOA and clinical uses

Answer 3

decrease formation of prostaglandins
clinical use:
- prophylactic treatment of transient cerebral ischemia 
- reduce risk of recurrent MI
- decrease mortality in post PI pts

Question 4

Aspirin ADR

Answer 4

gastric ulcers

Question 5

GP IIB/IIIA receptor inhibitor drugs

Answer 5

Abciximab: inhibits binding of fibrinogen to GP IIA/IIIB*
Eptifibatide: mediates binding of fibrinogen to the receptor
Tirofiban: occupy the receptor

Question 6

GP IIB/IIIA receptor clinical uses

Answer 6

prevents restenosis after the coronary angioplasty

used for acute coronary syndromes

Question 7

ADP receptor blocker drugs

Answer 7

Clopidogrel

Ticlopidine

Question 8

PDE inhibitor drug

Answer 8

Dipyridamole

Question 9

4 groups of Anticoagulants

Answer 9

1. Heparin
2. Coumarin (warfarin)
3. Lepirudin/ Hirudin
4. Antithrombin III

Question 10

Heparin MOA

Answer 10

bind to ATIII, exposing its active site: increase interaction with proteases -> inactivates thrombin quickly

Question 11

Heparin clinical uses

Answer 11

• DVT
• pulmonary embolism
• AMI
• angioplasty: use in combination with thrombolytics
  good for pregnancy use
  IV/ IM

Question 12

Heparin ADR

Answer 12

heparin induced thrombocytopenia (HIT)
decrease thrombocytes: cause thrombosis and thrombocytopenia
cause heparin triggers IgG response - target platelets -> platelet clot formation

also causes hemorrhage. to stop hemorrhage, give protamin sulfate - binds to heparin, prevents heparin from binding to ATIII

Question 13

Warfarin MOA

Answer 13

Warfarin is a Vit-K dependent epoxide reductase inhibitor
VitK epoxide cannot be reduced, inhibiting gamma-carboxylation of the cofactors 2 (prothrombin), 7, 9, 10, protein C and protein S -> will not mature and be activated

warfarin effectively lowers the concentration of clotting factors, 2, 7, 9 and 10, hence reducing hypercoagulating tendencies

Question 14

Warfarin ADR

Answer 14

Bleeding (has small therapeutic window)
NO PREGNANCY - crosses placenta and can cause haemorrhagic disorder in fetus - affect fetal proteins in bone and blood. cause embryo malformation

• Cutaneous necrosis:** (breast, buttock, intestines) due to reduction in protein C levels)

Question 15

thrombolytic agent drugs (4)

Answer 15

• t-PA (alteplase) - tPA = tissue plasminogen activator
• urokinase
• streptokinase
• anistreplase

Question 16

thrombolytic agents MOA

Answer 16

increase formation of plasmin, which is a fibrin degradation product

Question 17

thrombolytic agents clinical use

Answer 17

emergency treatment for coronary artery thrombosis
for peripheral arterial thrombosis and emboli
IV/ intracoronary

Question 18

thrombolytic agents ADR + CI

Answer 18

bleeding (ofc)
CI: healing wound - will form a scar that wont heal
NO pregnancy