Drugs

Question 1

What are the classes of anti-thrombotic drugs and where are they used for

Answer 1

Anti-platelet - for arterioles
Anti-coagulant - for both veins and arterioles
Fibrinolytics

Question 2

Name all anti-platelet drugs [4]

Answer 2

Aspirin
Clopidogrel; Ticlopidine
Abciximab

Question 3

Whats Aspirin;

Whats the dosage

Answer 3

Irreversible NSAID - hence work on COX1/2

• in platelets inhibit TXA2 - COX1
• although PG also blocked, where PG is antithrombotic, its regeneration in other cells is faster than platelets hence net antithrombotic

Give low dose; higher dose for anti-inflammatory

Question 4

Whats the clopis

MOA
AE

Answer 4

Clopidogrel, Ticlopidine

• Irreversible antagonist of P2Y12 receptor on platelet which ADP binds to for aggregation

AE Hemorrhage

Question 5

Whats the antibody drug for platelets

Answer 5

Abciximab

• Ab 2b 3a receptor for fibrinogen on platelets

Question 6

Function of thromboxane A2 [3]

Answer 6

Platelet activation, aggregation
Vasoconstriction

• Thromboxane (TXA2) is the most powerful vasoconstrictor known, whereas prostacyclin (PGI2) is a potent vasodilator

Question 7

Name all anticoagulants

Answer 7

Heparin (LMWH and UF) - Agatroban alternative

Warfarin

Question 8

Heparin + What if cant take Heparin

MOA

Answer 8

Penta-saccharide sequence
this PS will bind to antithrombin III

UF will enhance 10a and 2a blocking function / 2a is thrombin
LMWH will preferential to 10a

Agatroban - IV Thrombin inhibitor

Question 9

What’s Tissue Factor Pathway Inhibitor

Answer 9

inhibit factor 10 and 7

Question 10

Where is heparin made endogenously

Answer 10

Mast Cells

Question 11

Use of heparin

Answer 11

DVT, PE
MI
Pregnancy okay (no crossing placenta)

Question 12

Heparin AE short term [2] and long term [1]

Answer 12

Narrow Therapeutic Window

• Bleeding
• Heparin-induced thrombocytopenia - Thromboembolism (from AB complexes) AB binds to Heparin-PF4 complexes - AB Fc region then activates platelets; this fat ass complex can be removed in spleen

Osteoporosis [recall levothyroxine AE also] [Corticosteroids too uwu]

Question 13

LMW Heparin comparison

Answer 13

More Factor 10a blocking

Subcutaneous

Less side effect - TE, Osteoporosis

Question 14

Warfarin

Contra I

Answer 14

Block Vit K Epoxide Reductase VKED
- VKED activates Vit K (recycles it)

• Blocks 2 7 9 10 Protein C, S

NO PREGANCY USE - crosses placenta

Question 15

Faster onset Warfarin alternatives

Answer 15

Oral Factor 10 blocker
Rivaroxaban - Ban roxing the boat on the river

Oral Factor 2 blocker
Dabigatran - big dabs on the train

Question 16

Name all alternatives

Answer 16

IV Thrombin blocker
Argatroban

Oral Thrombin blocker
Dabigatran

Oral F10 blocker
Rivaroxaban

Question 17

Antidotes for overdose
Heparin
Warfarin

Answer 17

Protamine Sulfate (basic) - complex w Heparin (acidic)

Vit K

Question 18

Whats Argatroban

Answer 18

IV Thrombin blocker “arga”

Question 19

Whats Dabigatran

Answer 19

Oral Thrombin blocker “the big”

Question 20

Whats Rivaroxaban

Answer 20

Oral Factor 10 blocker

Question 21

Fibrinolytic

AE
Uses

Answer 21

Streptokinase IV
- micro B origin - allergy

Uses
- Acute MI, stroke, PE

Question 22

Why does NSAIDs lead to renal damage + sodium retention

Answer 22

NSAIDs block PG

PG inhibits Na reabsorption

PG from JGA leads to Renin secretion hence blocking PG blocks aldosterone