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Medicine Year 1 - Semester 2 - Part 1 > Drugs affecting haemostasis and thrombosis > Flashcards

Drugs affecting haemostasis and thrombosis Flashcards

(51 cards)

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1
Q

To list the drugs used to modify blood coagulation

A

Tranexamic Acid
Warfarin
DOACs
Heparin

Aspirin
Clopidogrel

Thrombolytic drugs

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2
Q

Function of drugs used to modify blood coagulation

A

Drugs that :

  • Help clot the blood
  • Prevent/slow the clotting of blood
  • Modify platelet function
  • Help clot removal
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3
Q

Where are platelets derived from ?

A

Megakaryocytes in marrow

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4
Q

Fresh frozen plasma

A

Contains coagulation factors in normal proportions
Dose 15ml/kg

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5
Q

Cryoprecipitate

A

Pools of 5 donations using precipitate at 4C - concentrated fibrinogen, von willebrand factor and VIII

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6
Q

Specific coagulation factors

A

IX
VIII (donor derived or recombinant)
Fibrinogen

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7
Q

What is tranexamic acid ?

A

Anti-fibrinolytic drug (inhibits the process that dissolves clots)

Taken orally/IV

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8
Q

Describe the method of action of tranexamic acid

A

Inhibits the activation of plasminogen to plasmin

Used in trauma/GI bleeding/ post-op or delivery

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9
Q

Tranexamic acid

When is it effective ?

A

Effective if given within 3-4 hours

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10
Q

Method of action of warfarin

A

Inhibits the production of vitamin K in its reduced form.

Effect measured by prothrombin time - venous/capillary sample

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11
Q

Positive aspects of warfarin

A

Established for decades
Cheap
Easily measurable effects

Can be reversed with Vitamin K or factor concentrate

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12
Q

Negative aspects of warfarin

A

Lots of drug and food interactions to enhance or inhibit effect.

Slow onset- several days

Unpredictable dose needed

Needs regular blood testing

Risk of bleeding

Narrow therapeutic window

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13
Q

State the drugs that increase the effect of warfarin

A

Amoxycillin
Erythromycin, Statins
Aspirin, Clopidogrel, NSAID’s

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14
Q

Amoxycillin

A

(increase the effect of warfarin)
Reduces gut Vitamin K

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15
Q

Erythromycin, Statins, Acute Alcohol intake

A

(increase the effect of warfarin)
Enzyme Inhibition

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16
Q

Aspirin, Clopidogrel, NSAID’s

A

(increase the effect of warfarin)
Platelet function and GI mucosal damage

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17
Q

State the drugs that decrease the effect of warfarin

A

Rifampicin, Carbamazepine, Phenytoin, Chronic Alcohol intake

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18
Q

Rifampicin, Carbamazepine, Phenytoin, Chronic Alcohol intake

A

(decrease the effect of warfarin)
Enzyme induction

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19
Q

DOACs

A

Direct Oral AntiCoagulants

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20
Q

What are DOACs ?

A

Xa inhibitors
Direct thrombin inhibitors

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21
Q

Name some DOACs

Xa inhibitors

Study These Flashcards
A

(Xa inhibitors)

Apixaban
Rivaroxaban
Edoxaban

22
Q

Name some DOAC’s

Direct thrombin inhibitors

23
Q

State some points that favour warfarin

Study These Flashcards
A

Established drug
Cheap- but needs monitoring
Can be reversed
Effect can be easily measured

Can be used with poor renal function

24
Q

State some points that favour DOACs

Study These Flashcards
A

No monitoring needed (except renal function)

Lower bleeding risk
As effective for stroke prevention

Reversible agents recently available (but expensive)

Short half life

25
State some key uses of oral anticoagulants
- Treatment of DVT and PE: short/long term depending on whether recurrent and/or provoked - Arterial fibrillation to reduce stroke risk
26
State a use for warfarin ONLY
Prosthetic heart valve replacement (warfarin only)
27
State a use for DOACs ONLY
Prevention of DVT after planned hip and knee surgery
28
Stroke risk reduction in atrial fibrillation Things to be aware of
Absolute and Relative risk reduction Balance of risks and benefits Risk score for thrombosis
29
State the stroke risk scoring system in AF
CHA2DS2 - VASc
30
CHA2DS2 - VASc
C - Congestive heart failure H - Hypertension A - Age >=75 D - Diabetes Mellitus S - Prior stroke / thromboembolism V - Vascular disease A - Age 65-74 Sc - Sex category
31
What is the ORBIT score ?
For bleeding risk
32
When is the ORBIT scoring system used ?
Age >75 Renal Impairment Co-prescription of anti-platelet drugs Anaemia Bleeding history
33
Mechanism of action of heparin
Binds to and activates anti-thrombin so reducing Xa and thrombin generation
34
Where is heparin found ?
Can be extracted from lung and liver
35
How is heparin given ?
IV infusion - immediate effects and wears off quickly (un-fractioned half life <1 hour) (LMW : half life approx 12hours )
36
How is heparin monitored ?
APPT plasma testing and dose adjusted (IV heparin)
37
State a low molecular weight heparin
Dalteparin
38
Dalteparin
Used as a fixed dose for prophylaxis No routine monitoring unless poor renal function, extreme body weight or pregnancy Treatment and prevention of DVT/PE
39
What gives a measure of anti-coagulation ?
Anti-Xa levels
40
State some adverse side effects of heparin
Pain at site of injection Increased bleeding risk Osteoporosis with prolonged use Heparin induced thrombocytopenia - antibody mediated 5-10 days into treatment
41
State the drugs to modify platelet function
Aspirin Clopidogrel
42
Mechanism of action of aspirin
Causes irreversible inhibition of COX-1 so less thromboxane A2 production Less platelet aggregation
43
Side effects of aspirin
Increases GI bleeding risk Dyspepsia Some effect in stroke prevention in AF
44
Uses of aspirin
Typically used after transient ischaemic heart attack or MI
45
Mechanism of action of clopidogrel
Inhibit ADP induced platelet aggregation Used with aspirin to prevent recurrent myocardial infarction
46
Uses of clopidogrel
Used in ischaemic stroke and TIAs
47
Side effects of clopidogrel
Increased risk of : - Dyspepsia - GI bleeding
48
Duration of action of aspirin and clopidogrel
NO reversal agents, so effect will last the duration of platelet lifespan. (5-10 days )
49
What are thrombolytic drugs ?
Drugs to increase the activation of plasminogen to plasmin Tissue plasminogen activators Cause breakdown of fibrin and fibrinogen
50
Side effects of thrombolytic drugs
Increased bleeding risk in hours after dose
51
Alternative treatment to thrombolytic drugs
Stenting and Clot removal

Medicine Year 1 - Semester 2 - Part 1 (51 decks)

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