Drugs For Thromboembolic Disorders (Konorev) Flashcards Preview

Cardiovascular Medicine-Unit 2 > Drugs For Thromboembolic Disorders (Konorev) > Flashcards

Flashcards in Drugs For Thromboembolic Disorders (Konorev) Deck (52):
1

What pathologic conditions are associated with white thrombi?

Local ischemia d/t arterial occlusion (in coronary arteries: MI/unstable angina)

2

This type of thrombus forms in low-prssure veins and in the heart; result of platelet bidning and aggregation followed by formation of bulky fibrin tails in which RBCs become enmeshed.

Red thrombus (fibrin-rich with trapped RBCs)

3

What are pathologic conditions associated with red thrombi?

Pain and severe swelling, embolism and distal pathology (embolic stroke)

4

This type of drug regulates the function and synthesis of clotting factors and is primarily used to prevent clots from forming in the venous system and heart (RED THROMBI)

Anticoagulants

5

This type of drug inhibits platelet function and is primarily used to prevent clots from forming in the arteries (white thrombi)

Antiplatelet drugs

6

This type of drug destroys blood clots after they are formed. These re-establish blood flow through vessels once clots have formed

Thrombolytic

7

Heparin sodium is this type of anticoagulant

Parenteral --> Indirect thrombin and FXa inhibitor --> HMW or UFH

8

Enoxaprin, Tinzaparin, and Dalteparin are this type of anticoagulant:

Parenteral --> Indirect thrombin and FXa inhibitor --> LMW

9

Fondaparinux is this type of anticoagulant:

Parenteral --> Indirect thrombin and FXa inhibitor --> Synthetic pentasaccharide

10

Lepirudin, Bivalirudin, and Argatroban are this type of anticoagulant:

Parenteral --> Direct thrombin inhibitors

11

What is the MOA of indirect thrombin and FXa inhibitors?

Bind plasma serine protease inhibitor ANTITHROMBIN III

Antithrombin III inhibits several clotting factor proteases, esp Thrombin (IIa), IXa, and Xa. Heparin increases antithrombin III activity 1000fold

12

This anticoagulant inhibits the activity of both thrombin and FXa

HMW heparin

13

This anticoagulant inhibits FXa with little effect on thrombin

LMW heparin

14

This anticoagulant inhibits FXa activity with no effect on thrombin

Fondaparinux

15

What is the MOA of DIRECT thrombin inhibitors (Parenteral)?

Direct inhibition of the protease activity of thrombin

16

The MOA of these anticoagulants is bivalent direct thrombin inhibitors (bind at both active site and substrate recognition site)

Lepirudin and Bivalirudin

17

The MOA of this anticoagulant is an inhibitor binding only at the thrombin active site

Argatroban

18

Warfarin (coumadin) is this type of anticoagulant:

Oral --> Coumarin anticoagulant

19

Rivaroxaban, Apixaban, Edoxaban are these types of anticoagulant:

Oral --> Novel oral anticoagulants (NOAC) --> Factor Xa inhibitors

20

Dabigatran is this type of anticoagulant:

Oral --> NOAC --> Direct thrombin inhibitor

21

What is the MOA of warfarin?

Inhibits reactivation of Vit K by inhibiting Vit K epoxide reductase. Inhibits carboxylation of GGCX in prothrombin and factors VII,IX, and X, making them inactive

22

What makes warfarin dosing so difficult?

Narrow therapeutic window of the drug and high individual variability, i.e., genetics, disease states, drug-drug interactions, diet

23

What is the INR for pts on warfarin?

2.0-3.0

24

Rivaroxaban, Apixaban, and Edoxaban inhibit ___

Xa

25

Dabigatran inhibits ___

IIa (thrombin)

26

Who gets parenteral anticoagulants?

Pts with DVT, atrial arrhythmias and other conditions that predispose towards RED THROMBI
Tx/prevention of embolic stroke, PE
Prevent emboli during surgery or in hospitalized pts
Heparin locks

27

Who gets oral anticoagulants?

Used to prevent thrombosis or prevent/treat thromboembolism
A Fib
Prosthetic heart valves

28

What is the antidote for HMW and LMW heparin?

Protamine sulfate

29

What is the antidote for warfarin?

Vit K, prothrombin complex concentrate

30

What is the antidote for NOAC-DTI?

Idarucizumab

31

Which coagulation test is specific for heparin?

PTT, anti-Xa --> the intrinsic pathway

32

Which coagulation test is specific for warfarin?

PT-based (INR) --> Extrinsic pathway

33

What blood coagulation test is specific for NOAC-FXa inhibitors?

Anti-Xa

34

What blood coagulation test is specific for NOAC-DTI?

Diluted thrombin time (TT)

35

What type of antiplatelet drug is aspirin?

Inhibitor of TxAs synthesis

36

What type of antiplatelet drug is Clopidogrel, Prasugrel, Ticlopidine, and Ticagrelor?

ADP receptor blocker

37

What type of antiplatelet drug is Abciximab, Eptifibatide, and Tirofiban?

Platelet glycoprotein receptor blocker

38

What type of antiplatelet drug is Dipyridamole and Cilostazol?

Phosphodiesterase inhibitor

39

What is the MOA of aspirin?

Inhibit COX
Decreased TxA2 production

40

What is the MOA of ADP receptor blockers?

Inhibition of AC by ai is relieved
Increased production of cAMP

Clopidogrel, ticlopidine, and prasugrel

41

What is the MOA of phosphodiesterase inhibitors?

Inhibit cAMP degradation
Levels of cAMP in platelets are increased

Dipyramidole and cilostazol

42

Platelet GP receptor antagonists target this sequence to prevent binding of ligands to the GP IIb/IIIa receptor to inhibit platelet aggregation

RGD

Abciximab, Tirofiban, Eptifibatide

43

What are clinical uses of antiplatelet drugs?

Prevent thrombosis in unstable angina and other acute coronary syndromes
Prevent ischemic stroke and arterial thrombosis in peripheral vascular disease
Pts undergoing percutaneous coronary angioplasty and stunting

44

This combo can be used to prevent cerebrovascular ischemia:

Dipyridamole (PDE inhibitor) with aspirin

45

This combo can be used to tx pts with prosthetic heart valves

Dipyridamole (PDE inhibitor) with warfarin

46

This drug can be used to tx intermittent claudication

Cilostazol

47

What is the MOA of thrombolytic drugs?

Activate endogenous fibrinolytic system by converting plasminogen into plasmin

48

Alteplase, Reteplase, and Tenecteplase are these types of thrombolytics:

tPA drugs

49

Urokinase is this type of thrombolytic drug:

uPA activator

50

Streptokinase is this type of thrombolytic drug:

Streptokinase preparation purified from bacteria

51

What are clinical uses of thrombolytic drugs?

Acute embolic/thrombotic stroke (within 3 hr)
Acute MI (within 3-6 hr)
PE
DVT
Ascending thrombophlebitis

52

This type of thrombus forms in high-pressure arteries and is the result of platelet binding to the damaged endothelium and aggregation with little involvement of fibrin.

White (platelet-rich) thrombus