Drugs used in Coagulation Disorders Flashcards by Robert Ellis

Drugs used in clotting/bleeding disorders fall into two categories

drugs used to decrease clotting or dissolve clots already present
drugs used to increase clotting in patients at risk of a bleed

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Anticoagulants are used for

acute MI
A-fib
Ischemic stroke
DVT

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anticoag drugs and thromoboylitic drugs are effective againt

arterial and venous thrombi

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antiplatelet drugs are used against

arterial thrombi only

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List the categories of anticoagulants

heparins, direct thrombin inhibitors, direct Xa inhibitor, warfarin

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name the thrombolytics

urokinase, TPA derivatives

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name the antiplatlet drugs

aspirin, glycoprotein IIb/IIIa inh., ADP inihibitors, pde uptake inhibitors

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dosage route of heparin

parenterally (IV or subQ)

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dosage route of coumadin

oral

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dosage route of thrombin/X inh

parenteral or oral

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antidote to heparin

protamine

works well on unfract. hep, partially on LMWH and not at all on Fondaparinux

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Advantages of LMWH

*more specific for ATIII and not II
greater F
longer duration
lower chance of HIT

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example of a LMWH

enoxaparin sodium

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heparin like products are measure

by APTT

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APPT used to measure

effect of heparin and direct thrombin inhibitors

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Antithrombin II inactivates

thrombin, X, 9, 11

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Heparin MOA

increases ATIII’s activity by 1000 fold

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GPIIb/IIIa is activated by

platelet release of ADP, TXA2, and serotonin–> cause upreg of GP2b3a on platelet surface

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How does HIT happen

more common with unfractionated heparin–> IgG ab to PF4-Heparin complex–> results in marked thrombocytopenia

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will APTT measure LMWH

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Can heparin be used in pregnancy

yes–> does not cross placenta

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Fondaparinux

mimics the bioactive pentasaccharide on heparin–> same effects, given sub Q once a day

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onset of heparin

instant (minutes)

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excretion of heparin

renal

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choice anticoag during pregnancy

heparin

site of action for heparin

blood

site of action for coumadin

liver

onset of coumadin

slow--> days 10 mg 5 mg 5 mg--> then recheck INR--> decide what to do from there

protein C inhibits

factors 5 and 8

cleaved by thrombin

1, 5, 8, 11, 13

common uses of heaprin

ACUTE | PE, MI, DVT

prolonged use of unfractionated heparin is associated with

osteoporosis

inibited by heparin

11, 8, 5, *accoriding to the book

inhibited by coumadin

2, 7, 9, 10 c, s

Direct thrombin inhibitors | administered parenterally

Lepuridin Desirudin bivalirudin argotroban

direct thrombin inhibitors | administered orally

Dabigatran

MOA of Lepuridin

bind simulatenously to the acitve site of thrombin and thrombin substrates

MOA of Argatroban

binds only the thrombin active site

reversal agents for dorect thrombin inhibitors and direct Xa inhibitors

none

Direct thrombin inhibitor that can also inhibit platelets

Bivalirudin

how do you monitor coumadin

PT--> turn it into INR

INR range for someone who needs coumadin

2-3

INR range for someone with persistent dvt

2.5-3.5

antidote for coumadin toxicity

vitamin K, FFP, prothombin complexes

MOAS for coumadin

inhibits Vitamin K epoxide reductase preventing Vit K from being replenished and therefore GAMMA carboxylation cannot occur for factors 2, 7, 9, 10 C or S

Direct Xa inhibitors

rivaroxaban | apixaban

do Direct Xa or Direct thrombin inhibitors require monitoring

preferred anticoagulant in pt.s with HIT

direct thrombin inhibitors

Rivaroxaban indication

pt.s undergoing hip/knee replacement and prevention of stroke for Afib pt.'s

Warfarin in the circulation

99% bound | *anything that causes it to come unbound will have a major impact

Warfarin broekn down in the liver by

CYP2C9

can coumadin be used in pregnant women

necrosis due to warfarin toxicity is due to

acute deficiency of factor C

inducers of CYP--> causing low coumadin and therefore hypercoaguability

rifampin, phenytoin, and barbituates

inhibitors of CYP causing warfarin to be too low--> blled risk

SSRI's, cimetidine

explain INR

inr= patients test PT/ standard PT (12-13)

high INR=

pt is more anticoagulated than a "normal" person and at a risk for bleed *their pt is long=slow clot

low INR=

pt is hypercoagulated and at a risk thrombus | *their pt time is quick=fast clotter)

Thrombolytic agents

T-PA (alteplase) | streptokinase (protein made by streptococci)

Thrombolytic enzymes MOA's

catalyze the cleavage of plasminogen to plasmin so it can cleave fibrin and free serum fibrinogen--> dissolving and preventing a clot

seletivity of TPa

only cleaves plasminogen when bound to fibrin (but selectivity is less than you would hope for)

streptokinase MOA

does not cleave plasminogen directly-->forms a complex with plasminogen and causes it to undergo conf. change where it is cleaved rapidly by normal TPA

does streptokinase show selectivity for fibrin

most important indication of thrombolytic agents

as an alternative to percuatenous coronary angioplasty in emergency tx of coronary artery thrombosis with 6 hours * also Stroke if within 3 hours * also severe PE

name the antiplasmin drugs

tranexamic acid and aminocaproic acid

side effect specific to streptokinase

those with prevoius infection to the bacteria may have ab's specific for the drug--> immune response

major adverse event you're concerned with about thrombolytic agents

cerebral hemorrhage and bleeding

how does PGI2 (prostacylin) inihibit platelet aggregation

increases cAMP which dereases free calcium levels--> this will inihibit platelet aggregation

Antipletelet drugs include

1. aspirin and other NSADS (not tyelenol) 2. GP2b3a inh, abciximab, tirofiban, 3. ADP antagonists (clopidogrel) 4. Phosphodiesterase inh. (dipyramidole)

dipyramidole MOA

prolong the platelet inhibiting action of cAMP by inhibiting phosphodesterase (which breaks down cAMP)--> Ca2+ stays low and pletelets dont aggregate * increases cGMP levels--> a vasodilator * inhibit the uptake of Adenosine--> increase plasma concentration of adenosine

Drug used to treat vitamin K deffieiency

phytonadione

most important agents to treat hemophillia A/B

FFP, and factor 8 (A), 9 (B)

increases plasma concentration of vWF

desmopressin and factor 8

when do you use desmopressin

hemophilia A or to prepare pt.'s non vW disease for elective surgery

antiplasmin agents do what

increas clotting for the prevention of acute bleeding apirsodes in patients with hemophillia and others with high risk of bleeding disorders

name he antiplasmin meds

aminocaproic acid and tranexamic acid

Drugs used in Coagulation Disorders Flashcards

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