Episode 6-Blood DRUGS!

Question 1

What are the for main classes of hemostasis that we will discuss in this deck?

Answer 1

1.Anti-coagulants 2. Thrombolytics/Fibrinolytics 3.Anti-Platelets 4.Anti-fibrinoytics

Question 2

___________ are substances that prevent the synthesis of a fibrin network which inhibits coagulation and the formation of thrombi.

Answer 2

Anticoagulants

Question 3

___________ are substances that promote the destruction of already formed blood clots or thrombi (i.e. – lyse thrombi) by disrupting the fibrin mesh

Answer 3

Thrombolytics/Fibrinolytics

Question 4

___________ are drugs that reduce the adhesion and aggregation of platelets

Answer 4

Antiplatelets

Question 5

___________ are drugs that promote the formation of clots and prevent excessive bleeding

Answer 5

Antifibrinolytics

Question 6

____________ all inhibit the action or formation of one or more of the clotting factors.

Answer 6

Anticoagulants

Question 7

Anticoagulants create an immediate defect (______ when given IV, ______ when given orally) in the clotting mechanism and should be treated with caution.

Answer 7

minutes….hours

Question 8

What are the 4 categories of AntiCoagulants? (2 old, 2 new)

Answer 8

1.Indirect Thrombin Inhibitors (heparin)2.Coumarin Anticoagulants (warfarin) 3.Direct Thrombin Inhibitors 4.Direct Factor X Inhibitors

Question 9

What are the two types of Heparin?

Answer 9

Unfractionated heparin (UFH)-c.1916 and Low-molecular-weight heparin-1990s

Question 10

Heparin stimulates _________, which in turn, neutralizes the activity of factor __ (and other clotting factors as we’ll).

Answer 10

antithrombin- III…X

Question 11

Heparin ALSO stimulates ____________, which inhibits thrombin.

Answer 11

heparin cofactor II

Question 12

Unfractionated Heparin (UFH) is not absorbed if given _____. It is typically given _____.

Answer 12

orally…I.V.(bolus or infusion)

Question 13

UFH also binds to _________ & _________ which further adds to its variability.

Answer 13

endothelial cells…..macrophages

Question 14

Since the anti-coagulant response to UFH varies among patients, it is standard practice to adjust the dose of UFH and monitor its clinical effectiveness with the __________.

Answer 14

activated partial thromboplastin time (APTT)

Question 15

Review from episode 5: What is the target APTT increase for treatment?

Answer 15

2-2.5 times the normal 25-36 seconds..about 1 min

Question 16

What are the blood drugs that do not require blood monitoring?

Answer 16

1. Low molecular weight Heparin 2. Oral Da-big-a-tran (DTI)

Question 17

What is the unique way to administer Low Molecular Weight Heparin?

Answer 17

SubCutaneously with a needle

Question 18

The only major coumarin anticoagulant in the USA is _______.

Answer 18

warfarin (Coumadin)

Question 19

As a side note, warfarin is the main active ingredient in many _________.

Answer 19

rodent poisons

Question 20

How does Warfarin work?

Answer 20

Stops Liver synthesis of the Vitamin K dependent factors!!! (II, VII, IX, X)

Question 21

What are the 6 times you would treat with Warfarin?

Answer 21

1.Venous Thrombosis 2. Pulmonary Embolism 3.Post-M.I. 4.Post-Op 5.Prosth Heart Valves 6.Atrial Fib

Question 22

The therapeutic range for oral anticoagulation therapy (Warfarin) is defined in terms of the _________.

Answer 22

INR

Question 23

For most patients, therapeutic levels of warfarin should be adjusted to achieve an INR of _____.

Answer 23

2.0-3.0

Question 24

BOOM!!! What are the 4 common drugs and 4 antibiotics that INHIBIT wardarin metalolism? (can lead to SPONTANEOUS BLEEDING)

Answer 24

Commoners: 1.Cim-et-idine(heartburn) 2.Ace-ta-min-o-ohen 3.High dose, acute EtOH 4.Synthetic Thyroid Hormones Antibiotics: 1.Az-ithro-mycin 2.Cipro-flox-acin 3.Clar-ithro-mycin 4.Erythro-mycin

Question 25

What are the three drug interactions that can discount warfarin and therefore lead to clotting?

Answer 25

1.CHRONIC EtOH abuse 2.Phen-y-to-in(anti-epileptic) 3.Oral Contraceptives

Question 26

What dietary items can inhibit the effect of warfarin?

Answer 26

Green, leafy veggies rich in Vitamin K!! Just keep a CONSISTENT intake..

Question 27

In fact, warfarin overdoses are typically treated with ______ and _______.

Answer 27

vitamin K....transfusion

Question 28

________ is the most common side effect of warfarin and occurs most often from the mucous membranes of the ___________ and the _________.

Answer 28

Bleeding....gastrointestinal tract.....genitourinary tract

Question 29

Warfarin is contraindicated during pregnancy (category X) because it __________ and is ________. In the same theme, _________ should also be avoided during warfarin therapy.

Answer 29

crosses the placenta.....teratogenic.....Breast feeding

Question 30

The first oral direct thrombin inhibitor came to market in 2010 is _________.

Answer 30

Da-big-a-tran

Question 31

What is the unique class of hemostatic drugs that was first released in August 2011?

Answer 31

Direct Factor X Inhibitors!

Question 32

_________ rapidly lyse thrombi when administered intravenously by catalyzing the formation of ______ from ________.

Answer 32

Thrombolytics.....plasmin.....plasminogen

Question 33

What are the 3 examples of Thrombolytics?

Answer 33

1.StreptoKinase 2.Uro-kinase 3.Synthetic tPA (was $10K/dose!!!!)

Question 34

What are the 3 indications for the use of Thrombolytics? When should these drugs be administered?

Answer 34

1.Acute M.I. 2.Ischemic Stroke 3.Pulmonary Embolism...Within 3 hours!!

Question 35

What are the 3 classes of Anti-Platelet agents?

Answer 35

1.Cyclo-oxygen-ase (COX) Inhibitors (Aspirin) 2.Thi-eno-pyridines (ADP inhibitors) 3.GPIIb/IIIa Inhibitors (newest of the new)

Question 36

The synthesis of which platelet substance is inhibited by the COX inhibitor Aspirin?

Answer 36

TXA2

Question 37

What is the main Thi-eno-pyradine (ADP inhibitor)?

Answer 37

Clo-pid-o-grel ("Clow-ped-i-grill")

Question 38

What is the main GP IIb/IIIa Inhibitor? How are they administered?

Answer 38

AB-cix-imab ("Ab-sicks-i-mab")...Administered with IV and initial bolus THEN constant infusion.

Question 39

INTERESTING: What is the only drug we talked about that PROMOTES clotting?! (Reminds me of ANP and blood pressure!)

Answer 39

Antifibrinolytics

Question 40

The antifibrinolytic _________ inhibits the activation of ________ to ______.

Answer 40

Tran-ex-am-ic Acid....plasminogen....plasmin

Question 41

__________ is used in dentistry in the form of a 5% mouth rinse after extractions or surgery in patients with prolonged bleeding time!!

Answer 41

Tran-ex-am-ic acid

Question 42

What are the Clot PROMOTERS? (4 endogenous, 2 exogenous)

Answer 42

Endogenous: 1.P.A.I. 1 2.P.A.I. 2 3.Alpha2-antiplasmin 4.alpha2-macroglobulin Exogenous: 1.Trans-ex-amic Acid 2.Amino-Cep-Ro-ic Acid