FINAL 01 - Drugs for Coagulation Disorders Flashcards
(138 cards)
1
Q
Refers to the prevention of blood loss
A
Hemostasis
2
Q
3 stages of platelet plug formation (AAA)
A
Adhesion, Activation, Aggregation
3
Q
When the endothelium is injured, platelets adhere to collagen in the tissues and to a protein called ___________ that leaks into the traumatized tissue from the plasma (Platelet adhesion phase - platelet plug formation)
A
von Willebrand factor (vWF)
4
Q
Involves morphologic changes in platelets; release of platelet granules adenosine diphosphate (ADP), TXA2, serotonin, platelet-activation factor (PAF), and thrombin (Platelet plug formation phase)
A
Platelet activation
5
Q
___________, a soluble plasma GP, simultaneously binds to GP IIb/IIIa receptors on two separate platelets, resulting in platelet cross-linking and platelet aggregation (Platelet aggregation - platelet plug formation phase)
A
Fibrinogen
6
Q
The clot begins to develop in __________ to __________ seconds if the trauma to the vascular wall has been severe (Formation of blood clot)
A
15-20
7
Q
The clot begins to develop in __________ to __________ minutes if the trauma has been minor (Formation of blood clot)
A
1-2
8
Q
Within __________ to __________ minutes after rupture of a vessel, if the vessel opening is not too large, the entire opening or broken end of the vessel is filled with clot (Formation of blood clot)
A
3-6
9
Q
After __________ minutes to an hour, the clot retracts and this closes the vessel still further (Formation of blood clot)
A
20
10
Q
Substances that promote coagulation
A
Procoagulants
11
Q
Substances that inhibit coagulation
A
Anticoagulants
12
Q
Clotting factor I to XIII are __________
A
Procoagulants
13
Q
Protein C and S are __________
A
Anticoagulants
14
Q
Plasminogen is a __________
A
Fibrinolytic
15
Q
Begins with a traumatized vascular wall or traumatized extravascular tissues that come in contact with the blood (Coagulation cascade pathways)
A
Extrinsic pathway
16
Q
Begins with trauma to the blood itself or exposure of the blood to collagen from a traumatized blood vessel wall (Coagulation cascade pathways)
A
Intrinsic pathway
17
Q
Activated by damage to the inside of blood vessels (Coagulation cascade pathways)
A
Intrinsic pathway
18
Q
Have fewer steps; occurs rapidly (in seconds) (Coagulation cascade pathways)
A
Extrinsic pathway
19
Q
Activated by damage to the outside of blood vessels (Coagulation cascade pathways)
A
Extrinsic pathway
20
Q
The final pathway where both the intrinsic and extrinsic pathways converge (Coagulation cascade pathways)
A
Common pathway
21
Q
Extrinsic pathway activates clotting factor X which combines with factor V in the presence of Ca2+ to form the active enzyme __________
A
Prothrombinase
22
Q
More complex; occurs more slowly (in minutes) (Coagulation cascade pathways)
A
Intrinsic pathway
23
Q
__________ is a plasma protein that inhibits coagulation factors of the intrinsic and common pathways
A
Antithrombin
24
Q
____________ are synthesized by endothelial cells and stimulate the activity of antithrombin
A
Heparan sulfate proteoglycans
25
Blood clot can become invaded by __________, which subsequently form connective tissue all through the clot
Fibroblasts
26
The process of fibrin digestion by the fibrin-specific protease, plasmin (fibrinolysin)
Fibrinolysis
27
Fibrinolysis is the process of fibrin digestion by the fibrin-specific protease, __________
Plasmin (fibrinolysin)
28
An abnormal clot that develops in a blood vessel
Thrombus
29
An abnormal clot flowing with the blood
Embolus
30
Leads to the tendency to form thrombi (Risks for venous thromboembolism)
Inherited disorders
31
Includes atrial fibrillation, prolonged bed risk, high-risk surgical procedures, cancer, and antiphospholipid antibody syndrome (Risks for venous thromboembolism)
Acquired disease
32
Drugs that inhibit either the action of the coagulation factors or interfere with the synthesis of the coagulation factors
Anticoagulants
33
Exerts antithrombotic effect via antithrombin (Indirect thrombin inhibitors)
Heparins
34
A glycosylated, single-chain polypeptide that inhibits clotting factor proteases by forming equimolar stable complexes with them; targeted by heparins
Antithrombin
35
Catalyzes inhibition of coagulation proteases by antithrombin by 1000-fold (Types of heparin)
Unfractionated heparin
36
Initial treatment of venous thrombosis and pulmonary embolism because of rapid onset of action (Types of heparin)
Unfractionated heparin
37
DOC for anticoagulation in pregnancy (Types of heparin)
Unfractionated heparin
38
Antidote for unfractionated heparin
Protamine sulfate
39
A highly basic, positively charged peptide that combines with negatively charged heparin; an antidote for unfractionated heparin toxicity
Protamine sulfate
40
LOVENOX (Low molecular-weight heparin drug)
Enoxaparin
41
FRAGMIN (Low molecular-weight heparin drug)
Dalteparin
42
INNOHEP, others (Low molecular-weight heparin drug)
Tinzaparin
43
NORMIFLO (Low molecular-weight heparin drug)
Ardeparin
44
FRAXIPARINE (Low molecular-weight heparin drug)
Nadroparin
45
CLIVARINE (Low molecular-weight heparin drug)
Reviparin
46
Catalyzes inhibition of factor Xa by antithrombin (Types of heparin)
Low molecular-weight heparin (LMWH)
47
A LMW heparinoid containing heparan sulfate, dermatan sulfate, and chondroitin sulfate (Low molecular-weight heparin drug)
Danaparoid (Orgaran)
48
Used for prevention of venous thromboembolism and treatment of venous thrombosis, pulmonary embolism, and unstable angina (Types of heparin)
Low molecular-weight heparin (LMWH)
49
A synthetic heparin derivative that mediates inhibition of factor Xa by antithrombin (Types of heparin)
Fondaparinux (Arixtra)
50
A synthetic heparin derivative used for thromboprophylaxis of patients undergoing hip or knee surgery (Types of heparin)
Fondaparinux (Arixtra)
51
A recombinant derivative of hirudin, a direct thrombin inhibitor present in the salivary glands of the medicinal leech (Direct thrombin inhibitors)
Lepirudin (Refludan)
52
Used for treatment in patients with HIT (Direct thrombin inhibitors)
Lepirudin (Refludan)
53
A synthetic, 20-amino-acid polypeptide that directly inhibits thrombin (Direct thrombin inhibitors)
Bivalirudin (Angiomax)
54
Used as an alternative to heparin in percutaneous coronary angioplasty (Direct thrombin inhibitors)
Bivalirudin (Angiomax)
55
A synthetic compound based on the structure of L-Arg; binds reversibly to the catalytic site of thrombin (Direct thrombin inhibitors)
Argatroban
56
Used as an alternative to lepirudin for prophylaxis or treatment of patients with or at risk of developing HIT (Direct thrombin inhibitors)
Argatroban
57
Binds to the active site of thrombin (Direct thrombin inhibitors)
Dabigatran etexilate mesylate
58
Used for prevention of stroke and systemic embolism in patients with atrial fibrillation (Direct thrombin inhibitors)
Dabigatran etexilate mesylate
59
A DOAC (direct oral anticoagulant) and NOAC (novel oral anticoagulant) (Direct thrombin inhibitors)
Dabigatran etexilate mesylate
60
Antidote for dabigatran etexilate mesylate toxicity
Idarucizumab
61
Humanized monoclonal antibody Fab fragment that binds to dabigatran and reverses the anticoagulant effect; approved for use in emergent surgery
Idarucizumab
62
Natural form; from sweet clover (Melilotus officinalis) (Vitamin K antagonists)
Bishydroxycoumarin
63
Synthetic derivative (Vitamin K antagonists)
Dicoumarol
64
Drug coined by Wisconsin Alumni Research Foundation, with "arin" coming from coumarin (Vitamin K antagonists)
Warfarin (Coumadin)
65
Used for prophylaxis and treatment of thrombotic disease (Anticoagulant drugs)
Vitamin K antagonists
66
Antidote for vitamin K antagonist toxicity
Vitamin K1 (phytonadione) (PO, IV)
67
Blocks the active site of factor Xa (Anticoagulant drugs)
Xa inhibitors
68
Used for the prevention of venous thromboembolism following hip or knee surgery (Anticoagulant drugs)
Xa inhibitors
69
Drugs that inhibit platelet function
Antiplatelets
70
Its MOA is irreversible acetylation of COX-1 (Antiplatelet drugs)
Aspirin
71
Used as primary prophylaxis of myocardial infarction and secondary prevention of vascular events (Antiplatelet drugs)
Aspirin
72
Irreversibly inhibit the binding of ADP to its receptors on platelets; inhibit the activation of GP IIb/IIIa receptors (Antiplatelet drugs)
ADP-induced platelet aggregation inhibitors
73
Ticlopidine, clopidogrel, prasugrel, and ticagrelor are examples of irreversible ADP P2Y12 receptor antagonists which are __________ (Antiplatelet drugs)
Thienopyridines
74
Secondary prevention of stroke in previous TIA; used in combination w/ aspirin (Irreversible ADP P2Y12 receptor antagonists)
Ticlopidine
75
Used in combination w/ aspirin; secondary prevention of ischemic stroke (Irreversible ADP P2Y12 receptor antagonists)
Clopidogrel
76
Has higher risk of bleeding than clopidogrel; contraindicated for previous TIA or ischemic stroke (Irreversible ADP P2Y12 receptor antagonists)
Prasugrel (PO)
77
Orally active; a cyclopentyl triazolopyrimidine (Irreversible ADP P2Y12 receptor antagonists)
Ticargrelor (PO)
78
Parenterally active; used for risk reduction of periprocedural MI (Irreversible ADP P2Y12 receptor antagonists)
Cangrelor (IV)
79
Used in combination w/ aspirin or clopidogrel; secondary prevention of thrombotic cardiovascular events (Irreversible ADP P2Y12 receptor antagonists)
Vorapaxar (PO)
80
Is a receptor for fibrinogen and von Willebrand factor
GP IIB/IIIA
81
Abciximab, eptifibatide, and tirofibam are examples of __________ (Antiplatelet drugs)
GP IIB/IIIA blockers
82
Used in conjunction with percutaneous angioplasty for coronary thromboses (Examples of GP IIB/IIIA blockers)
Abciximab
83
Derived from rattlesnake venom; used in combination with aspirin and heparin (Examples of GP IIB/IIIA blockers)
Eptifibatide
84
Has efficacy in non-Q-wave myocardial infarction and unstable angina (Examples of GP IIB/IIIA blockers)
Tirofiban
85
A vasodilator that inhibits platelet function by inhibiting adenosine uptake and phosphodiesterase activity; used in combination with warfarin and aspirin (Antiplatelet drugs)
Dipyridamole
86
A newer phosphodiesterase inhibitor that promotes vasodilation and inhibition of platelet aggregation; used as treatment of intermittent claudication (Antiplatelet drugs)
Cilostazol
87
Drugs that rapidly lyse thrombi by catalyzing the formation of plasmin from its precursor zymogen, plasminogen
Fibrinolytics
88
Synthesized by Group C beta-hemolytic streptococci (Examples of fibrinolytics)
Streptokinase
89
Used in acute pulmonary embolism, deep vein thrombosis, and acute myocardial infarction (Examples of fibrinolytics)
Streptokinase
90
A human enzyme synthesized by the kidney that directly converts plasminogen to active plasmin (Examples of fibrinolytics)
Urokinase
91
Used for lysis of pulmonary emboli (Examples of fibrinolytics)
Urokinase
92
Anisoylated plasminogen streptokinase activator complex (APSAC); considered to be a prodrug (Examples of fibrinolytics)
Anistreplase
93
Includes alteplase, reteplase, and tenecteplase; are examples of fibrinolytics
Tissue plasminogen activators (t-PAs)
94
Recombinant human t-PA (Examples of tissue plasminogen activators)
Alteplase
95
Another recombinant human t-PA from which several amino acid sequences have been deleted (Examples of tissue plasminogen activators)
Reteplase
96
Mutant form of t-PA that has a longer half-life (Examples of tissue plasminogen activators)
Tenecteplase
97
Preferentially activate plasminogen that is bound to fibrin (Examples of fibrinolytics)
Tissue plasminogen activators (t-PAs)
98
Used for treatment of MI, acute ischemic stroke, and life-threatening PE (Examples of fibrinolytics)
Tissue plasminogen activators (t-PAs)
99
Standard of care for acute systemic stroke
Thrombectomy
100
Within 4.5 hours of stroke onset (Drugs for acute systemic stroke)
Alteplase
101
Within 24-48 hours of stroke onset (Drugs for acute systemic stroke)
Aspirin
102
A synthetic inhibitor of fibrinolysis (Examples of antifibrinolytics)
Aminocaproic acid
103
An analog of aminocaproic acid and has the same properties; 10x more potent (Examples of antifibrinolytics)
Tranexamic acid (Hemostan)
104
A serine protease inhibitor that inhibits fibrinolysis by free plasmin (Examples of antifibrinolytics)
Aprotinin
105
Drugs used for adjunctive therapy in hemophilia and therapy for bleeding from fibrinolytic therapy
Antifibrinolytics
106
Disorders that may have their origin in naturally occurring pathologic conditions or as a result of fibrinolytic states
Bleeding disorders
107
Fat soluble substance found primarily in leafy green vegetables (Treatment for bleeding disorders)
Vitamin K
108
Also known as phytonadione; found in food (Natural forms of vitamin K)
Vitamin K1
109
Also known as menaquinone; synthesized by intestinal bacteria (Natural forms of vitamin K)
Vitamin K2
110
Is administered to all newborns and used for warfarin toxicity (Treatment for bleeding disorders)
Vitamin K
111
Used in hemophilia (Treatment for bleeding disorders)
Plasma fractions
112
Bleeding disorder that results from a congenital deficiency in a plasma coagulation protein
Hemophilia
113
Plasma fraction that contains all clotting factors
Fresh frozen plasma
114
Plasma fraction that contains fibrinogen, factor VIII, vWF, and factor XIII
Cryoprecipitate
115
Used for factor VII deficiency (Treatment for bleeding disorders)
Recombinant factor VIIa
116
Starts with tissue factor (Factor III) (Coagulation cascade pathways)
Extrinsic pathway
117
Starts with Hageman factor (Factor XII) (Coagulation cascade pathways)
Intrinsic pathway
118
Intrinsic and extrinsic pathways end with __________
Factor X (Stuart-Prower factor)
119
Common pathway starts with the formation of __________ from intrinsic and extrinsic pathways
Prothrombinase
120
Clotting factors X, IX, XII, and II are all part of the __________ group
Prothrombin
121
Triad that refers to the factors that contribute to thrombosis
Virchow's triad
122
3 factors under Virchow's triad (SEH)
Stasis, Endothelial injury, Hypercoagulability
123
__________ inhibits factor IIa, IXa, and Xa (Indirect thrombin inhibitors)
Heparin
124
2 source of unfractionated heparin (PB)
Porcine intestinal mucosa, Bovine lung
125
Quantity of heparin that prevents 1 mL of citrated sheep plasma from clotting for 1 hour
USP unit
126
DOc for surgery requiring cardiopulmonary bypass or percutaneous coronary intervention (balloon angioplasty or stent replacement) (Indirect thrombin inhibitots)
Heparin
127
Resistance wherein there is a failure to achieve therapeutic aPTT with daily doses of >35,000 U
Heparin resistance
128
Therapeutic anti-factor Xa but subtherapeutic aPTT (Types of heparin resistance)
Pseudoresistance
129
Subtherapeutic anti-factor Xa and aPTT (Types of heparin resistance)
True resistance
130
Occurs 5-10 days after initiation of heparin therapy; is a hypercoagulable state
Heparin-induced thrombocytopenia (HIT)
131
DOC for cancer-associated venous thromboembolism (Indirect thrombin inhibitors)
Low molecular weight heparin (LMWH)
132
Vitamin needed in the synthesis of clotting factors X, IX, VII, II, and anticoagulant proteins C and S
Vitamin K
133
Vitamins activated by reduction to the hydroquinone form (KH2)
Vitamin K1/K2
134
Rivaroxaban, apixaban, edoxaban, and betrixaban are examples of __________
Oral Xa inhibitors
135
2 antidotes for oral Xa inhibitors (AF)
Andexanet alfa, Four-factor concetrate
136
A factor Xa "decoy" molecule without procoagulant activity; antidote for oral Xa inhibitors
Andexanet alfa
137
Prostaglandin that is an inducer of platelet aggregation and a potent vasoconstrictor
TXA2
138
Antidote for ticagrelor
Bentracimab
