Hemostasis

Question 1

Aspirin(ASA)

Answer 1

Inhibits Thrombogenesis

Indications: Blood clot prevention

MOA: inhibits TXA2 synthesis in PLTs,

Effect: irreversible and last 7-10 days

Adverse: do not take before surgery.
When use w/ Warfarin **MONITOR **

Question 2

Clopidogrel( Plavix)

Answer 2

Inhibits thrombogenesis

indications: Given during MI

MOA: blocks ADP receptor

Adverse: less effective in GI

Give to pts allergic to ASA

Question 3

Abciximab(repro)

Answer 3

Inhibits thrombogenesis

Indications: use for pts undergoing angioplasty, atherectomy, and stent placement

MOA: Inhibits GP IIB/IIIa receptors… prevents binding of fibrinogen, and VWF

Give IV and it is an ABY fragment

Adverse: bleeding and thrombocytopenia

Expensive

Question 4

Heparin

Answer 4

Anticoags both in vivo and in vitro

Indications:

MOA: Enhances antithrombin II, prevents the formation of thrombin.

Effects: No clots formed

Adverse: Hemorrhage, osteoporosis, allergic, decreased PLT count.

Don’t use if actively bleeding, hemophilia, thrombocytopenia, or if have endocarditis, s/p surgery of the brain.

Question 5

Enoxaprin

Answer 5

Lw MW heparins, Anti-coags

Indications: Catheter, bypass use in pts who are prego, to replace warren

MOA:Enhances antithrombin II, prevents the formation of thrombin.

Question 6

Protamine Sulfate

Answer 6

Specific antagonist to heparin

W/o heparin protamine interacts w/ PLTs, and fibrinogen produced anticoagulant effect

Question 7

Lepirudin

Answer 7

Recombinant hirudin a natural anticoagulant from leeches.

Direct inhibitor of thrombin does not need intermediate antitthrombin

IV drug

Question 8

Ancrod

Answer 8

Enzyme derived from snake venom and depletes plasma of

Adverse: intracranial bleeding

Question 9

Warfarin

Answer 9

Prevents VII so ultimately no thrombin

Vitimin K reduction

monitor w/ INR

Give slowly over a week

Vit K is antidote

No use w/ prego

Question 10

Ximelgatran and melagatran

Answer 10

inhibits thrombin directly… Very Predictable* and rapid onset but difficult to reverse

Question 11

Otamixaban

Answer 11

Inhibits Xa but discontinued

Question 12

Dabigatran(pradaxa)

Answer 12

Direct thrombin inhibitor

Use for DVT, Afib, and post joint replacement

no antidote

Question 13

Ribarixaban(Xarelto)

Answer 13

Inhibits factor Xa

DVT and post joint replacement

Question 14

Aminocaproic acid

Answer 14

Inhibits fibrinolysis
Chemically similar to Lysine
inhibits plasminogen formation
inhibits fibrolytic activity and reverses fibrinolytic drugs

Used for bleeding disorders
prophylactic against re-bleeding