Part 8-2 Cardiovascular Pharmacology

Question 1

Coagulation disorders

Answer 1

• Inadequate clotting: hemorrhage

- Excessive clotting: thrombogenesis

Question 2

Clotting Mechanism Intrinsic System

Answer 2

Begins when factor XII contacts damaged vessel

Question 3

Clotting Mechanism Extrinsic system

Answer 3

Begins when damaged vessel releases tissue factor (Thromboplastin)

Question 4

Clotting Mechanism sequence

Answer 4

CF XII and CF VII lead to CF X

CF X turns prothrombin into Thrombin

Thrombin turns fibrinogen to Fibrin

Question 5

Clot Breakdown

Answer 5

Tissue Plasminogen Activator turns plasminogen into plasmin

Question 6

Drugs for overactive clotting

Answer 6

Anticoagulants
Antithrombotics
Thrombolytics

Question 7

Anticoagulants

Answer 7

Used primarily in venous thrombosis

1. Heparin
2. Oral anticoagulants

Question 8

Heparin

Answer 8

Acts by increasing effects of antithrombin III

• rapid effects
• Administered parenterally

Question 9

Types of heparin

Answer 9

Unfractionated heparin

Low molecular weight heparins

Question 10

Unfractioned heparin

Answer 10

• IV administration, several injections per day

- Unpredictable effects

Question 11

Low molecular weight heparins

Answer 11

Administered sub-Q, usually 1/day
Preferentially inhibit factor Xa
More predictable, safer effect

Question 12

Heparin induced thrombocytopenia

Answer 12

Heparins can decrease platelets
Type I HIT
Type II HIT

Question 13

Type I HIT

Answer 13

Asymptomatic, resolves spontaneously

Question 14

Type II HIT

Answer 14

Immune reaction…causes serious thrombosis, life/limb threatening

Question 15

Oral anticoagulants

Answer 15

Warfarin (Coumadin)
Dicumarol
-Inhibit vitamin K function in liver
-Decreased synthesis of certain clotting factors

Question 16

Oral anticoagulants administration

Answer 16

Oral administration
Time lag of 3-4 days
Typically used after heparin

Question 17

Other Anticoagulants

Answer 17

Can be used as primary or if other anticoagulants aren’t tolerated

Question 18

Other anticoagulant examples

Answer 18

Direct Thrombin inhibitors

Factor Xa Inhibitors

Question 19

Antithrombotics

Answer 19

-Inhibit platelet activity; decrease platelet induced clot
Primary agents
-aspirin
-Newer antiplatelet drugs

Question 20

Aspirin anticlotting effects

Answer 20

• Aspirin inhibits PG & Thrombozane (TX) biosynthesis

- Decreased TXs means less platelet induced clots

Question 21

Thromboxanes (TX)

Answer 21

Increase platelet activity/aggregation

Question 22

Aspirin

Answer 22

• Inhibits platelet function
• Prevents arterial thrombogenesis in MI, Ischemic stroke
• Therapeutic effects occur at very low doses

Question 23

Aspirin is….

Answer 23

Better at preventin MI in men

Better against stroke in women

Question 24

Newer antiplatelet drugs

Answer 24

ADP inhibitors

Glycoprotein IIb-IIa inhibitors

Question 25

ADP inhibitors

Answer 25

Block effects of ADP on platelets

Question 26

Glycoprotein IIa-IIb inhibitors

Answer 26

Block effects of fibrinogen, other activators on platelets

Question 27

Thrombolytics

Answer 27

- Initiate clot breakdown by activating plasmin - Help dissolve clots in coronary/carotid arteries - Can restore blood flow - Prevent/reverse damage during MI, ischemic stroke

Question 28

Typical Thrombolytic agents

Answer 28

- Tissue plasminogen activator (activase) - Urokinase - Reteplase - Tenecteplace

Question 29

Thrombolytics for MI

Answer 29

- No agent is best for MI - Can decrease mortality by 50% if given within 1 hr of symptoms - May still be helpful within 3-12 hrs

Question 30

Thrombolytics use in ischemic stroke

Answer 30

- Rule out hemorrhage first - Activase may be preferred - Administor within 2 hrs of symptoms - Benefits must balance risk of intracranial hemorrhage

Question 31

Anticlotting drugs rehab concerns

Answer 31

``` Risk of hemorrhage Use care when: -Dressing changes -Debridement -Aggressive manual techniques ```

Question 32

Treatment of clotting deficiencies...hemophilia

Answer 32

- Clotting factor replacement - CFs usually obtained from rDNA techniques - Pts can also develop alloantibodies to synthetic clot factors....tx with rituximab

Question 33

Hemophilia type A factor replacement

Answer 33

Factor VIII

Question 34

Hemophilia Type B factor replacement

Answer 34

Factor IX

Question 35

Fibrinolysis Inhibitors

Answer 35

Can be used in hemophilia and hyperfibrinolysis syndromes

Question 36

Vitamin K supplements

Answer 36

- Administered to newborns or in severe vitamin K deficiency | - Can also help tx excessive warfarin

Question 37

Treatment of hyperlipidemia

Answer 37

Statins Fibric Acids Others

Question 38

Statin mechanism

Answer 38

Inhibit HMG-Co A reductase enzyme - Decreased cholesterol biosynthesis - Increased hepatic LDL breakdown

Question 39

Statins primary effects

Answer 39

- Decreased LDL, VLDL cholesterol - Decreased triglycerides - Increased HDL

Question 40

Statins other beneficial effects

Answer 40

``` Enhance vasodilation by NO Anti-inflammatory Anti-oxidant Neuroprotection? Anticancer? ```

Question 41

Fibric Acids mechanisms

Answer 41

Activate nuclear receptor that effects gene controlling lipid metabolism

Question 42

Fibric Acid primary effects

Answer 42

Decreased triglycerides | Increased VLDL breakdown

Question 43

Niacin

Answer 43

Decreases VLDL % LDL synthesis | Decreases triglyceride levels

Question 44

Ezetimibe (Zetia)

Answer 44

Inhibits cholesterol absorption from GI tract | Can be combined with a statin

Question 45

Bile acid binding drugs

Answer 45

Increase GI excretion of bile acids | Decrease plasma cholesterol

Question 46

Antilipid agents adverse effects

Answer 46

Nausea, diarrhea, bloating | Liver toxicity, pancreatitis, blood dyscrasias, arrythmias

Question 47

Antilipid agents primary concern for rehab

Answer 47

Myalgia, Myositis, weakness, parasthesias

Question 48

Statin induced myopathy

Answer 48

5-7% of patients taking statins | Reasons unclear

Question 49

Fixed predisposing factors for statin induced myopathy

Answer 49

Renal/hepatic disease Genetic factors Advanced age Female

Question 50

Modifiable predisposing factors for statin induced myopathy

Answer 50

Concurrent meds High dose Lipophilic statin Heavy exercise