Flashcards in Pharm 14- Platelet Inhibitors, Thrombolytics, AT-III Deck (80)
What is used to monitor antiplatelet therapy?
What is the actual clinical response to antiplatelet therapies?
What drugs are Glycoprotein IIb/IIIa blockers?
How are Glycoprotein IIb/IIIa blockers administered?
All given parenterally
What are Glycoprotein IIb/IIIa blockers used extensively for?
ACS and in cath labs to make your life more miserable when they finally decide to send the pt to surgery
How does Dipyridamole (Persantine) work and what is it used for?
Primarily used as a coronary vasodilator
After a chain of thromboxane A2 synthesis is blocked
(No prostaglandin effect)
ubiquitous intracellular messenger chemical derived form that ubiquitous cellular energy currency ATP
What is Dypyridamole (Persantine) usually administered with?
Rarely used by itself
Usually as adjunt with warfarin (coumadin) or aspirin for anticoagulation post-prosthetic heart valve implanation or for a-fib
What are dextrans?
Heavily-branched complex glucose-based polymers
Who discovered Dextrans?
Louis Pasteur as a component of wine
What are Dextrans used as?
Volume exanders, particularly when albumin is available
Pump prime protocol maybe
Anti-thrombotic functions (ill-defined)
One gram of Dextran binds with how much water?
20-25 ml of H20
What are the two kinds of Dextrans?
Dextran 70 (Macrodex)
Dextran 40 (Rheomacrodex)
How are Dextrans administered?
How does Dextran 70 compare to Dextran 40?
Dextran 70 has somewhat greater osmotic capabilities than Dextran 40?
How are both kinds of Dextran excreted?
By kidneys over several hours and the rest metabolized
What does Dextran do?
Binds RBCs, platelets and vascular endothelium making them all less "sticky"
Decreases FV, VIII, and IX functionality
clots formed in the presence of dextrans are "less sturdy" and more easily lysed
What are some concerns and side effects with Dextrans?
1. Intra-op and post-op bleeding
2. Volume overload, particularly in heart failure and anuric renal failure patients**
3. Anaphylaxis (within minutes)
What is the max Dextran dose?
How does Hespan compare to Dextran?
Made with a mixture of starch polymers instead of glucose polymers; volume expander like Dextran; cleared similarly but has real tendency to hang around
What factors does Hespan effect?
Reduces Factor VIII casing elevated aPTT values
What is Hespan usage associated with?
Acute renal failure
How long is Hespan found in the plasma?
Months after administration
What is the max daily dose for Hespan?
20ml/kg; but this seems to be more dogma than evidence based
What are some thrombolytic drugs?
When do perfusionists give thrombolytics?
Perfusionists will never give these particularly on bypass
How do thrombolytics work?
These drugs actually dissolve ("lyse") clots that are already present in the critter
What is Streptokinase (Streptase) and what does it do?
Not really an enzyme, but it attaches to plasminogen and this complex acts to convert plasminogen into plasma
this complex also destroys fibrinogen and Factors V and VII
Made from bugs
What is Streptokinase (Streptase) approved for?
Pulmonary emboli, DVTs, AMIs and thrombosed shunts