Pharm: Anti Coag Anti Platelet Flashcards Preview

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Flashcards in Pharm: Anti Coag Anti Platelet Deck (62):
1

When do we use antithrombotic therapy?

prevent thrombosis in pts w/acute or symptomatic venous thromboembolism

2

3 subgroups of antithrombotic agents

anticoagulants
antiplatelet agents
fibrinolytic agents

3

Venous thrombosis thrombi?

Red thrombi, RBCs enmeshed in thrombi

4

Arterial thrombosis thrombi?

White thrombi, platelets with little fibrin or red cells

5

Venous thrombosis risk factors?

immobility, surgery, cancer, pregnancy, estrogen use

6

Arterial thrombosis risk factors?

smoking, HTN, DM, obesity, hyperlipidemia

7

Gain of function mutations associated with venous thrombosis?

G20210A
factor V leiden

8

What causes primary hemostasis?

formation of a platelet monolayer over the subendothelial matrix
platelets are held in place by vWF

9

What receptor is necessary for platelet aggregation?

GPIIb/IIIa

10

What do platelets synthesize from arachidonic acid?

TXA2

11

What causes secondary hemostasis?

coagulation cascase (conversion of soluble fibrinogen to insoluble fibrin)
clot formation

12

How to platelets activate the coagulation cascade?

surface phospholipids provide support on which the complexes of coag cascade are formed, allowing for calcium binding

13

Heparin mechanism

no intrinsic anticoag activity
binds antithrombin and thrombin simultaneously
accelerates rate of interaction of antithrombin w/Xa

14

Heparin admin

parenteral, immediate onset of action

15

What are the LMWHs?

exoxaparin
dalteparin

16

LMWH mechanism

potentiate factor Xa inhibition by antithrombin
(not as good at inhibiting thrombin)

17

LMWH admin

parenteral, can accumulate in pts w/renal disease

18

Heparin SEs

thrombocytopenia
bleeding

19

LMWH SEs

bleeding
lower risk of thrombocytopenia

20

What are the direct thrombin inhibitors?

lepirudin
bivalirudin

21

Lepirudin mechanism?

binds tightly to catalytic site and extended substrate recognition site of thrombin

22

Bivalirudin mechanism?

occupies catalytic site of thrombin

23

Direct thrombin inhibitors admin?

parenteral
excreted by kidneys

24

What is the direct factor Xa inhibitor?

Fondaparinux

25

Fondaparinux mechanism?

causes antithrombin mediated selective inhibition of Xa

26

Fondaparinux admin?

subcut
Do NOT use in pts w/renal failure

27

Direct thrombin inhibitor SEs?

bleeding if they accumulate

28

Fondaparinux SEs

bleeding
much less likely to cause thrombocytopenia

29

Warfarin mechanism?

inhibits vitamin K epoxide, which recycles vit K back to it's active form

30

What requires Vit K?

facotrs 2,7,9,10, protein C, protein S

31

Which enantiomer of warfarin ia most active?

S

32

What metabolizes warfarin?

CYP2C9

33

Polymorphisms in which protein affects dosing?

VKORC1
affects the susceptibility of hte enzyme to warfarin induced inhibition

34

Warfarin SEs?

bleeding
birth defects/abortion
skin necrosis
purple toe syndrome

35

What is the oral direct thrombin inhibitor?

dabigatran

36

Metab of dabigatran?

renal excretion

37

What drug should NOT be administered with dabigatran?

rifampin
(both are Pgp substrates)

38

Dabigatran SEs?

bleeding

39

What is the orally available direct factor Xa inhibitor?

Rivaroxaban

40

What does factor Xa do?

converts prothrombin to thrombin

41

How is rivaroxaban eliminated?

unchanged by kidneys or metabolized by liver

42

What are the thrombolytic agent?

alteplase

43

Mechanism of alteplase?

plasminogen activator

44

alteplase admin?

bolus dose over 1 min followed by infusion

45

Alteplase SEs?

bleeding

46

List the antiplatelet drugs

aspirin
clopidogrel/ticlopidine/prasugrel/ticagrelor
dipyridamole
abciximab/eptifibatide

47

Mehcanism of aspirin

inhibits platelet aggregation by irreversibly inhibiting COX
block PG and TXA2 production

48

Where is aspirin absorbed?

upper GI tract

49

Aspirin SEs

bleeding
GI irritation

50

What are the ADP receptor blockers?

clopidogrel, ticlopidine, prasurgrel, ticagrelor

51

Mechansim of clopidogrel et al?

inhibit ADP from binding P2Y12
except for ticagrelor, irreversible antagonists

52

What metabolises Clopidogrel/ticlopidine?

prodrugs, activated by CYP2C19

53

What drug can potentially inhibit clopidogrel?

PPIs used to tx peptic ulcer (ie/ omeprazole)

54

Clopidogrel SEs

bleeding
dyspnea (ticagrelor)
neutropenia (ticlopidine)

55

What is the adenosine deaminase and phosphodiesterase inhibitor?

dipyridamole

56

What is the end result of dipyridamole?

inhibits aggregation, may cause vasodilation, may also cause release of prostcyclin of PGD2, casues coronary vasodilation

57

Dipyridamole SEs

headache, GI upset, dixxiness

58

How do abciximab and eptifibatide work?

prevent platetlet aggregation by binding to CPIIb/IIIa to prevent fibrinogen binding/crosslinking platelets

59

Is abciximab competitive?

no

60

Is eptifibatide competitive?

yes

61

Abciximab/eptifibatide admin?

IV

62

Abciximab/eptifibatide SEs?

bleeding, thrombocytopenia
hTN
bradycardia
use caution in pts w/renal dysfunction