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36 Cards in this Set
- Front
- Back
Aspirin |
Controls the balance between TXA2 in platelet and PGI2 in endothelium TXA2 - decrease PGI2 - increase Through the inhibition of COX --> less PGH2 inactivates platelets irreversibly |
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Aspirin different doses |
low 180 mg - prevent mini stroke 335 mg - reduce heart attack risk >1000mg no effect due to inhibition of COS |
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Clinical use of aspirin |
After MI used with fibrinolytic drugs |
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ADP receptor antagonists (P2Y12 selective) |
Ticlopidine Clopidogrel Prasugrel Ticagrelor |
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Ticlopidine |
irreversible antagonist of P2Y receptor (ADP receptor) slow onset (3-7 days) |
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clinical uses of Ticlopidine |
Reducing stroke risk- efficacy like aspirin
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side effects of Ticlopidine |
unexplained - rash, diarrhoea, neutropenia (loss of blood cells) |
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Clopidogrel |
irreversible antagonist of P2Y receptor (ADP receptor) used in combination with aspirin |
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Clinical uses of Clopidogrel |
with aspirin Reducing ischeamic stroke, MI and vascular death |
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side effects of Clopidogrel |
Less than others - especially less neutropenia |
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Prasugrel |
irreversible antagonist of P2Y receptor (ADP receptor) faster onset and more efficacious than clopidogrel more easily metabolised into active less resistance |
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Side effects of Prasugrel |
higher risk of bleeding as more easily metabolised to active metabolite in liver |
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Ticagrelor |
reversible antagonist of P2Y receptor (ADP receptor) similar efficacy to |
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clinical use of Ticagrelor |
Reversibility is a clincal asset in situations stent clinic (CPCI) |
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IIb/IIIa receptor antagonists |
Tirifiban/ Abciximab Tirofiban/ Eptifbatide |
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Tirifiban/ Abciximab |
antibody fragment directed against the IIb/IIIa receptor single administration due to immunogenicity platelet function recovery in days |
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Clinical uses of Tirifiban/ Abciximab |
In patients with high risk coronary angioplasty with aspirin and heparin |
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Tirofiban/ Eptifbatide |
cyclic peptides ligands at the IIb/IIIa receptor platelet recovery in hours IV - (not long term oral = harmful) |
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Prostaglandin agonist |
Epoprostemol - chemically unstable --> IV |
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Phosphodiesterase inhibitor |
Dipyridamole - increase platelet cAMP levels |
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clinical use of Epoprostemol |
used in patients undergoing haemodialysis where heparin is contraindicated
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Clinical use of Dipyridamole |
in conjunction with aspirin |
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Antiplatelet drug groups? |
Aspirin ADP receptor (P2Y) Antagonists IIb/IIIa receptor antagonists phosphodiesterase inhibitors Prostaglandin agonist |
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Clinical uses of antiplatelet drugs |
acute MI risk of MI after coronary bypass unstable coronary syndromes after coronary artery angioplasty Transient cerebral ischeamic attack/ thrombotic stroke |
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Fibrinolytic agents |
streptokinase
Recombinant tPA
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Streptokinase |
Increase conversion of plasminogen --> plasmin Produced from streptococci Action blocked after 4 days due to antibody production One year must relapse before reuse |
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Recombinant tPA |
more active at fibrin bound plasminogen sites - clot specific Alteplase - short half life = infusion Reteplase - longer = bolus |
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contraindications of fibrinolytic agents |
Absolute - recent/ active bleeding; recent cerebral accident; invasive procedures Relative - pregnancy; cardiopulmonary resuscitation ; trauma; bacterial endocarditis |
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side effects of fibrinolytic agents |
GI haemorrage , stroke allergic reactions, fever burst of plasmin created by streptokinase can cause kinins --> hypotension |
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Clinical uses of fibrinolytic agents |
acute MI acute thrombotic stroke clearing thrombus shunts/ cannulae acute arterial thromboembolism |
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antifibrinolytic drugs |
Tranexamic acid Aproxinin inhibit the activation of plasminogen |
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Tranexamic acid |
inhibits activation of plasminogen Oral and iv used when increased risk of bleeding - dental extraction side effects - nausea and vomiting |
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Aproxinin |
proteolytic enzyme inhibitor of plasmin/ kallilerech? Slow iv Used in patients with high risk of blood loss during and after open heart surgery |
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Arterial thrombis |
Anti platelet drugs Aspirin, clopidogrel, Abciximab reduce platelet activation/ clotting |
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Venous thrombis |
anticoagulants Heparin, Warfarrin reduce effectiveness of clotting cascade reduce formation of fibrin |
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life threatening thrombis |
fibrinolytic Alteplase Activate plasminogen Increase fibrin breakdown |