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22 Cards in this Set
- Front
- Back
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Under normal conditions what does the endothelium do to prevent coagulation? 5
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1. maintenance of transmural electrical charge, which prevents adhesion
2. Releases Prostacyclin (PGI2) 3. Activate Protein C 4. Produces proteoglycans similar to heparin. 5. Releases plasminogen activators |
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What can you get from Arachidonic acid that matters here?
How? what do products do? |
Both via cyclooxygenase 1
PGI2: platelet disaggregation and vasodilation TXA2: Platelet aggregation and vasoconstriction |
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Three phases of hemostasis
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1. vascular
2. platelet 3. coagulation |
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What's up with GP IIb/IIa?
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They're integrins on the surface of platelets. Calcium-dependent association of IIb and IIa is required for proper platelet aggregation.
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Antiplatelet Drugs
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1. Aspirin
2. Dipyridamole 3. Ticlopidine and Clopidogrel 4. GP IIb/IIa Inhibitors Abciximab Eptifibatide Tirofiban |
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How does Aspirin Work?
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It blocks platelet cyclooxygenase which leads to decreased synthesis of TXA2. Good for reducing risk of infarction
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How does Dipyridamole work?
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Vasodilator via inhibiting PDE and increasing cAMP.
Good only Combined with warfarin |
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How do Ticlopidine and Clopidogrel work?
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Inhibit binding of ADP to its receptor, thus increasing cAMP.
Good alt. to aspirin or good with aspirin |
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what's up with abciximab?
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monoclonal AB screws up aggregation
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what's up with eptifibatide and tirofiban?
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Fibrinogen mimetics that screw with aggregation.
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How does Vitamin K work?
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It places residues on the coag factors(2, 7, 9, 10) and proteins (C/S/Z) which are essential to link them to phospholipids via Ca.
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Vitamin K Antagonists!
how do they work? why are they good? adverse rxn? |
Warfarin! its a structural analog to K so it blocks the addition of all those residues.
YOU CAN TAKE IT ORALLY! hemorrhage, dermatitis, SI necrosis |
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Where does Heparin come from?
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Mast Cells in animals (how we get the drug)
Naturally in our liver, lungs, and intestines |
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What does heparin require to work?
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ANTITHROMBIN!
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How does Heparin work?
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it accelerates activity of AntiThrombin on thrombin, 9 and 10
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How is heparin metabolized?
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not absorbed through GI, but by cells of RES, so you gotta inject it or IV it
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how can you inhibit heparin?
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Protamine Sulfate
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how do you reverse effects of warfarin?
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VITAMIN K!
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Other Parenteral Anticoagulant?
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Fondaparinux: synthetic heparin derivative. Only goes after 10
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NEW DRUGS
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LEPIRUDIN, BIVALIRUDIN, AND ARGATROBAN
All act against Thrombin DROTRECOGIN ALFA impostor protein C that inhibits V and VIII |
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Inhibitor of thrombolytic drugs?
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Aminocaproic Acid-Tranexamic Acid
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Thrombolytic Drugs
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STREPTOKINASE: exposes active site of plasminogen
UROKINASE: directly activates plasminogen TISSUE TYPE PLASMINOGEN ACTIVATOR: Alteplase, reteplase, Tenecteplase |
