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31 Cards in this Set
- Front
- Back
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Coagulation cascade
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Injured tissue and platelets -- formation of thrombin (factor II) -- converts fibrinogen to fibrin -- fibrin incorporates into plug
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Fibrin lysis
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Plasminogen converted to plasmin by plasminogen activators -- lyses fibrin
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Platelet activation
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Opposing: high prostacyclin level, low thrombin and thromboxane levels
Promoting: Decreased prostacyclin level, exposed collagen, increased synthesis of thromboxanes |
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Heparin
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Acts on antithrombin III which neutralizes activated forms of factors XII, XI, X, IX, and II.
Large particle, crosses membranes poorly, not absorbed through intestine Half life 1-4 hours, metabolized in liver |
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How is heparin monitored?
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aPTT/PTT, therapeutic if twice normal (normal 25-35).
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Heparin reversal agent?
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Protamine sulfate
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Heparin side effects
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Heparin induced toxicity: bleeding, heparin induced thrombocytopenia (HIT), hepatic function test abnormalities
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Lepirudin (Refludan)
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Recombinant form of hirudin (natural anticoagulant)
Substitute for heparin (including patients with heparin induced thrombocytopenia) |
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Argatroban (Acova)
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Substitute for heparin after Lepirudin (Refludan) (including patients with heparin induced thrombocytopenia).
Eliminated through liver, may be used in End Stage Renal Disease |
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Bivalirudin (Angiomax)
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Analog of thrombin inhibitor hirudin
Treatment of unstable angina (MI prophylaxis) in patients undergoing percutaneous transluminal coronary angioplasty, and treatment of acute MI in patients with history of HIT |
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Low Molecular Weight Heparin
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Enoxiparin (Lovenox)
Dalteparin (Fragmin) Danaproid (Orgaran) Tinzaparin (Innohep) Fondaparinux (Arixtra) Inhibit activated factor X DVT prophylaxis |
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Fondaparinux (Arixtra)
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DVT and Pulmonary embolism prevention
Inhibits factor Xa, does not inhibit thrombin |
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Antithrombin III (Thrombate III, Atnativ)
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Heparin cofactor I, factor in plasma necessary for heparin to work
Used in patients with congenital AT III deficiency (or acquired, e.g. DIC) |
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Pentosan (Elminron)
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Weak anticoagulant, 1/15 of heparin, indicated for relief of pain associated with interstitial cystitis in US
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Dabigatram (Pradaxa, only in Europe)
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Oral direct thrombin (factor IIa, FIIa) inhibitor
Under investigation (venous thromboembolism, stroke prophylaxis in patients with atrial fib., and acute VTE treatment) To substitute heparin |
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Warfarin (Coumadin)
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Teratogenic, (rat poison)
Inhibits hepatic synthesis of vitamin K dependent clotting factors (II, VII, IX, X) Competitively antagonizes vitamin K Slow onset, monitored through PT/INR (therapeutic if 1.5-2.5 notmal level), half life 37 hours Drug interactions: NSAIDs, barbiturates, anabolic sterioids, anti-tuberculosis medications |
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Warfarin (Coumadin) reversal?
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Vitamin K administration - several hours
Fresh frozen plasma (FFP) - immediate |
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Aspirin
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Antiplatelet, irreversibly inhibits cyclooxigenase, lasts 7-10 days
Prophylaxis of transient cerebral ischemia and MI SE: GI bleeding, hemorrhagic shock, cinchonism (tinitus, dizziness, blurred vision), renal toxicity |
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Ticlopidine (Ticlid)
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Antiplatelet, inhibits ADP pathway
TIA prophylaxis, patients who do not tolerate aspirin SE: GI upset, bleeding, leukopenia, |
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Dipyridamol (Persantine)
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Coronary vasodilator, in combination with ASA, prophylactic for angina
Inhibits cyclic nucleotide phosphodiesterase, keeping intracellular cAMP high, which inhibits thromboxane A2 synthesis. |
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Abciximab (Reopro)
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mouse/human chimeric monoclinal agent against platelet IIb/IIa receptors
Reduced MI in combination with heparin |
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Eptifibatide (Integrilin)
Tirofiban (Aggrastat) Cromafiban, Lamifiban, and Sibrafiban (under investigation) |
Similar to Abciximab (Reopro)
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Clopidogrel (Plavix)
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Analogue to ticlopidine, blocks ADP binding to platelets, inhibits platelet aggregation
Metabolized in lever/kidney, may increase drug concentration of other agents because of CPY I phase reactions inhibition |
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Prasugrel (Effient)
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Blocks ADP binding to platelets, similar to ticlopidine and clopidogrel
Benefit of reduction in thrombotic events but bleeding seen more frequently |
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Cilostazol (Pletal)
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Platelet aggregation inhibitor with vasodilating activity
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Altepase, t-PA (Activase, Cathflo)
Reteplase (Retavase, r-PA) |
Converts plasminogen to plasmin, only activates plasminogen in clot
Complication: bleeding, cerebral hemorrhage |
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Streptokinase (Kabikinase, Streptase)
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Indirectly activates plasminogen, loading dose required to inactivate streptococci derived antibodies, non-specific for clot bound fibrin
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Anistreplase (anysolated plasminogen streptokinase activator complex, APSAC, Eminase)
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Streptokinase plus reconvinant human plasminogen
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Urokinase (Abbokinase, Open-Cath)
Suruplase (prourokinase) |
Human enzyme synthesized in kidney, degrades fibrin and fibrinogen, does not depress plasminogen levels
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Tenecteplase (TNK-tPA, TNKase)
Amediplase, Lanoteplase, Saruplase, etc. under investigation |
Single, rapid IV bolus for MI, binds to fibrin and converts plasminogen to plasmin
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Garlic, allium sativum
Ginger, zingiber officinale |
Garlic: Inhibits platelet fuction
Ginger: Inhibits thromboxane synthesis |
