Pharm Final - Anticoagulant, Antiplatelet, And Fibrinolytic Drugs

Front 1

drugs that inhibit the synthesis of coagulation factors

Back 1

1) warfarin

Front 2

drugs that indirectly inactivate coagulation factors

Back 2

1) unfractionated and low molecular weight heparin
--UFH
--Fondaparinux
--Enoxaparin
--dalteparin

Front 3

drugs that directly inactivate coagulation factors

Back 3

1) Bivalirudin
2) Hirudin
3) Kepirudin

Front 4

antiplatelet drugs

Back 4

1) Aspirin
2) NSAID's
3) clopidogrel
4) ticlopidine
5) abciximab
6) tirofiban
7) eptifibitide

Front 5

Fibrinolytic drugs

Back 5

1) Alteplase
2) reteplase
3) tenecteplase
4) streptokinase
5) urokinase

Front 6

____________inhibits plasminogen activation

Back 6

aminocaproic acid

Front 7

___________antagonizes heparin

Back 7

protamine sulfate

Front 8

normal hemostasis

Back 8

Injury to blood vessel --> vasospasm --> platelet aggregation --> coagulation --> fibrin clot formation --> healing --> fibrinolysis

Front 9

thrombin converts ___________--> __________

Back 9

fibrinogen --> fibrin

Front 10

fibrinolysis

Back 10

plasminogen --> plasmin
---plasmin converts fibrin --> split products
--plasmin also converts fibrinogen --> degredation products

Front 11

3 major factors released by platelets

Back 11

1) TXA2
2) ADP
3) 5-HT

Front 12

____is the GP that connects plalets tgether in platelet aggregation

Back 12

GP IIb/IIIa

Front 13

Xa converts _________-->_________

Back 13

prothrombin --> thrombin

Front 14

major thrombotic disorders

Back 14

1) acute coronary syndrome
----unstable angina
----MI
2) stroke
3) DVT

Front 15

warfarin blocks _________

Back 15

Vit K reductase
--therefore prevents carboxylation of clotting factors

Front 16

adverse effects of warfarin

Back 16

1) hemorage
2) fetal abnormalities
--fetal warfarin syndrome
--chondrodysplasia punctata

Front 17

Drug interactions of warfarin

Back 17

1) anything that inhibits or induces p450
2) anything that has a direct effect on coagulation

Front 18

what drugs interact with warfarin by increasing PT (longer to clot)

Back 18

1) cimetidine (histimine Rc antagonist ; ulcers)
2) Aspirin (High doses)
3) cephalosporins (antibacterial, pneumonia)
4) Heparin
5) Hepatic disease

Front 19

what drugs interact with warfarin by decreasing PT

Back 19

1) barbituates (CNS depressant)
2) Rifampin (antibiotics, Tb, Meningitis)
3) Diuretics
4) Vit K
5) Hereditary resistance

Front 20

clinical uses of warfarin

Back 20

1) DVT
2) A-fib
3) artificial heart valves
4) stroke prevention
5) MI prevention

Front 21

tx of bleeding caused by warfarin

Back 21

1) reduce dosage of warfarin
2) administer vit K1 (phytonadione) to accelerate the recovery of clotting factors
3) give FFP or Factor IC concentrate

Front 22

ROA for warfarin

Back 22

Oral

Front 23

onset of action of warfarin

Back 23

delayed onset

Front 24

warfarin inhibits _________

Back 24

Vit K reductase

Front 25

warfarin inhibits synthesis of which factors

Back 25

1) vit K dependant factors
--II
--VII
--IX
--X

Front 26

warfarin is monitored with______

Back 26

PT

Front 27

is warfarin used in pregnancy?

Back 27

No

Front 28

the Heparin family are _______thrombin inhibitors

Back 28

indirect

Front 29

Unfractionated heparin (UFH)

Back 29

1) contains high and low molecular weight fractions

Front 30

Low molecular weight heparins (LMWH)

Back 30

less effective than the HMW of the UFH but more bioavalability

Front 31

2 LMH

Back 31

Enoxaparin
Dalteparin

Front 32

__________is a synthetic pentasaccaride for heparin

Back 32

fondaparinux

Front 33

heparin is a naturally occurring mixture of sulfated mucopolysaccarides that binds to _________when administered?

Back 33

Antithrombin III

Front 34

MOA of heparin

Back 34

1) heparin binds and activates antithrombin III
2) antithrombin III inactivates clotting factors (thrombin, Xa, and others)
3) this has a more imediate anticoagulatn effect than warfarin

Front 35

antithrombin III is a

Back 35

endogenous protease anticoagulant

Front 36

heparin site of action

Back 36

intrinsic pathway and common pathway (Xa)

Front 37

Factors inhibited by warfarin

Back 37

VII
IX
X
Prothrombin

Front 38

most important factors inhibited by warfarin

Back 38

X
prothrombin

Front 39

factors inhibited by heparin

Back 39

XIIa
Xa
IXa
VIIa
Xa
Thrombin

Front 40

Most important factors inhibited by heparin

Back 40

Xa
thrombin

Front 41

3 key characteristics of heparin

Back 41

1) it is a sulfated polysaccaride
2) it potentiates antithrombin III
3) it inactivates activated clotting factors

Front 42

Heparin Pharmicokinetics

Back 42

1) it is not absorbed from the gut
2) administered as an IV infusion or subcutaneous injection

Front 43

clinical use of heparin

Back 43

acute thromboembolism
--venous thrombosis
--pulmonary and other emboli
--DIC
2) cardiovascular surgery
3) a-fib
4) renal dialysis
5) blood transfusion
6) blood sampling

Front 44

adverse effectsof heparin

Back 44

1) hemorrage (elderly woman with renal failure)
2) thrombocytopenia (25% mild, ?5% severe)
3) hyperkalemia (decrease aldosterone)
4) osteoporosis (chronic administration)

Front 45

tx of bleeding caused by heparin

Back 45

1) discontinue heparin
2) give protamine sulfate
3) give FFP for severe bleeding

Front 46

clinical uses of the direct thrombin inhibitars

Back 46

1) acute coronary syndrome
2) heparin nduced thrombocytopenia (particularly lepirudin)

Front 47

process of platelet hemostasis

Back 47

adhesion of platelets to collagen and endothelium --> platelet activation (synthesis and release of mediators) --> platelet agregation (fibrinogen forms between GPIIb/IIIa sites on the platelets --> formation of platelet plug

Front 48

drugs that inhibit thromboxane synthesis

Back 48

Aspirin
NSAID's

Front 49

antiplatelet Drugs that block ADP receptors

Back 49

clopidogrel
ticlopidine

Front 50

antiplatelet drugs that block GPIIa/IIIb Rc

Back 50

1) abiximab
2) Tirofiban
3) Eptifibitide

Front 51

MOA of aspirin

Back 51

inhibits COX --> decrease in TXA2 synthesis --> prevents platelet agregation

--has less of an effect on prostoglandin synthesis

Front 52

clinical indications for aspirin

Back 52

1) unstable angina
2) TIA and stroke prevention
3) AMI

Front 53

ticlopidine and clopidogrel

Back 53

1) block ADP Rc --> reduces expression of GP receptor --> inhibits platelet aggregation

Front 54

MOA of abciximab

Back 54

MAB to the GP receptor (blocking it)

Front 55

MOA of tirofiban

Back 55

it has an analog sequence within fibrinogen (occupying the GP receptor)

Front 56

MOA of eptifibatide

Back 56

it has an analog sequence within fibrinogen (occupying the GP receptor)

Front 57

fibrinolytic drugs catalyze the formation of _________

Back 57

plasmin

Front 58

which fibrinolytic drugs are tissue fibrinogen activators?

Back 58

alteplase
reteplase
tenecteplase

Front 59

2 fibrinolytic drugs that are not tissue plasminogen activators

Back 59

streptokinase
urokinase

Front 60

clinical uses of fibrinolytic drugs

Back 60

1) AMI
2) ischemic (thrombotic) stroke)
3) PE

Front 61

contraindications to fibrinolytic drugs

Back 61

1) active bleeding
2) hemoragic stroke
3) severe HTN
4) intracranial surgery / trauma, anurysm, tumor

Front 62

drugs used to tx bleeding caused by fibrinolytic drugs

Back 62

1) aminocaproic acid (inhibits plasminogen activation)
2) protamine sulfate (antagonizes heparin)
3) Vit K

Front 63

warfarin has a simular structure to_______

Back 63

vit K

Front 64

warfarin prevents _________

Back 64

1) carboxylation of clotting factors...therefore preventing the formation of prothrombin