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28 Cards in this Set

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What is haemostasis?
the arrest of blood loss from damaged blood vessels.
What are the two main broad main steps in haemostasis?
1) the adhesion and activation of platelets 2) activation of clotting factors, leading to blood coagulation (fibrin formation)
What is Thrombosis?
a pathological condition. haemostatic plug formation associated with arterial disease or stasis of blood in veins and atria of the heart.
What is an embolus? What determines where they end up?
A portion of a thrombus that breaks away, if a venous thrombus it can end up in the lungs, if from the left heart it can end up in the brain/other organ.
Give a procoagulant drug, mechanism, effect, and pharmacokinetic aspects.
eg: Vit K (synthetic water soluble-menadiol) vit K dependent: II VII IX X factors
Mechanism: When reduced acts as a cofactor in gama-carboxylation of glutamic acid
Administration: oral, i.v., i.m.
Metabolised: in liver and excreated in bile and urine
Give two examples of Injectable anticoagulanys?
Heparin and low-molecular-weight heparins.
Who do heparin and low-molecular weight heparins work?
accelerates the action of antithrombin III which inactivates factors XIIa, IXa, Xa, IIa.
What are the Vit K dependent factors?
II, VII, IX, X
Give an example of a LMWH?
dalteparin
How is heparin administered and how is it eliminated?
i.v. (immediate action) s.c. (acts in an hour). Two phase elimination: first fast then slow.
How are the effects of heparin measured?
activated partial thromboplastin time
how are LMWH give and eliminated and why are they used more than heparin?
s.c. with a longer half life than heparin, blood monitoring not required. Eliminated by the kidney.
What are the unwanted effects of heparins and LMWHs?
Bleeding, Osteoporosis (with long term use), Thrombosis associated with thrombocytopenia
How can the unwanted effects of heparin and LMWH be treated?
Protamine sulfate for bleeding (basic-netrolisises heparin) Danaparoid for which is used for thrombocytopenia.
Give an example of an oral anticoagulant?
Warfarin
Give the mechanism of Warfarin?
inhibits of reduction of Vit K in the gama-carboxylation of Glu in factors II, VII, IX, X.
How is warfarin given?
Oral, small distribution volume, and effects take days as factors have to degraded.
How are Warfarins effects measured?
Prothrombin time
How is Warfarin metabolised?
In the liver
What are the effects of Warfarin?
Bleeding (bowle or brain)
How are the unwanted effects of warfarin treated?
Vit K, fresh plasma/coagulation factors.
What are the drug interactions of warfarin?
Increased risk of bleeding (aspirin, ciprofloxacin) or lessen anticoagulant action (carbamazepine)
What are the effects of Aspirin?
irreversible inhibits cyclo-oxgenase- altering the balance between thromboxane A2 (promotes platelet adhesion and aggregation) and PG-I2 which inhibits it. Unlike vascular endothelium platelets can't synthesis more enzyme os TXA2 only restored when new platelets are formed.
Give two antiplatelet agents?
Aspirin and a platelet aggregation inhibitor: GPIIb/IIIa receptor antagonist: abciximab.
Explain the actions of abciximab? How is it given?
Blockes fibrinogen linking platelets with antibody Fab. i.v. infusion.
Fibrinolytic drugs...what the fuck is going on here then?
Example: streptokinase. increases the conversion of plasminogen into plasmin. Main unwanted effect is bleeding.
What are the prophylactic uses of aspirin?
uses to reduce risk of occlusive cardiovascular disease in patients with MI of unstable angina.
What drugs would you pick for short term/long term treatment
Heparin and LMWH for short term and warfarin for long term.