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43 Cards in this Set
- Front
- Back
Misc Antiarrythmics
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Digoxin
Adenosine |
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Class IA
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Quinidine
Procainamide |
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Class IB
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Lidocaine
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Class IC
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Flecainide
Propafenone |
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Class II
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Propanolol
Esmolol |
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Class III
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AS I DD
Amioderone Sotalol Ibutilide Dofetilide Dronedarone |
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Class IV
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Verapamil
Diltiazem |
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Treatment of HIT
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Argatroban
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binds to ATIII complex and prevents II, IX, X, XII
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Heparin
X prothrombin to thrombin (thrombosis) II fibrinogen to fibrin (clot extension) |
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antidote for LMWH induced bleeding
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protamine
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Enhancement of Warfarin action
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due to inhibition of the P450 system:
Cimedtidine and amiodarone Additive effects from aspirin inhibition from Vitamin K |
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Warfarin interferes with
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action of vitamin K on activation of II, VII, IX, and X
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Direct Thrombin Inhibitors
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pharm actions of hirudin (binds directly to thrombin)
irreversible binding, potent thrombin inhibitor, but associated bleeding probs (not app in the US) |
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DTIs
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Bivalirudin (UA undergoing PTCA)-lower affinity and reversible with less side effects... immediate anticoag
Dabigatran (first orally active DTI) reduce stroke and systemic embolism risk with nonvalvular AF... take twice daily. requires no assessment or monitor and has no antidote for bleeding |
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DTI Side effects
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Dyspepsia
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how are DTIs eliminated?
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renally, not affected by P450 system
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Factor Xa Inhibs
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fondaparinux (indirect inhibitor) causes irreversible change in the ATIII and irreversible binding of Xa to ATIII (Prophy for DVT that may lead to PE from surgeries)
Rivaroxaban (first oral) no need for monitoring... same indications as above. |
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Best Anticoag?
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Dabigatrain>Warfarin... Rivaroxaban and warf are similar
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Bleeding from anticoags?
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Warfarin-IC bleeds
Dabigatran and Rivaroxaban-GI bleeds |
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Antifibrinolytics do what?
Which is strongest? |
inhibit plasminogen activator
Tranexamic Acid>Aminocaproic Acid |
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Tranexamic Acid is for what?
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short term in hemophilia patients following tooth extraction
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Thrombolytic/Fibrinolytics do what?
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activate plasminogen to converts plasminogen to plasmin and degrades the fibrin clots...
Use prophy aspiran or heparin to prevent rethrombosis from the thrombin being released from the lysed clot |
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Antifibrinolytics do what?
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they block plasminogen and don't allow for clot breakdown
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Thrombolytics produce what from lysis of the clot?
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fibrinogen is depleted and I, II, V, and VII are degraded. Lytic state inhibits further clotting but impairs hemostasis
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ADR for Thrombolytics
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Hemorrhage... bc the plasmin can't tell bt pathologic thrombus and hemostatic blud that prevents bleeding from a vascular injury... Plasminogen activators also work on circulating plasminogen producing a plasmin generated systemic fibrinolysis (lytic state)
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Who gets thrombolytics?
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within 12 hr of chest pain
12-24 hr after ongoing ischemia STEMI in 2 leads or new LBBB no contraind for thrombo therapy **can't use after 24 hours! so give ASAP |
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Alteplase dose of 150 is associated with what?
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intracranial bleeding
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Reteleplase has longer/shorter half life than alteplase?
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Longer and slightly lower affinity... use IV dose 10 over 2 mins. Major advantage is that its faster (30 compared to 90 with alteplase)
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Tenecteplase
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long half life allows single bolus dose over 5 seconds....highest specificity for pathologic fibrin clots....lowest antigenic potential...
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TXA2 inhibitor
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Aspirin
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enzyme aspirin uses
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COX-1
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Ticlopidine and Clopidogel work how?
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inhibit ADP induced platelet agg via ADP P2Y12 antag... inhibs prim and sec platelet agregation by ADP and fibrinogen
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Eptifibatide and Tirofiban work how?
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Prevent acti of BPIIb/IIIa receptor complex
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Abciximab work how?
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antibody to GPIIb/IIIa complex
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Dipyridamole does what?
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inhibits platelet PDE, increases cyclic AMP, inhibs platelet adhesion and aggregation... use with coumadin antcoags to prevent postop thromboembolic comps or cardiac valve replacement
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ADR to Ticlopidine?
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life threatening blood dyscrasias... use only in pts allergic to or who have failed aspirin treatment
Causes: TTP and Neutropenia |
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Clopidogrel
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3 times more potent than Ticlo. is a prodrug... about as effective as ASA but safer than Ticlopidine.
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Bare metal stents therapy
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antiplatelets... Aspirin plus clopidogrel, prasurgel, or ticagrelor for 1 month... continue aspirin forever
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Drug eluting stent therapy
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aspirin plus clopid, prasurg, or ticagrelor for 1 year!... continue aspirin forever
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Prasugrel
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produg... conversion by hepatic P450. inhibitors of 2C19 should not cause suboptimal response. Don't use if bleeding or >75
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Ticagrelor
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faster onset than clopid and prasugrel bc its not a prodrug... reversibly binds and shorter effects. Advantage in Acute Surgery! May cause dyspnea... Use in ACS works via P2Y12 inhibitor (active metaolite)
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Platelet GP IIb/IIIa antags
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Eptifibatide for ACS and PCI (use with heparin)
Tirofiban for ACS and PTCA or arthectomy (use with heparin) |
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Ab to GPIIb/a receptor
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Abciximab...inhibs platelet agg by binding of blocking binding of fibrinogen, vWF, and other factors. Use in PTCA for high risk pts to abrupt closure of treated coronary vessels... Use with asprin and heparin
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